On Therapy and Dependency

In earlier data, we've seen how some players use MMOs as a therapeutic tool to cope with stress and emotional trauma. In a recent survey, I asked players to talk more about this intersection of online games and psychological stressors and whether MMOs helped or hurt them in dealing with the stressor. One thing that struck me was the variety of psychological stressors players described that MMOs provide an outlet for. These ranged from chronic stress to physical disability and need for social support among others. While the narratives below show that MMOs can be therapeutic, they also show that using MMOs as coping mechanisms can lead to destructive vicious cycles. In this article, we'll take a closer look at this gray area between therapy and dependency.

Of course, the point isn't that MMO players in general have psychological problems and are all using MMOs as coping mechanisms, but this is an important area to look into because of the potential and positive and negative consequences.

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Chronic Stress

Many players talked about how the MMO was a way of dealing with chronic stress from work and life. In many of their cases, the game seemed to function as a way of gaining a sense of peace at the end of the day to avoid being constantly overrun by stress.

Stress Reliever

Logging into WoW at the end of the day is a great stress reliever, as it's one of the few times I'm not thinking (at all) about experiments, the future of my career, or anything like that. It allows me to relax, let things from the day go, and find a more healthy state of mind as the day ends. Also, although WoW gives me a list quests to do (sort of like work, in a way), I know I am in control of what I do, and I know that each task is, in the end, possible. Science just doesn't work that way. [WoW, F, 33]

I'm a dentist and my wife is the head of an insurance company claims department. These are 2 fairly stressful occupations - we use EQ to unwind. Neither one of us cares for the trash on television and this is something we can do together in a cooperative spirit. [EQ, M, 70]

There was a time when finances were tight due to a change in employment; this created a lot of pressure and stress until things smoothed out again. Having the game to escape into when I came home in the evening was very therapeutic. [CoH, M, 39]

Distracted Rumination

Other players used MMOs as a stepping-stone in dealing with and resolving a stressful problem. Thus, the MMO wasn't a way of simply leaving stress behind, but it played a role in helping to work out a problem. For many players, the MMO did this by allowing the problem to be mulled over in the back of the head without being overwhelming. Here are some examples of this "divide and conquer" approach:

It provided a way to divide my attention so that I could engage with the game while another, less communicative aspect could chew on what was bothering it. Ultimately, the space provided in that exercise catalyzed some insight and paved the way for change. [WoW, F, 51]

It was an area where I could concentrate on the mechanics of the game and my relation to the game (it was mostly a solo-based MMO) gave me some space to deal with the issues I was dealing with. [WoW, M, 28]

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Depression and Emotional Trauma

For others players, the game was an escape from more severe emotional stress typically stemming from traumatic events. The word "pain" was typically used in these narratives.

Emotional Sedative

For players in this situation, the game provided a temporary escape from this emotional pain that was becoming unbearable.

Divorce, troubles with my children, friends and parents. Sometimes I found myself really alone and with a lot pain. The best escape or refuge i found at this time was to go into the game to play and forget all that real life and pain. [Vanguard, M, 43]

Played a lot when my mother was diagnosed and shortly thereafter died of pancreatic cancer; the game was a way to escape from a harsh reality [WoW, M, 26]

Dull the Pain to Heal

One related thread of responses emphasized that the emotional sedation was helpful in allowing the trauma to be worked out slowly rather than being overwhelmed.

The first time I played one (Star Wars Galaxies), I was coping with being sexually assaulted. I wasn't working and couldn't sleep much. My personal life was totally off track and I felt helpless to improve it. It was easier to just play and I think it helped me get some temporal distance from the events so as to be ready to move on with life. [F, 30]

I had a really horrible break up with a long term boyfriend and focusing on in-game objectives prolonged the healing process but also seemed to dull the hurt and let understanding seep in as opposed to being overwhelmed with grief. All-in-all, I believe WoW to have ultimately helped me get through the hardest time I've ever experienced. [WoW, F, 26]

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Work Satisfaction

Other players used MMOs as a way to cope with dissatisfaction with their work and careers. For them, the problem wasn't stress but the sense that their jobs or lives weren't fulfilling.

Sense of Progress

For players who felt themselves to be at a standstill, the MMO provided a predictable sense of progress.

In the past, I have used the game as a proxy for achievement and accomplishment when I felt myself to be at a stagnant point in my life. For example, if I feel aimless in my career, I play WoW for its clear-cut, achievable goals (ie. getting loot, reaching a new level.) I have felt this to be very beneficial. Though I could see how it might become a substitute for real life for some people, I've used it as a way to get past those 'humps' where I don't feel satisfied. It gives me a sense of forward progress. [WoW, F, 23]

Working away several thousand dollars of debt away, for example, takes a long time, and it's hard to feel like one is making progress when one has rent and etc. to pay as well every month. By contrast, WoW seems engineered to make the player feel as though he/she is making 'progress', which makes me feel almost like my time is less 'wasted' because at least I made progress in the game, even when I'm not making a lot of progress in my personal life. [WoW, M, 23]

Control, Competence, and Status

The lack of control, competence, and social status that some players felt were alleviated when they logged on to an online game.

I use Guild Wars (GW) as a way to escape the stressors of life. There is more control in game. It is much easier, in most cases, to set a goal and achieve it in game. [GW, M, 25]

I hated my job and was constantly dwelling on several disappointments and poor choices I had made. Suddenly I found a world that allowed me far more control than I had in the real one, as well as a place where I could be admired and respected for my skills. I latched onto it strongly. [WoW, M, 36]

During a period of about a year where I was working at a job and role where my work was not particularly engaging, the MMO served as my means to exercise my brain, problem solve and more importantly work with others on problems. In the workplace, I was essentially working alone on most tasks, and have very little background or expertise in the domain I was working in. In the MMO (Wow), it was the reverse, as I frequently grouped with others, socialized and solved challenging in game problems. My game play during this period was very high, often playing late into the evenings, doing dungeon runs, raids; I was essentially filling a void that my job was leaving me with everyday. [WoW, M, 31]

A Sense of Purpose

And finally, some players used MMOs to gain a sense of meaning because they found their lives to be boring and unengaging.

This is a regular state of life for me. I am a worrier, a mother, a full time worker, a wife ... and I suffer from depression, for which I am being treated. I feel my regular life is very boring ... as is my work. WoW lets me feel as if I am doing something interesting. [WoW, F, 31]

It gives a sense of belonging somewhere, when in the RL sometimes you don't know where do you belong. And since all games have clear goals (or at least you make them clear) is easier to achieve them, compared to RL [WoW, F, 27]

I began playing because I had hours of free time, even with a full time job and a family, and I was bored and depressed. It really did make life more exciting and interesting at a time when I was feeling very disappointed in life, and gave me something to look forward to each day and especially on weekends. [LOTRO, F, 50]

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Social Support

In addition to using MMOs as a coping mechanism regarding emotional stress and work dissatisfaction, players described using online games to derive social support in a variety of ways.

Emotional Support

In the most straight-forward examples, some players noted that friends they had in the game provided emotional support in times of need.

The people I met in game became an important support group for me (my only support group) - whether I talked to them about my issues or not. I don't know how I would have made it through that tough time without them. [WoW, F, 21]

Once after an extremely painful breakup. It helped because the friends I had made online were more caring than most of the people I had called friends in real life, who blew me off. [Eve Online, M, 22]

Easier to Talk to People

Others described how talking to people online was different to talking to people face-to-face and the relative anonymity made it easier to talk about difficult issues. The first narrative is interesting in that the practice of talking about these emotional issues online made it easier subsequently to talk about it face-to-face.

When I went through a depression it was a relief to have the online friends to chat with. For some reason it was easier to break the ice talking about difficult issues with online friends before talking with friends irl. Once I had been warming up talking with online friends it was easier taking the step talking to irl friends. [WoW, M, 25]

There is something about online friends that let you break through walls you normally put up with real life friends. You can be you without judgment and they give you advice the same way. Online people don't have to care about protecting your feelings as much so they give you the benefit of saying exactly what they think without regard to how it affects your relationship (as much). [WoW, F, 26]

Alternate Social Network

Some players noted that it wasn't simply that they didn't have friends in real life, but that certain constraints made it difficult to tap their existing social network for emotional support. For them, the MMO provided an alternate social network that better fit their needs.

When I was in high school I was being raised in a very restrictive religious cult and afraid to tell my parents I was bisexual. I used to cry myself to sleep every night and engage in cutting behavior and a lot of withdrawal from my family. Since I was not allowed to have friends outside the religion and I could not trust those who were cult members I felt very much alone. By playing an MMO I found friends I could confide in who helped me and putting on my headset I could forget of where I was in my life. It made me even more driven to succeed in the game and I met friends who I still keep in touch with. It didn't help me solve my problems but it did help me cope until I was in a better situation to make changes in my life. [WoW, F, 21]

I live in a neighborhood where its dangerous to walk out my front door, and yet I can log onto World of Warcraft and talk to friends who are there for me and are willing to support me. I can in-turn support them in the best way I know how. [WoW, M, 19]

I have many good friends, but they live all over the world and it's hard to keep in touch. Part of my depression stemmed from having no good friends who I could be in consistent *regular* contact with, so I spent most of my days somewhat lonely, and at a loss how to start over making new friends. Gaming provided me with a more stable and satisfying social life. I ended up making many good friends and becoming a well-loved officer in a fun guild. [WoW, F, 33]

"Poor Dear"

Several respondents provided an interesting variant of using MMOs as alternate social networks. In these examples, the respondent has an existing social network they are able to tap into for emotional support, but it is that very support that they feel traps them in their grief by constantly reminding them of the traumatic event. Having a social network in an MMO allowed them to put the trauma behind them.

Several years ago I lost my husband and my daughter in an auto accident, leaving me the only survivor of my family. The constantly changing world of the MMO and the comings and goings of real live people provided something I needed at the time -- a whole world that I was part of, yet no one there knew of my pain. I could interact with real people and not have the pressure of being 'that poor woman who lost her family', which I hadn't realized was weighing so heavily on me in real life, and which well-meaning friends tended to put on me. [DAoC, F, 48]

When my father was released from prison (after being in since 1986) and tried to make contact with me, I started playing WoW more often than usual. I think, apart from playing too much, Warcraft helped to even out the stress in my life for that period of time. None of my guild mates knew of my problems, and therefore didn't ask me about them (whereas my RL friends would, naturally), which meant I wasn't being constantly reminded of the RL issues at hand. [WoW, F, 21]

Social Anxiety

And finally, some players used the MMO to cope with social anxiety problems. The MMO allowed them to interact with others at the pace and intensity that they were comfortable with.

I've also struggled with shyness for many years, and have used games as a way to hide from my social problems, which are bad enough to be paralyzing. I'm still shy in the game sometimes, and often have trouble finding groups. However, overall, I think I'm less shy now than I was before I started playing. I've definitely noticed a change in my behavior in the real world, and close friends (in real life) have noticed this change also. I'm a lot more likely to put myself and my opinions out there when I'm around other people, and with new people I've met in the past year, I've been a lot more outgoing. [WoW, F, 31]

I'm an extreme introvert (Asperger's Syndrome) and spending time with others irritates me. I play online games as entertainment that connects me with people 'a little' but not really connecting with people. Sociologists would probably say that this behaviour isn't psychologically sound, so in that sense feeding that would be hurting me more than trying to work out my so-called 'disorder' and socializing with people. [Guild Wars, M, 27]

I have been diagnosed with generalized anxiety disorder. When it was really bad, I liked playing games on line, because I could talk with people I didn't know. This was something I didn't dare in Real Life. It has helped me a bit to get my life going because people listened to me and supported me. [WoW, F, 21]

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Physical Challenges

The final category of problems that players described using MMOs as a coping mechanism for revolved around physical challenges.

Distraction from Physical Pain

Some players mentioned playing MMOs as an effective alternative to taking painkillers to manage chronic pain or pain resulting from a recent injury.

I suffer chronic back pains, and an MMO can help take my thoughts away from that. [CoH, M, 40]

The RL issue is total knee replacement - pain avoidance is much easier in game than otherwise; in game I can reduce pain medication [EQ, F, 61]

Dealing with surgery and the loss of a whole year athletically was a pretty tough thing for me to take. It was right around then that Guild Wars first came out. Ultimately, I became a better Guild Wars player but a worse person. It effectively made me forget about my injury and enjoy my three months without much pain. Though in hindsight, I wish i had not played nearly as much as i did and it took quite some time to rebound back into sports. [GW, M, 18]

Physical Handicaps

And for others, MMOs provide a way to cope with the social and emotional effects of being physically handicapped.

I suppose that one of the reasons I enjoy playing is that, unlike in RL (disabled and a wheelchair user), there are no physical barriers in the game. I can go where I want and do what I want without suffering for it (with the exception of making my painful hands and wrists worse through playing for too long). Also, other players don't know that I'm disabled unless I choose to tell them, so there's none of the awkwardness of RL; most people are invariably unsure how to interact with someone in a wheelchair still! [WoW, F, 50]

Well, I'm ill and disabled and I can't work. I have plenty of free time on my hands and MMOs have helped me spend that time online where no one can see my state and where I get to be at the same level as everyone else for once. It reinforces my self-esteem since I'm a good gamer ... I think. I tend to be more vocal and outgoing online than in real life. People get to know me better online than in real life because in real life they would probably just ignore me like they do now. I get to have some social contacts online because I don't get to have colleagues or friends in real life. [GW, F, 32]

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The Empowering Reality

When asked whether the MMO ultimately helped or hurt them in dealing with their problems, players talked about both positive and negative outcomes. On the positive side, players who were experiencing depression described how the online environment reminded them of the things they could achieve in the physical world.

As strange as it may sound, learning to play and enjoy life in an MMO helped me regain my life outside the MMO world -- not by substituting one fake world for a more painful real world, but by providing me with a much-needed detached environment to revitalize my own personal traits and strengths without the stress of being watched and analyzed constantly by well-meaning friends. [DAoC, F, 48]

The most important reason I play the game is because I've needed a different way of looking at myself since my depression after losing a child -- i find when I visualize myself differently (more positively) then I actually feel differently (more positively about myself) in real life. I wish there were more games for people that don't want to kill so much. Things like putting out fires, and emergency rescue leagues would be awesome. [Runescape, F, 43]

I began playing because I had hours of free time, even with a full time job and a family, and I was bored and depressed. Three years later, I had recovered a sense of myself and my potential, and had a more compatible relationship and an extremely satisfying job. And as my real life began to rival my online life, EverQuest began to fade away. It really did make life more exciting and interesting at a time when I was feeling very disappointed in life, and gave me something to look forward to each day and especially on weekends. [LoTR, F, 50]

And some players even described how the online game was helpful even when they their depression made them suicidal.

The people I met in game became an important support group for me (my only support group) - whether I talked to them about my issues or not. I don't know how I would have made it through that tough time without them, since I had constantly thought about suicide before I had been playing an mmo. [WoW, F, 21]

I was literally going to commit suicide - I had an idea, a method, and had planned it all out (I had recently been hit with the country western song trifecta of house burning down, dogs dying in the fire, and my mom's death shortly after). A friend invited me to try Everquest 2. I became engaged with it - every day I woke up wanting to see what would happen next. I made friends that I cared about, and began to form a community. Little by little, I started to see how what was going on virtually could also go on in my RL, and I began to venture forth there, too. Being involved in adventures and leveling LITERALLY saved my life. [WoW, F, 33]

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The Vicious Cycle

On the other hand, the opposite can also occur. Using the game environment as a coping mechanism can lead to ignoring the source problems and causing them to worsen over time. This in turn leads to a further dependence on the game as a coping mechanism.

I started playing WoW in a rough time in my life. I neglected pretty much everything in real life. There were days where I wouldn't even leave my room except to use the bathroom and get something to eat. I would play from waking until I was passing out in front of the keyboard. Real life sucked, but man I was having a blast in the game and it just made me forget about everything wrong in real life. At its worst, I went almost a week without even speaking to one of my room mates ...and things started to sour on that front. We got into arguments, and we couldn't pay any bills. I had to move home for the first time since I started college. [WoW, M, 25]

I hated my job and was constantly dwelling on several disappointments and poor choices I had made. Suddenly I found a world that allowed me far more control than I had in the real one, as well as a place where I could be admired and respected for my skills. I latched onto it strongly. Of course, the real world kept moving, and my wife began feeling more and more neglected. I ignored her attempts to pull me out of the game, and so she grew more and more distant, eventually having an affair which I was blissfully ignorant of for some time. Once the truth came out there was a truly horrible period of time, almost a year, where our home was more or less the site of a Cold War, with both of us staying together only for the sake of our children. I sank even deeper into the game to try and block out the misery of my real life. [WoW, M, 36]

My parents divorced, and although I was under the impression it wouldn't really affect me ... well, after playing the game every waking moment, not pursuing work or school, staying awake playing for 48 hours at a time or worse, it was certainly hurting my situation more than helping. I was very irritable, I would snap at my mother and younger sister, especially if the divorce or my father were brought up. I became quite simply very, very, mean-spirited. Eventually, after about 6 or so months of this every single day, I realized I had lost almost 40 pounds from starving myself and my condition slowly worsened. My immune system was completely shot. I had grown so ill that a week later I came down with tonsillitis as well as strep throat. [WoW, F, 18]

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Is the Gaming Problem just a Symptom?

Some of the narratives we've seen show how the gaming problem emerges as a coping mechanism in the midst of existing social or emotional stresses. For example, on the previous page, we saw the young woman who used the game to avoid the reality of her parents' divorce. Or consider the following example.

I'm having trouble with school - not because of grades, but because of my parents. They're pressuring me to do well in school because of the high tuition. They're having trouble affording it, and constantly tell me that it's up to me to do well so we might get more financial aid next year. I get it. I understand the situation we're in. But they're not helping me by constantly telling me the same thing over and over again. In fact, they're making it worse. I'm put under stress to try and do well, but it's not working. Then one day I got an e-mail invite to be a Closed Beta Tester for the MMO 'Secret of the Solstice.' I was intrigued by the whole 'Closed Beta' thing before - I'd never heard of it. I was a 'newbie' to the whole MMO scene. Almost instantly I downloaded the client, and started playing. I was hooked. I was in a world where I could be anyone. I didn't have to work to please someone, I didn't have certain standards to meet. I could just be who I wanted to be, doing what I wanted to do. I ended up playing every night, and on weekends for hours. [Secret of the Solstice, F, 14]

It's easy to take the most overt symptom and identify it as the primary problem, but this would lead us to the overly simplistic solution that taking away the game solves the problem. And as many Marriage and Family Therapists know, the parents who bring their child in for a problem may be unknowingly playing a part in sustaining that very problem themselves. Behavioral dependencies are seldom simple problems; more often than not, they involve underlying problems sustained by the social dynamics surrounding an individual.

Of course, this isn't to say that gaming problems only emerge when there are existing psychological stressors, but the research in this area does suggest that psychological stressors are a strong indicator of whether someone develops a gaming problem or not. Nevertheless, game mechanics that reinforce particular game-play motivations (e.g., reward cycles) are definitely a part of this process too.

The narratives we've seen also suggest other ways in which the gaming intersects with therapy. It is possible that therapists could actively leverage the online environment as exercises for certain social anxieties or teamwork skills. This is something that seems like it could fit as part of a cognitive behavioral therapy approach. More importantly, the narratives show that getting gamers to talk about their motivations for playing can help identify underlying causes of problematic gaming. Knowing how the gamer is using the online environment as a coping mechanism might help shed light on the larger problems an individual is dealing with.

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Reflections From Gamers

I'll close with a collection of varied perspectives from respondents on this gray area between coping, therapy, and dependency.

As long as the player remembers that a game is a game, and not an alternative to their present lives, then they will be alright. It can be dangerous when one forgets this, because ultimately I do not believe games are real. They are data stored on servers, data that could be easily erased if the company wished it. Our lives are so much more valuable than that. [WoW, M, 19]

Over the summer, I played what for me was way too much. I knew I shouldn't play as much as I did--and at the end of most days I regretted it. I learned a valuable lesson from that though--the game is enjoyable when I control how I interact with it, not when it controls me. [WoW, F, 22]

MMO's aren't the problem, they are just a way for people with other real life problems to escape and forget about them. My advice is to make sure you're happy and content with where you are in life before you touch an MMO. [WoW, M, 25]

I finally figured out that trying to compete to impress a bunch of anonymous strangers online is ridiculous if it means hurting the ones I love. MMOs now are only a form of entertainment for me, one of many, and not my refuge from reality. [WoW, M, 36]

There is a fine line between relaxing with a little gaming, and submersing yourself in a game in order to ignore something that shouldn't be ignored. I don't think this is unique to MMOGs. Some people use alcohol, for others its drugs, or gambling, or sports, or some other activity. It's a human problem, not a specific activity/technology problem. [Eve Online, M, 34]

Did the game contribute to the problem? No. 60 hours a week sitting in front of a computer contributed to the problem, but I could have done that watching DVDs, playing electronic bridge or laying on the couch watching TV. [WoW, F, 51]

Doing something pleasurable when you are feeling down is one way of coping. Of course, it never solves the problems. Of course, it's not meant to solve the problem. Neither does eating a bar of chocolate. But when there's no fun to be had in the real world, sometimes, there is fun to be had in the virtual world. [Guild Wars, M, 29]