As the metaverse grows, so are concerns about the mental health implications it might have. Pathological virtual-reality use could become a big problem – both similar to and much worse than gaming disorder, which is itself still a contested condition.
Chris Walz, a 29-year-old game developer from New York, was thinking of gaming addiction when working on Big Ballers Basketball, his virtual reality (VR) multiplayer. Walz experienced how addictive games can be in his late teens when he discovered StarCraft, a competitive real-time strategy. It was his favorite “pancake game” – a term he uses to describe non-VR video games.
“There was definitely a time when I would play constantly,” Walz said, adding that this affected his performance at school and consumed him to the point where he did not seem to have interest in anything else. Prioritizing gaming over other activities and interests could be a sign of gaming disorder, according to the World Health Organization (WHO).
“Real life is nice. VR is cool – but you should enjoy your main reality first,”Chris Walz, a VR game developer, said.
Walz’s concern is that the highly immersive – and much more engaging – VR environment will exacerbate the problem. He points to the oversaturated mobile gaming industry, where high competition means developers resorting to “dark patterns” to keep players hooked. According to Walz, practices used in the gambling industry are now common in online games, and could become an issue in VR.
“If you think of a gambling machine, that's kind of a classic example of a dark pattern of getting someone addicted to just spending their money. There are the flashing lights, there's the random probability,” Walz said. In-game promotions and upgrades that incentivize gamers to spend money – and even punish them for missing a day – are some of the many “nods” to gambling practices in gaming, he said.
This overlap with other addictive disorders, such as gambling, is complicating the debate on whether addiction to video games is a standalone mental condition or if it is a symptom of an underlying problem. It could even be a result of “moral panic” associated with the emergence of a new media, according to some skeptics.
One study published by the American Journal of Psychiatry in 2017 found that less than 1% of the general population was affected by internet gaming disorder. It said it was important to distinguish between passionate engagement in the game and pathology – or an illness – adding that whether the person is distressed while gaming could be the key factor in telling the two apart.
“Research supports that there are neurological and psychological impacts of chronic gaming, however this term may encourage the pathologization of all forms of gaming behaviors, including safe or adaptive gaming activities,” said Dr Ryan Warner, a clinical psychologist.
The WHO estimates that 3% of gamers could be affected by pathological behavior. It moved to recognize gaming disorder as a condition in 2018 – despite some critics in the academic community arguing that the scientific basis for such a designation is weak.
“This term may encourage the pathologization of all forms of gaming behaviors, including safe or adaptive gaming activities,”Dr Ryan Warner, a clinical psychologist, said.
Meanwhile, gambling is currently the only behavioral addiction – as opposed to substance misuse – that the American Psychiatric Association recognizes as such. It did, however, mention “internet gaming disorder” as a condition requiring further study in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released in 2013.
Despite the ongoing debate, only licensed professionals can officially diagnose mental health conditions, including gaming disorder. “This label should not be used unless consulting with a professional first,” Dr Warner said.
Are you feeling sick?
Even less research has been done on addiction to VR, but that does not mean it won’t be a problem, according to Dr Matt Glowiak, a clinical counsellor specializing in advanced addiction.
VR offers an experience that is as “immersive and immediately reinforcing as it gets” and “human beings are drawn toward that which feels good,” he said. According to Glowiak, research still has to catch up with the contemporary use of VR.
“But, yes, addiction to VR has the hallmarks to be described as a behavioral addiction,” he said, noting similarities to playing video games. Characteristics that could betray addiction include obsession with the game, withdrawal symptoms when offline, and the loss of interest in other activities.
Physical side-effects are also similar and can cause “cybersickness” – a form of motion sickness – that manifests in a headache, eye strain, dizziness and nausea.
“Because VR addiction is not met with the ultimate consequences of overdose or death, as are substance addictions, the consequences are seemingly trivial,” Dr Glowiak said. “But when addiction to VR impacts other areas of basic functioning, which it does, consequences may ultimately prove severe.”
“We’ll worry when it happens”
The gaming industry boomed during the pandemic, and is expected to be worth $321 billion by 2026, according to a report by PwC. The metaverse is projected to double that and reach $760 billion market value by the same year, a seven-fold increase from 2020. Companies like Meta pour billions into improving VR hardware that will make the experience much more immersive – and create health concerns in the future.
“They don't really have any plans to do anything about addiction. It's more of a reactionary thing,” Walz said, adding that “we’ll worry when it happens” was the response he got when raising the issue with one high-profile industry figure recently.
Many video games come with parental controls to ensure, among other things, that underage players maintain life-and-game balance, and supervision by parents is already becoming more common in VR.
At the same time, gaming industry lobby groups, such as the Entertainment Software Association, are stressing the “therapeutic” value video games have: as evidenced by a growing body of research, video games and VR can indeed be used to help with mental health problems.
As a game developer and an avid player himself, Walz does not deny the potential benefits of gaming. He does, however, say that game companies have a conflict of interest and some may prioritize high retention – something that keeps people wanting to come back for more – over healthy gameplay.
“If you want to have high retention then you can use various strategies, and some of them are more ethical than others,” Walz said. Doge Labs, his own small but expanding VR games studio, focuses on avoiding addictive patterns when developing a game.
Big Ballers Basketball, an early-access game to be released on the main Oculus store next year, is a competitive VR basketball game with time-capped matches that can last for as little as five minutes.
Walz believes this ensures the game’s retention without making it addictive. “Real life is nice. VR is cool – but you should enjoy your main reality first,” he said.
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