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[00:00:00] Dr. Sharp: Hello everyone. Welcome to the Testing Psychologist Podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR.

PAR offers the SPECTRA: Indices of Psychopathology, a hierarchical dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com/spectra.

Hey everyone, welcome to the Testing Psychologist Podcast.

My guest today is an expert in video games and gaming. I’m thrilled to be talking with Dr. Anthony Bean because I love video games. I don’t talk about video games on the podcast [00:01:00] much because I don’t have much reason to, but today that all changes. This is a bit of a dream come true. We’re exploring the intersection of gaming and psychology and assessment.

Dr. Anthony Bean is a Licensed Clinical Depth Psychologist, video game researcher, the Executive Director at the Telos Project, and the Executive Director of Geek Therapeutics, the leading agency in continued education with a dynamic focus on Geek culture, including evidence-based practices and treatments in Geek Therapy and culture.

He’s been consulted as an expert for CNN, Inverse, Polygon, and internationally for Gehirn & Geist, while also appearing on radio, podcasts and being a sought-after keynote speaker and conference speaker in the US, Canada, and Russia.

Anthony has a Doctorate in Philosophy, in Clinical Depth Psychology from Pacifica Graduate Institute, and specializes [00:02:00] in the therapeutic implications of video games and gaming, working with children and adolescents, and the use of video game character identification as a therapeutic technique.

He’s authored multiple academic articles, book chapters, and six books including; Working with Video Gamers and Games in Therapy, The Psychology of Zelda: Linking Our World to the Legend of Zelda Series, The Psychology of Final Fantasy: Surpassing the Limit Break, Integrating Geek Culture Into Therapeutic Practice: The Clinicians Guide to Geek Therapy, The Psychology of Pokemon: The Power To Catch ‘Em All and Checkpoints and Autosaves: Parenting Geeks to Thrive in the age of Geekdom.

As you can tell, Anthony has a ton of experience in this area, both from the research and practice sides of things. And we get into a fascinating discussion around these topics.

We talk about the history of gaming. [00:03:00] We talk about video gaming as an “addiction” and the relationship to problematic gaming. We talk about the positive aspects of gaming. We talk about integrating gaming and assessment and therapy and many other topics. This is a wide-ranging discussion, so there’s a lot in here for those of you who enjoy gaming and those of you who may be less familiar with it.

As always, I hope you enjoy this episode. And without further ado, let’s get to my interview with Dr. Anthony Bean.

Hey Anthony, welcome to the podcast.

Dr. Anthony: Hi. Thank you for having me.

Dr. Sharp: Yeah, glad to be here with you. I [00:04:00] am extra excited. I say this with all my guests, but I really mean it every time. I’m very excited to talk with you because we’re talking about gaming and psychology and mental health and assessment. I don’t think a lot of my audience knows. I don’t talk about it a whole lot, but I love video games. I don’t get as much time to play as I would like, but that is my go-to decompression thing if I get two hours somehow free over the course of the week. So I’m so thrilled to have you here and talk through some of these things.

Dr. Anthony: Same here. I’m on the same path as you as it just feels like time’s an illusion. Like I don’t even know what time is sometimes. Is it Wednesday? Is it Thursday? Is it Saturday? Why am I here? How did I get here?

Dr. Sharp: Yes. I get it. Well, let’s start with my typical question to open, which is, why is this important to you? Of all the things you could do in [00:05:00] psychology or mental health or assessment, why gaming?

Dr. Anthony: This is going to be a little bit more of a longer winded one.

Dr. Sharp: Let’s do it.

Dr. Anthony: That’s because I run 51C3 non-profit here in Texas. And the reason we opened it here in Texas, I’m not originally from Texas, is this state is known as a mental health black hole is what we’ll call it. And even just to find therapy people or anything like that, it’s hard. Everyone has waiting lists because there’s just not enough people that are out there- quality therapy that can be done out there.

Just this morning, I was in front of a large board, another non-profit, explaining what I do over here and what we do as a company and ascertain holistically centers around psychological assessment.

One of the big things [00:06:00] that we’ve seen, and this is why we do this, is there are too many people that just fall through the cracks. Let’s say if you’re listening in or you have a kid or something like that has been assessed by the school, you’re going to get some information from that. Is it all going to be great? I’m not going to go in. Is it helpful? Yes. Will I’ll find a use for it. Yes. But one of the big things that we strive to do, and we found that we’re really good at it, and we feel a sense of massive sense of accomplishment of helping out the community, is psychological assessment.

We have 60 different tests that we can do, and so we can mix and match based upon what the referral is. Just to have one of our kids come through testing, get completed and then I never see that kid again, means that we’ve done something. It means we’ve done something right because that means that they’ve gotten the help in all the [00:07:00] referrals, the appropriateness, and the psychological assessment has done it.

Our motto when we do the intake is, after this testing, we don’t want to see you again, because if we do, that means we failed somewhere. We will help out and we will correct that failure if it happens. However, we also want to make sure that everyone is taken care of. And especially here, we’re doing the best we possibly can with what we’re given with insurance wise.

And so for me it’s a passion. I love psychometrics, data, dissertations, writing papers, and things like that. So for me to pull in psychological assessment and be able to tease out characteristics that you may know or you may not know is very important. I just like data. It makes sense.

[00:08:00] Dr. Sharp: Right. Well, I think that’s why a lot of us get into assessment. And there is even extra data that we can pull from gaming and a lot of these activities that people engage in that is hidden under there, is worth looking at and extracting.

Dr. Anthony: Oh, yeah. The qualitative stuff is, in my opinion, just as important as the quantitative.

Dr. Sharp: Absolutely.

Dr. Anthony: I don’t know why there’s always a fight. I don’t think there should be.

Dr. Sharp: Sure. I’m going to ask, I don’t ask all of my guests this, but I have to imagine, you tell me if I’m wrong, I would have to imagine from the outside, it looks like you have been able to make a career out of a really fun hobby that a good number of people probably wish they could just do for the rest of their life. Like I would love to be able to play [00:09:00] video games. Not that that’s all you’re doing, but you get where I’m going. How did you continue this thread? Were you a big gamer as a kid and then just knew you wanted to do that as a psychologist? What was the development path there to get to where you are?

Dr. Anthony: This is another great question. One of my earliest video game memories is playing Adventure Island on the NES. It’s hard. I got to the fourth level and I died and I said, no, I don’t want to do this again. And I put it down. That’s one of my earliest things.

I actually didn’t find a love for psychology until my 12th grade of high school when they offered a sociology half a semester, and then half a semester of psychology. I really liked the idea of what that was coming from. We were obviously [00:10:00] exposed to a lot of different theories and everything like that, and it just started to make sense of like, oh, well, like what self-determination theory, if I’m playing this type of thing, I’m getting this type of experience from it, of course, that’s going to reinforce me to continue to do that. It’s also going to help me mentally masticate how is this affecting me and how is this imparting and giving me certain things?

And so, that’s just certainly how I curtailed out of high school into undergrad where I was uninformed and originally on the side of video games cause a lot of violence. Then I did a study in undergrad with that and it actually turns out, no, it wasn’t the the video game that was the culprit because we did logistical regression on this. It actually was the predisposed personality [00:11:00] characteristics that we have as people that is the biggest hallmark sign and in came up with I think like 70 to 80% of all of the entire variance. And so, it was very eye-opening to be like, okay, well I went in with here thinking that I was going to get these types of results, and in fact I didn’t, let’s look further into this.

And that’s just where I went psychology-wise. And then I’ve always worked with gamers, I can relate to them the easiest. Depending on, usually within about 20, 30 minutes, if you know video games really well, RPGs versus RTSs versus everything else, you can really get granular with people in a way and just pinpoint styles of their personality, healers versus tanks. They have similar needs, but they’re also very different in different ways.

Dr. Sharp: Can I ask a quick question?

[00:12:00] Dr. Anthony: Yeah.

Dr. Sharp: Just since you brought it up, is there any research out there, maybe it’s anecdotal, but is there any research around the characters that people pick or build in an RPG or a game where they can pick or build a care and their actual personality characteristics?

Dr. Anthony: Yes. There are some studies that are out there. The first time we generally play a game is we tend to play as artself. The type of thing that we want to play as is what a lot of the research is saying. And then the second time we play, we usually do an opposite, and then third time we just do whatever we want. If you play a game three times. But generally that’s what a lot of the research has been doing.

When I work with clients and I ask them why a healer? What about a healer is gravitating towards you? They start talking about how they just want harmonious abilities across everyone and everyone just to be well in different ways. And they tend to have a [00:13:00] systematic worldview of I need to keep everyone up in and ready to go without paying attention to myself in my own personal needs. And it’s a go, go, go, go. Let’s keep everything stable, but I’m not going to ignore what I have. And that’s the detriment, the shadow side of what we’d call, of usually a healer.

Dr. Sharp: Sure. That’s fascinating. I would love to dig into some of that. I’m so curious how this is done. Maybe you know. Whether tying in big five personality characteristics or more clinical personality assessment or what do you remember?

Dr. Anthony: My dissertation was actually… Over 19,000 video gamers took the BFI and we did it on World of Warcraft and based upon all of the different things. It came up with four different personalities. We had the introversion, the extroversion, and then we did what we call Secure Ambiversive and an Insecure Ambiversive based upon the [00:14:00] neuroticism scale.

And so, what we ended up finding was that healers tend to go more introversion, Tanks go more extroversion, and it just keeps on going down those things based on what your needs are on the personality characteristics, which is what I love to figure out and talk with them because I think that if you as a person can understand why you played this game or why is it space games versus a fantasy or why is it a tactician game over a first person shooter? That is going to give you massive insight into how you interact with your people around you, your friends, your family, your partners and how you have an outlook on life.

Dr. Sharp: Sure. So I’m just going to keep hammering these questions that come up because this is… you’re opening so many doors with this first few minutes. So I am curious about personality styles and [00:15:00] types of games that people choose. So First-person shooters versus, like you said, Tactical versus Strategy versus RPGs. Do we have any data on that?

Dr. Anthony: We have some basics type of stuff. So Nick Yee is one of the people that’s out there that’s doing the Gamer Motivational Profile and he’s fantastic to talk to. Always open, always willing to have a conversation. Super, super busy. He used to work for Ubisoft and then he left because it was, what’s the right phrase? He wanted to do more overall.

Dr. Sharp: Okay.

Dr. Anthony: So I think that that’s one of the things that drew him into that. But he has a motivational profile that’s like over 300-500,000 people that have taken it. And it’s broken into 16 different, is it a 20 or 16-20 different characteristics of motivational play based on self-determination theory? [00:16:00] And it’s pretty spot on.

I use it in my sessions for when I want to know a little bit more. We’ve discussed what type of person you’ve played as, we’ve discussed these types of characteristics. We’ve read up a little bit on it. We’ve gone and created some introspection. Let’s have you take this next step. What’s your motivation to play? What are your things? Is it achievement? Is it socialization? Is it exploration? What are those types of key characteristics.

And I think that is where we tend to see a lot more understanding of why we play these games. I think that’s the big aspect of what I focus on clinically in when we do some basic psychological testing that’s not billed to insurance.

Dr. Sharp: Right. There’s always that. Seriously. We take so much insurance. I’m totally with you.

[00:17:00] I’m just thinking how this would be helpful for so many parents that I work with. I work with a lot of kids and young adults. A lot of parents come in, and I’m guilty of this myself, because my son, I feel like is always trying to play video games and I catch myself in that trap of this not what he should be doing. This is a waste of time. I don’t know what this is about. I know other parents are thinking the same thing. So just like digging in and knowing that there is data out there around the motivation and what function it’s serving in kids’ lives. There’s so much more below the surface than just get off the video games.

Dr. Anthony: Well, it’s teaching them. It’s teaching them different skills. It’s teaching them different ideas. I wrote a whole parenting book specifically on this. And it doesn’t just do video games. It does like everything like Anna and I, Manga, Superheroes, D&D, those types of fun [00:18:00] things. And it gives a really good indication and idea for parents to know, like, oh, I can talk to my kids about this. I don’t have to be scared of this. That’s really what it comes down to.

Here’s the thing. I am, what are you, 2022? I am 37 years old. I have published 7 books in working with video gamers or in some capacity utilizing video games or Geek cultural artifacts in therapy or understanding ourselves to be better. My parents have all those books. Go ahead and ask me if they still understand anything compared to what I do and how I was grown up. They would tell us growing up that video games are going to rot your brain. They’re not going to do anything. How are you going to make a career out of that?

We can look at the millions of dollars that are [00:19:00] plugged into eSports every year. How an eSports players, their lifetime is actually about 6-8 years. That’s their career thing. Once you get past it, eight years, there’s a such a decline. You either go into coaching or you leave the field completely.

So there’s tons and tons of things that are out there, but the biggest thing for parents is always to be, what are the things that you are worried about? How have you interacted with this? Do you know what games your kids are playing? It’s not bad to play games, but are there time limits that are required? Do you see a mood change on that? What timeframe are you seeing that mood change?

My 6 year old and I, we had a dad Sunday. A dad and son fun day, is what I’ll call it. Well, it didn’t happen on the day Sunday. It happened on a Tuesday. We went to this place called Free Play. They have tons of video games and they’re all the old stuff, that’s like super hard to be, and thank God you don’t have quarters because he dropped $40 just on trying to be in [00:20:00] the teenage turtles again and he got to play for three hours with me. And do you know what, he specifically gravitated towards, it was pinball.

Dr. Sharp: Oh, that’s great.

Dr. Anthony: It wasn’t fighting games, it wasn’t anything. He goes, I like pinball. And I was like, “This is great. Let’s do this.” And it wasn’t because of the style of pinball or anything, it’s just he was building motor coordination and eye coordination with that. He was doing other things that require a little bit more of a kinesthetic approach rather than just moving a controller up and down. He wanted things that he had to turn, that he had to flip buttons, that he had to pay attention to. And he’s building up those neurons in his brain to be able to match the visual perceptional ability of life.

And for that, we allow him to play things. He’s being Pokemon already.[00:21:00] He’s learning to read off of video games. He’s just excelling very well. Even if me like, we place limits on those things, that’s not a bad thing. It’s easier to place limits on them now than it is later on.

And I think that’s one of our biggest things that we have with parents. They’re scared to place limits. They’re scared to do other things or they might not know what the right choice is. And here’s the first step of parenting is good luck, have fun. You’re going to mess up. And that’s cool. That’s part of the job.

Dr. Sharp: Sure. I know that we’re going to get into some of those nuances around screen time and limits and what’s appropriate in age and all that stuff. But I want to first acknowledge that I put so much money into Teenage Mutant into Turtles when I was younger. It’s amazing that that’s the example you pulled. I totally…

Dr. Anthony: That and The Simpsons. Those are the two [00:22:00] ones that we would do. I’ve beaten The Simpsons at Free Play Ninja Turtles. We beat that when we had four of us go and each bring $10 and we just beat the game right then and there. Had a high school thing there, they all went to the beach and we went to the arcade.

Dr. Sharp: That’s great.

Dr. Anthony: We spent an hour and a half beating that game.

Dr. Sharp: You got to have four.

Dr. Anthony: That’s the only way to beat that game, otherwise, if you haven’t played that game, you should because it’s just unfair. You’re like, oh, cool, I’m going to go and do a jump move. And the boss is like, yeah, no you’re not. And just punches you out of the midair. You’re like, what? That’s not how this works. That’s not fair.

Dr. Sharp: Well, let me back up. I know there are some folks out there who are like, what are y’all talking about? So let’s lay some groundwork real quick. We can back up a little bit. Tell me, when we say gaming, so we’re talking about video games so far, but when you talk about gaming in your practice [00:23:00] and in the literature, what does that encompass? Is it just video games? Is it more? Is it board games? What does that mean?

Dr. Anthony: It’s a little bit of everything. I utilize board games. I utilize video games. I utilize iPad games. Roblox is a very easy one to utilize with a lot of kids because it’s what we call a game engine. And there are literally thousands of games on there and you go and play and you’re like, oh, why wouldn’t you want to do this? And you’re like, well, if you have a specific intention, you can make any game into a therapeutic endeavor. And that’s what we do with our kids. And so when I’m talking gaming, it can be anything that is kinesthetic to a virtual screen.

Dr. Sharp: Got you. That’s great. I know there’s been a lot of talk over the years, especially with the most recent DSM, I believe, around specifically video gaming as an addiction. I just want to touch on that. I’m curious how [00:24:00] you view that. What lens are you looking through? Is it an addiction? If not, can it be problematic? How do we approach this?

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Dr. Anthony: I tend to err on the side of it being more problematic than an addiction. A lot of the researchers’ more prominent ones are not on either side, right in the middle. I’m actually a part of a board that looks at this. We talk about the idea of how we see it more as a behavioral addiction. The reason we use the term behavioral addiction is because a lot of addictions would fall into it.

And so, while we have an addiction for substance use, addiction for running, addiction for eating, those things still have so many behavioral characteristics that there’s actually a push in the addiction literature that grows every year to be like, why don’t we just have an overall category of behavioral addiction and have these as potential subsets. The subsets aren’t really needed. It’s just to help delineate [00:26:00] different factors and different behavioral characteristics. Huh. It’s really funny how they should probably be there.

I don’t agree with the WHO’s decision because the research that they chose was very cherry-picked, and the people that they have on the panel who created that thing aren’t clinicians. They aren’t people who treat things or work with therapy or anything like that. They’re just pure researchers. And so, I don’t know how everyone else has ever felt, but if a researcher who has no clinical experience tells me how to practice therapy, I’m going to walk away real fast because if you don’t have that experience, how can you tell me what to do? Because research does not e equate to what actually happens in that therapy room.

Therapy is an art in my opinion. Same thing with psychological testing. You can’t just do it for the sake of doing it. You have to like what you do. You have to be able to put those pieces together. You have to have a pretty high working memory and [00:27:00] to be able to do it properly. And I think that for me, I’m not saying that there isn’t a gaming disorder out there. I’m just saying in its current form, it’s not very reputable. It’s like a house of cards.

When we create a new diagnosis, we should be looking at it from an ethnographic approach. The bottom thing is what are the characteristics? What are those behavioral things that we’re seeing across the entire spectrum? They didn’t do that. All they did was take the substance abuse and throw it over here and change two wordings and they’re like, great, we have this taken care of. And you’re like, no, you started up here. You have no basis down at the bottom of this pyramid of a house of cards.

And so when someone who has no idea of what gaming is, what an RP is versus an RPG versus an RTS, and they’re out there telling you that your son or daughter is addicted to something because they play this many times, which is not a [00:28:00] delineated characteristic, just so we’re clear in gaming disorder, I’d raise a cautionary flag. And the reason is because if you don’t understand the culture, you shouldn’t probably be trying to run around in it.

I don’t understand Native American culture because I’m not steeped in it. I wouldn’t try to go into that culture blindsided and make some assumptions without first either getting well-versed in it through research and other things or in a different modality. Or I’d refer you out because it’s not my area.

To bring this all together, is it there? Quite possibly. Is it in its current form? I don’t believe so because it leaves too much open to really narrowly create it in the… Just to beat the dead horse here, the research that they chose to use for this [00:29:00] had such a wide variety of percentages of who has gaming disorder. It ranged from 2% to 50% of the world’s population has gaming disorder. I’m not going to lie to you. Now, if you look at the statistics for a depression or anxiety, we’re down to 4 to 6% or something like that. So I’m like, 50% of the world has gaming disorder. I don’t know, man. That’s not a very reputable research that should be used.

Dr. Sharp: Yeah, that does not seem likely.

Dr. Anthony: Yeah. That’s the type of research they used and that’s what a lot of us have issues with. It’s not that they can’t be there. It’s that use the research that doesn’t just prove your point or tries to prove your point. There’s tons of evidence. I have some of it myself because we published with it that they felt a lot of pressure from other [00:30:00] countries to include this diagnosis, which as a psychologist, a clinician or something else along those lines, we should not be pressured to create something that is not really there.

Dr. Sharp: Right. No, that makes sense. So let me ask you, I’m going to put you on the spot a little bit, if you could build it from the ground up, assuming that there is such a thing as problematic gaming, how would you conceptualize it? When does it cross over into any other, I guess, a diagnosis, if you want to call it that, but over that problematic threshold where we…

Dr. Anthony: What I’ve seen for problematic stuff, it crosses over the threshold is when you start neglecting your other duties of the world such as eating, such as family life, school work. When those things are starting to, like you think of it as a percentage graph not a pie chart, a [00:31:00] percentage bar graph, when you start seeing those things go down in percentages and the gaming go up, that’s your sign. That is hands down your sign that something’s going on.

Now the question is, why is more of gaming going on? Are you not feeling fulfilled in these other areas and therefore you’re feeling more fulfilled in this type of thing? Is there depression that’s happening? Is there something else that’s coming into play a little bit. When I work with gamers and other people that are in that digital space, what we tend to see is gaming is not the primary issue. It’s usually anxiety, it’s depression, it’s potential ASD diagnosis or something like that that comes into play. That if you hit those primary characteristics, those bar graphs even themselves up a little bit better. And I think that is where we are mistakenly creating a diagnosis that’s going to honestly do more harm than good.

Dr. Sharp: Right. [00:32:00] I want to dig into the history just a little bit. I’m curious. Video games have been around for a long time. I remember like early 80s, right? I would say the late 70s…

Dr. Anthony: 85 is when Mario came out, but you’ve heard Pong and Atari that goes back into the 70s.

Dr. Sharp: Yeah. So we’re going on almost 50 years now, I suppose, of having games around, but I feel like we haven’t paid attention to gaming as a “problem or addiction” until the last, I don’t even know, 10 years, 15 year. Is that even true? Is it my perception correct? And if so, is there any reason for that?

Dr. Anthony: Yes. I think that you’re on to something and I think the next step is virtual reality, just so we’re all clear. 5 to 10 years down the line, it’s going to be, oh, I have a problem with virtual reality. What’s going on here in Ready Player One. We’re going to ban that book from schools because of stupid reasons. But one of the things that we tend [00:33:00] to see a lot more of is the historical prevalence is, if you actually trace us back, it was back to pinball machines, dime comics a whole bunch of things back in the 20s, the 30s. Every decade in every generation seems to create what we call a moral panic around some things that they don’t understand.

So, D&D was part of this. In the 70s and 80s, rock music was in the 80s. We had video games and violence in the 90s. Early 2000s is when we start seeing a hefty push for video games as an issue. And now that the violence thing has been pretty clearly debunked in a lot of different ways and we’ve really narrowed that down pretty hard, now we’re on cortisol levels and dopamine ideas with video games and pleasure centers. And we’re like, guys, just because you have a 300% increase in something doesn’t mean that you’re addicted to it. Yes, you’re [00:34:00] reinforcing your neural pathways, but guess what? Me holding my newborn child does the same thing. Me eating a piece of cheese pizza does the same thing and actually increases your levels even higher than what a video game playing does. So to us it’s like bring the nuance in, bring those other types of things on.

There’s a big push right now with social media creating a lot of depression, anxiety, and social problems, which there’s definitely some life to that. However, the data that they’re choosing to use ends in 2012. Guys, what year are we in? We’re in 2022. Where’s all our data? Guess what? If you start using that extra data, you start seeing that they can’t prove their point anymore because all of their measures start going down. And so they are cherry picking the data set years in order to prove their point in order just to stay prominent in some capacities.

That’s not great science. That’s not great [00:35:00] research. And that’s not what we’re here to do. That doesn’t solve anything. You’re creating a problem that doesn’t have to be created. And the biggest thing for anyone, if you’re a researcher for every one bad study, you have to put out on average about 10 good studies to debunk it. So by the time you put out 10 studies, you’ve already had now a 100 other bad studies and it’s just creates a massively vicious cycle.

Dr. Sharp: Yeah, that makes sense to frame out of that just typical, like you said, moral panic. That’s just what we do.

Dr. Anthony: It’s normal for us to humans. Let’s be completely honest with that. We as humans, when something we don’t understand makes contact with us, our first initial reaction is to reject it. And that’s because it doesn’t align with what our experience is. Change is hard. I don’t care what anyone says. Change is hard in that the reason that we have such a difficult time accepting change is because it goes against [00:36:00] what we know. And if we add variables that we don’t know, it creates anxiety, it creates fear, and people can prey on that fear. And it’s not that hard to prey on that fear in a lot of different ways as we’ve seen in current political atmospheres right now. Those moral panics. There always going to be one.

The question that you should be asking yourself is, when I’m reading this research, when I’m looking at this type of stuff, is this the only opinion? Do I take other people’s opinions into consideration? You don’t have to just believe me. Let’s say you read one of my books or something like that. Go out and see what the other people say. What drives with you? What makes sense? What doesn’t make sense? Find your way on that.

Dr. Sharp: Yeah. I would love to switch over and talk about some of the positive aspects of gaming. We’ve talked about the potential negative impact and there’s also a lot of good that can come from it.[00:37:00] What are you seeing in the research and in your practice that’s going well with gaming?

Dr. Anthony: Social connectivity. We’ve seen a massive jump in that mainly due to Covid. And I think that that’s a fascinating experience because Sherry Turkle is MIT professor and before Covid, she has such an interesting trajectory and she’s so fascinating to talk to in that the reason she is because before she did one of her more recent books alone together is that she was very much very pro video games and then all of a sudden she just took a whole different turn because she saw them breaking us apart and actually disseminating us into little bubbles of spheres and we were interacting with each other, but we’re not connecting in different ways.

I [00:38:00] think the Covid pandemic disproved a lot of her stuff, unfortunately, because actually, that was the way that people would interact with each other. They’d interact over First-person shooters. They’d interact over Animal Crossing. Animal Crossing sales have been the highest they’ve ever been. And that’s because you can enter into someone else’s world and you can interact with them across the globe. That increase of social interactivity that we’re seeing and we’re actually very much enjoying in a lot of different ways. And we’re seeing that as a positive because sometimes some kids can’t go outside. Some kids weren’t able to to do things. Some friends live hundreds of miles away. That’s a way that we can really bring everyone together.

We’ve seen increases. My optometrist who does it, he actually brings video games in for eyesight rehabilitation. And he’s like, the research in this area is just so fascinating. He goes, I can work with a kid for [00:39:00] six weeks and I can, through data, prove through this game that I utilize that his eyesight has gotten better, more better acuity has happened, and he’s able to focus more. And he goes, I don’t understand it, but man, I love it.

And he just has this little thing over there. It’s $75 a session and these kids are just doing fantastic. We have video games out for ADHD symptomology these days. I love MMOs because I love the connectivity of it. I think that there’s a lot of more really positive things that are going to come out because a lot of anecdotal evidence of kids using video games to learn to read, to teach social skills, to engage with one another. It’s a tool. And I think that, as long as we keep that sense of idea that this is a tool and we should be handling this as a tool for better, for worse, whatever we want to do, we can [00:40:00] really make it whatever we want.

Dr. Sharp: Yeah. That is a really cool aspect that it’s super flexible. There’s so many kinds of games that you can utilize or develop. You can develop almost anything if you’ve got the skill.

Dr. Anthony: It’s one of the reasons why I love using Roblox, because mindfulness super easy. You just go Mining Simulator. If you want to work on team building, you go into a bot building one. If you want to work on ability to work in a team, again, are you going to like Bed Wars is the type of game. I’m going to tell you right now, I suck at Bed Wars, but my client loves it so much. I’ll play it with him. And he’s like, how did you die? And I was like, how are you alive? I’m like, I’m on a computer, you’re on an iPad, and you’re alive. I have faster computer skills than you do, but you’re beating the crap out of me. That helps bring up self-esteem. I’m thinking of [00:41:00] clients that have needed an outlet to express and experience themselves. Games themselves are a wonderful ability to do it. It’s a safe place.

Dr. Sharp: Yeah. That’s a good way to put it. I do see that. I talked about my son a minute ago, but that is a place where he has a lot of self-confidence. He has the skills that I don’t have, which are being able to be good at video games. He’ll pick something up and within two weeks he’s on whatever international leaderboard for whatever game he’s playing if they have. I’m like, I don’t know how you’re doing this, but he loves it. He’s gets a lot of juice from that balance.

Dr. Anthony: One of my good friends, he knows how to play games and his precision and his motor functionality is just incredible. He can play this car racing soccer game. I’m forgetting the name of it right now.

Dr. Sharp: Rocket League.

Dr. Anthony: It’s Rocket League, yeah. [00:42:00] That’s it.

Dr. Sharp: A lot of Rocket League in our house.

Dr. Anthony: Oh yeah. He goes and he’ll start with the ball in his car, right near his goal, and he’ll just lift it up and just paddle board it across while he’s flying across the entire thing and then flip his car down and hit it and just score on us. We’re like, what? How are you doing this? He goes, dude, I used to be ranked across the world. And I was like, dude, you’re a psychologist. What are you doing here? And he goes, oh, I don’t care about this. This is just fun. For him that’s what it is. But his skills are just in incredible. I’ll never get there. I’d have to spend hours a day, which anyone listening to this probably knows, we don’t have time to do very much because we’re usually just out giving our time for psychological testing, therapy or research.

Dr. Sharp: Sure. Are there any other aspects of the research just to pull out in terms of positive effects of video games before, I definitely want to talk about how you apply it in your practice, but just research [00:43:00] wise, anything else that we should be aware of in terms of good things that are coming out of gaming that we may not be aware of.

Dr. Anthony: So even in person stuff, so I work a lot with a charity called Child’s Play, and they’re in medical hospitals across the United States. And one of the big things that is coming out with them is that they utilize video games across the different floors. They create new land parties. It’s really fascinating to do. And with those land parties, they tend to really excite the clients in there and it gives the kids who maybe are in there for a week or maybe two months a sense of normalcy.

And I think that that helps them in a lot of different ways heal in not just mind body, but more like psychically. I’m away from everybody. I’m in a white sterile room, but I can play with these [00:44:00] people. I can do this type of game. I still have a sense of accomplishment. One of the big things we see with the geriatric population is once they get into a nursing home or a hospital bed or something like that, they lose hope.

And what we’ve seen with the kids and why Child’s Play is such a wonderful charity to work with, is they don’t let those kids get to that point because kids do, if they have been in there, they’re like, when can I go home? What’s going to happen? And like, why am I still here? That’s the big thing I think that people are trying to get an idea of what changes video games can do for us as people and healing just mind, body and connectedness. It’s gray as distraction tools. It’s fantastic.

My son just got his Covid booster. We watched a video game while he got it and he’s like, aw aw aw aw, but his eyes are still on [00:45:00] the screen and he goes, okay, that wasn’t as bad because I had this screen. It was an octopus escaping a jar guys.

We’ve seen this all before floating around on Facebook. He hadn’t. And you know what? Next time it’ll probably be something else. I don’t know what it’ll be. But it helps him overcome a lot of his own fears. It helps him feel more in sync with his own personal wellbeing and goals. He doesn’t like fighting games. He literally refuses to play fighting games. And he is like, I don’t like this daddy. And I’m like, cool. You know what? You know what you like. And that’s okay.

Dr. Sharp: Yeah, of course. Well, let’s shift to how you apply this- how you work gaming into your practice. I would love to start with assessment, a lot of our audience specializes in assessment, so let’s talk about how gaming can be helpful in assessment and then of course in treatment too. I’m curious about that.

Dr. Anthony: In assessment, it’s [00:46:00] a unique personality characteristic. And that’s really where it comes down to is our motivation. Again, if we’re looking at that type of thing in assessment of, and when I’m thinking of assessment in this current moment, I’m thinking of it as psychometrics coming through. I’m giving them away. So I’m giving them or a WISC or something like that, that is in here to assess that type of thing. If I want a little bit more personality, I’m going to give them a PAI- A or something else that’s around their eyes, their IQ level, I’d say.

But I might throw in a gamer motivation scale because if they like certain games, if they like certain things, it’s helpful for them to know, like, oh, this actually means a little something interesting because of your personality characteristics that came out in the PAI. And so we’ll throw some of those things in.

When we’re working in a therapeutic context, I tend to use [00:47:00] a little bit more of the IGD7 or IGD9. I should say the short form, just to bring awareness, not as a diagnostic tool. And the reason is because it’s not diagnostic ability. It’s a screener. Anyone who’s like, I’m using this to diagnose, that’s not good practices. That’s not best practice. You’re opening yourself up to being sued in a lot of different ways. It’s a screener tool and it’s there to me to bring awareness and ideas of how this is impacting us.

And so if we talk about it and we then graph it for them, visual graphs are one of the best easy ways to get clients to really see things. If we graph it for them, they’re like, oh, maybe there is something going on here that I was like, no, I’m fine. But this data point, this helps me understand a little bit more of where I’m coming from and what am I missing? Am I needing a need for affiliation? Cool. That means that I’m [00:48:00] probably going to score really high in some areas of the gamer profile, but I’m also going to be scoring high on the IGD Short Form Scale because I’m using that as a way to meet my need for affiliation.

And so when we bring that into a conversational standpoint, that changes the dynamic. That brings awareness. And our goal as mental health practitioners is to bring that awareness.

Dr. Sharp: Yeah. Absolutely. I am going to be thinking about this idea of some of these scales you mentioned around video games and how that can weave into personality and give us some insight into, what folks are doing. In my practice, I’m not doing anything nearly as formal, but I do ask folks a lot if they mention gaming as an interest. I try to go fairly deep with them about, okay, what games are you playing? What do you really like? How long are you spending on it? What do you get from it? How’s this? Are you playing with people? Do you know [00:49:00] those people? All those kinds of questions. And it’s valuable. I find that it’s really valuable to give some insight into personality.

Dr. Anthony: Oh yeah. Hands down. That’s kind of more the therapeutic approach of when we’re trying to align with the person in front of us. If you’ve work with the gamers, they’re very mistrustful. They mistrust a lot of people. And rightfully so. They think that they’re already being judged by being in front of a mental health expert. Like, oh God, I’m already judged. It’s a kangaroo court. I’ve already lost. And you’re like, no, no, no. That’s not how that works. We’re here to just figure this out and figure out is this really the problem or is there something else that’s going on? It’s impressive.

Dr. Sharp: Do you know of anything while we’re in this diagnostic realm around particular diagnosis and video game habits? The big one that comes up right away is autism and video games. Is there actually a link [00:50:00] there or is this just anecdotal and are there any other diagnoses?

Dr. Anthony: The four that I tend to see the most in there, and I think there’s some evidence for it in the research as well, is depression, anxiety, ADHD and autism. Those are the big Hallmark 4s. And that’s because there’s usually a comorbid issue that’s going on with that. And they’re aligning with the video game rather than aligning with what life needs to bring them a little bit more. And so, those are the usual diagnoses that I tend to see that usually are comorbid with something that’s going on.

Now, again, if you hit one of those four things, whether you’re doing ASD with behavioral interventions or depression anxiety load, let’s figure out where this stuff’s coming from. And through a different verbal lens, those gaming issues tend to reduce pretty significantly.

Dr. Sharp: Okay. [00:51:00] Yeah. That makes sense. Well, I’d love to chat about some of the interventions using games. When we had our pre-podcast chat, you mentioned two really cool things that you’re up to. So let’s spend a little time on that. How is gaming coming into the treatment or recommendations or intervention that you’re doing?

Dr. Anthony: So when I do anxiety, anxiety is one of my favorite ones to use video games for. And this’ll work with depression too just so we’re clear. One of the big things I really like to do is bringing in Roadblocks and a simulation game. And the reason is because the Simulation game, it doesn’t have fast paced, it doesn’t have anything that would impact you skill wise. It’s very repetitive. It’s very rote. It’s not hard at all.

Mining Simulator, you pick up an axe, you go mine. They give you a small little quest, [00:52:00] you got to go find those things in the mine. You don’t know where they are. And you can upgrade your mine pick as you get better and better in there. And so it has the little mini level up system. It’s great for mindfulness, it’s great for, if I’m having a lot of anxiety, what do I have to remember? Got to mine up my stuff a little bit here. It’s slow going. It doesn’t mean it’s going to happen right away, but I can make progress and then I’m going to upgrade myself a little bit in my skills, my abilities to mine a little bit easier, mine a little bit faster, and gather those supplies a little bit more.

The reason for anxiety is it helps alleviate that fight or flight response for them in different ways. It’s not to say, let’s say they’re having it in school or something like that. They’re going to whip out their phone and be like, give me five minutes and then I’ll be good. It’s more along the lines of, as we’re doing this, we’re talking about, what is this like for you? Let’s create this meaningful memory. Let’s crystallize this style of moment of some [00:53:00] deep breathing exercises as you’re doing it. And it creates a really a great system for alleviating physiological anxiety.

Depression wise, it works because you’re creating something, you’re doing something, you’re upgrading, you’re working yourself to a specific goal, which is getting them motivated, getting them to do something. If you’ve done this this quickly, what else do you think you can do?

One of the things that after we’ve played gaming for a while is we tend to talk about the idea that, how do we pull the same characteristics that we learned in the game outside of the game to apply them to our life? So if that is a different sense of skills that we’ve learned in the game. Is it daily quests?

Is it something that we have to think about? I really heard this amazing [00:54:00] sense of accomplishment or this quote in a game, is that my module today? That’s my mantra. I’m going to use that and every time something difficult happens, I’m going to repeat this back to myself. I’m going to think about, how did I overcome that situation? That’s just a similar situation, just a little bit different. It creates those templates, those schemes for us to easily pull those things out and really work with our kids.

I’m thinking of one of my clients that used to give up really easily. He used to run away in classrooms. He was an escape artist in there. I’ve been working with him for 2 or 3 years now. After about 3 or 4 months, he stopped escaping. He stopped running away. He started trying more. And all’s we’re doing is working together in Roblox. We’re mining, we’re building together, we’re seeing that we can do these things. And now, that kid is thriving. [00:55:00] He’s doing amazing stuff at his school. He got recently diagnosed with ASD as well. However, he’s doing fantastic stuff in other areas of his life because he’s utilizing those same skills inside the game outside. And that’s just us working through it, talking and him giving examples of how he can apply this to real life. We’ve done bullying; we’ve done everything with it.

Dr. Sharp: Yeah. I could see there are so many lessons and skills to take away from video games if you are willing to dive in and do it, right?

Dr. Anthony: That’s the biggest thing with parents is, are you willing to dive in? Are you willing to get in involved with your kid? I play video games with my kids, and that’s to help them when they hit a hard part. I’m still there. I’m there to help out with that thing, but I want to see what you can do first.

Dr. Sharp: Yeah. That makes sense. I know [00:56:00] you mentioned that y’all are also doing is it, D&D groups, as a treatment modality. Tell me about that.

Dr. Anthony: That is a wild ride. The reason it’s a wild ride is good. That’s because when we create an app, just for everyone, Dungeons & Dragons is an RPG. It’s a role-playing game in that you get to create characters, you get to act funny, funky, terrible, and great. You get to align your character in a lot of different ways. We have a lot of people use that as a safe space for coming out in trying out different genders, for trying out different styles of thinking. I want to be different from how I view this world, or maybe that’s how I want to be my art self, my wanting self. And I’m going to play that character as such, so I can try to get closer to that.

One of the things that we do is we [00:57:00] come up with a storyline and we will apply it to all three of our groups that we run every week. And in every group, you can say the same exact thing. This is the fun part about it, wWe can’t wait to standardize this a little bit, is you can use the same exact words and same exact everything. All those groups are going to problem solve it differently. They’re all going to choose a different path. We have one group who overtook the mountain and created a giant complex that is out there for serving food for the villages in the area through magical capabilities instead of having the evil source or torture of the land. And they’ve now done that. They’ve completely transformed the land.

Another one over here have become murder hobos in a different way. They’re like, we don’t really care what happens to these people. Now they’re outcasts. Now they have to resiliently find their way through the world because they’ve created choices that [00:58:00] impact them being able to go into towns or find quests and level up and stuff. But they don’t want to go to the bandit’s way. They only have some people who are just giving away everything that they want and finding that they feel better when they’re like, I don’t want this thing. You have a higher need for it. Let me help you out.

So there are so many different ways to approach a complex problem that we’re seeing these kids just flourish in different ways based upon a group mentality, but also an individual introspective ability.

Dr. Sharp: I love that. I’m guessing there’s some kind of social component in there, like where they’re learning to interact with one another and problem solve with each other, their disagreements, their…

Dr. Anthony: It’s a great opportunity. I’m trained in what we call very a […] focused Freudian secondary. I don’t really use a lot of Freudian but [00:59:00] my groups are very Byonic focused. If you’re familiar with that is, I will step in as needed. However, I’m going to let that group figure it out.

And if I see someone who’s, let’s say the groups are usually 4 to 6 people. We’ll imagine that this one has six people. If I see four people heated and they’re having an argument and they’re trying to solve this problem, 2people being silent, as the GM or the DM, I’ll go around and be like, I really wonder what so and so characters are thinking about their group arguing. And it takes it away from those four people and puts it on these other people and creates a group dynamic that they have to have a conversation because those four people forgot these other two people existed. And now that recreates the threshold and they tend to solve their problems much much easier in a different way that way.

Dr. Sharp: Yeah. I’m curious. I’m sure some folks are out there listening and thinking, oh, this would be great to implement in my practice somehow. Are there [01:00:00] any formal trainings out there or ways to get better at implementing gaming in your practice in some form or fashion?

Dr. Anthony: Oh, yeah. I run another company called Geek Therapeutics, and let me tell you, we have trainings of how to integrate this type of stuff in your practice. If you want to become a Therapeutic Dungeon Master in utilizing that, we have a 9-week program. It’s pretty intensive, but it doesn’t matter how much you know, or how little you know. It’s going to bring you from 0 to 100. You’re going to graduate that program and be like, I’m ready to do this group and create therapeutic encounters and encounters that matter.

Those trainings are all… you just go to geektherapeutics.com, you’ll see them all. Those things are in a lot of different really, really fun. And they are a [01:01:00] hoot to do because you’re going to be a part of a group of six. And I can tell you right now, your your group, you’re not going to know them, but you guys are going to be best friends by the end of it. I don’t have one of the cohorts that aren’t still talking or still running games for each other just to try to hone in on their skills even further. And that’s one of the benefits of the style of teaching that we do is to really bring those ideas home and really create that cohesiveness. And through nine weeks you’re going to see that cohesiveness, just happen between you and five other strangers. Imagine what it’s going to do for your groups.

Dr. Sharp: That’s great. I assume that you play games as part of the training and you answered that question. That’s great.

Let me see. Our time is flying and I am curious, where do you see the future of this going? Is gaming therapy [01:02:00] gaining steam? Is it getting more popular? Where are we headed with all of this?

Dr. Anthony: It’s getting more popular every year. Every year it gets more and more. We have a higher demand for even trainings. When we first started doing the trainings, we probably would have three or four people in a group and we’d be like, the day before, still waiting for someone to sign up. That’s not the case anymore. Our groups tend to fill up about 15 to 30 days ahead of time and that’s only going to increase coming forward because we have an entire therapeutic RPG game created by two neurodiverse individuals for healing and safe space for a lot of different ways.

And so, we have massive amounts of people and if you come into our program, you actually get to play in that world because we’ve built it into the training. So you get to see what a therapeutic world looks like and you can get it, [01:03:00] you cannot get it, you can do it whatever you want in there, but you’re going to learn the basics of what it really comes down to.

I wouldn’t suggest just jumping into it. I would probably suggest a little bit more of become a player before you become a GM. Dungeon and Dragons has a very high threshold of coming in. That’s because it’s so mechanic heavy. What we do to lessen that is we take like 60 to 70% of those mechanics out, we just give them to you in your character sheet. We just say, here’s your spell, here’s your thing like that. And that lowers that threshold, that guardian threshold and makes it much more enjoyable. I think that’s where Wizards of the Coast is missing a lot of different things. It’s easy to get lost in the weeds. It’s easy to get lost in this mechanic has to happen this specific way, and then you get this and this and this, but then you have to have this happen and your AC has to be these things. [01:04:00] That’s how a normal D&D game goes. But with us, it’s like, roll, roll to cast your fireball. Let’s see what happens. Cool. You hit a 16, that hits, we’re rolling D12, and let’s see how much damage you do. That’s a much simpler way and be like, wow, cool. I did some damage and I was like, it was roll these little plastic rocks here.

Dr. Sharp: Nice. That’s all we want to do. We just want to do damage, have that tower,

Dr. Anthony: Do damage, get that stuff and make sure your party survives.

Dr. Sharp: There you go. You mentioned this therapeutic RPG. Tell me about that.

Dr. Anthony: So that is called realms of […], and that is our therapeutic RPG that we have been building for about a year and a half now. I just got the samples this week for it because it’s going to be kickstarted next February. And it is already written. It’s already been play tested. It’s by [01:05:00] game Masters who have been playing for 40 years to people who have never played before, to therapists, to teachers, to parents, everything like that has been play tested already. We’ve had about 116 people play test this now.

Dr. Sharp: And this is a board game?

Dr. Anthony: This is an RPG. RPG in set up where you can pick up this manual, you can read it for 30 minutes and then you can just run it. It’s going to guide you through it all. Nice and easy. Nice simplistic, but it’s going to have therapeutic value to it and that value is vastly important to the game. And that’s why we created this game because a game can be therapeutic in a way, it can help you harness different choices, different ideas, different PACs but it’s also has built mechanics to it to really hone in on those therapeutic integrations. It will tell you when to stop and what to ask type of questions you want to do to build insight, to [01:06:00] do certain things, and then a decompression round at the end of it as well.

Dr. Sharp: I like that. Yeah. This sounds like such a cool project and I love that it’s coming to fruition.

Dr. Anthony: It’s beautiful. I’m not going to lie to you. I have all the artwork. It’s beautiful.

Dr. Sharp: That’s great. Well, certainly, I’m guessing this is going to go out before February for sure, but we’ll have to circle back and maybe I’ll do an update or something when it comes out, if folks want to go check it out.

Dr. Anthony: Yeah, absolutely. Absolutely do that. I’m happy to send anyone the link so they can look at it back on Kickstarter. It’s going to get backed because we’re actually demoing it in two weeks over in Philadelphia for PAX Unplugged. So what that is one of the biggest board game conventions in the United States. And so we’re going to allow people to play test it with us and you can [01:07:00] pre-order it pretty heavily discounted as well.

Dr. Sharp: Very cool. Well, I’ll throw any of these links in the show notes and make sure that folks can find what they want to find. I really appreciate you coming by and chatting with me. I know they’re…

Dr. Anthony: This has been fun. I love doing this.

Dr. Sharp: Good. Fun for me too. There are so many directions we could have gone. I was just holding myself back from getting in the weeds with all these games that we could talk about and trying to keep it on the rails here with the therapeutic piece.

Thanks for coming by and talking through this. I know a lot of folks are going to get a lot of value out of it.

Dr. Anthony: Well, I appreciate the chance to to be here as well.

Dr. Sharp: All right. Take care.

Dr. Anthony: Thank you.

Dr. Sharp: All right y’all, thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life.

Any resources that we mentioned during the episode will be listed in the show [01:08:00] notes, so make sure to check those out. If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcast.

And if you’re a practice owner or aspiring practice owner, I’d invite you to check out the Testing Psychologists Mastermind Groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.[01:09:00]

The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, [01:10:00] please find a supervisor with an expertise that fits your needs.

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