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ABSTRACT Examining the Effects of Casual Video Gameplay As An ABSTRACT Examining the Effects of Casual Video Gameplay as an Intervention to Alleviate Symptoms of Depression on Both Subjective and Objective Measures By Christina M. Brown-Bochicchio December 2020 Director of Dissertation: Dr. Paul J. Toriello Department of Addictions and Rehabilitation Studies Depression can be a debilitating illness that affects more than 300 million people worldwide. Although there are successful treatments for depression with pharmaceuticals and behavioral approaches such as psychotherapy, these approaches are often very costly and may carry a stigma of treatment for some individuals. The purpose of this dissertation study was to compare results of previously collected data that examine whether a prescribed regimen of casual videogame play (CVG) could reduce symptoms associated with depression. This dissertation specifically focused on comparing results of a study group and a comparison group on the self- report instrument, the Patient Health Questionnaire-9 (PHQ-9) as well as objectively measured changes in alpha wave, Electroencephalogram (EEG) data. Participants in the original study were screened for depression using the PHQ-9. There were a total of 57 participants who met the study inclusion criteria. Each participant that met the inclusion criteria was then randomized into either the comparison group (n=29) or the study group (n=28). Experimental group participants were prescribed to play one of three CVGs three times per week (with 24 hours between each session). This process occurred for 30 minutes each session, over a 1-month period. Comparison group participants reviewed the National Institute of Mental Health’s webpage on depression during a pre-test and a post-test session. The participants in this group did not engage in any intervention over the one-month period of time between the pre-test and post-test sessions. A repeated-measures analysis of covariance (ANCOVA) was completed to examine three research questions between subjects at Time 1 and Time 3 to compare changes in depression symptoms on both subjective, self-report (PHQ-9) and objective alpha wave EEG measures. The CVGs used as the intervention factor were either Peggle, Bejeweled or Bookworm Adventure. Study analysis revealed significant decreases in depression symptoms reported in the study group on the PHQ-9 self-report scale. Results along the objective, EEG alpha wave scale revealed non- statistically significant changes. Potential reasons for the non-significant findings along with recommendations for future research are also discussed. Conclusions from this study found that a prescribed regimen of CVG may have potential as an intervention to help reduce symptoms of depression as measured on the PHQ-9 scale. Further research should consider examining intricacies of CVG play as a potential intervention to address symptoms related to depression. Findings also revealed that while EEG findings were not statistically significant, participants self-report responses were significant and may underscore the importance of individual’s subjective feelings in the therapeutic process. EXAMINING THE EFFECTS OF CASUAL VIDEO GAMEPLAY AS AN INTERVENTION TO ALLEVIATE SYMPTOMS OF DEPRESSION ON BOTH SUBJECTIVE AND OBJECTIVE MEASURES A Dissertation Presented To The Faculty of the Department of Addictions and Rehabilitation Studies East Carolina University In Partial Fulfillment of the Requirements for the Degree Ph.D. Rehabilitation Counseling and Administration by Christina M. Brown-Bochicchio December 2020 ©Copyright 2020 Christina M. Brown-Bochicchio EXAMINING THE EFFECTS OF CASUAL VIDEO GAMEPLAY AS AN INTERVENTION TO ALLEVIATE SYMPTOMS OF DEPRESSION ON BOTH SUBJECTIVE AND OBJECTIVE MEASURES by Christina M. Brown-Bochicchio APPROVED BY: DIRECTOR OF DISSERTATION: _________________________________________________ Paul J. Toriello, Rh.D COMMITTEE MEMBER: ________________________________________________________ Carmen Russoniello, Ph.D. COMMITTEE MEMBER: ________________________________________________________ W. Leigh Atherton, Ph.D. COMMITTEE MEMBER: ________________________________________________________ Stephen J. Leierer, Ph.D. CHAIR OF THE DEPARTMENT OF ADDICTIONS AND REHABILITATION STUDIES: _______________________________________________ Paul Toriello, Rh.D. DEAN OF THE GRADUATE SCHOOL: ____________________________________________ Paul Gemperline, PhD DEDICATION This dissertation is dedicated to my family. To my parents, Ralph and Marina, you both never waiver in your constant and consistent support of my dreams and my passion to pursue a career in helping people. I am empowered to achieve success only through your support. This dissertation is equally dedicated to my sister Jane. You are my best confidant, advocate, friend and support through all the triumphs and tribulations of my work and life. Lastly, I would like to dedicate this dissertation to my uncle Kevin and all individuals with disabilities. May we all continue to pursue and support treatment that supports individuals’ optimal growth potential. TABLE OF CONTENTS LIST OF TABLES ......................................................................................................................... xi CHAPTER I: INTRODUCTION .................................................................................................. 1 Introduction to the Study ....................................................................................................... 1 Background to the Problem ................................................................................................... 4 Subtypes of Depression ................................................................................................. 6 Mild depression .................................................................................................... 6 Moderate depression ............................................................................................ 7 Major depression .................................................................................................. 7 Treatment-resistant depression ............................................................................ 7 Difficulty in Treating Depression ................................................................................. 8 Traditional Treatment Interventions for Depression ................................................... 10 Complementary and Alternative Interventions for Depression .................................. 13 Casual Video Games ............................................................................................................ 15 Theory of Relationship between Depression and Casual Video Game Interventions ......... 16 GameFlow Model ....................................................................................................... 16 Mental-health and Gaming ......................................................................................... 18 Depression and Alpha Wave EEG Measurement ....................................................... 19 Statement of the Problem ..................................................................................................... 21 Purpose of the Study ............................................................................................................ 25 Research Questions .............................................................................................................. 26 Definitions of Terms ............................................................................................................ 27 Study Justification ................................................................................................................ 28 Significance of the Study ..................................................................................................... 30 Chapter Summary ................................................................................................................ 33 CHAPTER II: LITERATURE REVIEW ..................................................................................... 34 Introduction to Literature Review ........................................................................................ 34 General Depression and Subtypes ....................................................................................... 34 Mild Depression ................................................................................................................... 35 Moderate Depression ........................................................................................................... 36 Major Depressive Disorder .................................................................................................. 37 Prevalence ................................................................................................................... 38 Etiology of Depression ............................................................................................... 39 Treatment-Resistant Depression .......................................................................................... 41 Depression Interventions ..................................................................................................... 43 Pharmacological Interventions .................................................................................... 46 Antidepressants .................................................................................................. 48 Psychotherapy ............................................................................................................
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