-
INTRODUCTION
Mental health is described by the World Health Organization
(WHO) as a state of wellbeing in which individuals manage
their lives productively and are able to contribute to
society [
45
]. The improvement of mental health is therefore
important from both an individual perspective, as well as from a
societal one. A large variety of demographic factors are
correlated with an increased risk of mental health issues, including
certain professions, minority groups, or individuals of lower
socio-economic status [
44
]. While mental health issues are
stigmatized, they are highly prevalent. Further, a survey of
the health system in Canada in 2015 found that a majority of
individuals with undiagnosed mental health issues ignore or
self-medicate their conditions [
11
].
While some of the risk factors are genetic, exposure to stress
in everyday life plays a significant role in increasing the
likelihood of individuals experiencing mental health issues,
including but not limited to burnout and depression. Specific
professions also carry increased risks of mental health issues, often
relating to the high stress environments they are performed in.
For example, some professions like education or health care
services feature environments with chronic imbalances in the
demands they place on individuals in comparison to resources
provided to meet those demands [
39
]. Exposure to stress and
related mental health issues in turn also predisposes people to
physical illness such as cancer and cardiovascular disease; this
link between mental and physical health issues also leads to
significant economic consequences [
39, 44
]. The WHO have
emphasized the importance of prevention for achieving this
goal [
44
]. The reduction of stress in everyday life is therefore a
good measure to improve the health of the general population
and support their wellbeing.
Games are, ideally, fun and enjoyable. One of the main
motivations of players of digital games is escapism, that is, it
facilitates relaxation through distraction from real life [
61
]. This
cognitive distraction is a positive and important way for
individuals to manage negative emotions [
33
]. While gameplay
can also be linked to increased rage, this generally correlates
with pathological use (that is, obsessive playing rather than
engaged playing) rather than merely with prolonged exposure
to gameplay. Many types of gameplay are associated with
short- and long-term positive effects on players’ affect and
wellbeing [
33
]. Further, games are relatively cheap, widely
accessible, and easy to use, particularly for generations that grew
up with pervasive technology and video games. Given that
cost factors are considered a systemic barrier stopping
individuals from accessing mental health care, and that mental health
issues are more likely to occur among younger individuals,
that is, under 30 years of age [
11
], this makes games a
particularly interesting candidate for assisting with the prevention of
mental health issues in the general population.
Music is also linked to positive effects on mental health: the
history of music as a therapeutic measure is extensive and
culturally comprehensive [
4
]. Many of these effects are
ascribed to actively making music, for example, drumming to
improve the mental health of individuals with post-traumatic
stress symptoms [
2
]. However, even passive music listening
can lower the risk of mental health issues [
36
]. For example,
studies have shown that music listening after stressful
experiences increases individuals’ sense of wellbeing and decreases
depression [
26
]. Because of these effects, passive music
listening is used in clinical settings to ease and control patients’ pain
and facilitate relaxation, where it shows a consistent positive
effect on psychological measures [
4
].
With this paper, we explore the potential of games to act
as a preventative measure against stress in everyday life by
facilitating relaxation and stress reduction, and in particular,
the role of audio in this effect. We discuss future research
directions and two potential use cases for studies.
RELATED WORK
In this section we discuss related work on music listening and
gaming in the context of improving wellbeing, and explore
games designed to be and perceived as being relaxing.
Music Listening for Wellbeing
Music has a long history of use in therapeutic settings due to
its positive influence on mental and social wellbeing [
4, 36,
57
]. For example, group drumming has been used to combat
feelings of isolation and helplessness, and provide an outlet
for negative emotions among soldiers diagnosed with combat
stress reactions [
2
]. Group drumming has also been shown
to improve social development (e.g. self-esteem) and mental
health of at-risk adolescents [
59
]. Of course, these effects may
also be linked to the social context in which group drumming
occurs; social context of gameplay has similarly been shown
as a predictor of player wellbeing [
58
], and an important factor
in game enjoyment [
60
]. Overall, however, there is a clear link
between music and the experience of flow [
8, 12
].
Even passive music listening (as opposed to music making)
has been linked to improvements in wellbeing and a reduction
of stress. For example, passive music listening has also been
used as a therapeutic measure: a review on the effect of music
listening found that standard care practices for depression were
improved through the addition of music therapy [
38
]. In
education for individuals with special needs, it is used to facilitate
relaxation, memory, and emotion regulation [
17
]. Listening to
music activates physiological and emotional responses, as well
as regions of the brain that involve reward processing [
6, 41
].
Individuals’ emotional responses to music depend on listeners’
familiarity with it, their exposure to it, and its complexity [
24
].
Even outside of clinical settings, individuals have been shown
to use music listening of their own initiative for emotional
selfregulation [
31, 51
]. Similarly, a multi-method approach by
Västfjäll et al. [
57
] showed that music listening significantly
lowers self-reported stress in everyday life.
Gameplay & Wellbeing
Playing games is also linked to wellbeing, and previous work
has pointed out that by providing relaxation and distraction,
games have the potential to help players manage negative
emotions [
33
]. Similarly, a survey by Vella et al. [
58
] found
positive effects of gameplay on wellbeing. According to
Sonnentag & Fritz, stress recovery is mediated by four aspects:
psychological detachment, relaxation, mastery experiences,
and control [
53
]. Research on players’ motivations for playing
has found escapism to be an important component, in the form
of facilitating relaxation through distraction [
52, 61
].
The phenomenon of wellbeing through gameplay has been
linked to self-determination theory, which describes humans
as trying to satisfy three psychological needs: autonomy,
competence, and relatedness [
14
]. When these needs are met,
individuals experience enjoyment. Games provide players
with experiences of autonomy, and (when well-balanced)
competence. Social interaction in games fulfils the need for
relatedness; facilitation of social interaction is part of the reason for
the popularity of games [
60
]. Co-located co-playing correlates
with greater fun, challenge and perceived competence [
19
].
Johnson et al. [
27
] have proposed a model of videogames and
wellbeing, in which they discuss three determining factors for
positive effects of gameplay: player characteristics, game
features, and experience of play. Mandryk and Birk [
37
] explored
how some of these factors correlate with wellbeing in a
survey, and found that people with depression or anxiety–despite
activating behaviour being an issue with these conditions–still
played games a few times a week. Another online survey by
Reinecke [
48
] showed that players explicitly use games after
stress in order to recover. Further, the importance of gameplay
for stress recovery was increased for players with less social
support. Reinecke also found that players who have a
tendency to cope with stress through emotional responses (e.g.,
distancing) are more likely to use games for stress relief than
participants who cope with stress through problem-focused
coping (e.g., pinpointing the problem and finding solutions).
For our research question on the role of audio in gameplay
effects on wellbeing, this is particularly interesting given the
close connection of music to emotional responses.
In a subsequent study, Reinecke et al. [
49
] explored how
participants reacted to different recovery options, that is, interactive
or non-interactive media, after a stressful task. Their results
show that media exposure in general, enjoyment, and
interactivity are highly relevant factors for stress relief. In a study
exploring psychosocial adjustment of youths aged 10 to 15,
Przyblski [
47
] found that low levels (<1 hour) of electronic
gaming per day was a key indicator of psychosocial
adjustment, correlating with higher life satisfaction and prosocial
behaviour compared to non-players. This effect was reversed
for high levels of play (>3 hours). In a study on MMORPG
gameplay, Kirby et al. [
29
] found a small but significant
negative effect of gaming on psychological wellbeing. This effect
was mediated through the type of use: obsessive play lowered
psychological wellbeing (i.e., when playing adversely affected
players’ lives), while engaged use did not. Overall, games
offer significant potential for facilitating stress reduction and
providing needs satisfaction, when not used pathologically.
Many Facets of Zen Gaming
It should be noted that there is a large diversity of opinions
regarding what kind of game is considered relaxing. There
are some games that are explicitly designed to be particularly
engrossing and relaxing. A lot of these can be classified as
casual games, and feature simple mechanics and a calm or
player-controlled pace. For example, many of these games
involve growing or raising virtual plants or animals, generally
at a slow pace or in real time (e.g. Viridi [
21
] or Zen Koi [
22
],
in which players grow succulants or raise and breed koi fish,
respectively). Similarly, casual farming games (’ville games)
attract a significant amount of players, even though they do not
pose a great deal of challenge even for players with little game
literacy [
32
]. A parody of these games led to the phenomenon
of clicker games, wherein players’ only mechanic consists of
clicking (e.g., Cow Clicker [
5
]). Nevertheless, this has sparked
the development of a large number of similar clicking games.
Other games that might be considered relaxing involve puzzles
– generally without a time limit, or with a non-timed mode.
Examples include Monument Valley [
56
], a puzzle game that
plays with M.C. Escher-style level layouts, using impossible
objects (e.g., Penrose triangles) for architectural design.
However, there are also games that offer more extensive game
worlds and mechanics, that are said to be particularly
relaxing. One example is Stardew Valley [
9
], an open-ended
roleplaying game in which players farm, forage, fish, and extract
resources while fighting monsters in the mines (see Figure 1).
Many game reviews have remarked on the game’s relaxing
and absorbing qualities, pointing out the open world, simple
mechanics, and continuous progress towards player-defined
goals [
13, 46, 50
]. Many of these also mention the background
music as playing a role in the relaxing effect.
Lundgren & Björk [
35
] have also explored games that
employ calm, arrangement-based game mechanics, which they
name “pottering”. They describe the use of these pottering
mechanics in games such as Zoo Tycoon [
20
], Minecraft [
42
],
The Sims [
40
], and FarmVille [
63
]. Among the patterns they
emphasize in these games is calm flow, which they describe as
an almost meditative experience. In contrast, fast-paced games
are also mentioned in the context of relaxation. For example,
racing games are considered relaxing by players partly due
to their challenge-based immersion. Taking flow theory to its
limit, high but still manageable challenge in games leads to
a flow state, which for many players is rewarding, and
sometimes even relaxing (even, for example, Dark Souls [
18
]).
LEVERAGING COMMERCIAL GAMES FOR WELLBEING
The related work shows that video games have the potential to
induce a calming and relaxing effect on players by providing
a distraction from stress factors. This can be leveraged to
improve wellbeing and mental health in the general population.
Regardless of whether they are designed to provide relaxation
through pottering or reaction-based challenges, games are
generally designed to be engrossing and immersive. This
also includes their sound design, ranging from aesthetically
pleasing sound effects and narration to suitable continuous
background music. However, despite research on effects of
music listening and research on the effects of gameplay on
wellbeing, we do not yet understand the role that game audio
plays in these effects on wellbeing.
Potentially, the background music of games that are perceived
as relaxing may be particularly well suited to improving
wellbeing through music listening alone, without the game. The
research based on self-determination theory, and stress
recovery factors suggests that the influence of gameplay itself
should have the greater effect, as it satisfies these
psychological needs to a larger degree. However, we would like to spark
a discussion in the games user research community on the role
that audio can perform in increasing the effects of gameplay
on wellbeing. Further, how should game audio be designed in
order to maximize the potential increase of this effect? In the
following we discuss potential research directions in this area.
Which Existing Games Cause Relaxation?
As mentioned, some existing commercial games are known to
be perceived as relaxing and engrossing by players. However,
there is little research on whether they have a measurable
effect on people’s affective state and mental wellbeing. By
exploring how beneficial these games can be, research has
the opportunity to encourage gameplay with casual games for
stress relief as a cost-effective preventative way of reducing
mental health issues in the general population. As such, the
games research community should consider exploring games
that players regard as particularly relaxing in more detail. For
example, this approach might begin with player surveys or
an analysis of blog reviews. By exploring which commercial
games cause relaxation, the games research community will
achieve an increased understanding of how this effect occurs.
Effect of Game Genre
We previously discussed that the games and game elements
that players consider relaxing may differ greatly, ranging from
pottering games or puzzle games, reaction-based racing games,
to high-challenge games. Game audio performs different
functions depending on game genre; this effect goes as far as to
elicit highly divergent reactions when exploring player
experience upon the removal of audio in a strategy game compared
to a stealth game [
28
]. We thus suggest that the effect of game
audio on wellbeing may also differ depending on the game
genre. In particular, the effects of different audio types (e.g.,
sound effects, voice/narration, and background music) may
also vary in their effects on wellbeing depending on game
genre. By exploring how the different audio types and game
genres can be combined to leverage a maximum increase in
subsequent wellbeing, the games research community could
provide guidelines for game developers to create game
experiences that are ideal for stress relief and mental health.
Feedback Function of Audio
Audio performs a large variety of functions in games, among
them dramaturgic uses (i.e., affirming the visuals or providing
a counterpoint to it), stylization or emphasis, representations
and evocations of time, locations, or emotions, or providing
a means of immersion [
3
]. Further, the effect of audio set to
media not one-sided; the visuals and story narrative inversely
also affect listeners’ music perception [
23
]. Finally, in
interactive media such as games, audio also interacts with the
player: music can be used to comment on player decisions,
or influence future one [
3
]; interactivity is considered a key
difference between game and film music [
15
].
Game audio is said to support cognitive appraisal, in that
it supports perceived realism, hides the game medium, and
heightening emotional responses [
15
]. A study by Nacke et
al. [
43
] reported highest flow values for gameplay with sound
effects but no background music; this emphasizes the role of
audio for providing feedback to the player. As the effect of
gameplay on wellbeing is linked to the fulfilment of
psychological needs including mastery experiences and competence,
the feedback function of audio is particularly important for
supporting and communicating players’ successful actions.
The Role of Game Background Music
As discussed, research on music listening has shown strong
ties to improved wellbeing. Given that certain games are
considered particularly relaxing, how much of a role does the
background music play in these specific games? Related work has
shown that the presence of background music can affect
players’ perception of a game, and increases immersion [
34, 62
].
Further, the tempo of background music influences player
behaviour, and there is evidence that allowing players to choose
their own custom background music increases enjoyment [
7
].
Some game soundtracks are designed explicitly to be
absorbing and soothing, and many game soundtracks are sold
independently of the game (e.g., the Bastion [
30
] or Monument
Valley [
54
] soundtracks). However, there has been no research
on whether the background music might already be well suited
for music listening for the purpose of stress relief. The games
research community should explore how much of the relaxing
effect of games is mediated through the games’ background
music. How much of it is caused by the audio itself, and
how much is caused by the combination of audio and game
mechanics, through satisfaction of psychological needs?
Potential Benefits of Exploring These Questions
By exploring these research questions, the games research
community will be able to design games that leverage their
potential for stress relief to the greatest degree possible. This
will help to improve players’ everyday life as a preventative
measure against mental health issues. Further, this will also
potentially open up research directions towards stress
management for people already diagnosed with mental health issues
such as depression or post-traumatic stress symptoms, and
shift the focus of games research for wellbeing from only
preventative to include therapeutic applications.
USE CASES: POTENTIAL GAMES
In this final section, we discuss two potential use cases in the
form of games which are generally considered relaxing, and
which may be a starting point for research.
Monument Valley
This puzzle game by ustwo consists of M. C. Escher-style
level designs (see Figure 2), which the player can rotate in
three dimensions while the camera remains fixed in a
twodimensional perspective (which are reminiscent of Fez [
10
]).
The game has received high praise for its game mechanics, but
is also described as relaxing and “actively soothing” due to its
background music [
16
]. With its game duration of roughly 2
hours overall [
55
], and the potential to present players with
specific levels without requiring lengthy tutorials, it would be
well suited to an in-lab study setting.
Stardew Valley
Playing Stardew Valley is considered relaxing by many
fans [
13, 25, 50
]. The game showcases many pottering game
patterns as described by Lundgren and Björk [
35
]:
construction by allowing the player to arrange their farm, nurturing
(for example through the farming elements), value of effort
through facilitating long-term goals (e.g., re-building the
community center), calm flow (even the combat mechanics are not
fast paced), and framed freedom through the game
mechanics of farming, foraging, fishing, and fighting monsters while
extracting resources from the mines.
The soundtrack of Stardew Valley has very positive ratings on
Steam [
1
]. It has also been mentioned in reviews specifically as
being relaxing [
25
], and also in the context of being crucial to
achieving a stress-free combat system [
46
]. Due to these player
responses, as well as an easy learning curve for beginners, it
is also well suited to a study exploring the relaxing effect of
music in gameplay on wellbeing.
CONCLUSION
Mental health is an issue of increasing societal and financial
importance, and prevention strategies include helping
individuals to reduce and manage stress in everyday life. In this paper,
we elaborate on research areas exploring the effects on
wellbeing of music listening and playing games, respectively. We
further discuss games which are considered relaxing and point
out research directions for exploring the role of game audio in
improving player wellbeing, and through stress reduction, also
helping to prevent mental health issues. With this paper, we
hope to spark a discussion and on the role of audio in game
design for wellbeing, as well as prompt potential collaborations
to further this research direction.