Playing Off the Pain: An autoethnographic study of video ... · diet and exercise to lose weight. Some suggested complementary medicine like homeopathy, or ... Using autoethnography

Running head: PLAYING OFF THE PAIN 1

Playing Off the Pain:

An autoethnographic study of video gaming as

pain-management in Autoimmune disorders

Sofia Styf

School of Arts and Creative Industries

London South Bank University

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PLAYING OFF THE PAIN

Abstract: This autoethnographic study looks at gaming as means of controlling pain in

autoimmune disease. My personal experience as a gamer with two life-long chronic,

degenerative autoimmune diseases is compared to those of others in my situation. I found that

gaming at least can create a space where you can exist without pain being a constant factor

influencing each move or decision.

Key words: video games, chronic pain, pain relief, pain-management, autoimmune disorder,

autoethnography.

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Playing Off the Pain: An autoethnographic study of gaming as

pain-management in Autoimmune disorders

1) INTRODUCTION

I am 25 years old, and I have never been well. Not a single day of my life has gone by

where I was not in pain, or felt weak, feverish and nauseous. As a child, a lot of the symptoms I

experienced were attributed to allergies by the doctors my mother took me to. When I was

approaching my teens, these “allergies” became “growing pains” that later became the result of

“too vivid an imagination”. I was too young to be ill, a doctor established, thus my problem

could not be physical. I must be lying.

My hands and feet were swollen to a point where I could barely hold a pen or a spoon,

and my feet were too painful for me to wear shoes. The swelling aside, my weight was normal

throughout my childhood and teens, yet a lot of doctors and nurses suggested that I should try

diet and exercise to lose weight. Some suggested complementary medicine like homeopathy, or

special diets e.g. gluten free, lactose free or low starch, and I tried them all without much effect.

One particularly disinterested doctor went as far as to suggest that I should move out and start a

family of my own. I was 14 at the time.

In 2012, when I was 19 years old, a rheumatologist finally gave me a proper diagnosis.

By that time, I was in so much pain that I could not function, or even care for myself. I was

severely depressed with suicidal tendencies; I had been forced to drop out of my A-levels; and I

could barely get out of bed, get dressed, or walk around the house without support.

Unfortunately, the diagnosis did not offer the remedy I had hoped for all my life. Instead, what

my mother and I had suspected all along was confirmed. I had an autoimmune disorder. Or two,

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to be precise: Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS). Instead of a cure, I

was prescribed steroids, disease modifying drugs, chemotherapy, biologics injections and large

amounts of pain relief; and it was explained to me that I would never, ever get to experience

what it is like to not be in pain.

As much as the verdict hurt on an emotional level, there was also a great sense of

vindication and relief that day. My pain was not imagined, and it was not a result of allergies,

growing pains, my weight, or even being fed up with living at home. I was chronically and

irreparably ill. I finally had a diagnosis on paper, a treatment plan aimed at slowing down the

disease progression and a pile of leaflets from Arthritis Research UK outlining coping strategies

for nigh on every imaginable, and a few unimaginable, situations.

At 25, the question I get asked the most when talking about my disability is: “But how

did you cope?” And the answer is simple: I played video games. It was always difficult for me to

keep up and play with the other children when I was little, but my brothers would always let me

play video games with them. As most of the games we had at the time required the use of mouse

and keyboard controls, and we were young children with less than amazing dexterity, my

brothers would divide up the controls between two or three of us. They would sit with me by the

family computer and tell me what the game was about and what I needed to do, which buttons

were mine to control and what those buttons did. In those moments, I realised that this was

something I could do just as well as, and even better than, other kids. I too could save the world.

But I also realised eventually that while I was gaming, the pain was not as bad. It was still there,

but somehow less intrusive and whilst I was focussed on a campaign, or immersed in a universe,

I could almost forget about it for a while. This is one of the reasons why video games became

such an important part of my life.

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Video games have become a huge industry since they rose to popularity in the 1980s. In

2016, the video games industry raked in $101.1 billion dollars globally, and that is expected to

rise to $108.9 billion by the end of 2017, and an incredible $128.5 billion by 2020 (MacDonald,

2017). Despite video games being so popular, there are a lot of negative associations toward

them. Many arguments against video games claim that playing them is inherently bad for one’s

physical and mental health. Arguments ranging from ‘it will ruin your eyesight’ to ‘it will make

you aggressive’ have been prevalent in my life as far back as I can remember, and rarely did I

hear anyone – other than my mother – discuss the benefits of playing video games. This attitude

was especially common in mainstream media, and to an extent it still is today. There are still

ongoing debates on whether video games are more harmful or helpful for players, and an article

that was printed in The Telegraph compared the pros and cons of playing video games as put

forth by different studies and researchers (Wells & Blagburn, 2017). Articles like this one are not

rare, in fact there are numerous articles available online that tally up the good or the bad side

effects of playing video games. However, twenty years after picking up my first ever video

game, I find more and more research put into the good uses of video games. Although there are

still a great many studies conducted that disparages video games as an art form and holds them

responsible for everything from aggression to poor academic performance, it is greatly

encouraging to see that many of these arguments are being proven groundless—for one there is

evidence that high video game usage is ‘associated with good intellectual functioning and

academic achievement’ (Kovess-Masfety, Keyes, Hamilton, Hanson, Bitfoi, Golitz & Pez,

2016). The positive effects gaming can have on various aspects of an individual’s life has been

put forth by different studies. Guarini (2013) listed nine ways video games can improve our

lives, according to science, e.g., playing video games can make us smarter (Glass, Maddox &

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Love, 2013), improve our eyesight (Handwerk, 2009), improve our reading skills (Franceschini,

Gori, Ruffino, Viola, Molteni & Facoetti, 2013), and we can even use video games to treat

depression, PTSD, and a range of other mental health conditions (Kühn, Gleich, Lorenz,

Lindenberger & Gallinat, 2014).

In his article, Guarini also references a 2011 study from Pain Management (Li,

Montaño, Chen & Gold), that examined how virtual reality (VR) games could be applied in

treating physical pain. It used Virtual Reality (VR) to ‘manage pain and distress associated with

a wide variety of known painful medical procedures.’ This study focused primarily on decreasing

acute pain in patients undergoing medical treatments for burns or cancer, and in the conclusion

states that ‘Virtual reality has consistently been demonstrated to decrease pain, anxiety,

unpleasantness, time spent thinking about pain and perceived time spent in a medical

procedure’. This study also touches on VR applications for chronic pain, and mentions the

successful application of VR alongside hypnosis as a potential treatment, based on results from a

case study (Oneal, Patterson, Soltani, Teeley & Jensen, 2008) of a chronic neuropathic pain

sufferer who had a 5-year history of failed treatments.

In the following sections, I will discuss the possibility that not only VR, but also regular

video games can have positive effects on chronic pain in people with autoimmune illnesses.

Using autoethnography as my method, I aim to present my experiences of using video games as

pain management. I deal with the symptoms of each of my conditions every day; and one of the

most prominent symptoms of both is physical pain. Aside from the fatigue, this is also, in my

opinion, one of the most difficult symptoms to live with on a day to day basis.

Since my diagnoses in 2012, I have been prescribed seven different pain relief

medications to manage my pain symptoms, replacing one after another when they became

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ineffective or the side effects proved too severe to cope with. Some medicines had side effects

that were bad enough that I often-times elected not to take the medicine, and instead opted to

handle my pain in other ways. Video games were already my pain management of choice, and

often I felt they helped me more than the medications did. For this reason, I hope to create a

discussion around the use of video games in treating chronic pain, and how doing this could have

positive effects on people with autoimmune disorders. My thesis, unsurprisingly, is that this

study will find evidence for gaming as an effective coping mechanism for chronic pain.

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2.1) AUTOETHNOGRAPHY AS THEORY

When I first met my rheumatologist in 2012, she assessed how much swelling there was

around my joints, examined which joints appeared to be more sensitive and sore than others, and

looked at my x-rays to see where the permanent damage to my bones was the worst. She started

me on the medications she believed would have the greatest benefit possible, without causing too

many side-effects, and she also discussed what kind of life-style changes would be beneficial for

me. One of the things she suggested, and the only thing we disagreed on, was that I should stop

playing video games.

In the eyes of the rheumatologist, playing video games, which required me to sit still for

long periods of time, would be detrimental to my health. It would serve me better to try to

exercise and stretch to keep my joints active and fully operational. I argued that I do not feel stiff

or in pain whilst I am playing video games, and that, on the contrary, video games were some of

the very few things that I felt gave me the motivation to stay alive. As a leading researcher into

my kind of arthritis, this interested her and she asked me what exactly I meant when I said I did

not feel like I was in pain when I played games. At the time, I found it incredibly difficult to

explain exactly how playing games affected me, and that is what made me want to undertake this

study. ‘Autoethnographies begin with the thoughts, feelings, identities, and experiences that

make us uncertain—knocking us for sense-making loops—and that make us question, reconsider,

and reorder our understandings of ourselves, others and our worlds (Adam, Holman Jones,

Ellis, 2014).’

I am hoping that by juxtaposing my personal experience to that of others in similar

situations, and doing a thorough search for literature supporting or refuting my thesis, I would be

able to finally answer the question.

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At a meeting with my supervisor, I was introduced to autoethnography as a research

method and after reading a few articles she gave me, I felt that this format would suit my topic

very well. I felt that I could best represent my research using autoethnography because, ‘our

ideas for research projects are often—perhaps always—guided by the ideas, feelings,

experiences, and questions we have in and about our lives. Rather than silence or disguise the

personal reasons that lead us to choose our research projects, autoethnographers make use of

personal experience and subjectivity in designing their research (Ibid.).’ I did not want to have

to write about a subject that was so personal in the clinical and voice-less way academic research

is usually presented. I found that, ‘authentic auto-ethnography and creative research can

demand risk-taking and vulnerability on the part of the researcher, which traditional academic

institutions can find challenging, if not unpalatable (Coffey, 2017).’

I was encouraged to find out more about this method of study and I became even more

excited at the idea of an autoethnographic dissertation when I discovered that ‘Autoethnographic

stories are artistic and analytic demonstrations of how we come to know, name, and interpret

personal and cultural experience (Adams, Holman Jones & Ellis, 2014).’

Autoethnography, unlike regular ethnography, does not separate the researcher from the

topic of research, but rather includes the lived experiences, feelings, and thoughts of the author

as part of the research. In simple terms, autoethnography, ‘shows people in the process of

figuring out what to do, how to live, and the meaning of their struggles (Ibid),’ and ‘strives for

social justice and to make life better (Ibid).’

To properly investigate the effectiveness of playing video games as a method of pain

relief, I first felt compelled to examine literature that discusses positive effects of playing video

games. Coffey (2017) says that for autoethnography to succeed, ‘it must take us beyond the

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presented story to something of ourselves, beyond the autoethnographer’s original design.’ From

this I understood that I would need to look at my original thesis from a wider perspective as well.

It would not be enough to only take my own feelings into account. I grew interested in how pain

is perceived and experienced by other patients, and subsequently how it is treated by medical

professionals. I also wanted to look at how pain occurs in RA and AS—by which I mean to say,

what causes it, and how it is interpreted by our bodies and brains—and compare coping

strategies between myself and other people with autoimmune illnesses.

To do this I felt that I needed to gather information from other people with autoimmune

disorders, as it is important in my eyes to prove that I am not the only one who finds video

games therapeutic against pain. ‘Autoethnography is a qualitative method—it offers nuanced,

complex, and specific knowledge about particular lives, experiences, and relationships rather

than general information about large groups of people (Adam, Holman Jones & Ellis, 2014).’

To present my theories and findings honestly, and clearly, it was important while

creating and compiling my research to focus on, ‘human intentions, motivations, emotions, and

actions, rather than generating demographic information and general descriptions of interaction

(Ibid).’

Even though autoethnography deals with personal stories, and allows the author a great

deal of creative freedom, it is still important to consider how to best represent the questions

asked, and the information gathered. Adam, Holman Jones & Ellis (Ibid) write, ‘Questions about

research practice and craft require autoethnographers to be invested in—and accountable to—

the creation of insight and knowledge and the engagement of compelling aesthetic practices. But

these are not the only commitments autoethnographers must make when choosing to do

autoethnography. They also must be equally committed to conducting their work responsibly and

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ethically; they must consider the personal, relational, and institutional risks and responsibilities

of doing autoethnography.’

I will be closely following the guidelines and ideals outlined in Autoethnography

(understanding qualitative research) (Ibid.) as I found that the authors’ have created fantastic

summaries of what the core ideals of autoethnographic projects should be. The core ideals are

outlined as follows:

‘• Recognizing the limits of scientific knowledge (what can be known or explained),

particularly regarding identities, lives, and relationships, and creating nuanced, complex, and

specific accounts of personal/cultural experience

• Connecting personal (insider) experience, insights, and knowledge to larger

(relational, cultural, political) conversations, contexts, and conventions

• Answering the call to narrative and storytelling and placing equal importance on

intellect/knowledge and aesthetics/artistic craft

• Attending to the ethical implications of their work for themselves, their participants,

and their readers/audiences.’

These core ideals created the framework for how I conducted my study, in terms of

gathering and presenting information, and then combining and contrasting it with my own

experiences.

Although autoethnography is a hermeneutic approach, we will be triangulating our

research by use of traditional positivist data-collection to support my thesis. To gather

information from other people with autoimmune disorders, I felt that I needed to conduct a small

survey to learn whether I was alone in feeling that playing games could be a valid method of pain

relief, as I did not have the opportunity to conduct as many close interviews—or do the kind of

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in-depth ‘field-work’—as I would have preferred. A survey would allow me to collect a lot of

information, although the information may not be as visceral as what I provide of my own

experiences.

When creating the questionnaire, I started by writing a summary about myself and my

research, so that anyone who responded to the questionnaire would understand what their

answers would be used for. I then moved on to creating the questions. Initially I asked for

anyone who had an autoimmune disorder and a regular gaming habit to fill out the questionnaire,

but in hindsight it might have been a better choice to ask for anyone with chronic pain and a

gaming habit to give their response, and ask for the cause of their chronic pain, since not every

autoimmune disorder causes chronic pain in the afflicted. Since I didn’t want to create biased

questions, I kept most of my questions direct. I inquired into which autoimmune disorder(s) the

informants had, if pain was a primary symptom of their conditions, and how they usually dealt

with their pain. I then asked if video games helped to alleviate the experience of pain while they

were playing—this was asked as a multiple-choice question, where the informants could answer

yes, no, sometimes, or ‘other’ if they wanted to give a written response. Including the ‘other’

option proved detrimental, as it created responses that invariably did not actually answer the

question, and those responses ended up being removed. They were then asked to describe in a

few words in which ways video games helped them to cope with their autoimmune disorder(s).

Finally, they were asked if they were open to being contacted with follow-up questions if the

need should arise. I gathered a total of 146 responses, but kept only the responses of people who

had specifically autoimmune disorders, and who did specifically play games. After removing all

the irrelevant responses, I had 78 left.

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2.2) AUTOIMMUNITY AND CHRONIC PAIN

Although I am presenting an account of my experiences—and the experiences of

others—in dealing with chronic pain through video games, it is important to recognise that

subjective experience alone cannot prove my thesis that video games can be used to relieve pain.

I have to acknowledge what is scientific fact, and what is hypothetical—or hopeful—discussion.

I must also bear in mind the original questions I asked myself when I began this study: how is

pain experienced, how is it treated, how does it occur in autoimmune disorders, and what is the

effectiveness of playing video games as a method of pain relief.

To begin with I want to outline pain as a biological and psychological process, and

highlight the difference between acute pain and chronic pain. Pain is defined as an ‘unpleasant

sensory and emotional experience associated with actual or potential tissue damage

(International Association for the Study of Pain, 1994).’ Pain is experienced when the brain or

spinal cord receives signals from specialised pain receptors throughout the body that indicate

harm—these pain receptors cause the spinal cord to send out a reflex to retract from whatever

stimulus is causing pain, and then the brain sends out signals for the body to begin repairing

itself (Jacques, 2017). This is what happens when we experience acute pain. Acute pain

continues only for as long as the body detects tissue damage, and when it has healed that tissue,

the pain signals stop. In some cases, pain receptors continue to fire, even after the initial injury

has healed—this is what constitutes chronic pain (Ibid.). In autoimmune disorders, the immune

system misinterprets healthy cells as foreign invaders, and subsequently attacks and destroys

them, which can cause pain responses in the body (Arthritis Research UK, 2017), that in my

case, and the case of the majority of those I surveyed becomes chronic pain.

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Chronic pain treatment is usually tailored to the specific needs and wishes of each

individual. In my case, I receive non-steroidal anti-inflammatory medications and opioid pain

medications to be taken daily, and follow a diet plan that my mother and I created together after

years of research into various other anti-inflammatory diets. Following the medical treatment

plan laid out by my rheumatologist, coupled with the life-style changes that worked best for me,

I have managed to keep my chronic pain from getting significantly worse over the past six years.

I still experience a great deal of pain daily, but the good days—read, less painful—that I

experience now were unimaginable to the me six years ago. Only on my worst days am I in the

amount of pain that I experienced before treatment, where I hurt too much to even dress myself

unaided. But even with all the progress I have made, the chronic pain that remains take a

psychological toll that cannot be overlooked.

2.3) EFFECTS OF CHRONIC PAIN

Being in pain constantly affects my ability to function not just physically, but mentally

as well. Having to focus on something can feel impossible at times, because there is always pain

eating away at me when I am doing something. Chronic pain changes how I think. The more

pain I am in, the harder it is for me to rationalise, make decisions, or just keep a good mood. This

has been observed in a 2008 study at Northwestern University. The study examined whether

long-term pain changed how the brain behaved while at rest. ‘It seems that enduring pain for a

long time affects brain function in response to even minimally demanding attention tasks

completely unrelated to pain (Baliki, Geha, Apkarian & Chialvo, 2008).’

The study compared the brain activity of a control group and a group of chronic back-

pain sufferers as they performed a simple task with a finger-spanning device. They found that

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while the task was achieved just as well by both groups, ‘the brain activity is dramatically

different.’ They noted that this raises the question of, ‘how other behaviors are impaired by the

altered brain activity (Ibid.).’

The results from this study backs up my feeling that chronic pain affects how I think. The

authors concluded the study by stating that their, ‘findings suggest that the brain of a chronic

pain patient is not simply a healthy brain processing pain information, but rather is altered by

the persistent pain in a manner reminiscent of other neurological conditions associated with

cognitive impairments (Ibid.).’

Chialvo, one of the authors of the study, states in an article (Paul, 2008) about his

research that the, ‘constant firing of neurons in these regions of the brain could cause permanent

damage. We know when neurons fire too much they may change their connections with other

neurons and or even die because they can't sustain high activity for so long.’ He goes on to say

that if you are a chronic pain patient, ‘you have pain 24 hours a day, seven days a week, every

minute of your life, that permanent perception of pain in your brain makes these areas in your

brain continuously active. This continuous dysfunction in the equilibrium of the brain can

change the wiring forever and could hurt the brain.’

I find this research relevant to our question of how video games can be an effective pain

management method because it supports my theory that chronic pain is not just a physical event,

but also a psychological one. This is part of why I believe that stimulating the brain through

playing video games is greatly beneficial in combating chronic pain. A different study (Kühn,

Gleich, Lorenz, Lindenberger & Gallinat, 2014) has found that certain video games—this study

used specifically Super Mario 64 DS (Nintendo EAD, 2004)—can change grey matter in the

brain! Video games can have a real, measurable, effect on our brains. ‘Comparing a control

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[group] with a video gaming training group that was trained for 2 months for at least 30 min per

day with a platformer game, we found significant grey matter (GM) increase in right

hippocampal formation (HC), right dorsolateral prefrontal cortex (DLPFC) and bilateral

cerebellum in the training group’

I found this study incredibly encouraging when I first came across it. I can feel the effect

chronic pain has on my thinking—when my pain is persistent I feel almost drunk, but without the

pleasant buzz you might expect with intoxication—and yet I have never been able to find

evidence that suggests this brain fog is related to my chronic pain. I have just felt certain that it

must be. It is only when I am in a lot of pain that I cannot hold on to a strand of thought, my

words become slow and slurred, and communicating becomes difficult and frustrating. This

study suggests that playing video games, or at the very least playing Super Mario 64 DS,

‘augments [grey matter] in brain areas crucial for spatial navigation, strategic planning,

working memory and motor performance going along with evidence for behavioral changes of

navigation strategy. The presented video game training could therefore be used to counteract

known risk factors for mental disease such as smaller hippocampus and prefrontal cortex volume

in, for example, post-traumatic stress disorder, schizophrenia and neurodegenerative disease

(Ibid.).’

2.4) POSITIVE PSYCHOLOGY

Another reason why I believe video games are effective in treating chronic pain is

because they have the potential to effect the release of our feel-good chemicals. Simply put, they

can make us happy. ‘The science behind video game enjoyment centers on a pair of body

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chemicals, endorphins and dopamine, which are responsible for feelings of pleasure and well-

being. These chemicals are abundant during positive game-playing experiences (Lee, 2013).’

When we are playing a good game, we are directly effecting our brains in the same way

that exercising or taking morphine would effect our brains. ‘Endorphins are commonly

associated with moments of euphoria or intense activity. You might be familiar with the

endorphin rush, a bump of good vibes, from a good workout. These brain chemicals actually

come from a variety of factors: stress and pain are among the most common. Endorphins help

the body reduce the perception of pain and manage stress more effectively, much the same way

that drugs like morphine and codeine affect the body. Endorphins make it easier to enjoy

yourself (Ibid.).’

The fact that we can effect our brain chemistry through positive experiences has also

been discussed by McGonigal (2012a) who wrote that, ‘the prevailing positive-psychology

theory that we are the one and only source of our own happiness isn’t just a metaphor. It’s a

biological fact. Our brains and bodies produce neurochemicals and physiological sensations

that we experience, in different quantities and combinations, as pleasure, enjoyment,

satisfaction, ecstasy, contentment, love, and every other kind of happiness. And positive

psychologists have shown that we don’t need to wait for life to trigger these chemicals and

sensations for us. We can trigger them ourselves through scientifically measurable autotelic

activities.’

McGonigal continues on to say that if we provoke our curiosity with ambiguous visual

stimuli, ‘we experience a rush of “interest” biochemicals also known as “internal opiates.”

These include endorphins, which make us feel powerful and in control, and beta-endorphin, a

“well-being” neurotransmitter that is eighty times more powerful than morphine (2012a).’ Based

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on this statement, video games that generate curiosity and interest in the player have the potential

to trigger the release of these “internal opiates” as McGonigal calls them.

When we consider the brains chemical responses to positive emotions, the discovery

that video games can have the ability to make us curious, interested and happy is quite

significant. It is important to note, however, that video games do not make us happy on their

own, video games—by definition—require that one participates, that one plays them.

Positive psychology theorist Csíkszentmihályi (2002) discovered in his research that,

‘happiness is not something that happens. It is not the result of good fortune or random chance.

It is not something that money can buy or power command. It does not depend on outside events,

but, rather, on how we interpret them. Happiness, in fact, is a condition that must be prepared

for, cultivated, and defended privately by each person. People who learn to control inner

experience will be able to determine the quality of their lives, which is as close as any of us can

come to being happy. Yet we cannot reach happiness by consciously searching for it. “Ask

yourself if you are happy,” said J. S. Mill, “and you cease to be so.”’ Csíkszentmihályi managed

to outline in his work that we are all ultimately in charge of creating our own happiness. He

states that, ‘how we feel about ourselves, the joy we get from living, ultimately depends directly

on how the mind filters and interprets everyday experiences (Ibid.).’

I mention Csíkszentmihályi’s work because his theory on optimal experience

investigated the innate ability of each person to create a state of happiness for themselves

through challenge, interest, and deep focus on an action or task. He called this flow, and explains

it as, ‘the state in which people are so involved in an activity that nothing else seems to matter;

the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of

doing it (Ibid.).’

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Csíkszentmihályi’s work becomes important to our discussion on using video games as

pain relief, because playing a good video game is, in effect, a flow-inducing activity. It is also

important to our discussion because Csíkszentmihályi examines our ability to control our

consciousness to change our experiences. He writes that the functions of the consciousness is, ‘to

represent information about what is happening outside and inside the organism in such a way

that it can be evaluated and acted upon by the body. In this sense, it functions as a clearinghouse

for sensations, perceptions, feelings, and ideas, establishing priorities among all the diverse

information (Ibid.).’

He also discusses the ability of our nervous system to effect itself, stating that the

human nervous system has, ‘become so complex that it is now able to affect its own states,

making it to a certain extent functionally independent of its genetic blueprint and of the objective

environment. A person can make himself happy, or miserable, regardless of what is actually

happening “outside,” just by changing the contents of consciousness (Ibid.).’ Changing the

contents of consciousness might sound challenging, or even impossible, at first. I believe that

this is something that can be learned over time, with practice, much in the same way that a

person might learn to meditate. The effectiveness of mindful meditation as pain relief has

previously been tested both in people with chronic pain (Morone, Greco, & Weiner, 2008) and

people experiencing acute pain (Zeidan, Gordon, Merchant, & Goolkasian, 2010) with

encouraging results.

It is also worth mentioning that cognitive behavioural therapy (CBT) is based on the

idea that we can effectively ‘edit’ our way of thinking and behaving to alleviate symptoms of

depression and anxiety, and cope more effectively (NHS Choices, 2017).

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Although we can exert a great deal of control over our brains and consciousnesses with

practice, Csíkszentmihályi (2002) also points out that our brains are not all powerful. He

mentions that our nervous system, ‘has definite limits on how much information it can process at

any given time. There are just so many “events” that can appear in consciousness and be

recognised and handled appropriately before they begin to crowd each other out.’

In terms of using video games as pain relief, the limitations of our brains and nervous

systems are also something that we can learn to take advantage of; we should learn to appreciate

that our brains can only do so much at a time. As Csíkszentmihályi puts it, our thoughts, ‘have to

follow each other, or they get jumbled. While we are thinking about a problem we cannot truly

experience either happiness or sadness. We cannot run, sing, and balance a checkbook

simultaneously, because each one of these activities exhausts most of our capacity for attention

(Ibid.).’

Following this same logic, although pain is not a conscious choice, we can prevent it

from appearing at the forefront of our consciousness while we are thinking about video games,

because our capacity for attention is limited. Csíkszentmihályi further writes that, ‘because

attention determines what will or will not appear in consciousness, and because it is also

required to make any other mental events—such as remembering, thinking, feeling and making

decisions—happen there, it is useful to think of it as psychic energy. Attention is like energy in

that without it no work can be done, and in doing work it is dissipated. We create ourselves in

how we invest this energy. Memories, thoughts and feelings are all shaped by how we use it. And

it is an energy under our control, to do with as we please; hence, attention is our most important

tool in the task of improving the quality of experience (Ibid.).’

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Since we can, to a great extent, choose what to spend our attention—our psychic

energy—on, we can also ultimately choose to not spend it on the pain we are experiencing. In

my experience, not thinking about the pain is not going to remove the pain, nor is it going to

remove the root cause of the pain, but when we do not think about being in pain, the pain

becomes more bearable.

2.5) FLOW AS PAIN RELIEF

Now that we have discussed the ability that each person has to control and change her

own conscious thoughts, or rather, choose where she places her attention, I want to focus on how

exactly video games are so effective at capturing our attention. What makes video games so good

at inducing flow states in people? Before I can answer this question, let me bring us back to our

definition of flow—‘the state in which people are so involved in an activity that nothing else

seems to matter.’ A person in flow can be so focussed on what they are doing that time becomes

irrelevant, hunger becomes irrelevant, and as in my case; pain becomes irrelevant.

Although referring to it as flow is relatively new—Csíkszentmihályi chose the term

after finding in his interviews that people often referred to the experience as being carried by a

water current, flying, or flowing (Ibid.)—optimal experience, or flow states, have been described

throughout history and in different cultures before. Csíkszentmihályi explains that, ‘during the

course of human evolution, every culture has developed activities designed primarily to improve

the quality of experience (2002).’

McGonigal (2012) analyses Herodotus’ story about the ancient Lydians surviving

eighteen years of famine through engaging in games so entirely on one day so as to not feel any

hunger, and then the on next day to eat and abstain from games, and continuing to alternate as

22


such. She explains that ‘we often think of immersive gameplay as “escapist,” a kind of passive

retreat from reality. But through the lens of Herodotus’ history, we can see how games could be

a purposeful escape, a thoughtful and active escape, and most importantly an extremely helpful

escape.’ She further explains that for the ancient Lydians, games, ‘made life bearable [and] gave

a starving population a feeling of power in a powerless situation, a sense of structure in a

chaotic environment [and] a better way to live when their circumstances were otherwise

completely unsupportive and uninhabitable.’

Just like the ancient Lydians could immerse themselves so entirely in games to forget

their hunger, in much the same way people with chronic pain today could use video games to

forget their pain. McGonigal has written about the power games can have to make life happier,

more meaningful, and more importantly, she has written about why games can make us happy.

She explains that games make us happy because, ‘they are hard work that we choose for

ourselves, and it turns out that almost nothing makes us happier than good, hard work (Ibid.).’

Now admittedly, in my mind, work and fun are not usually thought of as being the

same. But I also do not think of games as hard work. As McGonigal goes on to write, we play

games, ‘and we’ve been taught to think of play as the very opposite of work. But nothing could

be further from the truth. In fact, Brian Sutton-Smith, a leading psychologist of play, once said,

“The opposite of play isn’t work. It’s depression.” (Ibid.)’

As I have already mentioned, chronic pain has a very prominent psychological effect on

the afflicted as well as the physical, and, in fact, depression and chronic pain have a very high

comorbidity (Holmes, Christelis & Arnold, 2013). McGonigal points to the clinical definition of

depression, stating that when we are depressed, ‘we suffer from two things: a pessimistic sense of

inadequacy and a despondent lack of activity. If we were to reverse these two traits, we’d get

23


something like this: an optimistic sense of our own capabilities and an invigorating rush of

activity (2012).’

She goes on to point out that there is no clinical psychological term that describes this

positive and opposite condition to depression, but that it is still a, ‘perfect description of the

emotional state of gameplay. A game is an opportunity to focus our energy, with relentless

optimism, at something we’re good at (or getting better at) and enjoy. In other words, gameplay

is the direct emotional opposite of depression (Ibid.).’

It can thus be said that video games are effective at inducing flow states, because they

are mechanically and emotionally opposite to depression—video games put forward the

opportunity to participate in, and focus on, invigorating activity, which stimulates the brain and

creates feeling of enjoyment and well-being. According to McGonigal, when we are playing a

good game, and voluntary tackling unnecessary obstacles, ‘we are actively moving ourselves

toward the positive end of the emotional spectrum. We are intensely engaged, and this puts us in

precisely the right frame of mind and physical condition to generate all kinds of positive

emotions and experiences. All the neurological and physiological systems that underlie

happiness—our attention systems, our reward center, our motivation systems, our emotion and

memory centers—are fully activated by gameplay (Ibid.).’

It is when we play video games so intently that we achieve the flow state—where our

attention is focused entirely on the task at hand, and nothing else in the world seems to matter—

that we can experience the greatest relief from the burden of chronic pain. Not only because our

limited attention is pulled away from the pain we are experiencing, but also because the

experience of flow itself is immensely enjoyable.

24


2.6) SUPERBETTER

Although it is not a video game, I want to bring attention to a project that played an

important part in inspiring me to write about my experiences of dealing with chronic pain

through video games. McGonigal (2012a) recounts how she struggled to recover from post-

concussion syndrome in the summer of 2009, and that after the four most miserable weeks of her

life, she arrived at the conclusion that she was either going to, ‘kill [herself] or [she was] going

to turn this into a game.’ McGonigal had over a decade of experience working as a game

designer, and—while rising from a point in her life of severe adversity—she invented an

alternate reality game for herself that she dubbed Jane the Concussion Slayer. The objective of

the game was to give herself and her close friends a family an active role in her recovery.

She explains the process of research that she went through as she began developing her

recovery-based game from various medical journals and reports. She writes that she, ‘pieced

together what experts agree are the three most important strategies for getting better and coping

more effectively—not only from concussions, but any injury or chronic illness. First: stay

optimistic, set goals, and focus on any positive progress you make. Second: get support from

friends and family. And third: learn to read your symptoms like a temperature gauge. How you

feel tells you when to do more, do less, or take breaks, so you can gradually work your way up to

more demanding activity (Ibid.).’

Based on the three strategies that she discovered, she created the alternate reality game

SuperBetter, and described it as a, ‘superhero-themed game that turns getting better into a

multiplayer adventure. It’s designed to help anyone recovering from an injury or coping with a

chronic condition get better sooner—with more fun, and with less pain and misery, along the

way (Ibid.).’

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The rules of the game are referred to as missions, and are simple to follow and allow

each player to completely customise the gameplay experience to suit their injury or illness. In

brief, the five missions – paraphrased – are as follows:

Mission #1: Create your SuperBetter identity. You can be anyone you want, from any

story you love. You will borrow their superpowers, and play the leading role in this adventure.

This mission is meant to make the player feel empowered, rather than powerless.

Mission #2: Recruit your allies. Pick the friends and family members you want to count

on the most, and give each ally a specific mission. One of your allies should give you daily or

weekly achievements. This mission ensures that you have the support you need from near and

dear ones.

Mission #3: Find the bad guys. Pay attention to anything that makes you feel worse, and

put it on your bad-guys list. Some days, you’ll be able to battle the bad guys longer—some days

not so long. Every time you do battle, you’ll want to make a great escape before the bad guy

knocks you flat. If you vanquish one forever, you can take it off and claim the permanent victory.

This mission asks you to identify the triggers for your symptoms, which will make it easier for

you to avoid pain and suffering.

Mission #4: Identify your power-ups. Make a list of fun things you can do at a

moment’s notice to make yourself feel better. Call on them whenever the bad guys are getting

the better of you. This mission gives you specific positive things that you can do for yourself to

avoid feeling depressed or suffering under negative stress.

Mission #5: Create a list of goals for yourself, ranging from things you are 100 percent

positive you can do right now to things you might not have been able to do even in your wildest

dreams before you got sick or hurt. Everything on this list should be something that would make

26


you feel awesome and show off your strengths. The purpose of this mission is to use it as your

goal post to measure your progress by. When you start achieving the goals listed in Mission #5,

you have empirical evidence of your improvement.

Each of these missions serves a specific purpose toward aiding recovery and making the

player feel better. In my opinion, the genius of this game is that it motivates the player to look

closer at their symptoms, what causes them, and what makes them better, and it also motivates

the player to ask for help in a way that might not be as difficult as directly asking your friends

and family for help. You have the opportunity to invite your near and dear ones to participate in,

and potentially enjoy, your recovery process, by making it a social and fun experience, and by

making them feel like an important part of your improvement.

McGonigal says of her own experience using the game that she can not say for sure that

she got better any faster that she would have without playing the game, but that she suspects it

helped a great deal. She continues, ‘What I can say for sure is that I suffered a great deal less

during the recovery as a direct result of the game (Ibid.).’ This I feel is the most important part

of the whole account of her experience with creating and playing SuperBetter—playing the game

did not cure her, but it greatly reduced the feeling of suffering.

When dealing will injury or illness, especially chronic illness and chronic pain, it is

important to recognise that healing or recovering is a tough process that is physically and

emotionally draining, and that—sometimes—full recovery will never be possible regardless of

how much you might want it. As McGonigal phrases it, ‘when you’re sick or in pain, getting

better is all you want. But the longer it takes, the harder it gets. And when the tough reality we

have to face is that getting better won’t be easy, a good game can better prepare us to deal with

that reality (Ibid.).’

27


SuperBetter has since its initial conception been adapted into a book (McGonigal,

2016), and developed into a website and a smartphone app that players document their

experiences through, and many have shared their experiences of using SuperBetter in their

recovery journeys on blogs and social media. Recovering through gameplay is an idea that seems

to appeal to a great deal of people, which gives me even more encouragement that my thesis

about video games can provide effective pain relief will be proven correct.

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3.1) POST-TRAUMATIC GROWTH

McGonigal (2012b) presented the experiences that led her to create SuperBetter in a

TED Talk. In this talk she also mentions some of the research that she came across while trying

to answer the question of how a trivial game like SuperBetter could make its players feel

happier, better understood, and more empowered. ‘Some people get stronger and happier after a

traumatic event,’ McGonigal stated in her talk (Ibid.), and this is what was happening to

SuperBetter players. She found that this is related to a phenomenon that scientists call Post-

Traumatic Growth (Tedeschi & Calhoun, 1996). After experiencing trauma, not only can a

person’s self-perception change positively, but they might become more appreciative of

interpersonal relationships, or they might develop a new life philosophy (Ibid.). This is an

experience that I feel I can relate to, and it is also one that applies to my theory of video games as

pain relief.

One of the definitively most difficult times in my life was experienced roughly nine

months after I was diagnosed with autoimmune disease. About six months after beginning my

second treatment plan, I had an appointment with my rheumatologist to determine if the

treatment I was undergoing was effective—if there had been any progress made in slowing down

the disease progression. I walked into the rheumatologist’s office, accompanied by my mother,

and feeling not much different than I had six months prior. I was incredibly frustrated that I was

still ill, and still very much in pain, but hopeful that I could be offered a different, more effective,

treatment.

As the rheumatologist conducted her examination of my joints (done by squeezing them

and determining the amount of swelling and sensitivity experienced), I expressed my frustrations

that the medications I was taking were not working, and then expressed my desire to move onto a

29


different medication as soon as possible. Although I was aware, logically, that no medication

available offered a cure, I still had not accepted, emotionally, that I would never become entirely

free of my symptoms and wanted to find a medication with immediate and remarkable effect.

But when my rheumatologist explained to me that she would not change my medications at all,

only prescribe me more painkillers, I felt angry and questioned why I had to continue taking a

medication that I did not feel was working for me.

My rheumatologist explained that since I was a ‘young woman of child-bearing age’, I

would not be eligible for escalated treatment until they were certain that I would not want to

have children later in life. I was taken aback by this statement at first, then I assured my

rheumatologist, with all the confidence only a stubborn woman fresh out of her teens can muster,

that I had no interest in having children now, and would never be interested in the future. In

response, my rheumatologist simply stated that this was fortunate, as pregnancy and child-

rearing might not be easily achieved for me due to my ill health, but that she would still not risk

putting me on a different treatment just yet, not so long as my condition was stable, and not

deteriorating. She then re-iterated what she said to me when I first got my diagnoses—I could

not expect to ever be cured, but I could expect to get better treatment in the future. To be honest,

the latter part fell on deaf ears.

I could not expect a cure. This was the point at which I finally and fully realised that the

plans I had made for my life would not work out. The work I wanted to do seemed too difficult,

the places I wanted to go seemed unreachable, and the dreams of one day living happily and

without pain now felt entirely impossible. I would never wake up a single morning without

stiffness and pain. All my life plans were based on the idea that I would one day be well enough

30


to do extraordinary things, things that were currently impossible. It was now painfully clear to

me that things that were impossible to me now would be impossible to me forever.

At this point I fell into a deep depression, and the self-harming and suicidal ideation that

I had gone through in my teens, before diagnosis, returned in full force. If I would never achieve

any of my life plans, what was the point in living? I suddenly had nothing to look forward to. I

felt like there was nothing I could achieve, there was nothing within the scope of my abilities that

would actually give me joy or fulfilment. I could not even dream of having a family of my own

one day. What was the point? I kept asking myself this question, over and over. What is the point

of my life now?

During the worst weeks of this period, I did not play video games at all. I did not have

the emotional capacity to be invested in anything apart from eating, sleeping, or self-harming. I

would lie in my bed and cuddle my dogs when I could, but when I did not have my dogs with

me, I would go back to sleeping, or eating, or self-harming. My pain became so bad at this point

that even the increased dosage of pain medication I received was not taking the edge off. I felt

everything just as keenly as if I had taken no pain killers at all.

After a while, at the insistence of my family, I began to take anti-depressants again, but

struggled for a very long time to open up to my family about the hurt and upset I was

experiencing and what was causing it. But it was during this time that my mother began gently

guiding me towards pursuing studying again, and she eventually convinced me to apply for

university. It was also during this time that my mother suggested that I pursue video games as a

career. This simple guidance toward a new goal distracted me from my spiral of self-destruction,

and slowly but surely, I started thinking about a new, different, future. And then I found myself

wanting to play again.

31


I picked up my old video gaming habit, and spent more time sitting in front of a game

instead of lying down in bed. I started to experience moments of intrigue and excitement as I

played through a new game my brothers had bought me to cheer me up. In one of these moments

of happiness, I looked down at the last healing cuts on my arms and realised that I very nearly

lost my will to live, and perhaps my very life, just to being diagnosed with a chronic illness. And

this despite the fact I have been ill ever since childhood. The confirmation that I was sick—and

that my illness would require me to acknowledge a great many things as impossible for me—

almost killed me. It was a greatly traumatising experience, but I am happy to say that I stand on

the other side of it now.

My body still hurts, and I am still mourning the things I will never do, and the things I

will never have, but I am alive, I am coping, and I am finding that I have more confidence now,

and a greater interest in the new possibilities than I ever thought possible. And to my great

astonishment, I am physically in better shape now than I was when I went through this trauma. I

am finally on better treatments. I hurt, but I hurt less. I have stiffness, but it is less stiffness. But

more importantly, I have a greater appreciation for my family. All through the illness from

childhood, and the psychological impact it has had on me throughout my life, my family has

carried me through. They supported me through treatments, accompanied me to hospital

appointments, and forgave me when I lashed out toward them in anger and frustration. I have not

self-harmed in four years. I have grown from my experiences, become more resilient, learned to

appreciate the support I have from my family, and found the best way for me to cope, and take

enjoyment out of life, in video games.

Video games have helped me survive through childhood illness, chronic illness, mental

illness, and chronic physical pain, and have been the single most important coping mechanism in

32


my life since I first started experiencing pain as young child. Playing games—even though it

does not cure the symptoms of my condition at all, and does not take away the causes of pain or

anxiety at all—takes away the suffering.

3.2) RESULTS OF THE SURVEY

The survey consisted of five questions, three of which were open-ended, and two of

which were multiple choice. The survey was shared in autoimmune support groups on

Facebook, as well as through Twitter and Tumblr. The questions, and their responses, were as

follows:

1) Which autoimmune disorder(s) do you have?

a. 64 had Ankylosing Spondylitis

b. 13 had Psoriatic Arthritis

c. 9 had Rheumatoid Arthritis

d. 4 had Fibromyalgia

e. 2 had Crohn’s Disease

f. 2 had Hashimoto’s Thyroiditis

g. 1 had Sjögren’s Syndrome.

(The total number is higher than the number of informants due to several

informants having comorbid autoimmune disorders.)

2) Is pain one of the most prevalent symptoms of your autoimmune disorder(s)?

a. 93.6% (73) Yes

b. 5.1% (4) Sometimes

c. 1.3% (1) No.

33


3) How do you usually deal with the pain symptoms of your autoimmune disorder(s)?

a. 51 mentioned Medication

b. 29 mentioned Mild exercise/Stretching

c. 24 mentioned Distraction (listening to music, reading, watching TV, video

games, crafting)

d. 18 mentioned Heat/Cold packs/Hot Baths

e. 15 mentioned Sleep/Rest

f. 10 mentioned Meditation/Breathing/Relaxation techniques

g. 10 mentioned Doing nothing/Enduring

h. 4 mentioned Diet

i. 2 mentioned Socialising/Spending time with Family

The total number of answers is higher than the number of informants due to

most informants mentioning more than one coping strategy.

4) Does playing video games help to alleviate the pain you experience from your

autoimmune disorder(s)?

a. 67.9% (53) Sometimes

b. 32.1% (25) Yes

c. 0% (0) No.

5) Please describe the ways in which playing video games helps you to cope with your

autoimmune disorder(s). For example, what effect does it have on your physical

and/or psychological symptoms?

(These were written responses to an open-ended question. The responses were of

varying lengths, and as I read through them all, I made notes of the words and

34


themes that came up repeatedly, so that I could neatly represent the key words the

informants were using.)

a) 45 mentions of Distraction, Takes my mind off the pain, Lets me think of

something else.

b) 24 mentions of Focus on pain/game/something else, Concentrate on

pain/game/something else.

c) 15 mentions of Escape pain, Forget pain, Ignore pain.

d) 11 mentions of Relaxes, Soothes, Relieves stress.

e) 6 mentions of Removes/Relieves Worry, Anxiety, Depression.

f) 4 mentions of Social aspects.

There were some specific answers to the final question that I felt I could strongly relate

to, and that matches my theory about video games as pain relief. They have been included below,

edited only for conciseness and clarity.

‘Video games engage my mind, thus drawing away my awareness of pain. […] Focusing

on games relaxes me because it slows my mind down from useless fretting about how my

autoimmune diseases have robbed me of my once active life.’

‘It allows me to transport my mind somewhere else and not think about my body for

however brief a time. Makes me feel more powerful. However, when pain breaks through that

video game world, it's always pretty severe [...]’

‘Mental distraction, social interaction […], feeling of mobility. Very much helps me rest

without feeling like I am stuck in one room and isolated. The mental challenge of difficult games

helps take my mind off the pain. When the effort of holding up even a book is too much, I can sit

35


in my ergonomic chair and use ergonomic devices to be on my computer playing video games. I

am treated like a normal person since they can't see me. Player since 2004, so 12 years.’

‘I play World of Warcraft. I can get so caught up in the game that I forget all about

anything else. It has been my strongest coping mechanism.’

3.3) CONCLUSION

As a chronically ill person, you might have pain in your body at all times, but you only

suffer from it when you are experiencing it consciously, when it is at the forefront of your mind.

If we can occupy our brains so totally, or focus our attention on something so entirely, that there

is no room for the pain in our consciousness, we no longer experience that pain as keenly as

before. The results of my survey indicate that I am not alone in finding video games effective as

pain relief, on the contrary, my survey shows that 100% of my informants do find video games

effective in alleviating pain. The only difference is how often the informants find it helpful.

67.9% found video games helpful in alleviating the pain caused by their autoimmune disorder

only Sometimes, as opposed to finding it helpful all the time like the 32.1% who answered Yes

to the question do. Originally, there were 12 responses for No, however, when reading their

submissions I discovered that all of the informants who answered No admitted to not playing

games at all, and thus were not able to answer the question of whether video games alleviates

pain for them.

I am happy that all my research points to my thesis being valid. Video games DO

alleviate chronic pain. However I feel that more research should be dedicated to understanding

video games as therapeutic experiences so that we can continue to create video games that

promote well-being, healing and happiness in autoimmune chronic pain sufferers.

36


References used:

MacDonald, E. (2017, April 20). The global games market 2017 | per region & segment.

Retrieved August 19, 2017, from https://newzoo.com/insights/articles/the-global-games-market-

will-reach-108-9-billion-in-2017-with-mobile-taking-42/

Wells, J. & Blagburn, F. (2017, August 8). Is video gaming bad for you? The science for and

against. The Telegraph. Retrieved from: http://www.telegraph.co.uk/men/thinking-man/is-video-

gaming-bad-for-you-the-science-for-and-against/

Kovess-Masfety, V., Keyes, K., Hamilton, A., Hanson, G., Bitfoi, A., Golitz, D., … Pez, O.

(2016). Is time spent playing video games associated with mental health, cognitive and social

skills in young children? Social Psychiatry and Psychiatric Epidemiology, 51(3), 349–357.

http://doi.org/10.1007/s00127-016-1179-6

Guarini, D. (2013). 9 ways video games can actually be good for you. [online] The Huffington

Post. Available at: http://www.huffingtonpost.com/2013/11/07/video-games-good-for-

us_n_4164723.html

Glass, B. D., Maddox, W. T., Love, B. C. (2013) Real-time strategy game training: emergence of

a cognitive flexibility trait. PLOS ONE 8(8):

e70350.https://doi.org/10.1371/journal.pone.0070350

Handwerk, B. (2009). Video games improve vision, study says. [online]

News.nationalgeographic.com. Available at:

http://news.nationalgeographic.com/news/2009/03/090329-video-game-vision.html

Franceschini, S., Gori, S., Ruffino, M., Viola, S., Molteni, M., Facoetti, A. (2013) Action video

games make dyslexic children read better. Current Biology, Volume 23, Issue 6, 2013, Pages

462-466, ISSN 0960-9822, http://dx.doi.org/10.1016/j.cub.2013.01.044.

Kühn, S., Gleich, T., Lorenz, R C., Lindenberger, U., Gallinat, J. (2014) Playing Super Mario

induces structural brain plasticity: gray matter changes resulting from training with a commercial

video game. Molecular Psychiatry, Volume 19, Pages 265-271. Available at:

http://www.nature.com/mp/journal/v19/n2/abs/mp2013120a.html

Li, A., Montaño, Z., Chen, V. J., & Gold, J. I. (2011). Virtual reality and pain management:

current trends and future directions. Pain Management, 1(2), 147–157.

http://doi.org/10.2217/pmt.10.15

Oneal, B. J., Patterson, D. R., Soltani, M., Teeley, A., & Jensen, M. P. (2008). Virtual reality

hypnosis in the treatment of chronic neuropathic pain: a case report. The International Journal of

Clinical and Experimental Hypnosis, 56(4), 451–462.

http://doi.org/10.1080/00207140802255534

Adams, T. E., Holman Jones, S. & Ellis, C. (2014). Autoethnography (understanding qualitative

research). (1st ed.). Oxford: Oxford University Press.

37


Coffey, P. (2017) Beyond the Silence – Autoethnography an act of will. (1st ed.) (n.p.): Author

International Association for the Study of Pain. (1994). IASP taxonomy. [online] Retrieved

from: https://www.iasp-pain.org/Taxonomy

Jacques, E. (2017). How we feel pain: overview of the nervous system. [online]

www.verywell.com. Retrieved from: https://www.verywell.com/how-we-feel-pain-2564638

Arthritis Research UK. (2017) The inflammatory arthritis pathway. [online] Retrieved from:

http://www.arthritisresearchuk.org/arthritis-information/inflammatory-arthritis-pathway.aspx

Baliki, M. N., Geha, P. Y., Apkarian, A. V. & Chialvo, D. R. (2008) Beyond feeling: chronic

pain hurts the brain, disrupting the default-mode network dynamics. The Journal of

Neuroscience. 28(6). 1398 –1403. http://www.jneurosci.org/content/jneuro/28/6/1398.full.pdf

Paul, M. (2008) Chronic pain harms the brain. Retrieved from:

http://www.northwestern.edu/newscenter/stories/2008/02/chronicpain.html

Nintendo EAD. (2004). Super Mario 64 DS [Software] Kyoto: Nintendo.

Lee, K. (2013). Games and your brain: how to use gamification to stop procrastinating. [online]

Retrieved from: https://blog.bufferapp.com/brain-playing-games-why-our-brains-are-so-

attracted-to-playing-games-the-science-of-gamification

McGonigal, J. (2012a). Reality is broken: why games make us better and how they can change

the world. Great Britain: Random House.

Csikszentmihalyi, M. (2002). Flow: the classic work on how to achieve happiness. Great Britain:

Random House.

Morone, N. E., Greco, C. M., & Weiner, D. K. (2008). Mindfulness meditation for the treatment

of chronic low back pain in older adults: A randomized controlled pilot study. Pain, 134(3), 310–

319. http://doi.org/10.1016/j.pain.2007.04.038

Zeidan, F., Gordon, N. S., Merchant, J., & Goolkasian, P. (2010). The effects of brief

mindfulness meditation training on experimentally induced pain. The Journal of Pain, 11(3),

199-209. doi:10.1016/j.jpain.2009.07.015

NHS Choices. (2017). Cognitive behavioural therapy [online] Retrieved from:

http://www.nhs.uk/conditions/cognitive-behavioural-therapy/Pages/Introduction.aspx

Holmes, A., Christelis, N., & Arnold, C. (2013). Depression and chronic pain. The Medical

Journal of Australia, 199(6), 17-20. doi:10.5694/mja12.10589

McGonigal, J., (2016). SuperBetter: how a gameful life can make you stronger, happier, braver

and more resilient. [E-Book] Harper Thorsons.

38


McGonigal, J. (2012b). The game that can give you 10 extra years of life [Video file] Retrieved

from: https://youtu.be/lfBpsV1Hwqs

Tedeschi, R. G. & Calhoun, L. G. (1996). The posttraumatic growth inventory: measuring the

positive legacy of trauma. Journal of Traumatic Stress. 9(3). Retrieved from:

http://66.199.228.237/boundary/Childhood_trauma_and_PTSD/PosttraumaticGrowthInventory.p

df

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