The emotional and therapeutic impact of video games for health: Is motivation to improve more important than expectations for improvement?

Self Determination Theory (SDT) has been used to explain the benefits observed from video game play. However, this theory may over-rely on the role of motivation and self-determination in behavior change. The present study investigated how expectations may influence behavior change from video game play and hypothesized that changes in outcomes from pre- to post-play would not be accounted for only by motivation and self-determination as SDT claims. To accomplish this, 47 participants were recruited to play two video games for mental health. In order to isolate the impact of expectations, participants were randomized to a “high expectation” or “low expectation” condition in which the “high expectation” group was told about the scientific evidence supporting the benefit of these specific games, and the “low expectation” group was told there is no evidence to suggest these games work. Expectations about how helpful the game will be and their motivation to play were assessed before and after each game, as well as changes in emotions and therapeutic skills the game was meant to teach. Changes in expectations and motivation were then correlated with changes in outcome measures, after which a mediation model was used to assess whether expectations or motivations were more responsible for observed changes. Flow was also measured after video game play to measure in-game enjoyment. Results found that expectations, flow, and motivation were all significantly associated with the changes in emotions and therapeutic skills that each game was targeting. A mediation analysis revealed that expectations mediated the impact of motivations on outcomes, and flow meditated some, but not all of the impact of expectations on outcomes. Taken together, the results of the study add to a growing body of literature demonstrating video games’ potential aid in improving mental health, especially over a short period of time. Further, these results suggest that SDT may be over-estimating the role of motivation and self-determination as agents responsible for changes in one’s growth and development. Specifically, this study found that expectations akin to the placebo effect may in fact be responsible for some of the changes currently being attributed to SDT. Future studies are encouraged to investigate the full extent of the relationships between expectations, flow, and motivation.