CGDHI Researcher Taps Power of Online Gaming Communities to Improve Mental Health

Dr. Michelle Colder Carras dons her armor, wields her Emberstone Staff, and grabs her pet dragon when she goes to work. No, she’s not on Game of the Thrones – that’s her World of Warcraft (WoW) gear. Her membership in an online gaming community while playing WoW helped facilitate fascinating digital mental health research that was recently published in Psychiatric Services. What she learned working with these communities has implications for future research and implementation of digital mental health interventions worldwide. 

The Stack Up Overwatch Program (StOP) study evaluated the usability and efficacy of an online gaming community in addressing mental health crises among US military veterans. Started by a WoW player who is a US veteran, the StOP intervention utilized trained and supervised volunteers who provided mental health support to the Stack Up community on Discord, a global networking and communication platform popular with online gamers. A member of this community herself, Dr. Colder Carras leveraged her in-group status and deep commitment to research based on lived-experience when co-designing the evaluation with Stack Up leadership, later gathering data through surveys, Zoom calls, and chat interviews over several months. The study yielded impressive results, noting that the intervention reduced veterans’ anxiety, increased their coping skills, and decreased the symptoms that lead them to seek out crisis intervention services. 

Dr. Colder Carras also gained insights on the benefits and challenges of conducting research in online communities, as well as using these fora for implementing global digital health programs. Her observations include:

• Online gaming communities can indeed be successfully used for mental health interventions and research.
• As with StOP, these communities can engender grassroots, community-led interventions, an intervention structure often found to be successful in global health. 
• Many online communities (including Stack Up) are already global in reach and use existing technology for their platforms, obviating the need for a new digital tool and making scale up easier. Discord, for example, averages 150 million users each month according to statista.com. 
• Intervention implementers and researchers need to understand, or be willing to learn about, different cultures within the online community. Colder Carras felt her status as a gamer gave her an intrinsic understanding of gaming culture, and her embeddedness in the Stack Up Discord community helped foster trust, making it easier to truly co-design and co-lead research. 
• If delivering in a global context, it is vital to meet users where they are by leveraging  commonly-used technology for the delivery platform, such as social media messaging apps or mobile-based games. Discord, for example, may not be as viable in lower-bandwidth environments. 

Dr. Colder Carras believes the potential of online communities and online gaming for digital health interventions is vast. Her research—and all of her time spent online as a gamer—prompts her to want to explore how public service announcements about health can be integrated into the online gaming environment, or even how gaming can be used to promote positive, healthy behaviors. “Public health research on gaming is finally going beyond studying addiction,” she says. “Technology developments, such as online communities, have caused a paradigm shift in how we view gaming. Now we’re looking at the benefits of gaming, not just harms.”

Her current global work on digital wellbeing looks at mental health in a digital environment more broadly. Conducted with Dr. Johannes Thrul, the study’s principal investigator, this multi-year study in Saudi Arabia focuses on helping people learn how to have a healthy relationship with technology, how to become aware of its benefits and drawbacks and adapt one’s technology use accordingly. 

“It’s all about balancing the positives and negatives,” she says, “We need to build an awareness of how we use our screens so that we feel comfortable and in control of our mental, social, and physical health. Online communities and screens can actually help foster skill building and strengthen relationships if the tech is used with care and intention.” 

For more information on the StOP study and Dr. Colder Carras’ work, read more here and listen to the latest episode of “Public Health On Call,” the award-winning podcast produced by the Johns Hopkins Bloomberg School of Public Health.