[00:00:01] Speaker A: Welcome to pixaparenting, the podcast where we explore how to raise kids in a world full of screens using science and curiosity. Today's episode is about how video games can support mental health, emotional development, and even shape how we see ourselves and others.
Learn how games can be designed to build emotional awareness, teach communication skills, and offer players a space to explore identity and relationships, especially during adolescence.
We will also learn the difference between games that are intentionally designed to support mental health, some even used in clinical settings, and those games that are purely for entertainment but still carry emotional and social messages. We also get into how parents can use games as conversation starters, what to watch for in the messages that games communicate, and how narrative and gameplay can work together to promote psychological growth.
So I'm very excited to welcome Dr. Celeste San Giorgio to Pixel Parenting.
She's a clinical psychologist and researcher at Rochester Institute of Technology and she's doing some amazing work at the intersection of therapy and video games. She designs story based games that help people build real life skills like how to talk about your feelings or handle tough situations.
So I'm very excited to work. Welcome Dr. Celeste San Giorgio to Pixoparenting. And she's especially focused on conflict, communication and identity. She also looks closely at what games teach us about romance, masculinity, parenting and more, and how we can use games as a tool to reflect, connect and grow. Her work is super thoughtful, super relatable, and I hope that you will appreciate her perspective. I am very excited to welcome Dr. San Giorgio to the podcast.
Welcome. Thank you so much for being here. I'm very excited about this conversation. So to start, can you tell us a little bit about your background and what drew you to the intersection of video games and mental health?
[00:02:08] Speaker B: And I'm happy to be here. Thank you for having me.
So my name is Dr. Celeste San Giorgio. I am a licensed clinical psychologist and research faculty at Rochester Institute of Technology.
And my work focuses on how to translate concepts from cognitive behavior therapy. So how people typically learn in therapy into game environments and then how to use game environments so that people can learn these type of mental health skills. And I also do advocacy and work in how games represent mental health skills and different kind of relationship skills generally across different games that are kind of out there fascinating.
[00:02:50] Speaker A: And that's such a specific niche of the industry. How did you get there?
[00:02:55] Speaker B: Well, I've always been very interested in, and I think also working as a therapist myself, I watch people describe the foundation of how they learn things and I've also experienced like learning different skills and What I found is people tend to learn things in pop culture environments, and game environments are one of those places. So growing up, my cousins and I played a lot of different platformer games like Donkey Kong and Mario. And we, looking back on it now, I could see us doing group problem solving and how we were approaching the games. We would discuss, like, different strategies. And this was. It was really an area for us to build our kind of awareness, what we were noticing, and then our communication skills, so how we were talking to each other about what we're noticing. So as I built my own area as a clinical psychologist, I was very curious to see how I could use that as a springboard kind of purposefully to teach people skills.
[00:03:57] Speaker A: Yeah, Fascinating. I'm happy you're doing that.
[00:04:00] Speaker B: Yeah, thanks.
[00:04:02] Speaker A: So you've helped design games that support mental health.
What kind of mental health challenges are these games aiming to address?
[00:04:13] Speaker B: So everyone has their kind of niche within clinical psychology on the type of things that they specialize in.
I work with adults, and so I see how.
And specifically within adults, I work on trauma and conflict and communication skills. And so my games focus on how. How to build people's awareness of their emotions within themselves and then how to communicate effectively with others about what they're seeing.
But there again, in other areas, right. Relaxation, anxiety, depression. But that's where my niche is on conflict and communication skills.
[00:04:48] Speaker A: Okay, can you, like, describe one or two games that stand out from the ones that you've worked in?
[00:04:54] Speaker B: So right now I'm building out a game.
It's. Oh, and I also build out. I mean, there's different types of. Of ways to approach behavior change in games.
I'm specifically building out narrative games. So games that have a plot and kind of incorporate the skills learning and skills training within the plot of the game naturally.
And so right now we're working in the lab on. It's called a dating simulation game. So a dating sim game where people go on dates and they build relationships with other people. And then the kind of other genre for this game is that it's also like a horror thriller game. So there's an element of stress and worry. And so it simulates how people have to navigate multiple things, build their identity, while they're also meeting new people. And so I'm really excited about that game. We've run a few studies. The way that we're building out the skills development in that game is that it stacks so similar to. In therapy, the first thing you'd learn is how to figure out what you're feeling and then you, you learn how to communicate what you're feeling or if you want to communicate or self regulate.
And so we just tested out the emotion awareness piece and we're getting some pretty good results there. That people who are exposed to the game have a better, they better appraise their ability to differentiate their emotions from each other.
[00:06:22] Speaker A: And do you think that having a plot is a critical part of it or why is it that you use plots and not just, you know, just straightforward exercises?
[00:06:32] Speaker B: Let's say that's a really good question.
I don't think that you need one or the other. I think they're different approaches. We have another project out of the lab that's more prescriptive. It looks more like traditional therapy. And so people, and that's for co occurring substance use and violence.
And for that one, which is actually in FDA trials, which is exciting, people move through psychoeducation, the content of a typical therapy session and they just rehearse their skills.
For the game that I'm focusing on building out, I'm considering those less prescriptive and more over the counter things, more just almost edutainment games. Right? Things that people can pick up and buy for themselves and just while they're playing also learn these skills.
[00:07:18] Speaker A: That's interesting. And so for the audience because I know there are some games that are under prescription. Right? But can you speak about those specific video games versus the entertainment and over the counter ones? What's the difference?
[00:07:32] Speaker B: So the entertainment games are kind of like those you would think, like math skills games, reading skills games, games where you are exposed to plot and you move the plot forward through using these skills that the games are trying to teach you, like math and read to a certain extent. All games have these in their mechanics. Right? That's what I was saying with Donkey Kong and stuff. Any game where you're solving a puzzle, you're like learning a skill and then using it in usually increasingly sophisticated environments. The more prescriptive games target something that's related to therapy. In our co occurring violence and substance use project, we are looking at ability to regulate and ability to notice warning signs, which is typical of CBT therapy.
I know that there's great work out there on biofeedback using games so that those isolates and looks at people's ability to regulate their heart rate or other metrics of arousal. And so in that case a therapist will meet with the patient, they'll work on whatever the skill is that helps them regulate themselves and then they'll use the game, and they'll test out their ability to use those skills in a more complicated environment than they typically be exposed to in therapy. Right. So it's kind of like scaffolding out or building out that skill.
[00:08:59] Speaker A: Okay. So that's basically more or less the way that you ensure that these games are both, like, with the plot, they're engaging, and at the same time, they're effective from a therapeutical perspective. Right. Because you're targeting those specific areas.
[00:09:12] Speaker B: Right. Is that correct? Yeah. Yeah. And then there's some that mix them. I know that there's a game called Mindlight that's been having really good data coming out about it and its effectiveness, and I believe that that has narrative as well as a biofeedback component.
And that's for children.
[00:09:29] Speaker A: Yeah, that's for children. Okay. Okay. I don't know. I don't know about it. I will check it out.
[00:09:34] Speaker B: Yeah. Yeah. I highly recommend it. I think the research behind it's really strong.
[00:09:39] Speaker A: Put it in the show notes for people to check it out. Yeah. So since we're talking about children, how do video games influence how kids and teens see themselves and the world?
[00:09:50] Speaker B: Right.
[00:09:51] Speaker A: The whole identity development part of video games.
[00:09:54] Speaker B: Yeah. And that's a big part of my advocacy and more kind of critical work on games. I am really interested in what's being communicated and how people learn about the world around them through games. I know I talked about myself with Donkey Kong and building these skills, but games inhabit this kind of cultural space where people learn about whether it's ideas of masculinity, of how relationships should be formed and what people should do within them. I actually.
And I've done a few panels on this topic at PACs and other conferences, gaming conferences.
So last year, I did a panel on what games kind of communicate to us about romance and how we should have relationships with others. And then in this. This year, I looked at masculinity, information about masculinity that gets communicated through games.
And in both cases, you can not only see information be communicated, but you can also embody different characters that are negotiating their own sense of these kind of archetypes and ideas, these, like, stereotypes of masculinity. And often through the course of a narrative, you can see people change their opinions and personalize their idea, usually for, like, a healthier thing. I think God of War is a really good example that people talk about a lot, about how that character has maybe an unhealthy. There's a lot of unhealthy messages that he's internalized. And then he's challenged through his relationship with his son to have a healthier relationship with other people and himself.
[00:11:41] Speaker A: And what about like when you, when you play a game, the character you, you make, sometimes males use females, females use males. There's, you know, like, especially in role playing games, you know, the whole role that you play in the game and how do you role play the character? How, how does that shape identity development? What does it mean for parents especially?
[00:12:06] Speaker B: Right.
[00:12:06] Speaker A: Because that's our audience.
[00:12:08] Speaker B: Yeah, it is so interesting. And there's people who, there are researchers out there who just study this, right. What avatars do people choose? How does it affect them in general? We.
There are a few things, kind of broad findings that I can speak on.
One is that people can try things out in a safe environment in a game, in a game environment, they can feel what. They can choose actions and then feel if it is comfortable or uncomfortable to them or see consequences.
And they can see it play out on a really large scale. And so a lot of findings in games and embodiment have found that or a lot of research has found that people expand their sense of identity and their capabilities through playing games, whether it's getting multiple avatars in like World of Warcraft or.
I presented a GDC this last year on researching games with a few other panelists, and one of the other panelists was talking about exposure to different types of romance narratives that didn't necessarily match with the person playing the game. So exposure to like queer narratives, if you're not queer, identified. And they found this feature researcher, I believe his name is Reed, Reed Devani, he found that people tend to take away things that relate to themselves. Right. So they might not be queer identified themselves, but they might feel an openness that they share with the character. And so it expands their sense of openness and makes them feel related to other people.
So people learn about their own qualities and stuff that they can take out of the game environment for themselves through this meeting.
[00:13:55] Speaker A: And so for instance, can video games help build empathy or confidence even? Or. I mean, you're talking about probably new perspectives that you learn about yourself, right? And then you take it on, you take it on and adapt it to your own self. Right. That's what I'm hearing. But what about empathy or even confidence? Is that some. Are those, some things that games can build on?
[00:14:19] Speaker B: Yeah, it's a great question. And there was a period of time where people were calling games empathy machines. Right. Because with that idea, right. That you're embodying different perspectives. And so it will make you feel empathy for them. I think the data or the research is still really pending on that. There are mixed findings.
They are finding that people will take away things that help them learn about themselves. Whether it changes their attitude about, you know, different themes and ideas that are in the game. It's really complicated and I think people are still trying to figure out how to measure it.
It's actually one of the long term goals of the studies that we're doing. Right. So we're starting really kind of building blocks. So you know, if to empathize with people you need to know what you're feeling. Right. That's that first emotional awareness. And then eventually one of our later studies will be looking at like gender based beliefs and also relationship beliefs. What do people believe is acceptable in relationships? And as a building block up to that, we're looking at like sexual assertiveness and stuff.
[00:15:30] Speaker A: So fascinating. And so it looks really complex and hard indeed to measure.
[00:15:36] Speaker B: Right? Yeah. What is empathy? Right. That's the question.
And when is it affected?
[00:15:41] Speaker A: Yes.
And are there any particular types of games or genres that are most impactful in this space?
[00:15:49] Speaker B: I think there are games that are definitely designed to invoke that type of thought or evoke that type of thought more.
There are games that are built fully around moral reasoning and, and exposing kind of the long term results of the moral decisions that you make and those are wrapped within the narrative. So games like Mass Effect, Dragon Age or the Witcher, they all have these like very intense moral decisions and players. I, I, at least I found when I was playing the Witcher myself, I had to kind of come up with a, my own moral philosophy that I would use as a shorthand for these complex decisions because there are so many and they feel like though none of these games. Well, some of the games have time decisions.
In the Witcher they're not time decisions, but you do feel a pressure to make them.
And so they're. And I don't know much of the research about, I know that people ask questions about people's perception of their moral reasoning after exposure to the games, but I don't, I don't know if there's been any kind of clean like pre post measure of moral reasoning. Okay.
There is very good data. I remember you asked about self efficacy. There's very good data on self efficacy. People do generally feel like they can do more after they're exposed to games. Whether or not they actually do those things is different than what they feel about this. You know Their capacity to do them.
[00:17:23] Speaker A: Interesting. And regarding the decisions and talking about trying out new things, I guess there's a whole landscape there about making moral decisions that are opposite to what you would make in real life.
[00:17:35] Speaker B: Right.
[00:17:35] Speaker A: Like, hey, I'm going to try to be the evil. You know, like, what would happen if I'm super evil? And, like, I made moral decisions against my own beliefs.
[00:17:47] Speaker B: Yeah.
It's interesting. I think there's a lot of jokes, or you'll find a lot of jokes online about people saying that they tried to be mean in a video game, and then it felt so wrong or so uncomfortable that they had to go back to an earlier save or change their decision or they couldn't handle it. Right. So I think you see a lot of that.
[00:18:07] Speaker A: Interesting. So let's jump into the Final Fantasy VII work that you did. So you looked at parenting styles through the lens of the video game Final Fantasy vii. So can you speak about what different parenting styles are there in case our listeners are not aware of them? And what did you discover through that work?
[00:18:27] Speaker B: So I'm editing a book on the psychology of Final Fantasy 7. It's called the Psycheist of Final Fantasy 7. And my own chapter in that book is on caregiving leadership and parenting representations through the idea that these are all tapping into a similar thing. Right. How you choose to act as a leader, how you choose to act as a caregiver.
One of the things I think is so interesting about Final Fantasy VII and games in general is that people come to them with, you know, who they are as a person and what they end up taking out of it is unique to what they look for. Right. So we have chapters on, like, B movie horror in that game, music theory, weaponry, and, like, medieval weaponry. And for myself, as I think about what I'm going to be like as a parent, I found myself thinking about caregivers and parenting representations in this game. That is very important to me. And so Final Fantasy VII is a game. Are you familiar with Final Fantasy 7?
[00:19:33] Speaker A: Yes, I am.
[00:19:34] Speaker B: Yes.
[00:19:35] Speaker A: But maybe we can provide some context for the audience, because maybe they don't. Not familiar. Yes.
[00:19:40] Speaker B: Yeah, that's. Yeah. So I can give a quick overview, which is you are part of a kind of ragtag team of eco terrorists that are going against this kind of large corporate entity that has stakes in every part of, like, development, whether it's energy and power to, like, creating media. Right. Like cartoons and media for children.
So it's a very epic tale, and it spans a long time, and it kind of gets Grander and grander until they're fighting like, kind of massive entities, threats to the world and so forth.
And so you can understand that in a narrative like that, people are talking about what. Why they do the things they do, what. What is their sense of meaning that motivates them to take on these grand actions.
And that speaks to this psychological concept called generativity, which is the interest in the world outside of yourself, what you have learned about yourself and what your identity is and how you're going to kind of leave a mark based on who you uniquely are.
And in the generativity phase, people tend to talk about, like, parenting and caregiving and stewardship of the planet.
And so I looked across all these characters and I looked for patterns in what they discuss and how often parenting and caregiving came up as their like, meaning and the source of their kind of grand actions in this game. And I found positive and negative representations. I found that there were when people were very upset and motivated to do harmful things to others, they spoke about how it was justified and right that they were doing those things because they had this more kind of authoritarian approach.
And I found when people talked about why they were protecting others, they talked about a need to protect others because they had this sense of self that was invested in caring and protecting and being helpful to specific people, like whether it's their children or someone that they've been mentoring or the planet itself. And so what I did was I compared that to parenting theories, right? What.
What informs this? Like, what is this tapping into?
There's a approach to parenting that kind of silos how people develop their parenting identity into four main categories.
So you have these four main pathways, right, to developing who you are as a parent. There are two more common ones. One is achievement, which is this idea that you've kind of scanned everything around you and you've developed a unique sense of who you are as a parent through integrating all these ideas that you've noticed that feel most like who you are as a person.
This was definitely viewable, and I covered it in the chapter through the lens of different characters.
There's also foreclosure, and I think this is probably the easiest one to remember because you just kind of take it wholesale from another place that you've seen it.
So these are people who say, like, I am like this because my parent was like this, right?
And then the other two parenting development styles, you can see them, you see them less, but you see the ramifications of them. So one is diffuse, where you kind of don't want to commit to anything. You don't really want to think about it. And so you just don't. You just don't have an idea of it, and you just kind of commit to things as they come up. And the other one's moratorium, where you just, like, don't have it and don't think about it at all. And so you can see it in the parent, in the people in the game and how they talk about themselves. And you can also see demonstrations of the different ways that people tend to fit into parenting, which, like authoritative being the healthiest, which is you tend to communicate. So people in the game are also parents, and you get to see them demonstrate parenting. And authoritative is a style where you communicate with your children. You explain why things are happening, and you build on what you know about them, and you build them towards what you think is the healthiest. And you explain to them that that's why you're doing each of the things you're doing. And then authoritarian is another parenting style, right, where you tend to tell. It's like a harsh discipline and tell people why the reason that you give them for why they're doing things is because you said so.
And you can see people doing this as a leadership style in the game as well. And then permissive parenting being the third most common, which is you just kind of let the kids do whatever.
All three of these parenting styles tend to have impacts on the children in different ways. And you can see that demonstrated in the game, too. And I. I cover that in the chat.
[00:25:05] Speaker A: It's fascinating how a game can reflect reality, you know, psychologically speaking. Like, I never thought about it before before meeting you, basically.
So. Thanks.
[00:25:16] Speaker B: And I think, like, I feel like I had thought about a little bit, right, Because I was thinking about what I'd be like as a parent and, like, building this identity. And I found myself, I guess, doing the more kind of integrated achievement style. Like, I. I'm looking towards these characters that I'm familiar with.
And then as I wrote the chapter, I realized, like, how much it actually was represented in the game. And one of my favorite parts of doing these presentations and advocacy is I think other people realize that too. And it's really helpful. Like, it's really. It could be very helpful to put it into words so they could connect to what they're seeing.
[00:25:55] Speaker A: Yeah, yeah, 100%.
Do you think parents and children see themselves when they play these games? Is that I wonder.
[00:26:05] Speaker B: I think so, Yeah. I definitely, after the. The presentation I gave on MASCULINITY in games. It covered all different types of games, from like Metal Gear Solid to God of War to the more recent Final Fantasy games, the ones with Clive and Jill. And a few people came up afterwards and they were talking about how they play games with their kids and they were hoping, you know, that they can choose games that they can discuss with their kids and talk about what's being represented and how they see it and how their kids sees it and so forth.
[00:26:41] Speaker A: That's actually a great point. It's a conversation starter. Right. These kinds of games for older kids, these games are not for, you know, the youngest, but yeah, definitely conversation starters.
Oh, we're going towards the end. So if you had to share one or maybe two takeaways for parents from today's conversations, what would it be?
[00:27:03] Speaker B: So one of the biggest. Well, I guess I'll say something for the research area and one for kind of the advocacy and gaming one is that there is a lot of work in mental health representations in games, different things that people can learn in games. That work is happening and it's out there. And they can find games where there are healthy messages and are things that could be learned. And so I would suggest that they look up researchers in this area, look up what people have said, and they can find games that they'll be satisfied to expose their children to, to play with their kids whatever they're comfortable with.
And then the second takeaway, the one that's more advocacy, is kind of what the takeaway was also for that Final Fantasy VII paper, which is the healthiest thing that you can do with your kids is really to communicate to them and explain your reasoning and kind of process together what you're going through. Like you said, use the game as a conversation starter.
And that can really happen with any game at any level, most games. But when I was very young, like 4 or 5 years old, my dad played Link to the Past and he would have me read the strategy guide to him. Right. So that was building reading skills. Right. So just connecting it to your child's kind of developmental level and doing the developmental appropriate conversation.
[00:28:37] Speaker A: It's a great idea. Reading the strategic instructions.
[00:28:40] Speaker B: Yeah, Very early memory and very positive one for video games.
Nice.
[00:28:46] Speaker A: So what gives you hope about the future of video games and their potential in mental health?
[00:28:52] Speaker B: I think a lot of things. I see a lot of people putting in a lot of work.
I see a lot of people talking about each component. Right. So you mentioned the empathy and then there's the skills building.
I know that research is really the shoulders of giants.
Right. And those giants are being built now. And I'm very excited and hopeful to see what the next steps are. Whether it's making more edutainment games for mental health skills, whether it's figuring out how to make more games that fit into treat the course of treatment. Right. More prescriptive games.
It's growing quickly and the most important part, growing effectively. Right. There's the efficacy and research supporting that now.
[00:29:42] Speaker A: Yep.
I, I share that hope. Games are such a powerful tool. Right. So we gotta use them for mental health and not probably against it sometimes. It's not that they're against it, but maybe I take that out.
So where can listeners go? Learn more about, more about your work.
[00:30:04] Speaker B: So I'm in, I'm in a bunch of places. I have a personal website that I try to keep updated with the different kind of advocacy work that I do, the research that I'm doing. And then I work at Rochester Institute of Technology, so I have a lot of connection through. Like I have a faculty page there and a lab, so can always be found there as well.
[00:30:28] Speaker A: Perfect. I'll add the URLs to the show notes so everybody can check them out.
And finally, is there a paper, because you have done so many things, is there one paper that you'd like to highlight for parents or educators?
[00:30:44] Speaker B: I think a lot of my research is in scientific writing, so it's not the kind of most engaging.
My dissertation was a meta analysis on all of the different. So a study of studies on all of the different digital treatments that target conflict and aggressive behavior. And so I looked at different components of them, different behaviors that they were targeting, and I found patterns across which ones were effective. So it, it's a very kind of educational read.
But if parents are looking to read something that covers kind of the state of the art and learn about how they can incorporate kind of a healthy relationship with gaming with their children into their relationship with their children. I think that there are a lot of psychologists doing that work. I know that the psychology series that I am doing, the Final Fantasy book for has a Psycheist of or a Psychology of Bluey book. So I think a lot of parents would enjoy that. Dr. Rachel Cowart, who organizes the Psyche series, she has a book about talking to children and understanding games as a parent. So I think her work is probably great to check as well. And I believe that there is, there are a few different people who are very prominent in this area. And obviously there's this podcast as well.
[00:32:17] Speaker A: Yeah. Yes.
But yeah. I'll put everything on the show notes, I'll research it, and definitely we'll add it there. Well, thank you so much. This was super interesting. Such a different perspective of video games, the work you do. I mean, we humanity needs it. So.
[00:32:34] Speaker B: Yeah. And I hope to kind of keep chipping away, helping and building that giant. Right.
Yeah.
[00:32:41] Speaker A: Thank you so much for listening to Pixel Parenting. If you enjoyed this episode, make sure to follow or subscribe so you don't miss what's coming next. And if you know other parents or caregivers who would love this conversation, share it with them.
Also, you can find the show notes and
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See you next time.
