Gaming and PTSD: 'I'm more relaxed and happy online'
A woman with post-traumatic stress disorder (PTSD) says playing video games has helped her manage her condition for more than a decade.
Jennie Manley, 34, from Swansea, was introduced to gaming by her now-husband, when she was 19.
She said: "Even when I wasn't playing, during everyday life, it felt easier."
Experts said more research was needed on the therapeutic value of gaming, but there was "scope" for it to help mental health problems.
Ms Manley, a mother-of-two, had tried to kill herself a couple of times: "I was extremely low, my anxiety was through the roof and I was very depressed."
But she said her anxiety and depression "seemed to ease off a bit while I was playing".
She explained that her anxiety was "easier to cope with because I'm not face-to-face with somebody" when talking online.
"I feel I can be more myself, whereas I'd normally be very nervous. I'm far more relaxed and happy when I'm online."
At one point, she would play for many hours every day, while holding down a job and being at university.
"Some people might see it as gaming too much, but I didn't go out drinking or go out with friends or go out shopping all the time - that was my way of socialising with people," Ms Manley said.
"I don't think it was too much for me - I went to work every day, I went to uni.
"My husband gamed with me at the same time."
Could video games be used to help with mental health issues?
"Having fun is healthy psychologically in general," said Dr Eva Murzyn, of the University of Edinburgh.
She focuses on how video games can have an impact on human cognition and behaviour.
But Dr Murzyn added that evidence of the self-driven therapeutic value of video gaming was "uncertain" and there was a need for more research.
There was a minor risk of addiction in gaming but "that's the case for pretty much every case of self-medication", she explained.
Dr Murzyn added that video escapism was something people would turn to if they "don't have access to proper therapy, resources and social support".
Dr Peter Etchells, a reader in psychology and science communications at Bath Spa University, said there was "not much research on how people deal with anxiety disorders with escapism".
But he said there was "definitely" scope for gaming to be used to relieve and treat mental health symptoms.
Virtual reality has been used in a trial to treat war veterans' PTSD and there is a video game designed to help children cope with grief.
Dr Etchells said that for people who are isolated, gaming immediately finds a "common interest" - the game that is being played.
He added that the risk of gaming addiction was relative to each person and there was no set number of hours that could result in it.
Prof Neil Greenberg, an academic psychiatrist from the Royal College of Psychiatrists, agreed there was scope "and indeed some evidence" that gaming could help mental health problems.
But he added: "There is also some suggestion that some people with PTSD may find that video games exacerbate their symptoms.
"At present, it's not clear who may benefit and quite what sort of games are likely to make a positive difference and what magnitude a difference playing games might play."
The World Heath Organization updated its guidelines to include "gaming disorder" as a mental health condition in 2018.
It defines it as a pattern of problematic or compulsive behaviour where the user prioritises gaming over all other activities, despite the negative consequences it might have on their health and life.
Ms Manley credits gaming with helping with promotions at work, where she went from barmaid to pot washer, to chef.
"I wouldn't have even had the confidence to ask for the pot-washing job to work my way up if it wasn't for gaming," Ms Manley said.
She added that "there are real-life aspects" of gaming as well, and said she and her husband made friends through it who visit them in person.
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Ms Manley, who is now a carer for her husband, reduced her gaming hours when she had children but now plays alongside them.
She said she believes that because she knows more about it than other parents, it makes it safer.
"The negative sides [to gaming] you see are mostly to do with kids," she explained.
"Parents don't know how to control the kids that are gaming.
"My kids game, they are limited to their times, we monitor what they're doing, they play the same games that I do but the people on there are aware that it's kids playing, they curb what they're saying."
If she had not found gaming, Ms Manley said she "wouldn't be the person I am today".
"I would probably still be a shell of anxiety, it's really helped my PTSD," she said.
"Honestly I don't know where I would be without it."