Systematic Review of Gaming and Neuropsychological

Neuropsychology Review
https://doi.org/10.1007/s11065-023-09599-y
REVIEW
Systematic Review of Gaming and Neuropsychological Assessment

of Social Cognition
Elodie Hurel1,2 · Marie Grall‑Bronnec1,2 · Orianne Bouillard1 · Marion Chirio‑Espitalier1,2 ·
Malcolm Barrangou‑Poueys‑Darlas1 · Gaëlle Challet‑Bouju1,2
Received: 1 July 2022 / Accepted: 24 May 2023

© The Author(s) 2023
Abstract
Playing video games is associated with cognitive changes and possibly psychosocial difficulties. Problematic gaming occurs
upon the loss of control over videogame playing; gaming disorder is considered a behavioral addiction in the 11th version
of the International Classification of Diseases. Models used to understand behavioral addictions include cognition as an
essential factor in the development, maintenance, and relapse of addiction. Nevertheless, some aspects of cognition, such as
social cognition, remain underexplored, despite evidence of alterations in cognitive and social function among patients with
problematic gaming. This review aimed to describe the current understanding of social cognition in individuals exposed to
videogames. We included all studies assessing social cognition in participants of any age with a wide range of exposure to
video games (from simple use of video games (such as at least two exposures) to problematic gaming, defined according to
the included study). This wide range of exposure allowed us to explore the whole process from repeated exposure to addic-
tion. We included only studies that used neuropsychological tasks to assess social cognition. Patient-reported outcomes that
could be biased by subjective self-report data were not included. The search was conducted from inception to January 2022
in three databases (PubMed, PsycINFO, and Web of Science). The systematic search identified 39 studies that assessed
facial emotion processing, empathy, theory of mind, social decision-making, aggressive behavior, and moral competence.
In general, results have been mixed, and a number of questions remain unanswered. Nevertheless, several studies showed
cerebral changes when processing facial emotion that were linked with problematic gaming, while no link was obtained
between nonproblematic gaming and empathy alterations. The influences of cooperation patterns, theory of mind, moral
competence, and gaming frequency were highlighted. Finally, there was substantial heterogeneity in the population assessed
and the methods used.
Keywords Video games · Gaming disorder · Social cognition · Neuropsychology · Problematic gaming
Introduction online battle arenas (MOBAs), first-person shooters (FPSs),

or even sandbox games (games without planned scenarios)
Video Gaming (Leouzon et al., 2019). Gamers can play for entertainment
but also to deal with anxiety, depression, or other psycho-
Video gaming is a modern leisure activity that refers to logical difficulties. Nevertheless, the causality of the rela-
the use of video games (VGs), such as massively multi- tionship between motives/psychological difficulties and
player online role-playing games (MMORPGs), multiplayer gaming is poorly understood (Sunil et al., 2021). Playing
VGs has been found to increase the activity of the sym-
pathetic nervous system (Krarup & Krarup, 2020). Gam-
* Gaëlle Challet‑Bouju
gaelle.bouju@chu-nantes.fr ing also leads to brain changes (Brilliant et al. 2019) and
enhances aspects of cognition, such as top-down atten-
1
CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes tion processes and spatial cognition (Bediou et al., 2018).
Université, Nantes F‑44000, France Regarding social function, time spent playing VGs is nega-
2
MethodS in Patient‑centered outcomes and HEalth ResEarch, tively associated with the quality of social relationships
SPHERE, Nantes Université, Univ Tours, CHU Nantes, (Lo et al., 2005). In contrast, psychological well-being and
INSERM, Nantes F‑44000, France
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social functioning were positively linked with VG use in a Regarding social functioning, PG was found to negatively
population of heavy gamers (van den Eijnden et al., 2018). impact social relationships (Ryu et al., 2018). More specifi-
Gamers also have high online social capital (i.e., network- cally, individuals with PG have high online social capital, as
ing and its resulting benefits (Williams, 2006; Collins & do gamers without PG, but low offline social capital (Collins
Freeman, 2013). & Freeman, 2013). Additionally, psychological well-being and
social functioning were negatively linked with the presence of
Problematic Gaming and Gaming Disorder PG (van den Eijnden et al., 2018) and were even a predictor of
it (Lemmens et al., 2011). The presence of PG has also been
The 11th version of the International Classification of Dis- linked to familial (Hyun et al., 2015), emotional, and behavioral
eases (ICD-11) (World Health Organization, 2018) defines problems (Frölich et al., 2016). Taken together, these findings
gaming disorder (GD) as “impaired control over gaming, suggest an alteration in social functioning in people with PG.
increased priority given to gaming over other activities to
the extent that gaming takes precedence over other interests Definition of Social Cognition
and daily activities, and continuation or escalation of gaming
despite the occurrence of negative consequences.” Another The literature suggests the presence of altered social func-
clinical definition was provided for Internet gaming disorder tioning among individuals with PG. Nevertheless, gamers’
(IGD) in the Diagnostic and Statistical Manual of Mental social functioning is less understood for those without PG.
Disorders, 5th edition (DSM-5), within the section outlining On the borderline between cognition and social functioning,
disorders requiring further investigation (American Psychia- there is social cognition (SC). This concept includes all cog-
try Association, 2013). Both IGD (in the DSM-5) and GD nitive processes underlying social interactions, from the abil-
(in the ICD-11) refer to similar disorders characterized by a ity to detect and identify social cues, to interpret social cues,
loss of control over video gaming leading to negative con- to the generation of socially appropriate responses (Adolphs,
sequences but have slight differences in operationalization 2001; Frith, 2008; Saxe, 2006). SC also allows people to
for diagnosis. construct social norms that will serve as standards for future
In the present review, we use the umbrella term “problem- social interactions (Beer & Ochsner, 2006; Bertoux, 2016;
atic gaming” (PG) to encompass the variety of clinical defi- Greifeneder et al., 2017). Indeed, given these social abilities,
nitions used in the studies reviewed. PG includes the clinical the “social brain” theory postulates that the human brain is
definitions provided in the international classifications (IGD larger than that of other species because of the complexity
in the DSM-5 and GD in the ICD-11) as well as other defini- of our social world and, specifically, our ability to bond with
tions used before the development of the ICD-11 or DSM-5 others (Adolphs, 2009). The crucial role of SC in daily func-
or within other conceptual frameworks used to characterize tioning has been demonstrated in several psychiatric clinical
excessive and harmful use of VGs (Schettler et al., 2022). In populations, such as patients who suffer from schizophrenia
the present review, the term PG is contrasted with nonprob- (Brunet et al., 2003; Couture et al., 2006).
lematic gaming (NPG) which is defined as leisure activity
without a loss of control or harmful consequences. Components of Social Cognition
The prevalence of PG is estimated to be between 0.7 and
27.5% in the general or gamer population, depending on the SC covers a wide spectrum of cognitive functions. SC
clinical definition used, with more men affected (Mihara & tasks can range from the simplest tasks (e.g., recognizing
Higuchi, 2017). an emotion on a face) to the most complex (e.g., under-
Models of the underlying processes of addictions are standing irony or social decision-making). Several models
multifactorial, and these processes include cognitive func- have been constructed to determine the number of SC com-
tioning, among other factors (Brand et al., 2016, 2019; ponents (Fiske & Taylor, 2016; Green et al., 2015; Happé
Noel et al., 2013). Indeed, alterations in inhibitory control & Conway, 2016). For example, it is debated whether the
(Argyriou et al., 2017) and in frontostriatal and frontocin- self should be included in this concept (Happé & Conway,
gulate networks (Yao et al., 2017) have been highlighted in 2016). Similarly, the inclusion of alexithymia (which
people with PG. Moreover, improvements in PG symptoms reflects the inability to identify and describe emotions expe-
have been linked to improvements in cognitive functioning rienced by oneself or others (Etchepare & Prouteau 2017;
(Lim et al., 2016). In contrast, NPG has been linked with Taylor et al., 1985) within the spectrum of SC is contro-
improvements in cerebral structures and connectivity and versial. Several authors have also proposed differentiating
optimization of neuronal recruitment, especially for attention SC components based on more general characteristics. For
and visuospatial skills (Palaus et al., 2017). example, the level of processing (e.g., high, low or dual
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processing (Adolphs, 2009, 2010; Etchepare & Prouteau, & Klimecki, 2014). It reflects the ability to infer mental
2017; Frith & Frith, 2008) or the nature of the stimuli states (cognitive ToM) or emotional states (affective ToM)
involved (affective versus cognitive stimuli) may be used of another person (Shamay-Tsoory & Aharon-Peretz, 2007).
(Adolphs, 2010; Etchepare & Prouteau, 2017; McDonald, It allows individuals to understand and predict the behavior
2013; Shamay-Tsoory & Aharon-Peretz, 2007). of others (Premack & Woodruff, 1978). ToM seems to be
In the following paragraphs, only SC components identi- supported by a network including at least the medial prefron-
fied in the literature and described with systematic research tal cortex (mPFC) and bilateral temporoparietal junctions
are presented for the sake of clarity. (Happé & Conway, 2016; Schurz et al., 2014). Attribution
style is defined as “how people deduce causal relation-
Social Information/Emotion Processing, Emotion ships and characteristics of other persons in the environ-
Attribution, and Affective Cognition ment” (Fiske & Taylor, 2016). Attribution style is linked to
the concept of ToM and allows the observation of hostile
The study of social or emotional processing can occur at two attribution bias, as found in individuals with schizophrenia
levels. The conscious level is assessed by asking the subject (Buck et al., 2020).
to identify an emotion or rate its intensity, for example. The
unconscious level can be measured when the participant
Social Decision‑Making
attends to another task while faces are presented. Facial
emotion processing seems to be supported by two networks.
On another level of reasoning, social decision-making is the
The ventral network deals with static stimuli and associated
ability to make a decision that will affect oneself and another
stimuli with information such as the identity of the face.
person, with the outcome depending on the behavior of one-
The dorsal network deals with dynamic stimuli (Duchaine
self and another person. This function seems to be supported
& Yovel, 2015). The ability to process emotions and make
by the prefrontal cortex but also by the amygdala and insula,
assumptions about them is also called affective cognition
which handle affective biases that impact decision-making
(Ong et al., 2015).
(Rilling & Sanfey, 2011).
Empathy
Aggressive Behavior
Empathy is the ability to feel what another person is feel-
ing and understand him or her (Lockwood, 2016). Several Aggressive behavior involves the administration of an
models of empathy have been proposed. For example, one unpleasant stimulus to another person (Taylor, 1967). Cogni-
model postulates that empathy has two components. The first tive activity associated with this behavior seems to be linked
component involves the ability to understand motives and with the dorsal part of the mPFC. The affective component
thoughts from another person (i.e., cognitive empathy). The (i.e., compassion during punishment) seems to be supported
second component involves the ability to experience the feel- by the ventral part of the mPFC (Lotze et al., 2007).
ings of another person (i.e., emotional empathy) (S. Shamay-
Tsoory et al., 2009). Another model separates empathy into
two different components. The first component, personal Moral Decision‑Making
distress, is self-oriented and reflects the tendency to try to
alleviate one’s pain. The second component, compassion (or Another component of SC is moral decision-making. This
empathic concern), involves the ability to feel sympathy for ability has 3 aspects: a particular predilection toward a
others (Singer & Klimecki, 2014). The function of empathy, moral orientation (affective component), the ability to
also called vicarious experience, seems to be supported by the make decisions regarding moral dilemmas based on those
anterior cingulate cortex and the anterior insula (Lockwood, moral aspects (cognitive component, also called moral
2016; Singer & Klimecki, 2014). competence), and the fact that decision-making is not
dependent on the issues in the particular situation (Jung
Theory of Mind, Attribution Style/Bias, and Intention et al., 2016; Lind, 2008). This ability is underpinned by
Attribution emotional and cognitive processes that come into play in
decision-making. For example, a higher level of moral
Another component that is sometimes considered similar competence has been linked to stronger functional con-
to affective empathy (Decety & Lamm, 2006; Lockwood, nectivity between the amygdala and the ventral mPFC and
2016) is theory of mind (ToM). ToM is also called men- weaker connectivity between the amygdala and frontopa-
talizing, mind reading, or cognitive perspective (Singer rietal control network (Jung et al., 2016).
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Social Knowledge Table 1 Keywords used in the database search

Gaming keywords Social cognition keywords
Social knowledge refers to all the information stored in
memory that can be used to infer mental states. This infor- Video game(s)/videogame(s) Social function(ing)
mation can be general, such as norms about how to behave in Gaming Social cognition/social cognitive
certain situations or places. Information may also be specific Game(s) Social interaction
to the person with whom the interaction takes place such Social brain
as history with that person (Achim et al., 2013; Langdon Social perception
et al., 2014). Social information processing
Affective cognition
Social Cognition and Gaming Emotion attribution
Emotion processing
The aim of this review is to describe the current understand- Empathy
ing of the relationship between SC and gaming. Indeed, it Mentalization/mentalising/mentalizing
seems that NPG, and, to a greater extent, PG, can impact Mind reading
both cognitive and social functioning (e.g., building relation- Attributional style
ships); thus, they may also impact SC (e.g., identification of Theory of mind
facial emotions). Furthermore poor cognitive functioning, Attribution bias
specifically poor SC, may lead to increased time spent gam- Intention attribution
ing and even PG. As SC involves both cognition and social Social decision
functioning, it is logical to explore the literature on SC in Social knowledge
gamers to elucidate the sociocognitive profiles of gamers
with or without PG. This review will also allow us to iden-
tify the SC competencies involved. SC-related keywords were determined based on the current
literature on SC, regardless of the theoretical model, to scan
a wide variety of SC components. The search focused on
Methods articles published in French or English.
Search Strategy
Inclusion and Exclusion Criteria
The search strategy was developed in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta- This systematic review focused on both NPG and PG. As
analyses (PRISMA) recommendations (Moher et al., 2009). SC in VGs is a recent research area, we chose not to restrict
The search was conducted from database inception through our review to any specific pattern of gaming exposure (e.g.,
January 2022. No registration was made, and no protocol early exposure during childhood, training people with no
was prepared. We initially planned to register the protocol VG experience, or controlled studies of people with and
of this literature review ahead of time with the PROSPERO without VG experience) or any level of exposure (e.g., fre-
registry. However, the registration was not accepted because quency of VG playing). However, we did not include stud-
the data explored were not considered related to a health ies that did not assess the frequency of VG exposure or did
condition (Moher et al., 2014). The search was performed not expose participants to VGs more than once. Indeed, a
in three databases (PubMed, PsycINFO, and Web of Sci- single exposure to VGs is insufficient to induce changes in
ence). Key words regarding SC and VGs were crossed (see cognitive functioning, as the repetition of an action (harm-
Table 1), resulting in the following search: (“video game” ful or therapeutic) is necessary. This strategy allowed us
OR “video games” OR “videogame” OR “videogames” to explore the whole process from repeated exposure to
OR “game” OR “games” OR “gaming” OR “gamer”) AND addiction and to identify the areas in which the literature
(“mentalization” OR “mentalizing” OR “mentalising” OR was the most developed and, conversely, the areas in which
“mind reading” OR “social cogniti*” OR “social interac- additional research is needed.
tion” OR “social function*” OR “social brain” OR “social Moreover, only assessments of SC based on neuropsy-
decision” OR “social perception” OR “affective cognition” chological performance (i.e., performance-based tasks
OR “social knowledge” OR “social information process- objectively linking behavior and the brain (Casaletto &
ing” OR “emotion attribution” OR “attributional style” OR Heaton, 2017) were included in this review. Studies using
“theory of mind” OR “emotion processing” OR “attribu- self-reported outcomes, which are subjective assessments
tion bias” OR “intention attribution” OR “empathy”). The made by the participant (Rothman et al., 2007), were not
13

included. Indeed, self-reported data are subjective, and they abstracts was performed using Abstrackr software (Wallace
do not allow an evaluation of the quality of cognition. et al., 2012) by the first and fifth authors. This software can
Articles were included if they (i) evaluated participants’ be used to save time by screening titles and abstracts based
frequency of gaming OR the effect of playing VGs more on machine learning that classifies titles as relevant or not
than once OR patients with PG AND explored its impact (Rathbone et al., 2015). We used it only as a collaborative
and (ii) included a neuropsychological task to assess SC. tool that was accessible online.
Because of the lack of information in abstracts, a large
Study Selection number of articles were retained during this abstract screen-
ing step. The methods of these articles were screened by
After the exclusion of duplicates, each title was screened the first and fifth authors to ensure that we did not miss
by the first author and excluded if it was clearly not within any study that could have included neuropsychological SC
the scope of the review (i.e., articles not considering VG tasks. Therefore, we read the methods of all articles dealing
as a leisure activity or not assessing cognition). This selec- with cognition in gaming, even without apparent SC assess-
tion process resulted in a large sample of abstracts that were ments and/or apparent exclusive use of self-rated question-
screened twice. The first reading by the first author excluded naires. Finally, the full texts of studies were read, and studies
abstracts that were clearly off-topic. The second selection of were included in accordance with the inclusion criteria. To
Table 2 Reasons for exclusion Reasons for exclusion based on titles (n = 8947)
at each step of screening
Not an original research article 282
Videogame (VG) was used as a tool or a serious game 2664
Not about gaming 5618
Not about cognition 384
Reasons for exclusion based on abstracts — first reading (n = 948)
Not an experimental research article 88
Not published in English or French 1
Not about gaming 56
VG is used as a tool or a serious game 55
Not focused on cognition 572
Single exposure and/or assessment of frequency of gaming 19
Not focused on social cognition 157
Reasons for exclusion based on abstracts — second reading (n = 119)
Not about gaming 5
Reasons for exclusion based on methods (n = 185)
Not about gaming 3
Reasons for exclusion based on full texts (n = 110)
Single exposure with no assessment of frequency of gaming 32
No social cognition (SC) neuropsychological task 38
Frequency of gaming was assessed but not used to study its impact on SC 18
Only short-term exposure to VG was assessed 7
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complete the database search, the first author performed a on their abstract, 15 were then screened based on their full text,
manual search and screening of the bibliographic references and 3 were finally included. All numbers and reasons for exclu-
of the studies included and from a recently published meta- sion at each step are included in Table 2 and Fig. 1. Moreover,
analysis regarding gaming and social outcomes (Greitemeyer all references from articles included in the systematic review
& Mügge, 2014). and previously published relevant meta-analyses (n = 23) were
also screened, and four articles were included from these lists. In
Data Extraction total, the systematic search resulted in the selection of 39 studies.
Each full text that was considered eligible was read by the
first author. Information about the study population, meas- Results Summary
ures of VG use or PG, cognitive assessment of SC, and
main results exploring the effect of VGS are presented in In these 39 studies, the average sample size was approxi-
Table 3. Table 3 also provides information on the power of mately 230 (min = 28, max = 3,034, median = 99, average
the studies reviewed, by categorizing studies according to sample size of comparative studies = 73, average sample
their methodology (comparative or correlational studies). A size of correlational studies = 342).
summary is provided at the beginning of the “Results” sec- The mean age of participants included in these studies
tion to describe demographic information, SC outcomes, and was 20.13 years (min = 5.06, max = 32.04, 3 studies with
VG information. In the interpretation of the results, we were missing data, mean age of comparative studies = 22.12,
careful to differentiate the results from samples of gamers mean age of correlational studies = 18.78). Participants
with and without PG. Indeed, this may provide information were mostly male (59.64%) (2 studies with missing data).
on the links of SC with NPG versus PG. Within the 39 studies, 23 different SC outcome meas-
ures were used to assess 6 components of SC (facial emo-
tion processing, empathy, ToM, social decision-making,
Results aggressive behavior, and moral competence). Of the 39
studies, 27 found significant results regarding SC outcome
Research included in the previously published meta-analysis measures (11 on facial emotion processing, 1 on empathy,
(Greitemeyer & Mügge, 2014) led to the screening of 52 addi- 6 on ToM, 2 on social decision-making, 5 on aggressive
tional records. From these 52 studies, 34 were screened based behavior, and 2 on moral competency).
Fig. 1 Flowchart of the system-

atic review PubMed (n = 5,160) Records identified Additional records
PsycINFO (n = 4,318) through database identified through
Web of Science (n = 3,854) searching (n= 13,332) other sources (n= 58)
Records after duplicates removed (n= 10,348)
Titles screened (n= 10,348)

Screening
First screening of abstracts (n= 1401)
Second screening of abstracts (n= 453)

Elgibility
Methods assessed for eligibility (n= 334)
Full text assessed for eligibility (n= 149)

Included
Studies included in qualitative synthesis (n= 39)
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Regarding VG information, only 13 experiments of 43 gamers without PG. Studies have shown that years of expe-
provided information regarding the type of VG played by rience with VGs could improve emotion identification and
gamers (8 assessing facial emotion processing, 2 assessing that the number of hours played may negatively impact joy
empathy, 2 assessing ToM, and 1 assessing social decision- identification (Miguel et al., 2017). Exposure to VGs may
making). Moreover, a large number of experiments (32 of 43) also be linked with worse ability to identify negative emo-
focused on exposure to violent VGs. Among them, 19 found tions (Miedzobrodzka et al., 2021a). Moreover, VG players
significant results (8/11 on facial emotion processing, 1/5 on seemed better at recognizing fear but worse at recognizing
empathy, 4/7 on ToM, 2/2 on social decision-making, and 4/7 disgust than controls (Diaz et al., 2015). Additionally, a
on aggressive behavior). Additionally, 11 studies included fre- study found that professional e-sport players and controls
quent video gamers, 4 included addicted video gamers, and 27 displayed similar abilities in identifying identical emotions;
included individuals from the general population (23 assessed both were lower than the capacity of professional baseball
the frequency of gaming, 3 exposed to VGs, and 1 assessed players. In the same study, the authors showed that elite
the severity of addiction). Among the 15 studies assessing at e-sport players displayed faster reaction times than the
least regular gamers, 12/15 (80%) reported significant results rest of the group (Kang et al., 2020). Finally, no difference
in the domains of facial and social emotion processing (n = 7), appeared between VG players and non-VG players in the
social decision-making (n = 2), aggressive behavior (n = 2), identification of morphing emotions (Pichon et al., 2021).
and moral competence (n = 1). Among the studies conducted Using the reading the mind in the eyes task (RMET), no
in the general population, 16/28 (57%) found significant link between violent VGs and RMET scores was found
results (5 assessing facial emotion processing, 1 assessing in participants after 8 weeks of VG practice (Kühn et al.,
ToM, 6 assessing empathy, 3 assessing aggressive behav- 2019). With the same task, a positive link between the abil-
ior, and 1 assessing moral competency). Finally, 19 studies ity to infer correct mental states and better VG (MOBA)
included a control group. Among them, 13 (68%) found sig- performance was observed (Bonny et al., 2020).
nificant results, while 15/24 (63%) studies without a control In comparisons of participants with PG and controls
group showed significant results. on tasks assessing unconscious processing of faces (Peng
Regarding the assessment of addicted gamers, three et al., 2017) and cartoons and faces (He et al., 2019), stud-
studies used the Internet Addiction Test (IAT (Young, ies have shown differences in ERPs. For example, one study
2016)), and one of them used the DSM-5 criteria to clas- showed a reduction in the N170 component, which reflects
sify participants. All three reported significant results. the detection of a face (Schweinberger & Neumann, 2016),
in the PG group when processing neutral faces compared to
Detailed Results on Each SC Domain happy faces. There was no reduction in the control group.
Another study showed a larger peak in response to cartoons
To facilitate understanding, the articles are presented accord- faces than in response to human faces in only the right hemi-
ing to the various components of SC assessed and ranked sphere in the PG group, while this difference was present in
from the most recent to the oldest in Table 3. both hemispheres in the control group. These results suggest
specific alterations in the processing of facial stimuli in PG
Facial/Social Emotion Processing (see Table 3 for details). Moreover, when comparing PG
patients to controls or to patients with methamphetamine use
Thirteen articles explored the link between exposure to disorder on a task of social perception, both patient groups
VGs and social emotion processing. Cerebral processing displayed lower scores than the control group (Jiang et al.,
was assessed in some of these studies. For example, the 2020). Finally, a higher number of symptoms of PG were
articles compared the performance of two groups of play- linked with worse scores on the RMET (Aydın et al., 2020).
ers of violent VGs (frequent or infrequent players) on the
stop signal task (SST) and recorded event-related potentials Empathy
(ERPs). The unconscious processing of emotional facial
stimuli was different for happy faces, with smaller ampli- Five studies assessed empathy in a population of gamers.
tudes observed in frequent players (Stockdale et al., 2017). No differences were found regarding empathy between fre-
Regarding the detection of emotional stimuli, research has quent and nonfrequent gamers, using an empathy-for-pain
shown that after 10 h of training on VGs (action or nonac- task with emotional stimuli (photography or drawings) and
tion), differences in reaction times are observed between functional magnetic resonance imaging (fMRI) (Gao et al.,
the nonaction VG group and control group, and the type of 2017; Szycik et al., 2017). No significant changes were
VG played had influences the impact on cerebral process- observed, after an 8-week period of exposure to VGs (Kühn
ing (Bailey & West, 2013). Finally, seven studies assessed et al., 2018). However, comparisons of individuals with low
the ability to process and discriminate facial emotions in exposure to violent VGs with individuals with a high level of
13

Table 3 Description of articles found in the systematic search
First author, year of publi- Population assessed Group characteristics Gaming information SC measure Main results
cation
13
Facial emotion processing
Group comparisons
Pichon et al. (2021) Study 1: prticipants that Study 1: 47 VG players AVGPs: played 5 h per week Study 1: face stimuli: mor- Study 1: no difference between
answered local ads (AVGP): mean age = 22.3, of FPSs and 1–5 h per week phing expression over a groups in emotional identifi-
Study 2: university students SD = 4.3; 50 non-VG players of another VG. NVGPs: sequence of 15 steps, from cation in both sessions. Study
(NVGP): mean age = 24.2, played at most 5 h per week sad to angry and from pain 2: no group difference in
SD = 5.1 across all games possible to happy as well as from discrimination
Study 2: 27 AVGPs (mean and 1 h at most of each pos- neutral to pain, happy, fear,
age = 22.81, SD = 2.69); 27 sible VG or sadness in session 2.
NVGP (mean age = 22.96, Participants had to identify
SD = 3.66) the emotion displayed.
Study 2: facial animation of
3 facial muscles randomly
chosen among 42 possible
action muscles. After each
animation, participants had
to categorize the emotion
displayed among 7 possible
choices (happy, sad, angry,
fearful, surprised, disgusted
or other), and had to rate the
intensity of emotion
Kang et al. (2020) Professionals gamers (e-sport EPG: n = 55, mean age = 21.3, EPG: included an elite group Emotion perception test: The PBG group displayed faster
players group; EPG) and SD = 1.4; PBG: n = 57, (n = 12) that participated in 108 trials with 2–8 faces reaction times than the EPG
professional baseball players mean age = 21.3, SD = 1.4. 80% of games each season; displayed on the screen. Par- and the CG. The elite group
(pro-baseball group; PBG) Control group (CG) from PBG: included an elite ticipants had to indicate if in the EPG displayed faster
the general population group that attended 144 all faces presented displayed reaction times on the emotion
matched on sex, n = 60, major league games out of the same emotion or not perception test than the rest of
mean age = 21.3, SD = 1.5 144 or that had 446 plate the EPG group
appearances

Table 3 (continued)
cation
Jiang et al. (2020) Patients from a mental health Internet gaming disorder The IGD group met the IGD The interpersonal perception The IGD and MD groups had
facility and citizens of Wuxi (IGD) group: n = 30, mean criteria of the DSM-5; task (IPT-15) was used to similar IPT-15 scores. Both
age = 22, SD = 5, 53.3% the MD group met the measure social perception. groups scored lower than the
male. Methamphetamine criteria of MD dependence It consists of 20 min of NC group

(MD) group: n = 30, mean according to the DSM-5, video of 15 scenes including
age = 22, SD = 6, 43.3% had a cumulative MD use one to four roles. Five social
male. Normal control of over 50 mg, and spent roles were possible (kin-
(NC) group: n = 30, mean less than 2 h per day on ship, intimacy, deception,
age = 22, SD = 6, 50% males the Internet. The NC group competition, and status).
excluded smokers, alcohol Participants had to identify
use disorder or substance the correct role displayed in
dependence; participants the scene
spent less than 2 h per day
on the Internet
He et al. (2019) Undergraduate students from PG group: n = 15, mean PG group: IAT score ≥ 80, Oddball paradigm: partici- Analyses showed that, for char-
Wuhan University age = 20.97, SD = 1.65. Internet gaming addiction pants indicated the change acter faces, the PG displayed
Control group: n = 15, mean scale (IGAS) score ≥ 7, in size of the fixation cross enhanced P100, P200, and
age = 21.02, SD = 1.70 mainly played “Strike of while pictures of faces MMN components, and an
Kings,” and PG diagnosis (humans or characters from absence of left dominance
according to a clinical inter- the VG “Strike of Kings”) of the N170 component. The
view led by two psychia- appeared. Participants were PG group also displayed an
trists. Control group: IAT to ignore the faces. Two advantage when processing
score ≤ 40, IGAS score ≤ 3, blocs were included, one characters
preferred to play “Strike of with humans as standard
Kings” stimuli and characters as
deviant stimuli (with a
ratio of 8:2) and vice versa.
EEG data were continually
recorded
Kühn et al. (2019) Participants from the general Violent video game (VVG) The VVG group played Grand Reading the mind in the eyes No effects of the VVG were
population group: n = 25, mean Theft Auto 5 for 8 weeks, task (RMET; attribution of was shown
age = 26.6 years, SD = 6.0, 30 min a day, while the complex emotions based on
14 females. Active active control group played photographs of eyes) along
control group: n = 24, Sims 3 for weeks, 30 min a with several other non-SC
mean age = 25.8 years, day. The control group was tasks
SD = 6.8, 12 females. not given a game to play

Control group: n = 28, mean
age = 30.9 years, SD = 8.4,
12 females
13
Table 3 (continued)
cation
13
Stockdale et al. (2017) University students Frequent players of violent, Frequent players played at The stop signal task (SST) SST results: no significant
graphic VGs: n = 30. Infre- least 30 h of VGs per week, involved two emotions difference was found between
quent players of violent, with 2 violent VGs out of displayed by faces: happy groups
graphic VGs: n = 31. Mean 3 VGs played. Infrequent or afraid. Participants were Regarding the P100/N200 and
age = 20.68, SD = .21 players played no more than asked to press the button to P300 components, smaller
5 h a week, with 2 nonvio- indicate if the face presented amplitudes were observed
lent VGs out of 3 VGs was male or female and in frequent players than
to refrain from pressing infrequent players, specifi-
the button if a striped box cally for happy faces. For the
appeared around the stimu- N170 component, infrequent
lus. The difficulty increases players had shorter laten-
when participants produce cies to identify fearful facial
correct answers. EEG data expressions than for happy
were continually recorded facial expressions
Frequent players had shorter
latencies for happy expres-
sions than for fearful expres-
sion in go trials. In stop trials,
frequent players had lower
mean amplitudes than infre-
quent players
Peng et al. (2017) Local university students of in PG group: n = 16, mean PG group: participants with Faces (neutral or happy/sad The CG was faster than the
Shenzhen, China age = 20.75, SD = 0.36. an IAT score ≥ 40 who spent depending on the block) PG group on the sad block.
Control group (CG): n = 16, at least 4 h a day and 30 h a were displayed on the screen Reduced amplitudes of the
mean age = 20.24, SD = 0.4 week on Internet games and with a backward mask N170 component (reflect-
had scores of less than 40 paradigm permitting the ing facial processing) were
points on the Zhung Self- observation of unconscious observed for the PG group
Rating Depression Scale processing. Participants had when processing neutral
and the Zhung Self-Rating to indicate if the stimuli faces compared to happy
Anxiety Scale were emotional or neutral. ones, while the CG did not
EEG data were recorded show any difference in this
situation. No other difference
between groups was found
Diaz et al. (2015) Undergraduate students from N = 152, 73 males, mean Prescreening was used to A facial emotion identifica- No overall effect of group was
the University of Calgary age = 20.45, SD = 3.12 select participants playing tion task was used in which found. VVG players were
0 h of VVGs per day or at participants had to evaluate more accurate and faster in
least 2 h per day of VVGs the emotion displayed by identifying fearful faces than

(realistic or fantasy, accord- the face or the gender of nongamers. Nongamers were
ing to the Entertainment the face (in the control more accurate in identifying
Software Rating Board) condition). The intensity of disgusted faces than VVG
emotion was low, medium players
or high
Table 3 (continued)
cation
Bailey and West (2013) Students from Iowa State Nonexposure group: n = 9 Subjects reported playing 0 h The emotion search task was Attenuation of reaction times
University (mean age = 24.22, of gaming per week and used; this task presents was found when comparing
SD = 8.43). Action weekend at baseline. The matrices with 9 faces to par- the nonexposure group to
group: n = 10 (mean nonaction group played ticipants, who are instructed the nonaction group, with a
age = 20.40, SD = 2.01). Tetris for 1 h each day for to decide whether an emo- diminution of difference in
Nonaction group = 9 (mean 10 days, while the action tional face (angry or happy) reaction time according to tar-
age = 21.77, SD = 4.02) group played an action is among the neutral faces. get presence for the nonaction
game for the same amount This task was performed group. Effects on cerebral
of time. The nonexposure with EEG recording processing were different
group did not play VGs. The between gaming groups.
three groups were assessed For example, there was a
twice, separated by 10 days decrease in attention to happy
faces in the action group
(shorter latencies of the P3
in the action group between
pretest and posttest), while
the nonaction group showed
differences in the process-
ing of targets (difference in
the P3 electrode on the right
hemisphere, with a greater
amplitude between pretest
and posttest). An analysis
of latent variables was also
conducted (see the original
article for details)
Correlational studies
Miedzobrodzka et al. (2021a) High school students (study Study 1: N = 69, mean Both studies: VVG exposure Both studies: the facial There was a negative relation-
1) and university students age = 17.06, SD = 0.69. was computed according expressions matching test ship between VVG exposure
(study 2) Study 2: N = 151, mean to rating of the frequency was used, which measures and accuracy in the rec-
age = 26.68, SD = 6.93) and violent content of VGs the ability to recognize ognition of negative facial
played negative facial expres- expressions in adolescents
sions (disgust, fear, anger, and adults
sadness). Four faces were
displayed. Participants were
instructed to match the face
in the center with the emo-

tion of one of the three faces
shown on the bottom
13
Table 3 (continued)
cation
13
Aydin et al. (2020) 8th grade secondary school 477 students Internet gaming disorder test RMET, child version: 28 Poor negative emotion recogni-
students (IGDT): self-report of 6 photographs with only the tion was linked to PG symp-
subscales of IGD symptoms region of the eyes were toms and may be a vulner-
displayed. Participants had ability factor for PG
to choose the emotion dis-
played among four options
Bonny et al. (2020) Players of MOBA (Dota 2) N = 335 (31 females, Participants provided a Steam The RMET was used a RMET accuracy was a
attending a tournament 311 males), mean account for statistics data. measure of ToM. Only pic- significant predictor of the
age = 23.418 years, Experience was assessed tures of eyes were shown; MMR. Better RMET scores
SD = 4.075) by the number of matches participants had to decide had a greater impact on the
completed. Player perfor- which emotion was shown performance improvement
mance was assessed using among four options. In the in party (i.e., playing with
the match making rating economic cooperation task, familiar people) games than
(MMR, calculated by the participants had to choose solo games
algorithm of the platform whether to cooperate with There was no association
and not available) and the strangers for a fictional between VG exposure and
win–loss ratio (WLR). company. If both cooper- visual attention allocation
Several measures of gaming ated, the profit was higher Results of the economic task
experience were recorded than if both defected. If were not included in the
(T0 = at the tournament, only one cooperates, their analysis because of poor
T2 = at 3 months and T3 = at company had an economic reliability
4 months) disadvantage compared to
the company of the partici-
pant that defected
A task of elicited attention
using a line drawn eye gaze
cue was used to assessed
attentional allocation to
visual cues

Table 3 (continued)
cation
Miguel et al. (2017) Participants recruited via N = 164, mean age = 18.93, A game preference question- The computerized test of A positive correlation between
online systems SD = 6.36, min = 14, naire was created to assess primary emotion perception the time spent playing VGs
max = 59, 123 females the frequency, type of game, (PEP) included 38 sound- (in years) and the general
and who players played less videos in which actors perception of emotion were
with, etc displayed emotions that the found. Moreover, a negative
participant had to identify correlation between playing
hours and attribution of joy
was found; in other words,
greater VG exposure led to
worse identification of joy.
A correlation between the
frequency of meeting people
to play and general emotion
perception was highlighted, in
which the more you met, the
better the emotion identifica-
tion
Empathy
Group comparisons
Kühn et al. (2018) General community, recruited N = 90, mean age = 28, No VG use in the past Twenty-eight photographs No desensitization for pain
using flyers and Internet SD = 7.3, range = 18–45, 48 6 months. Training con- of hands with tools were (diminution of reaction
advertising females. VVG group: n = 26, sisted of playing VGs for shown during fMRI scans; to presentation of violent
mean age = 27, SD = 6.1, eight weeks, approximately half of the photos contained stimuli) was found
14 females. Active game 30 min a day. The VVG painful contexts
control group: n = 24, mean group played Grand Theft
age = 26.1, SD = 6.9, 13 Auto, the active control
females. Passive con- group played the Sims, and
trol group: n = 30, mean the passive control group
age = 30.8, SD = 8.3, 13 did not play any VGs.
females Assessments took place
before the gaming training
(baseline), right after the
2 months of training (T1)
and then 2 months later (T2)
Szycik et al. (2017) Only males. VVG group: The VVG group included Drawings with black lines No differences between groups
n = 15, mean age = 22.8, participants who played (varying in emotional were found

SD = 4.3 years. Con- FPSs for at least 4 years for charge [yes/no] and social
trol group: n = 15, mean 2 h daily. The control group context [yes/no]) were pre-
age = 22.1, SD = 3.0 reported no experience of sented for 4 s during fMRI
playing VGs scans. Participants were
asked to look at them care-
fully and imagine how they
would feel in that situation
13
Table 3 (continued)
cation
13
Gao et al. (2017) Southwest University, China 20 students from the 25th Two hundred undergraduates In the fMRI, painful or No difference between groups
percentile (low-exposure) completed the Ander- nonpainful pictures of hands was found
and 20 students from the son and Dill video game were displayed. Participants
75th percentile (high-expo- questionnaire in which they were asked to concentrate
sure) of VG exposure. Age listed the VGs played and and imagine the experience
range: 18–27 years, mean then rated the amount of of the persons whose body
age = 21.17, SD = 0.065. VG violence in each VG and the parts were shown in the
group: n = 18. Nongaming frequency played. A score picture
group, n = 17 of VG exposure was then
calculated
Ferguson and Colwell (2020) Mail and social media diffu- 125 participants (57 men), Participants listed their three A vignette of rape was pre- No effect of VVG or sexualized
sion mean age = 26, SD = 11.2 favorite VGs and rate the sented to participants, and a VG exposure on empathy
frequency of play of each. scale of empathy toward the toward the rape victim was
Each VG was rated in term victim was used to assess found
of violence and sexualized feelings (Gabbiadini et al.,
content 2016)
Miedzobrodzka et al. (2021b) University students N = 58 (100% male), mean VVG exposure was measured Pain judgment task: in this The P3 component (particularly
age = 22.41, SD = 3.42, right using the name of their task, participants viewed sensitive to aversive stimuli)
handed three favorite games, the pictures of hands in painful and the P625 are reflective
time spent on these games, or nonpainful contexts, of top-down responses to
and official violent content while EEG data were painful pictures. Regard-
ratings recorded. Participants had ing the P3: no difference
to categorize each picture was found between painful
as painful or not. Intensity and nonpainful pictures in
of pain was rated within a the high-exposure group, in
second block contrast to the low-exposure
group, suggesting desensitiza-
tion. Regarding the P625: a
difference between painful
and nonpainful pictures (with
higher amplitudes for painful
pictures) was found in both
groups
Theory of mind — attribution bias

Ferguson and Wang (2019) Children N = 3034. Mean age at VVG exposure was meas- Hostile aggression bias was No link between hostile bias
T1 = 11.21, SD = 2.06, mean ured using the name of the measured with six ambigu- and exposure to VVG was
age at T3 = 13.12, SD = 2.13 three favorite games, the ous scenes. Children had to found
time spent on these games, rate the level of aggressive
and official violent content intent in each scene
ratings
Table 3 (continued)
cation
MacGowan and Children 73 typically developing Mother reported time spent ToM was assessed using six At T1, gaming of boys nega-
Schmidt (2021) (TD) children (39 female). gaming in the past 7 days tasks: knowledge access, tively predicted ToM scores
Two assessments: mean unexpected contents, real- at T2. No link between ToM
age at T1 = 54.7 months, apparent emotion, Smarties, scores and gaming time was
SD = 2.8, mean age at the Sally Ann first order observed in girls
T2 = 66.7 months, SD = 2.8 false belief and second order
false belief tasks
Hopp et al. (2018) Online survey N = 312, 60.77% male, mean VGs played were listed and Eight stories were used. No significant relationships
age = 32.042, SD = 9.927 rated in terms of violence Participants had to rate the were found between exposure
and the frequency played behavior and the intent as to FPS military-themed VGs
hostile, instrumental, or and hostile attribution bias
benign
Zhen et al. (2011) Adolescent students in urban 795 students divided into VGs played were listed and Presented with ambiguous Hostile expectations may medi-
China three groups. Grade 5: then rated regarding their stories, participants had to ate the relationship between
n = 232, mean age = 11.63, violent content and the imagine and write down ten VVG exposure and physi-
SD = 0.57. Grade 8: frequency played possibilities of what hap- cal aggression. However,
n = 247, mean age = 14.82, pened next. The number of mediation effects were not
SD = 0.59. Grade 11: aggressive possibilities was significant for most of the
n = 316, mean age = 16.80, recorded subgroups (according to
SD = 0.59 grade or sex)
Moller and Krahe (2009) Secondary school students 3 waves of a longitudinal VVG exposure was assessed Four scenarios were pre- Aggressive norms mediated the
assessment: T1 (n = 295, with questionnaires sented, in which participants link between hostile attribu-
mean age = 13.34, SD = .83) regarding VGs played and had to decide if the harm tion bias and VVG exposure.
and T2 (30 months later, frequency occurred was on purpose Moreover, VVG exposure at
n = 143) T1 seemed to impact aggres-
sion (measured by self-report
questionnaires) by increasing
aggressive norms (measured
with a self-report question-
naire) and hostile attribution
bias. No significant direct link
between VVG exposure and
hostile attribution was found

13
Table 3 (continued)
cation
13
Eastin and Griffiths (2009) Midwestern University N = 162, mean age = 21.50, VG experience was measured Participants completed three VG experience was positively
students SD = .80, range = 18–41 by assessing how long ambiguous stories and correlated with hostile
participants had played VGs had to decide what would attribution bias: greater VG
in terms of which frequency happen next and what the experience was associated
and duration character was feeling or with higher hostility bias
thinking (20 answers).
Answers were then catego-
rized as aggressive/hostile
or nonaggressive/nonhostile.
Hostile expectation scores
corresponded to the number
of hostile answers divided
by the total number of
answers
Gentile et al. (2009) (first of Singaporean secondary school 7th grade: n = 446. 8th grade: Frequency of gaming, the Six ambiguous stories were A negative correlation was
the three studies) children n = 281. Mean age = 13.0, content of games played used, and participants had to found between exposure to
SD = 0.79 and the number of hours per explain the event prosocial VGs and hostile
week played were rated attribution bias, while VVG
exposure was positively cor-
related with hostile attribu-
tion bias
Krahé and Moller (2004) 8th grade students N = 231, mean age = 13.6, VVG exposure was measured Four scenarios were proposed No significant correlation
SD = 0.63 by self-reports of liked and in which participants had to between frequency of VVG
played games, frequency, rate the hostile intent use and hostile attribution
and duration of use. The bias was found
rating of violence was
determined by two groups
of experts
Funk et al. (2003) Children 8- to 12-year-olds: n = 35, Self-reports revealed gaming Ten drawings depicting Regression results revealed a
mean age = 10.14 years, frequency and content. This stories in which empathy negative association between
SD = 0.97. 5- to 7-year-olds: study also studied the short- or aggression were induced VVG exposure and empathy
n = 31, mean age = 5.61, term impact of gaming were read to children. scores
SD = 0.62 Children had to say what
follows (assessing ToM)
and how they would react.
A higher score for empathy
vignettes indicated higher

empathy, and a higher score
for aggressive vignettes
indicated higher aggression
Table 3 (continued)
cation
Social decision-making (group comparisons)

Su et al. (2018) College students from Fuzhou Problematic Internet game use The PIGU group was com- Both economic games were No significant difference was
University, players of (PIGU): n = 23. Occasional posed of participants with played with a friend, with a found on the PD task, but
“League of Legends” Internet game use (OIGU): an IAT score ≥ 50, at least recently met experimenter there was a reduced tendency
n = 23 14 h of Internet gaming per who played with the par- to cooperate on the CG task
week, with gaming as the ticipant just before, and a in the PIGU group compared
principal activity among stranger. Prisoner’s dilemma to the OIGU group. Both
Internet activities. The (PD): single exposure, groups were more cooperative
OIGU group was composed participants could give 0 with their friends, but only
of participants with an IAT to 10 talers. Talers given the PIGU group displayed
score ≤ 50 and no more than were doubled if the other similar levels of cooperative
7 h of gaming per week for participant cooperated and behavior between friends and
at least 1 year lost if the other participant the game mate just met in the
did not cooperate. The CG task
chicken game (CG): single
exposure, the riskiest choice
was to defect
Jin and Li (2017) (only study Undergraduate students from N = 132, 102 men, mean Groups were composed based Social dilemma task: 10 trials, Inexperienced gamers tended
three is presented) Sichuan University, China age = 18.93, SD = 2.01, on the total gaming expo- 1 yen for each trial. Partici- to be more cooperative than
range = 18–21. Experienced sure. Those in the top 25% pants could give coins to the experienced gamers, even
players: 67 participants. comprised the experienced partner; money was doubled when controlling for experi-
Inexperienced players: group, and those in the if the partner cooperated or mental conditions
n = 67 bottom 25% comprised the lost if they did not
inexperienced group. Three
experimental conditions
were used in which two
participants performed a
task together: 2 players from
the same group (experi-
enced or nonexperienced) or
one player from each group
(experienced and nonexpe-
rienced)
Aggressive behavior
Group comparisons
Pichon et al. (2021) Same as previously explained Same as previously explained Same as previously explained Study 1: CRT with zero as a Study 1: In the CRT, the AVGP

in this table in this table in this table possible level of noise blast group displayed higher level
in Session 1 of aggression than the NVGP
group
13
Table 3 (continued)
cation
13
Engelhardt et al. (2011) Undergraduate students Age range: 18–22 years A subgroup of 2000 under- The CRT was used. Par- Participants who played an
graduates who completed ticipants were told that they aggressive VG were more
a survey on VG habits would play a rapid game aggressive than the other
(number of hours per week against another participant group (mean = − 0.59),
and violent content). One and that the loser would regardless of previous experi-
subgroup was randomly receive a noise blast with ence. The level of aggression
selected from the bottom the duration and intensity was mediated by desensitiza-
25th percentile (low-expo- decided by the winner. In tion to violence (according
sure group); the other was reality, they played against to EEG) in low-exposure
selected randomly from the a computer, and intensity participants
75th percentile (high-expo- and duration chosen were
sure group) used to a measure aggres-
sive behavior. Participants
played a violent or a nonvio-
lent VG and viewed violent
or nonviolent photos during
EEG recording before the
CRT
Arriaga et al. (2011) College students N = 58, mean age = 22.6, Participants were separated The CRT was used. Partici- For non-VGH participants,
SD = 2.5, range = 18–27 based on violent game pants were then interviewed no difference in aggressive
habits (VGH, n = 30, played to determine their moti- behavior was found between
VVGs in the past 3 months) vations regarding their before and after playing VGs.
and not having a habit of answers. Participants were For the VGH group, partici-
playing violent games (non- also asked to play a violent pants who played the VVG
VGH; did not play a violent or nonviolent VG before displayed more aggressive
game in the past 3 months, behavior than participants
n = 28) that did not play the VVG
before
MacGowan and Children Same as previously explained Same as previously explained Prosocial behavior was only Regarding prosocial behav-
Schmidt (2021) in this table in this table assessed at T2. It consisted ior, there was no significant
of engineered interactions association with time spent
with the experimenter (one gaming, in girls or boys
in which the experimenter
drops a tape, another in
which the experimenter
drops paperclips). Latency

to help the experimenter
was the measure of proso-
cial behavior
Table 3 (continued)
cation
Devilly et al. (2021) University students and non- 151 participants (141 A questionnaire about media The modified Taylor com- Media exposure and specifi-
student gamers university students, 10 usage was used to assess petition reaction time task cally VVG exposure did not
nonstudent gamers recruited weekly media usage, includ- (TCRTT) was used, with a predict the level of aggression
via announcements), 59 ing type of media (TV, “no sound” option indicat- on the TCRTT
males (mean age = 54.44, movies, VGs) ing a nonviolent answer
SD = 8.95) and 92 females
(mean age = 22.89,
SD = 7.72)
Ferguson and Rueda (2010) Young adults from a N = 103, mean age = 23.6, VG habits were assessed with The CRT was used. Before No link was found between pre-
Hispanic-serving public SD = 2.82 a self-report in terms of this task, participants played vious exposure to VVGs and
university the frequency and violent a violent game (high violent aggression in the laboratory
content of VGs or morally acceptable
violent games), a nonviolent
game or no game at all
Ferguson et al. (2008) (first Undergraduate students N = 101, mean age = 20.9, VG habits were assessed with The CRT was used. Before No significant effect of past
study) SD = 3.7, range = 18–40 a self-report in terms of the CRT, participants played VG exposure on aggressive
the frequency and violent the (assigned or chosen) behavior was found, and there
content of VGs VG, which could be violent was no interaction with VG
or nonviolent play before the CRT

13
Table 3 (continued)
cation
13
Bartholow et al. (2006) Undergraduate students N = 39, mean age = 19.5, only VVG habits were assessed The CRT was used. Pictures VVG exposure was highly
men (only 34 participants with a self-report in terms (violent or not) were also correlated with aggression
were included in the results) of the frequency and violent presented while EEG data scores. In the VVG group,
content of VVGs were recorded the levels of aggression
were negatively correlated
with the amplitude of the
P300 (reflecting information
processing, in this study:
reaction to violent pictures).
A separate regression analysis
showed that increased VVG
exposure was associated with
greater aggression in the CRT
Additionally, the greater the
difference in P300 amplitudes
between violent and non-
violent pictures (with higher
reactions to violent pictures),
the greater the aggression
was. Finally, when separating
the frequency and content of
the game, only VVG exposure
(not the frequency) was corre-
lated with higher aggression
scores
Bartholow et al. (2005). Two Undergraduate students Subset of participants of the This study assessed the short- The CRT was used. A violent Participants with higher VVG
studies. Only one assessed other study described in the term effect of VG expo- or nonviolent VG was exposure displayed more
social cognition with cogni- article (n = 92, from 18 to sure and measured VVG played before the CRT aggressive behavior than
tive measures 22 years old) exposure participants with low VVG
exposure, especially for
those who played a VVG just
before the CRT
Tamborini et al. (2004) College students N = 182, 99 males, mean VVG and VG exposure in Aggressive behavior was No variable predicted aggres-
age = 20.57, SD = 1.52, general were assessed with a assessed by a research assis- sive behavior
range = 18–30 self-report of the amount of tant. Participants were told
time spent playing VG that an applicant applied for
a position at the laboratory

and that they had to rate the
courteousness, competency,
and worthiness of deserv-
ing financial support. Low
scores indicated a high level
of aggressive behavior
Table 3 (continued)
cation
Moral competence
Group comparison
Sofia and Klimenko (2019) Undergraduate students N = 236, 20% of males Two subsamples were created The moral competency test A positive correlation between
from the global sample (MCT) asked participants frequency of play and MCT
never/rarely play and play to rate the resolution of scores was shown; greater fre-
twice or more. The experi- two moral dilemmas on a quency of play was reflected
mental group saw an excerpt scale regarding their agree- in a higher MCT score, but
of a VG moral dilemma at ment with the resolution. only for those in the experi-
the end of the semester A higher score showed mental condition who had to
high consistency in moral think about a specific moral
reasoning dilemma
Correlational study
Krcmar and Cingel (2016) University students N = 65, median age = 20 Frequency of VG play in last Participants were told to play Participants who reported
week and last month was a VG and had to explain playing more frequently each
rated the reasons for each of their week were more likely to
choices in the VG. Each use moral reasoning during
choice was coded as strate- VGs. Moreover, VG use was
gic choice/reasoning (aimed significantly linked with the
to improve the character/ foundation of fairness/reci-
progress in the game) and/or procity
moral reasoning (irrelevant
to progress but reflected
morality). For each moral
choice, a rating on the
foundation behind it was
made (harm/care, fairness/
reciprocity, in-group/loyalty,
authority/respect, purity/
respect)
CRTCompetitive Reaction Time Task, EEG Electroencephalogram, ERPs Event-related Brain Potentials, fMRI Functional Magnetic Resonance Imaging, FPS First-person Shooter, IAT Internet
Addiction Test (Young, 2016), IGAS Internet Game Addiction Scale (Cui, 2006), GD Gaming Disorder, SC Social Cognition, MMN Mismatch Negativity, SD Standard Deviation, ToM Theory
of Mind, VG video games, VVG Violent Video Games

13
exposure revealed a desensitization to painful stimuli (i.e., Aggressive Behavior

similar EEG results for painful and nonpainful stimuli) in
only the high-exposure group (Miedzobrodzka et al., 2021b). Nine studies explored the link between the frequency of
Finally, no link between violent VG exposure and a scale playing VGs and the competitive reaction task (CRT)
measuring empathy for a rape victim was found (Ferguson which is designed to explore aggressive behavior. In this
& Colwell, 2020). task, participants are instructed to react as fast as pos-
No study was identified that assessed empathy in PG. sible to a noise stimulus. The loser (i.e., the slowest indi-
vidual) is punished by a blast of noise, with the duration
Theory of Mind/Bias of Attribution and intensity of noise are decided by the winner. In most
experiments, tasks are programmed to provide half of the
Nine studies explored ToM in relation to VG exposure. Among victories to the participant, and the intensity and duration
them, eight studies explored ToM by means of stories. Stud- of the blast of noise are measures of aggressive behavior
ies with young children showed no link between the rate of (Chester & Lasko, 2019; Taylor, 1967). These studies have
aggressive intent in ambiguous stories and exposure to VGs shown mixed results. A higher level of exposure to violent
(Ferguson & Wang, 2019). Nevertheless, when using vignettes VGs has been linked to a more aggressive response pattern
in which participants had to tell what was going on next but also (Bartholow et al., 2005, 2006) and specific EEG responses
how they would have reacted in stories that were designed to in reaction to violent pictures (Bartholow et al., 2006).
induce empathy, a significant link between higher exposure to Interestingly, in this last study, the authors separated the
violent VGs and lower scores was reported (Funk et al., 2003). effect of content (violent or not) from the frequency of
Studies with adolescents showed a negative correlation between play, and the link with aggressive behavior was signifi-
exposure to prosocial VGs and hostile attribution bias as well cant only in relation to the content. Furthermore, action
as a positive correlation between hostile attribution bias and VG players displayed a higher level of aggression than
exposure to violent VGs (Gentile et al., 2009). Moreover, one nonplayers (Pichon et al., 2021). Moreover, a tendency
study did not find a relationship between exposure to VGs and to display greater aggression in the CRT after playing
attribution bias (Krahé & Möller, 2004). Finally, attribution bias a violent VG was found, regardless of previous gaming
was identified to mediate the relationship between exposure to experience (Engelhardt et al., 2011). Nevertheless, among
VGs and behavior (Möller & Krahé, 2009; Zhen et al., 2011). a population of regular gamers, this link was found only
Studies with adults showed a positive correlation between expo- in the group that played a violent VG and not in the group
sure to VGs and levels of aggressive thoughts, feelings, and that played a neutral game (Arriaga et al., 2011). Finally,
behaviors attributed to characters in ambiguous stories (Eastin no links were found in four other studies (Devilly et al.,
& Griffiths, 2009). However, no link between attribution bias 2021; Ferguson & Rueda, 2010; Ferguson et al., 2008;
and frequent exposure to FPSs was reported (Hopp et al., 2018). MacGowan & Schmidt, 2021).
Finally, in a study of children that used six different tasks to Another type of measure was used in the last study:
assess ToM, gaming time negatively predicted boys’ scores on participants were asked to rate the profile of an applicant
the ToM task after a year (MacGowan & Schmidt, 2021). for a paid position in the laboratory in terms of compe-
tence, courtesy, merit of financial support, and merit of
Social Decision‑Making employment. Lower ratings were considered a measure of
aggressive behavior. No link was found between exposure
One study assessed social decision-making in undergradu- to VGs and the level of aggressive behavior (Tamborini
ates relative to their experience with VGs. This study showed et al., 2004).
that experienced gamers tended to be less cooperative than No study was identified that assessed aggressive behavior
nonexperienced gamers (Jin & Li, 2017). in PG.
One study assessed social decision-making in PG using
the chicken game paradigm. The chicken game is an eco- Moral Competence
nomic game in which two players have to simultaneously
make a decision. In this paradigm, not cooperating is the Two studies assessed moral competence in a popula-
riskiest option but has the highest gain. PG patients tended tion of students and showed a positive link between the
to take riskier options and cooperate less than controls (Su exposure to VGs and moral reasoning during VG play
et al., 2018). Moreover, PG patients displayed comparable (Krcmar & Cingel, 2016). Moreover, exposure to VGs
levels of cooperative behavior when playing either with a was also correlated with moral competence (Sofia & Kli-
friend or a game mate who they just met in the chicken game menko, 2019).
task. In contrast, controls were more cooperative with only No study was found on moral competence and PG.
their friend.
13

Discussion should be interpreted with caution because the psychometric

properties of the RMET appear to be fragile (Higgins et al.,
This article aimed to review all studies assessing SC with 2022; Pavlova & Sokolov, 2022). Indeed, one limitation of
neuropsychological tasks NPG and PG. Thirty-nine arti- studying SC is that cognitive tasks are mainly experimen-
cles that examined several aspects of SC were identified. tal and statistically weak. There is no consensus regarding
Regarding facial emotion processing, the results of con- the assessment of SC in the general population. Neverthe-
scious facial emotion processing were mixed, but the results less, this limitation has been overcome in the framework
of unconscious and cerebral processing suggested that a of schizophrenia. Indeed, researchers have studied several
change in processing emotions can in participants with PG. components of SC and identified tools to assess them, pro-
However, the variety of methods and populations assessed posing a gold standard of SC assessment in schizophrenia.
did not allow us to conclude that better or worse abilities The social cognition psychometric evaluation (SCOPE)
were linked to VG use or PG. The results involving empa- study concluded that the hinting task (hint understanding),
thy mostly showed no differences linked to the use of VGs. the Penn Emotion Recognition Test (ER40, facial emotion
Attribution bias studies had mixed results and assessed mul- recognition) and the Bell Lysaker Emotion Recognition
tiple populations (children, adolescents, and adults). Social Task (BLERT, facial/vocal/body emotional identification)
decision-making studies reported a change in the processing were the tools with the strongest psychometric properties
of social distance (assessed when playing with friends or and should be used in clinical trials (Pinkham et al., 2018).
strangers just met in the game) in the PG population. Studies Replicating such work in other pathologies or for the general
also showed less cooperative behavior in the adult popula- population may improve assessments of SC and understand-
tion linked to NPG and PG. Regarding aggressive behav- ing of the SC in gamers.
ior, the results were mixed, and further research is needed.
Nevertheless, half of the studies did not find a link between Gaming and Empathy
exposure to VG and CRT scores. Studies with PG are lack-
ing. Finally, two studies showed that higher moral compe- Regarding empathy, no effects of VGs were found in studies
tence when presented with a moral dilemma was linked to using fMRI and diverse cognitive tasks. The interpersonal reac-
higher VG exposure. tivity index (IRI (Davis, 1983)) is a self-report questionnaire
that comprises fantasy and perspective-taking subscales (two
Gaming and Face Processing measures of cognitive empathy) and empathic concern and per-
sonal distress subscales (two measures of affective empathy). A
Numerous studies were reviewed in this article, which shows study that used to IRI to assess problematic Internet users found
the interest in and the importance of understanding the link no stable associations (Melchers et al., 2015). However, when
between facial emotion processing and gaming. Neverthe- another questionnaire, the empathy quotient (Baron-Cohen &
less, the neuropsychological data did not clearly indicate Wheelwright, 2004), was used, a link was found between lower
deficits or improvements in identifying facial emotions but levels of empathy and higher problematic Internet use (Melchers
rather suggested cerebral changes in facial emotion process- et al., 2015). Furthermore, no differences were found when
ing. PG patients exhibit deficits in EEG studies and more comparing PG and NPG players (Collins & Freeman, 2013).
precisely in the P300 component, which reflects attention These data suggest that PG is not associated with a diminution
allocation (Kuss, 2018). Moreover, it has been shown that of empathy. Nevertheless, more studies are needed to reach con-
excessive Internet users also display altered early processing clusions regarding the profile of empathy among gamers and
of faces in terms of ERPs (He et al., 2011). Thus, studies specifically those with PG. For example, no study has explored
have suggested changes in the cognitive processing of faces. the affective and cognitive components of empathy, such as
These changes need to be confirmed. The preservation of those proposed in the substance use disorders population with
emotion identification also needs to be confirmed with other the Condensed and Revised Multifaceted Empathy Test (MET-
studies in regular NPG and PG. CORE) (Grynberg et al., 2017). This study showed an alteration
Three studies used the RMET to assess the ability to in the cognitive ability to decode complex emotions but pres-
identify complex facial emotions based on pictures of eyes ervation of sharing abilities (affective component, as assessed
(Kittel et al., 2022). One study showed no effect of VG by self-reports cited herein). Thus, further studies are needed
exposure (Kühn et al., 2019). Another study identified a link to explore whether PG is associated with the same patterns of
between negative emotion recognition and PG (Aydın et al., alterations as those observed with substance use disorders. If
2020). Finally, one study demonstrated a positive association this is the case, it would suggest that alterations in cognitive
between improved emotion recognition and MOBA com- empathy are linked to addiction per se and not to the ingestion
petencies (Bonny et al., 2020). Nevertheless, these results of neurotoxic substances.
13

Finally, in the general population, it has been shown that Gaming and Social Decision‑Making
asking participants to feel empathy while in the fMRI scan-
ner during an empathy-for-pain task created a bias for pain- Studies assessing VG experience with and without addiction
ful faces, with an overestimation of the intensity on faces showed a tendency for reduced cooperation by experienced
(Naor et al., 2020). This study showed that SC components players. In PG, the study by Su et al. (2018) showed less
such as empathy and facial emotion processing are not dis- overall cooperation during the chicken game, suggesting a
crete functions and that they have to be measured together preference for risky situations or less cooperative behavior.
to evaluate their reciprocal impacts. Specific patterns of responses were also found in nonsocial
decision-making tasks in this population, with the same level
Gaming, Theory of Mind, and Aggressive Behavior of preference for risky decision-making (Dong & Potenza,
in the General Aggression Model (GAM) 2016). Moreover, PG subjects tended to prefer short-term
rewards (Dong & Potenza, 2014). Therefore, it is not clear
Studies assessing ToM and VGs mainly focused on attribution whether these subjects choose riskier situations or display
bias and showed mixed results, while aggressive behavior was less cooperation per se.
mainly assessed with the CRT and yileded mixed results. For Finally, during the chicken game (Su et al., 2018), PG
those two SC components, correlational methods have mainly players tended to cooperate with game mates as much as
been used, making interpretation more complex and less power- they did with friends and cooperated less often with occa-
ful. Two studies suggested that immediately after having played sional players. These results suggest that game mates were
violent VGs, there is an increase in aggressive behavior, but viewed as friends. PG participants, therefore, seem to pre-
only for frequent gamers (Bartholow et al., 2005, 2006). This sent a specific pattern of relationships that may be altered
aspect has not been explored in the PG population. This field in real life but not online.
of research was developed in relation to the general aggression Social decision-making has been explored in relation to
model (GAM) (DeWall et al., 2011). This model postulates that PG and NPG, and research has shown that players’ decision-
repeated exposure to violent VGs impacts cognition by increas- making seems to be marked by decreased cooperation. Nev-
ing aggressiveness and then increasing aggressive behavior ertheless, the pattern of decision-making in individuals with
(Greitemeyer & Mügge, 2014). In our review, 18 out of 31 PG is a tendency to choose the riskiest options (Schiebener
studies found significant results when assessing the impact & Brand, 2017), explaining this lack of cooperation. More
of exposure to violent VGs. Moreover, several meta-analyses research is needed to determine whether the tendency to
explored the impact of violent VGs on aggression showing that cooperate is altered or impacted by the tendency to make
violent VGs seem to be linked to aggression (Anderson et al., riskier decisions.
2010; Bushman & Huesmann, 2006; Prescott et al., 2018).
Other meta-analyses have shown no effect of VGs on aggres- Gaming and Moral Competency
sive behavior (Elson & Ferguson, 2014; Ferguson and Kilburn,
2010; Sherry, 2001). Another meta-analysis reported nuanced Regarding moral competence, both studies described in
these results and as VGs impacted social outcomes (behavio- this review suggested an improvement in moral compe-
ral, cognitive, affective and arousal measures, all mixed in the tence associated with VG frequency, highlighting a positive
analysis) by increasing aggressive cognitions and decreasing impact of VGs (Krcmar & Cingel, 2016; Sofia & Klimenko,
prosocial outcomes (violent VGs) and increasing prosocial out- 2019). The authors linked these results to the fact that play-
comes and decreasing aggressive cognitions (prosocial VGs) ers used to violent VGs tended to more easily emotionally
(Greitemeyer & Mügge, 2014). The variety of the methods used connect with the character presented in the moral dilemma
in the reviewed studies prevents firm conclusions, highlighting (Sofia & Klimenko, 2019).
the complexity of the relationships between violent VGs and More research is needed to determine whether VG play-
aggressive behavior. More research is needed, and future stud- ers show higher moral competence than nongamers and to
ies should consider using a thorough assessment of VG habits explore this aspect in the PG population.
together with a wide ranging assessment of aggressive behavior
(using both cognitive tasks and self-report measures). Impact of SC as a Whole
Studies on aggressive behavior are absent from the PG
literature, and this topic needs further research. Only four studies of 39 used more than one task to assess
Additionally, aggression is rarely cited in theoretical SC, thus preventing conclusions regarding on an overall SC
models of SC, as it may be considered a biased behavior profile among video gamers. Such an overall profile can
rather than a cognitive ability. Nevertheless, aggression can only be investigated by using a combination of measures,
also be conceptualized as a non-prosocial behavior that falls which may facilitate investigation of links between several
under the spectrum of SC. components of SC. Thus, there is a need for studies to assess
13

SC in video gamers using a combination of measures to Limitations

assess a combination of SC components. Such multimodal
assessment may also provide useful insight into the manage- Limitations of the Included Studies
ment of PG, by enabling therapists to focus treatment on the
specific functions that are altered. Most included studies had a small sample size and assessed
Additionally, SC may be linked with social functioning students from universities, which is a recruitment bias.
in gamers or with the motive to play. Indeed, the profile of Moreover, most research assessing the effects of long-term
SC may be different depending on what is looking for in exposure to VGs has not assessed addictive symptoms, yet
VG by gamers. Complementary studies including levels of the presence of addictive symptoms can bias the results.
loveliness and motivation to play may allow us to examine Additionally, all included articles assessed only one com-
the bigger picture of SC in gamers. ponent of SC and therefore did not permit the generation of
SC profiles of participants, which could allow us to examine
Problematic Gaming and SC the links among SC components. Finally, most studies used
correlation methods or group comparisons, but no longitu-
Interestingly, all studies including PG participants found sig- dinal study was included, which does not allow us to make
nificant results when assessing SC abilities. Indeed, when conclusions about the causality of identified links.
presented with facial emotions, PG subjects displayed unique
cerebral functioning in two studies (He et al., 2019; Peng
et al., 2017). Compared to controls, PG patients displayed Limitations of the Review
a deficit in social perception similar to that of patients with
methamphetamine use disorder (Jiang et al., 2020). Addi- Several limitations arose from the articles reviewed in this
tionally, lower scores on the RMET were linked to Inter- article. In particular, heterogeneity was the main character-
net PG symptoms (Aydın et al., 2020). Finally, PG patients istic of the research included. Indeed, variations in partici-
displayed lower cooperation than control participants who pants included age groups, definitions of PG (based on either
played a VG (Su et al., 2018). These deficits were be linked international classifications — GD/IGD — or not), and
with alterations at the on a cerebral level in adolescents gaming intensity; methods used and components assessed
(Schettler et al., 2022) and adults (Yan et al., 2021) with did not allow comparison between studies or generaliza-
PG. Specifically, hyperconnectivity of networks supporting tion of results. Given this heterogeneity, this review did not
affective processes (limbic structures and cortex networks) include a meta-analysis, and therefore, we could not draw
and hypoconnectivity of structures supporting cognitive conclusions regarding specific alterations or preservations of
control (such as frontoparietal areas) have been highlighted cognitive functioning. Moreover, SC is a wide concept that
(Yan et al., 2021). Finally, studies assessing children and could benefit from a consensus about which components
adolescents must be considered carefully because the brain should be included and how to assess them. Regarding the
and other cognitive functions are still under development information collected about PG, the main limitation was the
and must be considered in transition (Kilford et al., 2016). lack of homogeneity in the methods used, which highlights
On the other hand, no massive effect of exposure to the necessity to conduct new research examining PG and SC.
VGs appeared in the experimental literature. It would be
interesting to assess addictive symptoms as a function of Future Directions
VG frequency or exposure to determine if the differences
observed in this literature search, specifically those that This review showed that VGs have been investigated through
show alterations in SC, are linked with an addictive pro- the prism of SC but with many different methods and popu-
file. Indeed, as explained in Bandura’s model, psychoso- lations, leading to mixed results. Nevertheless, studies exam-
cial functioning can be explained as individual factors, ining PG and SC remain scarce. Understanding SC abilities
such as cognitive functioning, reciprocally interacting with in VG players with or without addiction is essential to (i)
the environment and behavior (Bandura, 1986). In the con- better understand mechanisms of addiction and (ii) better
text of VG use (behavior), the presence of alterations in inform the treatment of patients with PG by developing spe-
SC (individual factor) may be a vulnerability factor that cific cognitive remediation programs that focus on specific
leads to addictive disorders. Reciprocally, the repetition of alterations in SC. Questions that remain unexplored are as
behavior and time spent playing VGs may lead to altera- follows: (i) whether offline relationships are impaired and
tions in SC. In the same way, social capital or relationships whether this impairments is explained by deficits in SC or
(the environment) reciprocally interact with VG use and withdrawal from offline relationships because of an overin-
alterations in SC. More longitudinal studies are needed to vestment in online relationships; (ii) whether the difficul-
answer these questions. ties related to offline relationships are present before the
13

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review. EH and MBPD did the screening of the articles. EH wrote the aggression, empathy, and prosocial behavior in eastern and
draft, and all authors provided feedback and helped shape the manu- western countries: A meta-analytic review. Psychological Bul-
script. All authors have approved the manuscript. letin, 136(2), 151–173. https://doi.org/10.1037/a0018251
Argyriou, E., Davison, C. B., & Lee, T. T. C. (2017). Response inhi-
Funding Elodie Hurel received funding from the University of Nantes bition and Internet gaming disorder: A meta-analysis. Addictive
in the form of a doctoral allowance for her PhD. Additionally, this study Behaviors, 7.
received funding from the two French gambling operators holding Arriaga, P., Monteiro, M. B., & Esteves, F. (2011). Effects of playing vio-
exclusive rights (FDJ and PMU), as part of the implementation of the lent computer games on emotional desensitization and aggressive
French obligation to finance scientific studies on gambling and related behavior1. Journal of Applied Social Psychology, 41(8), 1900–1925.
addictive disorders (Law n° 2010-476 of May 12th modified, art. 3). https://doi.org/10.1111/j.1559-1816.2011.00791.x
Aydın, O., Güçlü, M., Ünal-Aydın, P., & Spada, M. M. (2020). Meta-
Availability of Data and Materials Data and code sharing is not appli- cognitions and emotion recognition in Internet gaming disorder
cable to this article as no datasets were generated or analyzed during among adolescents. Addictive Behaviors Reports, 12, 100296.
the current study. https://doi.org/10.1016/j.abrep.2020.100296
Bailey, K., & West, R. (2013). The effects of an action video game
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Bandura, A. (1986). Social foundations of thought and action: A
Ethic Approval Not applicable. social cognitive theory (pp. xiii, 617). Englewood Cliffs, NJ,
US: Prentice-Hall, Inc.
Competing Interests EH, MGB, MBPD, MCE, GCB, declare that the Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient: An
Endowment Fund of the University Hospital of Nantes received fund- investigation of adults with Asperger syndrome or high function-
ing from the gambling industry (FDJ and PMU) for the present study as ing autism, and normal sex differences. Journal of Autism and
part of the implementation of the obligation to finance scientific stud- Developmental Disorders, 34(2), 163–175.
ies on gambling and related addictive disorders (Law n° 2010-476 of Bartholow, B. D., Bushman, B. J., & Sestir, M. A. (2006). Chronic
May 12th modified, art. 3). This funding is carried out in the form of a violent video game exposure and desensitization to violence:
sponsorship donated to the Endowment Fund of the University Hospital Behavioral and event-related brain potential data. Journal of
of Nantes whereas the sponsor of the study is the University Hospital Experimental Social Psychology, 42(4), 532–539. https://doi.
of Nantes, making it possible to guarantee the scientific independence, org/10.1016/j.jesp.2005.08.006
objectivity and impartiality of the research work. Bartholow, B. D., Sestir, M. A., & Davis, E. B. (2005). Correlates and
consequences of exposure to video game violence: Hostile per-
Open Access This article is licensed under a Creative Commons Attri- sonality, empathy, and aggressive behavior. Personality & Social
bution 4.0 International License, which permits use, sharing, adapta- Psychology Bulletin, 31(11), 1573–1586. https://d oi.o rg/1 0.1 177/
tion, distribution and reproduction in any medium or format, as long 0146167205277205
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provide a link to the Creative Commons licence, and indicate if changes Bavelier, D. (2018). Meta-analysis of action video game impact
were made. The images or other third party material in this article are on perceptual, attentional, and cognitive skills. Psychological
included in the article's Creative Commons licence, unless indicated Bulletin, 144(1), 77–110. https://doi.org/10.1037/bul0000130
otherwise in a credit line to the material. If material is not included in Beer, J. S., & Ochsner, K. N. (2006). Social cognition: A multi level
the article's Creative Commons licence and your intended use is not analysis. Brain Research, 1079(1), 98–105. https://doi.org/10.
permitted by statutory regulation or exceeds the permitted use, you will 1016/j.brainres.2006.01.002
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Systematic Review of Gaming and Neuropsychological

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Systematic Review of Gaming and Neuropsychological

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Neuropsychology Review

Systematic Review of Gaming and Neuropsychological Assessment

Received: 1 July 2022 / Accepted: 24 May 2023

Introduction online battle arenas (MOBAs), first-person shooters (FPSs),

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Social Knowledge Table 1 Keywords used in the database search

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Fig. 1 Flowchart of the system-

Records after duplicates removed (n= 10,348)

Titles screened (n= 10,348)

First screening of abstracts (n= 1401)

Second screening of abstracts (n= 453)

Methods assessed for eligibility (n= 334)

Full text assessed for eligibility (n= 149)

Studies included in qualitative synthesis (n= 39)

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male. Methamphetamine criteria of MD dependence It consists of 20 min of NC group

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Social decision-making (group comparisons)

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exposure revealed a desensitization to painful stimuli (i.e., Aggressive Behavior

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Discussion should be interpreted with caution because the psychometric

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SC in video gamers using a combination of measures to Limitations

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