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A survey of 529 participants compared High vs Low Hikikomori Risk using the NEET-Hikikomori Risk scale. No genre differences emerged between groups, but high-risk participants reported more negative player interactions, preferring cooperative gameplay and favoring narrative, action, adventure and strategic elements.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/extreme-social-isolation-risk-is-associated-with-story-driven-strategic-and-cooperative-first-gameplay-preferences-research-article/280554/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/extreme-social-isolation-risk-is-associated-with-story-driven-strategic-and-cooperative-first-gameplay-preferences-research-article/280554.png","ImageObject",442,249,{"name":88,"@type":89},"Levi","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-30","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"How were participants grouped to assess hikikomori risk?","Question",{"text":109,"@type":110},"Participants were classified into High and Low Hikikomori Risk (H-NHR and L-NHR) using the NEET-Hikikomori Risk (NHR) scale.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Did the study find a relationship between hikikomori risk and favorite game genres?",{"text":114,"@type":110},"No significant relationship was found between favorite game genres and hikikomori risk tendencies across the compared groups.",{"name":116,"@type":107,"acceptedAnswer":117},"What gameplay tendencies distinguished high-risk players in the thematic analysis?",{"text":118,"@type":110},"High-risk players reported more negative player interactions and showed a preference for cooperative over competitive gameplay, with positive mentions of narrative, action, adventure, and strategic elements.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},280554,1791738692,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":142},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","OPEN ACCESS  \nCitation: Confessor B, Perusquía-Hernández M, Liew K, Siriaraya P, Matsuda Y, Kimura E, et al. (2026) Extreme social isolation risk is associated with story-driven, strategic and cooperative-first gameplay preferences. PLOSMent Health 3(7): e0000517. [https://doi](https://doi). org/10.1371/journal.pmen.0000517  \nEditor: Lucas Murrins Marques, Santa Casa de Sao Paulo School of Medical Sciences, BRAZIL Received: June 20, 2025  \nAccepted: May 19, 2026  \nPublished: July 29, 2026  \nPeer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pmen.0000517  \nCopyright: © 2026 Confessor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,  \nRESEARCH ARTICLE  \nExtreme social isolation risk is associated with story-driven, strategic and cooperative-first gameplay preferences  \nBrian Confessor1¤*, Monica Perusquía-Hernández1☯, Kongmeng Liew2☯, Panote Siriaraya3☯, Yoriko Matsuda1‡, Erika Kimura1‡, Yutaro Hirao1‡, Hideaki Uchiyama1‡, Kiyoshi Kiyokawa1‡  \n1 Nara Institute of Science and Technology, Ikoma, Japan, 2 University of Canterbury, Christchurch, New Zealand, 3 Kyoto Institute of Technology, Kyoto, Japan  \n☯ These authors contributed equally to this work.  \n‡ YM, EK, YH, HU, and KK are also contributed equally to this work.  \n¤ Current address: Nara Institute of Science and Technology, Ikoma, Nara, Japan.  \n* [rocha_confessor.brian.rd2@is.naist.jp](rocha_confessor.brian.rd2@is.naist.jp)  \nAbstract  \nVideo-games could help players deal with hikikomori – extreme social withdrawal. However, it is still unclear what game elements are preferred by this audience, and thus it is difficult to design game-based interventions for them. To address this gap, we investigated the gaming preferences of hikikomori players through a survey (N = 529) . To focus on those at higher risk of becoming hikikomori, participants were categorized into High and Low Hikikomori Risk (H-NHR and L-NHR) using the NEET-Hikikomori Risk (NHR) scale. Open-ended questions were asked about participants’ opinions towards favourite games, single-player, multiplayer, and online games. We quantitatively compared favourite game genres and hikikomori risk tendencies, finding no significant relationship between the two groups. Inductive thematic analysis showed that H-NHR players reported experiencing more negative player interactions, preferring cooperative over competitive gameplay. These resonate with the heightened social anxiety and sensitivity to social rejection that have been known to exacerbate the hikikomori condition. Moreover, there were several positive mentions of action, adventure, narrative, and strategic gameplay elements from the H-NHR group. From our findings, we summarise game design features that could be used in future game-based interventions to help hikikomori players overcome their social withdrawal without worsening their conditions, such as short play sessions, simple mechanics, involving narratives and location-based elements.  \nIntroduction  \nHikikomori refers to a severe form of social withdrawal that has affected millions of people worldwide over the last decades, and is particularly pronounced in Japan  \nPLOS Mental Health | [https://doi.org/10.1371/journal.pmen.0000517](https://doi.org/10.1371/journal.pmen.0000517) July 29, 2026 1 / 27  \nand reproduction in any medium, provided the original author and source are credited.  \nData availability statement: All data are in the paper and/or Supporting Information files, which are stored in the Open Science Framework repository under the DOI 10. 17605/ OSF. IO/5JBHY, and available through [https://](htt","cbCaimRVzuXbMaYH","https://ap.wps.com/l/cbCaimRVzuXbMaYH","pdf",806978,27,"English","# Abstract\n## Study design and participant grouping\n## Preference comparisons and thematic findings\n## Implications for game-based intervention design\n# Introduction","[{\"question\":\"How were participants grouped to assess hikikomori risk?\",\"answer\":\"Participants were classified into High and Low Hikikomori Risk (H-NHR and L-NHR) using the NEET-Hikikomori Risk (NHR) scale.\"},{\"question\":\"Did the study find a relationship between hikikomori risk and favorite game genres?\",\"answer\":\"No significant relationship was found between favorite game genres and hikikomori risk tendencies across the compared groups.\"},{\"question\":\"What gameplay tendencies distinguished high-risk players in the thematic analysis?\",\"answer\":\"High-risk players reported more negative player interactions and showed a preference for cooperative over competitive gameplay, with positive mentions of narrative, action, adventure, and strategic elements.\"}]","Extreme social isolation risk is associated with story-driven, strategic and cooperative-first gameplay preferences - Research article | PDF",1789550739,9]