SuperBetter: How a gameful life can make you stronger, happier, braver and more resilient

1

You Are Stronger Than You Know

Your Mission

Unlock the ability to control what you think and feel, even during extreme stress or pain

Games are famously, perhaps even notoriously, attention grabbing. Players frequently become so immersed, they lose track of time and seem to ignore everything and everyone around them. Parents and spouses of gamers often complain that it’s nearly impossible to tear their loved ones away from their favorite games. But could the highly immersive quality of good games actually be a clue to how our attention works—and how we can better control it?

In this chapter, we’ll look at video game research that reveals the power we have to prevent anxiety, depression, trauma, and physical pain, by learning to control our attention. Whether you struggle with any of these challenges currently, or you just want to increase your mental and emotional resilience, games provide the perfect platform for mastering life-changing attention skills. This chapter will show you the science behind attention control and teach you the practical, gameful techniques you can use to discover and develop your attention superpowers.

Nothing hurts more than a severe burn injury. Doctors describe it as the most intense and prolonged pain a human being can experience. Naturally, burn patients receive powerful drugs during wound care, most commonly morphine. But the drugs aren’t very effective at alleviating this uniquely excruciating pain. Medical researchers have spent decades searching for something better. Is there anything that can treat the most severe pain in the world more effectively than the traditional morphine approach?

Yes. And it’s a video game.

Snow World is a 3-D virtual environment created by University of Washington researchers to help patients undergoing treatment for severe burns. Patients are given a virtual reality (VR) headset to wear and a joystick for navigating a virtual frozen ice world. There are ice caves to explore, snowballs to throw, and a whole landscape of winter delights to encounter. Patients wear their VR headset and play this game during the most painful part of burn treatment, while their wounds are being cleaned and redressed.

Medical researchers have tested Snow World in clinical trials. Here’s what they learned: this VR game reduced pain by a whopping 30 to 50 percent. For the most severe burn patients, the game proved to have a bigger impact on their pain and overall suffering than the morphine they also received.¹

Better yet, Snow World players were able to almost entirely ignore whatever pain did remain. They reported being consciously aware of pain only 8 percent of the time. Compare this with traditional burn treatment: even with the highest doses of opiates that can be safely administered, patients typically report spending 100 percent of treatment time thinking about their excruciating pain.

Simply by playing Snow World, patients discovered they were able to control what they were thinking and feeling an extraordinary 92 percent of the time. As a result, doctors have found that with the game, they can reduce the level of medication and dramatically improve pain management at the same time. And the benefits are more than psychological. When patients feel less pain, doctors are able to pursue more aggressive wound care and physical therapy—two factors that can speed up recovery and reduce medical costs. Most important, the patients feel more in control and suffer far less.²

How exactly did a video game create such a powerful change? In scientific papers describing the game’s positive impacts, Snow World’s inventors, Dr. Hunter Hoffman and Dr. David Patterson, attribute its success to a well-established psychological phenomenon: the spotlight theory of attention.³

According to this theory, human attention is like a spotlight. Your brain can process and absorb only a limited amount of new information at any given moment. So you focus on one source of information at a time, ignoring everything else. As a result, information everywhere competes constantly for your brain’s attention—sights, sounds, tastes, smells, thoughts, and physical sensations.

What does this have to do with pain? The signals from your nerves that cause pain are just one of many competing streams of information. It’s a particularly compelling stream. Your nerves are sending signals to your brain to let you know that you’re injured—which is pretty important information! It makes perfect sense that without conscious intervention, you’d be more likely to focus your attention spotlight on these pain signals than just about any other source of information.

But you’re not powerless against pain signals. In fact, if you learn to control your attention spotlight, you can actually stop your brain from spending its limited processing resources on pain signals from your nerves.

For burn patients, that’s where Snow World comes in. In order to prevent pain signals from turning into a conscious awareness of pain, patients need to swing their spotlight of attention somewhere else—and keep it there. How? By deliberately monopolizing all their brain’s processing power with as challenging and information-rich a target as possible. Games, and particularly virtual worlds rich in 3-D imagery, serve this purpose perfectly. They require so much active attention, the patient runs out of cognitive resources to process the pain.

This is exactly what scientists observed when they decided to study the brain activity of Snow World players using functional magnetic resonance imaging (fMRI). This technology allows researchers to see where blood is flowing in the brain—the more blood flow, the more active that region of the brain. In Snow World studies, fMRI footage showed reduced blood flow to all five regions of the brain associated with processing pain. This data revealed that players weren’t just doing a better job of dealing with the pain they felt—they were actively blocking the brain from dedicating resources to processing the pain signals.⁴ No cognitive resources, no pain.

This is the real breakthrough at the heart of the Snow World technique: the game isn’t merely a distraction from feelings of pain; it actively prevents conscious feelings of pain in the first place. And you can learn to use this technique in your own life.

You may never be in as much physical pain as a burn patient. But if and when you do find yourself in pain, you now know: You don’t have to pay attention to the signals from your nerves. You can choose to pay attention to anything you want. Even when you’re in pain, even when you’re suffering, you can control your attention spotlight and change your experience for the better.

And you don’t necessarily need a fancy 3-D VR headset to do it. Although advanced game technology makes it easier to commandeer cognitive resources, other studies on pain and gaming show that in less extreme cases, a simple handheld game—the kind you can play on your mobile phone or iPad—can also block pain signals effectively.⁵

Or if you prefer a nongaming solution, you can choose any challenging activity that successfully captures your full attention. Research suggests, for example, that knitting and crafting both require enough brain-processing resources to successfully reduce chronic pain.⁶ The key is simply to realize that you are in charge of your cognitive resources. If you don’t want your brain to pay attention to pain signals, give it something else to pay attention to instead.

Snow World is an important health care innovation—but it’s also much more than that. It’s a clear lesson in how much untapped power we all have over what we physically feel. Even when we’re in pain, even when we’re suffering, we can control our attention spotlight and change our experience for the better.

As you’ll see in the coming pages, this finding is repeated again and again in video game research: we have more power, more mental control, over what we feel, moment to moment, than we realize.

You have this power—and it comes from your ability to control your attention spotlight, and in doing so, to change what is happening in your body and your brain.

Let’s start practicing that power now, with your next quest.

QUEST 6: Stop the Pink Elephant!

Don’t think of a pink elephant. Whatever you do, do not think of a pink elephant.

Stop reading this book for the next ten seconds, and in that time, be absolutely sure you do not once think about a pink elephant. Go!

10 . . . 9 . . . 8 . . .

Did you think of a pink elephant? Of course you did, even though I told you not to. Fortunately, that’s not your quest. At least not yet—not until you have a concrete strategy for controlling your attention spotlight.

The command “Don’t think of an elephant” (or sometimes “Don’t think of a bear”) is one of the most widely employed exercises in cognitive psychology. Devised by Harvard University professor Daniel Wegner and later made popular by University of California at Berkeley professor George Lakoff, the idea is simple: once you evoke a concept in someone’s mind, they are essentially powerless to block it. Despite the instructions to not picture a large gray (or pink) mammal with a trunk and floppy ears, the brain is incapable of obeying. The word elephant calls up the idea of an elephant, and you’re stuck with it, for better or for worse.⁷

We’re going to try a different experiment here. I want you to keep trying to not think about a pink elephant, but I’m going to give you a strategy for doing just that.

What to do: This time you’re going to control your attention spotlight by focusing your cognitive resources on a challenging, high-attention task.

To stop the pink elephant from commanding your attention, I want you picture a giant letter P and E (short for pink elephant, naturally). P and E. Got it?

Now I’m going to give you sixty seconds—set a timer, or just estimate it—to list as many words that contain both the letter P and the letter E, in any order. Here are a few to get you started: help, hope, pickle, peanut.

Write the words down, or if it’s easier, just think of them and tick them off on your fingers, or keep a mental tally.

If you can think of at least ten more words with a P and an E in sixty seconds, that’s very good. If you can think of twenty or more, that’s amazing. If you can think of thirty or more, you’re a rock star at this, one of the best in the world. Try to aim for at least ten—and remember, while you’re doing it, don’t think about a pink elephant.

Go!

Okay, now I want you to notice two things.

1. Were you better able to stop thinking about a pink elephant while you were engaged in this high-attention, challenging task? I hope so. The higher your word score, the more likely you are to have completely blocked that silly animal out of your mind. (If you don’t like your score or you couldn’t stop the pink elephant from occupying your thoughts, give it another try with these two letters: S and B, for SuperBetter!)

2. As you go back to reading this book or go about the rest of your day, see which is more likely to occur: you keep picturing a pink elephant or you randomly think of or spot another word with the letters P and E in them. If you are like most people, you’re more likely to flash back to the word game than to the mental image of an elephant. That’s because your attention spotlight is more likely to drift back to something that engaged more cognitive resources. Be sure to notice what happens in the next few minutes or hours to see if this is true for you!

Quest complete: If you found this word game an effective technique to control your attention spotlight, congratulations. You now have a new tool in your toolkit for blocking unwanted thoughts, feelings, or physical sensations. Try it anytime, with any two letters, to practice swinging that spotlight of attention quickly and more effectively.

Just for fun: Check out the following footnote for twenty P and E words you could have thought of!^*

* People, preach, happen, pamphlet, prairie, prayer, apple, yelp, rope, dampen, patent, prehistoric, petal, penumbra, pennant, sniper, eclipse, epicenter, spine, rapture, empty, prince, poke.

As you’re hopefully starting to see, researchers have figured out all kinds of ways people can get better at controlling their attention spotlight. Let’s take a look at other types of mental and emotional resilience you can develop by mastering this important skill—such as the power to prevent trauma, fight cravings, block anxiety, and heal from depression.

You’ve almost certainly seen Tetris, the falling blocks puzzle game, even if you’ve never played it. It’s estimated to be one of the most widely played video games of all time, with nearly half a billion players to date.

Despite having been around since 1984, it wasn’t until recently that researchers realized that Tetris can do more than entertain us. It can, remarkably, help us recover more quickly from traumatic events.

Post-traumatic stress disorder, or PTSD, is a psychological condition that can develop after an individual witnesses or experiences a terrifying or tragic event. The hallmark symptom of PTSD is recurring flashbacks. Unwanted, intrusive memories can haunt individuals for months or even years after a traumatic event, disrupting sleep, triggering panic attacks, and causing severe emotional distress. Typically, these flashbacks have a strong visual component. Someone repeatedly “sees” a traumatic event in their mind’s eye, as vividly as if it were really happening all over again. Psychologists consider these flashbacks to be the single most stressful and difficult-to-treat symptom of PTSD.

But what if, instead of trying to treat flashbacks as an unavoidable symptom of trauma, we could prevent them in the first place? Cognitive scientists have shown that memories change and take shape for up to six hours after a traumatic event. That has led some researchers to wonder: Is there anything we can do in the first six hours after trauma to inhibit our brains from forming the kinds of visual memories that lead to flashbacks?

Yes, there is. You can play Tetris.

In 2009 and 2010 a team of psychiatrists at Oxford University completed two studies showing that playing Tetris within six hours of viewing traumatic imagery helped reduce flashbacks of the traumatic events. It worked so well, in fact, that the Oxford researchers proposed that a single ten-­minute session of Tetris could effectively serve as a “cognitive vaccine” against PTSD. Play the game as soon as possible after a traumatic event, and you may significantly reduce your likelihood of experiencing severe post-traumatic stress.⁸

How did the Oxford researchers figure this out? It’s not easy to study trauma in a laboratory, as you can imagine. It’s simply not ethical for researchers to do horrible things to study participants just to measure their traumatic response. So the Oxford team used an experimental method that has been tested and validated in hundreds of other trauma studies: they gathered together test subjects in a laboratory and showed them a series of extremely graphic, gory images of death and injury. (Trust me, these are the kind of images you truly hope you will never see.) Then they measured the subjects’ emotional response to the images to ensure that they were truly disturbed.

In the hours that followed, half of the test subjects played Tetris for ten minutes while the other group did nothing special. Here’s what the researchers found: most of the group that did nothing special reported a high number of disturbing visual flashbacks from the images over the next week. The group that played Tetris, however, had just half as many flashbacks. And when both groups completed a psychological survey one week later, the Tetris players had significantly fewer symptoms of PTSD than the group that did not play.

So how did ten minutes of game play prevent flashbacks and PTSD symptoms? The Oxford researchers explain that Tetris occupies the visual processing circuitry of the brain with something other than what it’s usually preoccupied with after a trauma—involuntarily remembering and replaying the trauma over and over again. It’s similar to how Snow World works to prevent pain, but it’s a more targeted approach. To interfere with involuntary visual memories of the trauma, you have to swing the attention spotlight to something that specifically demands a huge amount of visual attention.

Crucially, the Oxford researchers found that not every video game can successfully hijack the visual processing centers. It must be a game that requires a massive amount of constant, visual processing—ideally, a pattern-matching game like Tetris or Candy Crush Saga, in which your goal is to move and connect game pieces according to a visual pattern. These kinds of games are so visually engaging, players notoriously report seeing game play flashbacks—typically, colored blocks falling, or matching candies swapping places—whenever they close their eyes, even hours after they’ve stopped playing. But if you play a less visual game, like Scrabble or a trivia quiz, this technique doesn’t work. Your brain will have too many visual processing resources still available to replay traumatic images.⁹

One more important detail from the Oxford study: playing Tetris did not prevent individuals from voluntarily remembering details of what they saw. A week later, when they were asked questions like “What color was the hair of the man who drowned?” or “About how old was the woman on the stretcher?” the Tetris players accurately recalled as many details as the group that did not play. Their memories were intact—they just weren’t as haunted by them.

This is extremely important, so I’ll say it again: the Tetris technique does not erase memories; it simply stops the cognitive process of involuntary memory. It gives you control over the memory. You won’t think about it when you don’t want to.

The Oxford researchers have not followed up their initial study with research on how well this technique works in real-world contexts. However, since they publicly shared this work five years ago at scientific conferences and in the media, many individuals have had the chance to learn and try it outside formal scientific studies. As part of my ongoing work to understand how people use games to become stronger and heal faster, I’ve heard from many people who have conducted successful Tetris-style interventions in their own lives: a runner who, after the 2013 Boston marathon bombings, found herself worried about whether she would ever be able to participate in road races again; a high school student in Norway who lost a friend in the 2011 mass shooting and kept replaying media images of the scene in his mind; a woman who did not want to suffer flashbacks of her elderly father’s final moments, which were not peaceful. What I have heard from individuals like these is that a short period of game play in the hours, days, and even weeks after the trauma gave them control over what they were thinking and seeing in their mind’s eye—and that this level of control not only helped limit flashbacks but also gave them a sense of comfort and strength.

Let’s put this Tetris research into a bigger perspective. The power to prevent flashbacks can potentially help anyone, even someone not directly involved with a traumatic event. We often see traumatic images of violence or accidents in the media. Children can be especially disturbed by these images. But a quick session of visually absorbing game play can help them avoid nightmares or intrusive memories.

The Tetris technique also has potential to change how you respond to ordinary negative events. When you have a particularly upsetting day, or if you can’t stop thinking about something that went wrong, you can activate this gameful ability.

You can put a stop to involuntary thoughts quickly and simply. This power to control what you’re remembering in the moment, right now, ensures that you can choose to truly leave difficult moments in the past when you need to.

There’s one more surprising—and potentially life-changing—way to apply the Tetris technique in everyday life.

To find out what it is, try this quick quest!

QUEST 7: Control the Mind’s Eye

What to do: Think of something you often crave—something that, once you start thinking about it, it usually feels impossible to resist. Imagine it in detail. Picture yourself enjoying it, as vividly as you can. Do you have a specific craving in mind? Good.

The next time this craving kicks in—including right now, if you’re already feeling it!—I want you to play a pattern-matching game like Tetris for three minutes. Do this, and you will be much better able to successfully resist your craving.

Why it works: Multiple studies have shown that playing Tetris for three minutes while feeling an intense craving cuts the intensity of the craving by 25 percent.¹⁰

This may not sound like a lot, but a 25 percent reduction in craving intensity is enough to change behavior. It’s just enough of a boost to give your willpower a fighting chance. (Keep in mind that if you’re hungry when you play Tetris, you’ll still be hungry afterward—but you’ll be less likely to give in to a specific, unhealthy craving, and more likely to make a smarter choice about what to eat.)

This anticraving strategy works on exactly the same scientific principle as the strategy of using a pattern-matching game to prevent flashbacks and PTSD. Research has shown that cravings have a very strong visual component. The more you mentally imagine yourself enjoying what you crave, the more likely you are to give in. To resist a craving, you simply need to give your brain’s visual-processing centers something else to visualize—and you’ll find the craving significantly reduced.¹¹

What to play: You can find countless pattern-matching games for free online and on your mobile phone or tablet. The easiest ones to pick up from scratch if you’ve never played them are Tetris, Bejeweled, and Candy Crush Saga. (This last is the first video game my sixty-seven-year-old mom played in her entire life—and she taught herself how to play it in less than a minute.)

If you don’t want to play a digital game, a wonderful pattern-matching card game called SET offers the same powerful flashback effects. You can find it on Amazon or at Setgame.com. Finally, some SuperBetter players report that solving jigsaw puzzles is another way to control visual attention and stave off cravings effectively.

A SuperBetter Story: The Bride- and Groom-to-Be

When Joe and Elisa decided to get married, they promised each other that they would both successfully quit smoking by their wedding day.

In the months before the big day, the Michigan-based couple both wore nicotine patches, which helped them fight their cravings at work. But when they came home in the evening, Joe told me, it was harder to avoid reverting back to old habits.

“There was so much going on at work, the patch was enough—we didn’t need anything else. But at home, with less going on, we were really tempted. We thought about lighting up constantly.”

Thanks to the nicotine-replacement therapy, their physical cravings were in check. But they hadn’t yet gotten control over their mental cravings. They kept picturing themselves smoking and imagining how good it would feel. Those mental images were the real problem.

The gameful solution? Joe and Elisa decided to start a new tradition: puzzle nights. Every evening after dinner they sat down at the kitchen table to work on a giant jigsaw puzzle together.

“It totally worked for us,” Joe told me. “Zero cigarettes on puzzle nights.” It worked so well, in fact, that they worked on puzzles every night all the way up to their wedding. Two years later the happily married couple are still smoke-free.

Puzzle nights had one additional surprise benefit for the bride- and groom-to-be: working cooperatively on the puzzles together for so many hours, night after night, boosted their communication and problem-solving skills. “We got really good at working together and solving the puzzles as a team.” Not a bad way to prepare for marriage!

Joe and Elisa were, as it turns out, ahead of the curve with their creative solution. In 2014 a team of researchers from the American Cancer Society, Brown University, and Stony Brook University found that nicotine-deprived smokers were able to reduce their cravings by playing two-player cooperative games with their relationship partners. Functional magnetic resonance imaging (fMRI) scans showed that cooperative game play and puzzle solving lit up the same reward centers of the brain that nicotine does. The scientists believe this is evidence that social games and puzzles could provide smokers with an alternative neurological pathway to feeling a reward when they crave it most.¹²

In other words, game play provides a powerful one-two punch for changing behavior. First, it gives you control over your thoughts and mental cravings by fully absorbing the visual-­processing center of the brain. Second, it gives you a pleasurable neurochemical reward—the same kind you would get from a cigarette or a cookie or whatever else you might crave. Who needs a cigarette or cookie when you already feel deeply satisfied by the game?

Sweethearts Joe and Elisa might not be surprised to hear about one final scientific discovery from the same team of fMRI-scanning researchers: falling in love also dampens cravings for food, alcohol, and drugs, by activating the same reward pathways.¹³ “Intense, passionate love,” as the researchers put it, is like kryptonite to cravings—they just can’t stand up to it.

The moral of the story: if you want to quit something, anything, just solve a puzzle—or fall in love. Or if you’re really lucky, like Joe and Elisa, do both at the same time.

By now, you’re catching on: purposefully controlling your attention has all sorts of real-life benefits. By why are games such an effective means of attention control, compared with other activities? Let’s explore this question by taking a look at another strength you can develop through game play: the ability to block anxiety, even in extremely stressful situations.

Surgery is scary—especially for kids. Over the past twenty-five years, doctors have tested every idea imaginable to reduce kids’ anxiety in the operating room. They’ve tested powerful medications. They’ve allowed parents to hold their kids’ hands while they go under and wake up from anesthesia. They’ve even tested clowns in the operating room.

What works best? Not surprisingly, it’s not clowns. But it’s not parents or medication either. Kids who are allowed to play handheld video games—such as Super Mario on the Nintendo DS—experience virtually no anxiety before surgery. And after surgery, they wake up from anesthesia with less than half the anxiety of children given drugs—and with zero medication side effects.¹⁴

It’s another headline-worthy scientific result: “Ordinary video games prevent anxiety more effectively than the most powerful antianxiety medications.” But what makes it work? The research team at the department of anesthesiology at New Jersey Medical School argues that—as with the Snow World and Tetris techniques—cognitive absorption is the key. By focusing intensely on something other than the impending surgery, young patients avoid becoming upset or panicked.

This hypothesis makes perfect sense, given what we already know about the spotlight theory of attention. Anxiety—just like pain, traumatic memory, and cravings—requires conscious attention in order to develop and unfold. It’s fueled by active thoughts about what could possibly go wrong. Fear is a response to something actually going wrong right now. Anxiety, on the other hand, is the anticipation that something might go wrong in the future. The more vividly we imagine something bad happening, the more anxious we get.

Physiological sensations can contribute to anxiety—for example, caffeine can cause rapid heartbeats and sweaty palms, and a sudden surprise can trigger a jolt of adrenaline. If we notice these physical sensations, we may start to rack our brains for something specific to be nervous about, which can lead to a full-blown case of anxiety or even a panic attack. But without a conscious story about what might go wrong next, these symptoms are just physical sensations. They become an emotional feeling of anxiety only when we actively start to imagine terrible things happening in the future. Such imaginings can trigger more physiological changes—more adrenaline, an even faster heart rate—that we interpret as more reason to worry, and so the vicious cycle of anxiety goes.

Game play, the research shows, helps us stop imagining what might go wrong. The game breaks the cycle of attention. Even if we feel physical symptoms of anxiety while we’re playing, we’re too preoccupied with the game to actively imagine the worst. And without a nervous imagination, there is no anxiety.

In some situations, anxiety can be a helpful emotion—if it alerts you to a potential problem in the future, and if you have the time and ability to take steps now to prevent that problem. For example, if you’re anxious about an upcoming exam or presentation, anxiety can be a useful cue to study or practice more. For this reason, you should not always seek to block anxiety. However, for most people, in most situations, anxiety does not lead to productive action. Instead, it merely creates needless suffering and can prevent us from taking helpful action. Here’s a good rule of thumb for when to safely use a gameful technique to block anxiety: if the anxiety is not helping you identify concrete positive steps you can take, but rather is simply creating distress, play a game. Likewise, if the anxiety is trying to talk you out of doing something you truly want or need to do (like getting on a plane, giving a presentation, or going to a social event), go ahead and block it with a few minutes of play.