Tetris to prevent Post-Traumatic Stress Disorder flashbacks

Blogging on Peer-Reviewed ResearchYou've just been in a horrific car crash. You're unharmed but the vividness of the experience - the sight of a looming car, the crunching of metal, the overwhelming panic - has left you a bit traumatised. You want something to help take the edge off and fortunately a doctor is on hand to prescribe you with... Tetris.

i-529adb698f605a728ef79e0acf1bd4e7-Tetris.jpgYes, that Tetris. According to Emily Holmes from the University of Oxford, the classic video game of falling coloured blocks could prevent people who have suffered through a traumatic experience from developing full-blown post-traumatic stress disorder (PTSD). As ideas go, it's practically the definition of quirky, but there is scientific method behind the madness.

Every traumatic experience flips a mental hourglass that runs out in about six hours. After that time, memories of the original event become firmly etched in the brain, greatly increasing the odds that the person will experience the vivid, distressing flashbacks that are the hallmark of PTSD. But the brain, powerful though it is, only has so much processing power available for laying down such memories. If something can be done soon enough to interfere with this process, the symptoms of PTSD could potentially be prevented.

Tetris, it seems, makes an ideal choice for that. To position its rotating blocks, players need good "visuospatial skills" - they need to see, focus on, and act upon the positions of different objects, all at high speed. These are the same sort of mental abilities that provide the foundations for flashback images.

Holmes's idea is that playing Tetris after a shocking event would take up the same mental resources that would normally be used to consolidate future flashbacks. In doing so, the notoriously addictive game could act as a "cognitive vaccine" against PTSD and provide an ironic example of a video game actually being good for you...

Holmes recruited 40 volunteers and showed them an unpleasant 12-minute film including graphic scenes of human surgery, fatal road accidents and drowning (although not Adam Sandler - there are some things that ethics boards just won't allow). Thirty minutes later, half of the group played Tetris for ten minutes, while the other half sat quietly.

Over the next week, the recruits noted down every flashback to the traumatic video in a diary. These records revealed that the Tetris players experienced less than half as many flashbacks as the group who never touched the game. And when the volunteers were brought back to the lab, a series of 32 true-or-false questions about the video showed that both groups had remembered the same level of detail about what they saw. Their memories were all intact, but their reactions differed. The Tetris players scored lower on the Impact of Events Scale, a tool used in the clinic to measure the strength of a person's response to a traumatic experience.

These results support Holmes's theory that Tetris can help to prevent PTSD flashbacks by occupying the brain's energies during the narrow time window when traumatic memories are consolidated. There are other treatments that probably work along similar lines. One of these, known as Eye Movement Desensitisation and Reprocessing (or EMDR) asks patients to keep a traumatic memory in mind while moving their eyes about. It's possible that making eye movements - another visuospatial task - competes for the mental resources needed to process upsetting images and so reduces their impact.

But EMDR is only used to treat PTSD and there are several ways of doing that. Holmes's goal is more proactive - she wants to find ways of preventing the symptoms from appearing in the first place. There are a few potential options for doing that, from drugs to psychotherapy, but few can be delivered so quickly or cheaply as a quick game of Tetris on a handheld machine. The game has another big advantage in that it affects a person's reactions to an event but not their actual memories of it - Holmes notes that they would feel relief, but their ability to, say, testify in court wouldn't be diminished.

Holmes also asserts that the benefits of Tetris are very specific to its nature as a visual and spatial exercise. The game isn't just providing a simple distraction. Indeed, Holmes's group had previously shown that some tasks that are mentally demanding but lack any spatial element - like counting backwards in threes - actually increase the frequency of flashbacks.

Clearly, Holmes's team has more work ahead of them before the game could actually be used in real-life clinical situations. For a start, they'll need to find a way of combating the unfeasible stress that players experience when one of the long, straight blocks fails to show up for ages. But the method clearly has some promise and in some ways, the results shouldn't be surprising.

Tetris is well-known for its ability to get inside the heads of those who play it, with many people continuing to play or see the game in their heads long after they've left their keyboards or joypads behind. In fact, the ability of any activity to overshadow the thoughts or dreams of people taking part in it has been labelled the "Tetris effect". Perhaps the T in PTSD should stand for Tetris instead.

Reference: Emily A. Holmes, Ella L. James, Thomas Coode-Bate, Catherine Deeprose (2009). Can Playing the Computer Game "Tetris" Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science PLoS ONE, 4 (1) DOI: 10.1371/journal.pone.0004153

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When I read the initial description, I thought it sounded like it was based on a similar principle to emdr, so it was interesting then to read your comparison, which pointed out the differences. I wonder whether it could provide any relief to people who are experiencing flashbacks as a result of ptsd, eg as a way of breaking the looping where people get stuck in a traumatic moment when triggered.

Not bad. Tetris gave me RSI so I guess it'd be an improvement.

Why not Tetris AND Ecstacy? Belt and braces I say...

It's interesting that a lot of commonsense* turns out to have some science behind it. Isn't it always true that having something to do helps after a traumatic event? Similarly, we've known for a long time that repressing these things is harmful, and perhaps for even longer (trouble shared is trouble halved..).

Is this ethical? Some people might not think so.

Last year at about this time, I heard about a drug study to limit the effects of PTSD. A drug was given promptly after a traumatic event to prevent long-term memories from forming.

Some people on the review board said that it was unethical to take a drug that would 'alter' memories. Their analysis was that terrible memories are part of life and you just aren't supposed to mess with 'em (I'm paraphrasing a bit)

While I found their rationale lacking, I wonder if they would have the same reaction to this 'therapy'.

We give pain medication to people that have been in accidents in order to prevent suffering. Physical pain is a 'normal' part of life that we are quite eager to alter.

So, it seems to me that altering memories, whether by drug or Tetris, in order to relieve likely future mental anguish would be warranted.

But some people draw a line between altering physical pain and mental pain.

By David C. Brayton (not verified) on 16 Jan 2009 #permalink

But the Tetris treatment didn't alter the memories in any way. See this bit:

And when the volunteers were brought back to the lab, a series of 32 true-or-false questions about the video showed that both groups had remembered the same level of detail about what they saw. Their memories were all intact, but their reactions differed.

Tetris is popular because it has been proven to reduce stress and enhance brain power. The most notable was a UK study showed Tetris helped people that were victims of trauma reduce flashbacks.

As a documentary-article clearly points out, today's video games spend millions and must use violence and marketing to achieve even a percentage of what Tetris has accomplished.

It's amazing how many people playing now. Must see, http://tinyurl.com/r97xna

Great site!!!!! Good health is very important with the high cost of medical coverage. We need to have a healther lifestyle by taking care of our health eating and exercising and also avoiding stress. I am a cancer survivor and I know. Our health is our greatest asset. Keep up the Good Work!!!!!