Tetris to prevent Post-Traumatic Stress Disorder flashbacks

You'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.

Yes, 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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