How Playing Tetris Tames The Trauma Of A Car Crash

Enlarge this image Nicole Xu for NPR Nicole Xu for NPR

I spent an alarmingly large chunk of 1989 trying to align a falling shower of digital building blocks into perfect rows of 10.

The Russian video game Tetris had just caught on in the States. Like many American children, I was rapt.

Plenty of video games are all-immersive, yet there was a particular 8-bit entrancement to Tetris — something about the simplicity and repetition of rotating descending blocks so they snugly fit together that allowed a complete dissociation from self, and from parental provocations ("Maybe, uh, go do something outside?").

I eventually emerged from our den, thumbs sore, eyes bleary, and found running around our Buffalo suburb with friends ultimately more fulfilling.

But it turns out the particular brand of disconnection provided by Tetris may reflect a mental state long sought by healers to treat patients who have lived through a trauma.

I'm referring to the idea that some combination of facing negative memories, but also being distracted from them, might help alleviate the vivid psychological scars of trauma. Clinicians and philosophers have tried countless ways of treating trauma and anxiety through the years — of finding, as Roman stoic philosopher Seneca called it, tranquillitas, or peace of mind. And many of them were, in all likelihood, bunk. But the science now shows that activities as simple as playing distracting video games or focusing on eye movements can help patients cope with a tragic experience.

"Blocking" bad memories

Last week a group of researchers from the U.K. and Sweden published a study reporting that playing just 20 minutes of Tetris — in research parlance, a "Tetris-based intervention" — following an automobile accident can help prevent the formation of the painful, intrusive memories that can follow trauma.

The new research looked at 71 patients who had presented to the John Radcliffe Hospital emergency room in Oxford, England, within six hours of being in a car accident. While waiting to be seen, patients were first asked to recall their trauma and recount the worst moments that sprang to mind. (If it helps, they were paid.) They were then randomized to either play Tetris for 20 minutes on a handheld Nintendo DS XL system or to instead fill out an activity log of what they had experienced since arriving at the hospital. The latter group served as the control.

The gamers were found to have 62 percent fewer intrusive memories in the first week after their accident than the control group. What's more, their bad memories diminished more quickly than in controls.

The study was small, but the authors feel the results justify a larger follow-up trial to test the long-term effects of Tetris therapy, for which they are now seeking funding.

Traumatic memories and all-to-real flashbacks are central to anxiety conditions like acute stress disorder and post-traumatic stress disorder. Per the criteria in the DSM-5 — psychiatry's go-to diagnostic reference — a diagnosis of PTSD cannot be made until one month after the inciting incident; if Tetris proves effective this far out, doctors and therapists treating the condition might have an effective and easy-to-prescribe option to turn to.

"More research is definitely needed to develop this approach," says Emily Holmes, a psychology professor at the Karolinska Institute in Sweden and lead author of the study. "But we're encouraged. And we need to develop preventative interventions that can be delivered soon after trauma to prevent the buildup of symptoms." Think of such an intervention as a kind of "cognitive vaccine."

Holmes feels that playing Tetris shortly after an accident can interfere with memory consolidation, or the gradual conversion of short-term memories into more permanent ones. Evidence suggests that there is a window following a trauma in which a bad memory can be disrupted or avoided — and in which memories can be uncoupled from the brain's emotional centers.

She admits that the findings are probably not unique to Tetris. Traumatic memories are often highly sensory: Sights and sounds of a trauma can flash back in horrifying detail. Holmes believes that any highly visual activity that stimulates the brain's sensory centers might prevent graphic recollections from forming in the first place. The colors, shapes and constant movement of Tetris may do just that, but based on Holmes' past research, activities like digital pub quizzes and counting exercises do not. She plans to study other visually engaging interventions like drawing and the video game Candy Crush in the near future.

Age-old trauma

The psychological effects of trauma were recognized long ago and were even mentioned in the Old Testament. Hippocrates and Lucretius each wrote of traumatic battle memories. And the 13th century Icelandic saga Gisli Súrsson finds the story's eponymous hero reliving gruesome battle scenes and unable to spend his nights alone. "Methought my foemen, axes wielding... Worse I dreamt — my forehead splitting," he fretted.

Various forms of trauma therapy have been tried over the centuries, often in the context of warfare. Among them is hypnosis, touted for at least a few hundred years as a means of purging or tempering bad memories.

In the early 1900s, French psychologist Pierre Janet developed a stepwise hypnotic approach to treat the symptoms of what we would now call PTSD. He felt it could help people to perhaps divorce unpleasant recollections from emotion. Plenty of modern clinicians still turn to hypnosis to help manage trauma, yet as it was 100 years ago, the practice remains controversial. Some evidence suggests it could even be harmful to people plagued with traumatic memories.

"Hypnosis should not be used to recover traumatic memories, as studies consistently show that hypnosis can increase the production of inaccurate as well as accurate memories," explains Binghamton University professor of psychology Steven Jay Lynn. "Individuals who are hypnotized often hold such recovered memories with greater confidence or certainty, regardless of whether the memories are accurate or not."

Lynn feels the risk of solidifying false memories is too great to fully endorse hypnosis as a stand-alone trauma treatment. But he does cite evidence that it can be a valuable addition to proven psychotherapies such as cognitive processing therapy, based on changing upsetting thoughts, and prolonged exposure, which involves remembering and re-engaging with traumatic memories.

Another controversial PTSD treatment is what is called eye movement desensitization and reprocessing. Developed in the 1980s by psychologist Francine Shapiro, EMDR is a form of psychotherapy that involves having patients recall traumatic events while moving their eyes from side to side or engaging in some other distracting activity. In theory, doing so allows patients to reprocess memories and render them less upsetting.

Criticism of the treatment came in the 1990s, when clinical trials suggested that it is actually the recollection itself that explains EMDR's efficacy, not the eye movements. At the time, recalling trauma was already known to be effective in helping patients cope with PTSD. However, as Harvard psychologist Richard J. McNally explains, "Careful laboratory studies suggest that bilateral eye movements do tax memory in such a way that trauma-related images become degraded and less emotionally evocative."

McNally cites work by Dutch psychologist Marcel van den Hout, which concluded that eye movements, as well as other tasks that require short-term memory, are effective at alleviating trauma symptoms.

Patients suffering from trauma now have a number of options to turn to. Multiple forms of psychotherapy can be effective, as can antidepressant medications and perhaps a compound called N-acetylcysteine. Among the growing research looking at psychoactive and psychedelic drugs for mental illness, the recreational drug MDMA, or ecstasy, looks promising in PTSD.

Holmes' application of Tetris shows promise, says McNally, who was not involved in the research. "Our field needs to be open to possible breakthroughs. Just beware of people claiming 'miracle cures!' "

And there are plenty to beware of — including the bevy of questionable supplements touted for trauma. Green tea might be healthy for the brain, but can it assuage the horrors of war by itself? Probably not.

Perhaps soon the benefits of visual distraction by the right activity at the right time, coupled with reliving painful past experiences, will also be used to treat the traumatized. It remains to be seen whether doing so will require a Nintendo DS XL, or not.

Bret Stetka is a writer based in New York and an editorial director at Medscape. His work has appeared in Wired and Scientific American, and on The Atlantic.com. He graduated from the University of Virginia School of Medicine in 2005. He's on Twitter: @BretStetka