People may experience anxiety for a number of reasons, including fears of failure, embarrassment or recalling anxiety-provoking events (APA, 2013). In 2017, anxiety was described as an ‘epidemic’ as anxiety disorders are now the most commonly diagnosed mental health disorders in the world (Rosen, 2017; Kessler et al., 2005). Approximately 117 million people worldwide are diagnosed with an anxiety disorder and is the sixth most common reason for disability (Baxter et al., 2014).

Anxiety impacts the 15-34 year old population the most (Baxter et al.), with two main arguments being made for why this is the case. Firstly, this age group may be under intense pressure to succeed academically and financially, leading to increased perfectionism and high self-expectations (Kaplan et al., 2005). When these expectations are not met, they experience periods of existential crisis that are anxiety-provoking (Berman et al., 2006). Secondly, in a world where communication is rapidly changing, people may fear being judged by others more than ever (La & Harrison, 2005).

It is important to reduce this anxiety epidemic due to its negative impact on work, education, health and socialising (Copeland et al., 2014). However, with research finding that 50-80% of people do not seek help for their anxiety, researchers are challenged to find ways to reduce anxiety outside of a clinical setting (Kessler et al., 2008; Merikangas et al., 2011; Collins et al., 2004).

This article will use a plethora of research to show how video games can help with a range of anxiety disorders and unhealthy ways of coping with anxiety. The findings will then be applied to everyday levels of anxiety to show how and why gaming in your leisure time is beneficial for you.

As usual, there will be a summary at the bottom if you do not wish to read everything. Please also note that this article will discuss PTSD and self-harm, but will provide helpful advice for both. Thank you and I hope you enjoy.

Contents

A Different Tetris Effect?

Tetris is the world’s best-selling video game and is enjoyed by millions on many devices, including calculators and oscilloscopes (Sparkes, 2014; Svenne, 2003). The widespread success of Tetris sparked research interest into what is known as the ‘Tetris Effect’. The Tetris Effect refers to Tetris players thinking of ways to arrange shapes outside of the game, even when trying to fall asleep (Earling, 1996). Researchers found that this effect is associated with thickening grey matter in the brain, potentially indicating greater brain efficiency (Haier et al., 2009; Fordham, 2011).

However, is this the only effect that Tetris can have on our brain?

Sometimes our brain is not kind to us. After experiencing a singular or series of traumatic events, our brain may produce flashbacks which cause us to become anxious (McIsaac & Eich, 2004; Grey & Holmes, 2008). Those who experience ‘recurrent, involuntary and intrusive distressing memories’ may be diagnosed with Post-Traumatic Stress Disorder (PTSD; APA, 2013). While mental health systems have a number of helpful treatments for PTSD, the system has been criticised for not helping shortly after trauma; people must wait until they have developed PTSD before receiving help (NIHCE, 2005; Holmes et al., 2014).

Researchers have explored ways to reduce flashbacks shortly after witnessing a horrific event. Research using a non-PTSD group found that taking anxiety medication could reduce the number of times an event was remembered (Kindt et al, 2009; Lonergan et al., 2013). However, the artificial nature of the trauma (e.g. watching a violent video) limits how applicable this research is to those who have suffered real-life trauma. There are also concerns that those who have experienced trauma may become chemically dependent and may suffer side effects of the medication (NHS, 2016). Thus, researchers began looking for a non-intrusive, non-chemical method of reducing flashbacks following trauma.

Researchers turned to Tetris. While we view Tetris as a fun video game, researchers viewed Tetris as a task that keeps our brains occupied as we are constantly thinking of how to rotate and place Tetrominoes (Baddeley & Andrade, 2000; Kavanagh et al., 2001). Due to the relationship between frequent flashbacks shortly after trauma and the development of PTSD (Creamer et al., 2004), a theory was developed for how Tetris could be useful in preventing PTSD.

The theory argued that distracting the brain with Tetris post-trauma would reduce the number of flashbacks. Fewer flashbacks means reduced anxiety and fewer opportunities to establish the relationship between a flashback and feeling anxious. This theory meant that a person wouldn’t have to play Tetris for the rest of their life to reduce flashbacks, just in the period following the trauma so the flashback-anxiety relationship is not established.

As a proof of concept, this theory was tested in an artificial situation similar to the medication studies. When participants played Tetris following a traumatic video, flashbacks of the video were reduced compared to the group that did not play Tetris (James et al., 2015). This was also found in a study comparing Tetris with a pub quiz-style game (Holmes et al.), demonstrating that it is the attention and strategy that is required of video games that successfully distracts participants.

After initial testing was successful, a study was conducted using Tetris on those who were hospitalised following a car accident (Iyadurai et al., 2018). After playing only 20 minutes of Tetris in hospital, participants experienced fewer flashbacks the following week than those who did not play. Participant feedback was overwhelmingly positive, with one woman in her 60s who had never played Tetris before requesting extra time with the DS as it prevented her “brooding and feeling very sorry for myself”. Others expressed how grateful they were to participate:

I think that Tetris helped focus my mind and bring some ‘normality’ back to my head. I didn’t dwell on the accident too much while I was in hospital. Playing Tetris seemed a bit strange at the time, but looking back it has been a help. Thank you.

Although the research base is still emerging, the current evidence points to Tetris as an easy, safe, cost-effective, fun and successful method of reducing harmful flashbacks following trauma.

Gaming to Cope with Anxiety

As part of the anxiety epidemic, we should be concerned with how people choose to cope with their anxiety. People may externalise and distract from their anxiety in several ways, including leg shaking, skin picking or nail biting (Sachan & Chaturvedi, 2012). However, methods of coping with anxiety can become dangerous as people may choose to deliberately self-harm to manage their anxiety (Klonsky et al., 2003). The Experiential Avoidance Model argues that self-harm may be maintained as a coping mechanism as it helps translate emotional pain into physical pain, something which may be easier to manage (Gottman & Katz, 1989; Gross, 1998).

To stop someone from self-harming, we must take their harmful coping behaviour and replace it with something healthier. If someone were to search online for help on how to stop self-harming, they may be told to do things such as take a bath or watch a movie (The Mix, 2015). However, these may not be entirely effective for something as serious as self-harm for two reasons.

Firstly, we have previously seen how someone who was left alone in the hospital was ‘brooding’ and ‘feeling sorry for themselves’ (Iyadurai et al.). Leaving a highly-anxious individual in the bathtub alone with their thoughts may not be the best way to calm them down.

Secondly, when we experience periods of anxiety, our body produces the stress hormone cortisol which is involved in our fight-or-flight response (Elenkov et al., 2000). This anxiety-induced energy encourages our body to do something physical in response, with physical behaviours such as nail biting and skin picking reducing our cortisol levels (Tasaka et al., 2014; Kubo et al., 2015).

Ideally, we need an anxiety-reducing coping mechanism that keeps both our minds and hands busy.

Research demonstrates that video games are powerful tools for distracting from anxiety. In a study by Patel et al. (2006), children aged 4-12 were given a video game to play to distract from pre-operation anxiety. Playing a video game while receiving anaesthetic significantly reduced their self-reported anxiety compared to those who were distracted by their parents. Video games can also be used to reduce anxiety during chemotherapy, physiotherapy and other medical procedures (Vasterling et al., 1993; Spence, 1998; Kolko & Rickard-Figueroa, 1985).

Due to the distractive powers of video gaming in medicine, researchers experimented with the idea of delivering anxiety-reducing therapy through a video game. As the onset of anxiety disorders increases during adolescence (Grant, 2003), the distracting video game ‘Dojo’ was developed and administered after-school to adolescents (Scholten et al., 2016).

Dojo is a first-person dungeon-crawling game where players explore rooms themed around anger, frustration and fear. Each room would have a dojo master that would teach participants how to deal with each emotion safely. Dojo was able to reduce anxiety symptoms in adolescents, with participants reporting the game to be more engaging than ‘just talking’. Not only do video games seem to be a simple way to reduce anxiety, but they can also be helpful for those who experience difficulties talking about their emotions.

Video games appear to be an ideal solution in the quest to find a coping mechanism that occupies both the mind and body. The evidence suggests that video games keep our mind occupied instead of dwelling on anxiety, and our hands will be too busy playing to injure ourselves. With the accessible nature of mobile and handheld gaming, it is easy to stop and start playing games whenever we need to. Certain genres of games may also have additional benefits, with rhythm games further boosting our mood due to listening to upbeat music while focusing on hitting notes (Hanser & Thompson, 1994).

Gaming and Social Anxiety

Social Anxiety Disorder is defined as a persistent fear of social situations due to fear of judgement and humiliation (APA, 2013). While those with social anxiety may avoid leaving home to minimise anxiety, this can hinder their quality of life. As you can imagine, social anxiety is related to a poor social support network and isolation (Gross et al., 2002; La Greca & Lopez, 1998).

It is easier than ever to talk to our friends without leaving home. The ‘Rich Get Richer’ hypothesis argues that those who are popular offline make even more friends online due to factors such as friends introducing one another on social media (Abbas & Mesch, 2018). This hypothesis would argue that socially anxious people have poor offline and online social circles due to lack of friends introducing each other.

However, it is possible for socially anxious people to make friends of their own through online gaming communities. When communicating with people offline, socially anxious people are hyperaware of the fact that they may be talking too quickly, stuttering or sweating (Clark & Wells, 1995; Alden & Bieling, 1998; Caplan, 2007; Erwin et al., 2004). This encourages them to believe they are socially incompetent and to avoid speaking to others (Alden & Bieling; Rapee & Heimberg, 1997).

As online communities are not bound by the same demands of offline conversation, this encourages anxious people to relax and show their true personality online (Campbell et al., 2006; Selfhout et al., 2009; McKenna et al., 2002). After making friends through text, transitioning to speech may be easier than talking offline. The friendship has already been established so you do not need to worry about making a bad first impression.

Alongside gaming communities, research has been conducted on how often people form friendships through online games. In a study of 912 MMORPG players, Cole and Griffiths (2007) found that approximately 75% said that they had made good friends through gaming. People on average made seven good friends by playing an MMORPG, and approximately 30% of participants met a romantic partner through the game. These online friendships would culminate in face-to-face meetings, with 43% of participants meeting online friends at offline gatherings.

Two interesting findings emerged regarding the quality of online friendships. Firstly, 45.6% of participants stated that they found their MMORPG friends comparable to their offline friends in terms of friendship quality. Secondly, 39% of participants said that they talked about sensitive issues with their MMORPG friends that they would not discuss with their offline friends.

In the context of social anxiety, these findings offer hope. They suggest that in a world where the socially rich get richer through social media, online games and gaming communities can offer high-quality, supportive friendships. These friendships can allow you to be yourself without fear of judgement for stuttering or talking too quickly. Once you have made a good impression and have established a friendship, voice communication may be easier and less anxiety-provoking. These friendships can result in offline meetings that encourage people to leave their home, talk to people more often and realise that they are not being judged.

Gaming and Everyday Anxiety

So far, evidence has been presented for how gaming can help with PTSD, social anxiety and anxiety-provoked self-harm. As I appreciate that not all readers can directly benefit from this information, I would like to take this research and apply it to anxiety that we may face in everyday life.

It has been established that anxiety may be common among those who are perfectionists, those who aim to perform well in their career and education, and those who fear being judged by others. Research has pinpointed that the source of this anxiety may be due to something called rumination. Rumination is defined as repeatedly thinking about something even if you are not in the original context of the thought (Martin & Tesser, 1996). For example, if you are at home worrying about the mountain of paperwork arriving at your desk at 9am, you are ruminating.

Rumination is not only bad for our mental and physical health, but it is also bad for our career and education. By constantly ruminating, we are keeping our body in an anxious state that increases our heart rate and blood pressure (Geurts & Sonnentag, 2007). Frequent heightened blood pressure can cause damage to your blood vessels, heart and kidneys (Heitler, 2018).

Rumination is also linked with depression, burnout and mental fatigue (Segerstrom et al., 2000; Felsten, 2009; Demerouti et al., 2002; Cropley & Zijlstra, 2011). Mental fatigue is subsequently linked to concentration issues, reduced productivity and academic dropout (Boksem et al., 2005; Galbraith & Merril, 2015; Pritchard & Wilson, 2003).

To combat rumination and burnout, it is important to let our leisure time be leisurely and to not let it be dominated by anxiety. The research discussed throughout this article suggests that video games are an excellent way to achieve this. Games that demand our attention and concentration distract us from ruminating and allow us to engage in something fun. Instead of dwelling on your workload, your demanding boss or a rude customer, unwinding with a video game can keep us calm and distracted. Overcoming challenges and obstacles in a video game can also help boost your mood and keep you motivated (Deci & Ryan, 2000).

If you enjoy playing games online, this offers even more benefits as you have the opportunity to communicate with friends, play with their friends and make new friends online. After a hard day of work, you and your online friends can distract yourselves, have fun together and perhaps even meet one another.

Summary

The increasing prevalence of anxiety has been described as an ‘epidemic’, yet 50-80% of people do not seek help for their anxiety. This finding challenges researchers to find ways of minimising anxiety outside of a clinical setting.

Post-Traumatic Stress Disorder (PTSD) involves frequent flashbacks of traumatic events that cause anxiety. Researchers have begun to explore how to minimise the intensity of these flashbacks, reduce anxiety and hopefully prevent the onset of PTSD. The safest and most successful way of doing this appears to be Tetris. Providing copies of Tetris to those hospitalised following a car accident reduced the number of traumatic flashbacks after the accident. Participants expressed their gratitute in being able to play Tetris as it kept them busy and prevented them from dwelling on the moment of impact.

Those who suffer intense periods of anxiety may self-harm to distract or gain relief from their anxiety. It is important to replace this dangerous coping behaviour with a healthy coping behaviour. Video games may be ideal for this as research demonstrates that video games can distract from anxiety and help keep your hands busy. Genres such as rhythm games can have additional benefits as listening to upbeat music improves one’s mood. This finding can also be helpful for stopping anxious behaviours such as nail biting and skin picking.

Social anxiety may limit the ability to socialise and make friends due to fears of embarrassment or humiliation. Online gaming communities allow you to confidently portray your true self without fear of stuttering or making a bad impression. Research shows that people make an average of seven close friends playing an online game. These close friends were considered comparable to offline friends, and participants would even talk about sensitive issues that they would not talk about with offline friends. Some participants would go on to date these close friends and meet friends offline, giving socially anxious people an opportunity to make good friends and speak with those they are comfortable with.

Due to pressures to succeed in the modern world, people may constantly worry about work and studies even during their leisure time (known as rumination). Rumination is detrimental to your physical health, mental health, career and education. Playing video games in your leisure time helps distract you from ruminating, helps keep you calm, prevents fatigue and burnout, and provides you with psychological rewards for overcoming challenges. Playing games online and with friends offers additional benefits as you have the opportunity to make new and close friends and to socialise without leaving home.

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References

Hi there, thank you for looking in the reference section. I have never done this before, but I have decided to include the reference section separately in this Google document. The reason I am doing this is that I have 66 references and the reference section was as long as the article itself. Every reader counts in the quest to improve mental health through gaming, so I was afraid that people would see the size of the scroll bar and instantly close the article due to the reference section inflating its length. Thank you for understanding!