For those of you just tuning in, this is Part 2 of the Don’t Fight Alone campaign, an initiative created to explore the therapeutic value of video games for veterans who suffer from PTSD. As a way of introduction, my name is Joshua Hood, and I am a combat veteran, author, and current game writer for Bohemia Interactive. I am also one of the thousands of veterans who served in Iraq and Afghanistan to be diagnosed with PTSD.
In the previous article we discussed that while the military will spare no expense in preparing a soldier for war, the resources available for making the transition back to civilian are woefully small. Which is crazy when you consider that according to the National Center for Post-Traumatic Stress Disorder, PTSD is a mental health problem that develops after someone experiences or witnesses a life-threatening event. It is estimated that at some point in their life, 7 out of every 100 veterans will meet the criteria for post-traumatic stress disorder.
In this new reality just getting out of bed is a fight. Many struggle to find work, hold jobs, or form and maintain meaningful relationships with their peers. To escape this hell, some turn to drugs, alcohol, or worse, suicide. It is only recently that those struggling for a way out have turned to video games.
Wait, what?
That's right, video games.
The Team
To better understand the science behind the positive effects of video games on mental health, we assembled a team of three subject matter experts: John Hopkins Researcher, Dr. Colder Carras, psychologist and author Dr. Rachel Kowert, and retired Army Captain, turned CEO of the non-profit organization Stack Up Stephen Machuga.
Considering all the press on how violent video games affect the mind and promote anti-social behavior, it seemed counterproductive to think they could offer any help. However, according to Dr. Michelle Colder Carras, Senior Associate at Johns Hopkins Bloomberg School of Public Health, that is exactly the case. But how?
The Science According to Dr. Colder Carras' 2016 study, Connection, meaning, and distraction: A QUALITATIVE STUDY OF VIDEO GAME PLAY AND MENTAL HEALTH RECOVERY IN VETERANS TREATED FOR MENTAL AND/OR BEHAVIORAL HEALTH PROBLEMS, “veteran participants reported that video games helped not only with managing moods and stress but also with three areas related to other aspects of recovery: adaptive coping (e.g. distraction, control, symptom substitution); eudaimonic well-being (confidence, insight, role functioning); and socializing (participation, support, brotherhood).
In layman's terms, this means that instead of stressing a veteran out, (as scientists previously suspected) video games provided a calming environment and gave them meaning and opportunities to connect with other veterans. Colder Carras continues, "Video games seemed to provide some veterans with a potent form of 'personal medicine' and clinicians may wish to discuss video game play with their patients as a method to support recovery.”
Stress Inoculation
Dr. Carras further explained that video games can serve as a stress inoculator. That is, “while you are playing a game, your brain is so fully occupied with what is going on that it doesn’t have time to think—or worry—about anything else. In essence, you are giving your brain a mental distraction, that allows it to replace stress with play.
This was echoed by our second subject matter expert, Dr. Rachel Kowert, a research psychologist and award-winning author who specializes in gameplay and mental health. In our talks, Dr. Kowert cited a study in which people who recently experienced a traumatic event were women who underwent emergency c-sections and were asked to play Tetris shortly afterward. The results: those women who played Tetris had fewer traumatic flashbacks following the traumatic experience than those who didn't.
While it is difficult to definitively identify the specific mechanism at work here, the theory goes that immersing yourself in a task that requires a high cognitive load can serve to diffuse lasting negative cognitive effects. Immediately flooding your mind with neutral or positive activities and images that require intense focus can help keep negative images and experiences from imprinting as deeply in your memory.
While the idea of replacing stress with play (my words) made sense if I were playing a game like Candy Crush, common sense would suggest that a realistic military simulator like Arma would cause the exact opposite effect. Oddly enough, according to a 2019 interview Dr. Carras did for the Veteran Affairs Research News “ten of the fifteen men in her study described shooter video games as one of their favorites.”
When I asked “why” Dr. Colder explained many forms of therapy for overcoming phobias and trauma involve repeated exposure to negative stimuli. ERP or exposure and response prevention therapy is the most evidence-based and is commonly used as treatment for PTSD, OCD, and other mental health issues and stress disorders. Dr. Carras gave the following example, “say you have a phobia of spiders. In ERP, if you are afraid of spiders, you might be shown a small picture of a cartoon spider and asked to control whatever your reflexive fear response is, such as turning your head away or leaving the room.
Gradually you are shown pictures of larger and larger more realistic spiders until you are eventually shown a real spider, and, if the therapy is effective, you will have a diminished response to that gut-clenching fear reaction.
For veterans, if the spider is combat, and the therapy is a military simulator, repeated exposure to potentially traumatic stimuli could function similarly to conventional ERP therapy. Exposing oneself to realistic combat situations, in the safe and controlled environment of a game, could help calm the physiological response to these stimuli, and then reduce the effects of PTSD from past combat trauma.
When talking about triggers following combat with Stephen Machuga, he hit the nail on the head when he said, “Many things that people might think would trigger PTSD for veterans (gunshot sounds, explosions, violence in general), do not. In reality, triggers often come unexpectedly, in different, more complex contexts. However, it may still be helpful for veterans to recreate the contexts they experienced while deployed to potentially simulate these more nuanced triggers, and subsequently learn to work through them.”
This “working through them” was especially powerful coming from Stephen, a warrior and longtime gamer who’d turned to video games as therapy after returning from Iraq. He went on to say, “Video games are vital for mental health because they are FUN. The fact is, many veterans who are suffering from PTSD need something to simply put a smile on their faces and get through one more night.”
Having been close to rock bottom myself, this simple statement hit me like a ton of bricks, little did I know the best was yet to come, so stay tuned.
