A DLC for treating schizophrenia
Video games could be a doorway for treatment
I want to try something a bit new for this space above the email, so this week, I’m sharing a post that I’ve been thinking about outside of gaming (but potentially still very relevant).
It’s this one (https://substack.com/home/post/p-145684350) about how to prioritize problems for AI to solve. I think about this all the time at work, and I’m curious how you are all approaching it (or if you are).
I’ll open up a chat thread just for subscribers to talk about this so head on over if you would like to talk about this more!
Hello Scientist Gamer!
We are all lifelong learners. Every day, we take in information, process it, and learn from it, whether it is a new skill or gossip to be stored for personal satisfaction (I am not suggesting you all spread that gossip).
Each time we are faced with a learning situation, our brains reorganize their structure, functions, and connections; this amazing ability is collectively called brain plasticity (sometimes neuroplasticity).1 It’s how we learn that hot things are to be handled carefully and why we remember the most obscure movie quotes (I am horrible at this by the way).
Unfortunately, there are people who have conditions, like schizophrenia, that make it hard to learn. Researchers think that schizophrenia is a disease caused by disruptions to brain plasticity.2 These disruptions in turn lead to symptoms like impairments in thinking, lack of motivation, and social withdrawal.
Drug treatments for schizophrenia only treat a portion of the symptoms. Behavioural therapies can be a good supplement to drug treatments but it may be difficult to treat patients who are socially withdrawn or have difficulty expressing their feelings.3
Fortunately, video games might hold the answer.
Video games as therapy
Video games have been shown to affect brain plasticity,4 which makes them good candidates as treatments for schizophrenia. Because video games can be played alone, they may be good first-step treatments for patients with schizophrenia who are withdrawn or otherwise anxious about being around other people.
So the authors of this study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11133354/) took healthy participants (76 participants) and patients with schizophrenia (59 patients) and over an 8-week period, gave them an e-book to read, or play Super Mario 64 (3D), or New Super Mario Bros. (2D). The researchers then analyzed the participants and patients for behaviour as well as symptoms of schizophrenia.
Video games hold people’s attention for longer
Avid readers aside, most people would prefer to play games than read books. I am constantly fighting with my kids over the lure of the Almighty Screen, trying to get them to bury their noses in pages instead. That was no different for patients with schizophrenia playing Super Mario 64 or New Super Mario Bros.: sustained attention increased over time for those playing games over those who were reading.
This was measured by a tool called the MATRICS Consensus Cognitive Battery (MCCB), which is a series of questions that assess patients and their brain functions. Among the seven brain functions that were measured by this tool, only one, sustained attention, showed an effect after playing video games for 8 weeks.
While this isn’t an earth-shattering discovery, it has important consequences for what the researchers found next.
Video games made patients feel better
The symptoms of schizophrenia were measured using a tool called the Positive and Negative Syndrome Scale (PANSS) and the Recovery Assessment Scale (RAS). PANSS is conducted as an interview with a healthcare professional, while RAS is a short questionnaire.
In particular, the researchers saw improvement in several aspects of schizophrenia through the PANSS score. Symptoms like emotional and social withdrawal, lack of emotional response, and lack of spontaneity, all improved after playing Super Mario 64 or New Super Mario Bros. Video game playing also improved symptoms like anxiety, depression, and preoccupation. Unfortunately, I don’t have access to data that could tell me the effects video game playing has on individual symptoms, but maybe that is the next step in this research path.
When these effects are combined with sustained attention, video games can improve symptoms of schizophrenia by making them feel better the more they play. On average, participants played for about 30 minutes per day during this study but it is unclear if more playing time could lead to more improvement. It’s another question for future researchers to answer.
3D games aren’t better than 2D games
Before conducting the study, the researchers thought that 3D games might have a bigger effect than 2D games because players have more dimensions to be aware of. They weren’t sure if the brain plasticity effects of video games were driven by the need for players to navigate a 3D environment. That’s why the researchers included both Super Mario 64 and New Super Mario Bros.
In short, no matter what parameters they looked at, there was no real difference in effect between the 3D and 2D game. At least in this study, it didn’t matter whether you were playing a 3D or 2D game; as long as it wasn’t reading, playing the game was what mattered the most.
Limitations of the study
If you just skim the subheads, you might be led to believe that playing games is the answer to schizophrenia. So I always include this sections to help put on the mental brakes and think about the results.
The first limitation is that this is a very small study. Only 59 patients with schizophrenia were included in the study, who were further divided into the e-book, 2D, and 3D game groups. With a larger number of patients, some of the effects seen here may average out and go away.
The second limitation is that participants only played video games for 8 weeks. A typical schizophrenia treatment plan could last years or even a lifetime — the long-term effects of video game playing on patients with schizophrenia is yet to be determined. What’s more, the patients only played for 30 minutes a day; what would happen if they play longer? Is there a plateau effect where after a certain number of minutes per day or weeks of treatment, you wouldn’t see any beneficial effect?
Finally, I think it’s important to keep in mind that the authors are not suggesting that video games replace other treatments. They end the article with this statement:
…video game training should not be understood as a substitute for relevant pharmacological (drug), social and psychotherapeutic treatments but rather seen as an add-on.
In other words, it’s a DLC for treatments for schizophrenia.
If you want to read the article for yourself, you can access it for free right here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11133354/
If you liked what you read, please consider giving this post a like!
https://www.frontiersin.org/articles/10.3389/fncel.2019.00066/full
This article is an overview of the history of how we came to understand brain plasticity and the impacts of research in this field.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810231/
This article is a survey of existing research, gathering evidence for the argument that disruptions in brain plasticity are what causes schizophrenia.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498814/
This article describes cognitive behavioural therapy, a behavioural treatment commonly used to treat patients with schizophrenia.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826942/
This is a review about the effects of video games on the brain.
Very interesting! I'm currently ill with flu, and I've noticed that once I start getting into a game, I tend to not notice my symptoms as much. This is likely because games have a very low threshold requirement for concentration and a high propensity for dopamine release. Alas, that's also (I think) why many people use games as a coping mechanism to avoid issues or chores.
Still, really cool that this mechanism can be used to treat major mental disorders.