Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder

Abstract

Background: Tetris has been proposed as a preventive intervention to reduce intrusive memories of a traumatic event. However, no neuro imaging study has assessed Tetris in patients with existing posttraumatic stress disorder (PTSD) or explored how playing Tetris may affect brain structure. Methods: We recruited patients with combat-related PTSD before psychotherapy and randomly assigned them to an experimental Tetris and therapy group (n = 20) or to a therapy-only control group (n = 20). In the control group, participants completed therapy as usual: eye movement desensitization and reprocessing (EMDR) psychotherapy. In the Tetris group, in addition to EMDR, participants also played 60 minutes of Tetris every day from onset to completion of therapy, approximately 6 weeks later. Participants completed structural MRI and psychological questionnaires before and after therapy, and we collected psychological questionnaire data at follow-up, approximately 6 months later. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms, both directly after completion of therapy and at follow-up. Results: Following therapy, hippocampal volume increased in the Tetris group, but not the control group. As well, hippocampal increases were correlated with reductions in symptoms of PTSD, depression and anxiety between completion of therapy and follow-up in the Tetris group, but not the control group. Limitations: Playing Tetris may act as a cognitive interference task and as a brain-training intervention, but it was not possible to distinguish between these 2 potential mechanisms. Conclusion: Tetris may be useful as an adjunct therapeutic intervention for PTSD. Tetris-related increases in hippocampal volume may ensure that therapeutic gains are maintained after completion of therapy. contributions.

Changes in Brain Volume Associated with Trauma‐Focused Cognitive Behavioral Therapy Among Youth with Posttraumatic Stress Disorder

“…The entorhinal cortex receives converging input from many areas of the cortex and projects this information to the hippocampus (Li et al., 2017). Therefore, our finding in the entorhinal cortex could be linked to previous findings of treatment‐related increases in hippocampal volume among adults with PTSD (Butler et al., 2020).…”

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

“…Fifteen studies involved healthy participants, in most cases recruited from university staff and students, whereas three studies recruited participants among full-time workers [ 82 ], soldiers [ 86 ], and older adults in federal programs for assistance [ 117 ]. The other studies included soldiers who had posttraumatic stress disorder [ 113 ]; older adults who lived in a nursing home [ 112 ] and with Parkinson disease [ 109 ]; adults with at least minimal symptoms of depression [ 114 ], clinical depression, and comorbid anxiety [ 102 ], systemic lupus erythematosus [ 122 ], obesity [ 108 ], physical disabilities [ 116 ], and hematologic malignancies [ 105 ]; women after emergency cesarean section [ 115 ]; children with molar incisor hypomineralization–affected teeth [ 103 ], chronic wounds on the lower limbs that require active dressing changes [ 110 ], and who sustained second- and third-degree burns to the shoulders, neck, chest, bilateral forearms, and left thigh [ 123 ] ( Table 3 ).…”

“…In particular, 7 studies used Nintendo Wii Fit, 5 studies used Microsoft Xbox 360 with Xbox Kinect, 1 study used tXbox One [107], and 1 study used Sony PlayStation 3 [108]. Nine studies used a PC, three studies used a virtual reality viewer [103,110,119], one study used a smartphone [82], and two studies used a portable console (ie, Nintendo DS and Nintendo DS XL) [113,115].…”

The neural basis of Tetris gameplay: implicating the role of visuospatial processing

“…In these studies, Tetris gameplay was also associated with activations in the occipital and parietal lobes (Haier et al, 2009;Price et al, 2013) as well as the premotor areas (Haier et al, 2009). Notably, we did find a local maxima (Supplementary Table S1) and many activated voxels within the hippocampus (Supplementary Table S2), an area in which volume has been observed to increase with daily Tetris gameplay practice (3 months; Butler et al, 2020). In the current study, the global peak during Tetris gameplay, controlling for motor activity, was in the middle temporal gyrus (Table 1).…”

“…Tetris gameplay has previously been used in neuroimaging studies to investigate brain activity in emotion regulatory neural circuits (amygdala and occipital cortex; Price et al, 2013), to examine the impact of repeated practice of a visuospatial/ motor task on overall brain activity (Haier et al, 1992;Rietschel et al, 2012), and to assess the plasticity of cortical grey matter (Haier et al, 2009). Also, a neuroimaging study on posttraumatic stress disorder (PTSD) showed that daily Tetris gameplay (3 months), in conjunction with psychological treatment, increased hippocampal volume, which was associated with PTSD symptom reduction (Butler et al, 2020). However, there is a need for further neuroimaging studies pinpointing the visuospatial aspects of Tetris gameplay.…”