When it comes to video games, I think most people watching this video have at some point experienced a flow state, zoning out to a repetitive game with limited interactions. Maybe it’s jamming out in Guitar Hero and playing amazingly while not really thinking about it, or navigating flawlessly through levels of Super Hexagon.

Games with limited possible interactions, paced consistently, can sometimes lead players to mentally tune out, doing well while not actively focused in detail on the task. In some cases, this can give room to think about other stuff in the background. I myself often find these kinds of games great for playing while stuck on problems, coming out the other side with new ideas.

Perhaps the most classic example of this is Tetris, a game that for decades has been used by people looking to zone out and pass time. However, some studies have found that zoning out to Tetris specifically may have some psychological benefits for players with PTSD.

So today, on Access-Ability, we’re going to talk about studies into the therapeutic use of Tetris by people with PTSD. We’re going to look at how EMDR therapy is used to help people with PTSD manage their symptoms, how Tetris can play a role in EMDR therapy, and some of the unofficial Tetris clones that could be useful for people trying to use Tetris alongside other PTSD therapy.

Before I get any further into this video, I want to be clear that nothing in this video should be taken as medical advice or opinion. Please talk to a medical professional about your treatment plans for PTSD, rather than taking advice directly from a gaming accessibility YouTuber without a medical training background.

Let’s start by talking a little bit about what PTSD is, and how EMDR therapy for the condition is intended to work.

Post Traumatic Stress Disorder is a condition in which a person experiences stress, as a result of trauma, that reaches a stage where it impacts their ability to live their day to day life. Most people experience trauma in their lives, but the degree to which it impacts us, and our responses to those sources of trauma, are what constitute a PTSD diagnosis. While PTSD is commonly thought of as impacting people like soldiers who have seen war, the condition can impact people for a wide variety of trauma sources, ranging from parental neglect to an abusive relationship.

Eye Movement Desensitization and Reprocessing therapy works on the theory that PTSD can be caused by experiences of traumatic events that the brain does not properly process and store at the time. Put simply, during traumatic events the brain is focused on keeping you alive, and that survival mode can mess up how you store memories, causing them to potentially repeat as flashbacks. These flashbacks can involve the sensory information, emotions, and memories of the traumatic event to be relived, causing intense distress at times long after the occurrence of the event itself. The same areas of the brain that handle external stimuli are active during these flashbacks. They’re not simply being remembered, but re-experienced.

This can lead to a person with PTSD to experience highly elevated amounts of stress, which can lead to physical changes in the brain, like the decreasing in size of the hippocampus, which leads to increased rates of depression. The trauma of PTSD makes physical changes to the brain that have lasting impacts.

EMDR therapy focuses on combining eye movements with bilateral body movements (Such as crossing your arms and alternating tapping certain body parts), in order to make thinking about the traumatic event less emotionally intense, due to the movements offering a mental distraction. By engaging the brain in this way, combined with traditional therapy, studies have found that traumatic memories can be more easily processed and stored differently, leading to reductions in PTSD symptoms. EMDR therapy can still be traumatic for some, but for others it gives enough mental distance to make therapy more manageable. It’s not the only therapy option for the condition, but it’s one option that can be helpful.

So, how does Tetris play into this? Well, a 2020 study found that by combining gameplay sessions of Tetris with traditional EMDR and therapy sessions, compared to just EMDR and therapy alone, the group that incorporated Tetris had measurably improved hippocampus growth in the adult participants, which correlated to a greater reduction in PTSD symptoms, depression, and anxiety. To put that into context, the group who incorporated Tetris actively saw increased reversal of the physical changes stress from trauma causes to the brain. The study also found that the positive results of EMDR seemed to last longer in those who combined Tetris play with therapy.

This is a single study, and it doesn’t state definitively whether the improvements were caused by having a task to focus on while processing the traumatic events, or by Tetris being mental work that could be substituted for something else, but the core of the finding seems to be that Tetris alongside EMDR therapy can improve the quality of improvement seen by people with PTSD.

Additionally, it has also been theorised that playing Tetris directly in the aftermath of a traumatic event can have a similar effect, and help to ensure that the traumatic event is properly processed.

Now, at this point in the video I am moving outside the bounds of the study, and talking more anecdotally about the experiences of those with PTSD I have spoken with who have been engaging with Tetris after news of this study started to spread. While there is no definitive proof, most people with PTSD who I spoke to who have had positive experiences with Tetris alongside EMDR seem to attribute the reaction to the game’s flow state, and its similarities to EMDR. Both playing Tetris and EMDR therapy focus on eye movements and bilateral body movements. The key difference with Tetris is that the activity itself is a bit more mentally engaging. Because someone playing Tetris has to actively engage with those eye movements and sensory inputs, replicating the conditions used in safe EMDR, it’s easier to get lost in them, helping to compartmentalise their actions and the memories they are focused on.

Quinn Clark (pronouns they/them) is a writer, researcher and person with CPTSD who helped with the writing of this video’s script. Here’s what they had to say on the subject, as someone who had undergone EMDR therapy in the past.

“Dissociation (and comorbid dissociative disorders) are commonly associated with PTSD, including states of depersonalisation (detachment from one’s self) and derealisation (detachment from one’s reality). This state is entered involuntarily in order to protect against the very real pain of re-experiencing a traumatic memory through a flashback. When someone dissociates due to the pain of a traumatic event, they can end up dissociating as a coping mechanism to avoid that pain, and therefore delay the process of properly storing their traumatic memories. This is what EMDR aims to rectify. It would make sense then that having a safe, predictable, distracting form of entertainment which utilises bilateral body movement – like Tetris gameplay – would help the processing of traumatic memories. During a flashback, panic attack or dissociative episode, a helpful technique is to ground yourself using movement, sight, sound, touch, taste, and smell. I can anecdotally attest to the benefits of video games helping me come out of a flashback!”

Now, not all Tetris versions and modes are equally useful for this. One aspect of Tetris highlighted to me while working on this video was the need for modes where a player can set a consistent gameplay speed. As default, most Tetris games force the player to increase in speed and difficulty the longer they play. This can cause the game to get more stressful, and take up more mental processing to keep up with, disrupting the benefits of getting lost in the zone for a while. The last thing you want if you’re using this as an EMDR tool is to abruptly find your grounding tool getting too difficult and hitting a game over screen.

Additionally, many Tetris games are not portable, or on dedicated devices a person may not always carry with them, which can limit their effectiveness. Someone having a flare up of symptoms may not have a console or handheld on hand to play Tetris on at short notice, when it’s most useful as a therapeutic tool. Ideally, a version of Tetris on a phone would be most likely to be accessible at any given time, as phones are more commonly kept on someone’s person day to day.

That said, there are some third party Tetris clones that do seem to tackle some of these issues, and some Tetris games that have modes which manage these concerns, but with slight caveats.

Tetr.io, a browser based game on PC, has a Zen mode, where players can set a speed level, and turn off levelling, in order to play Tetris at a fixed speed which does not change, for as long as they want or need.

NullpoMino is a downloadable PC Tetris Clone that has similar customisation options to allow for consistent speed play, with a slightly more polished control setup. By going to practice, you can set a speed that does not increase.

On Android and iOS phones, Classic Blocks is a tetris clone that, while very bare bones, allows you to manually set a gameplay speed which does not change, if you would benefit from having tetris on hand to play without needing a dedicated device to play it on.

If you’re looking for an official Tetris game that is portable, modern, and supports unchanging speed gameplay of reasonable length, Tetris Effect on Switch supports fairly lengthy, but not unlimited length, fixed speed gameplay. Go to effect modes, then quick play, and you can set a consistent speed match. At most you can play 600 line clears worth of Tetris, but that will take a long time to complete, roughly an hour at level 1 speed, and for most players will be plenty.

While Tetris itself isn’t a definitive treatment for PTSD, or even a treatment by itself, it does seem to work well as a part of a treatment plan alongside EMDR and therapy. We don’t know for certain the mechanism behind it working, but the fact it seems to is great news to have.

EMDR PTSD therapy is all about distracting parts of your brain, and grounding yourself, while you revisit trauma, and if Tetris can function as a calming flow state distraction when revisiting trauma, that’s great news.

Trauma can be distressing to work through, and if having a game like Tetris to play can help to process trauma with a little distance, in a less distressing manner, that’s a positive option to be aware of.

You should obviously discuss any treatment plans for PTSD a psychologist rather than taking your advice from a gaming YouTube video, but Tetris may well be a grounding tool worth considering trying, and discussing with your healthcare professional.

It’s important to keep in mind to separate your gameplay for fun, and gameplay for therapeutic purposes. You should always get approval from your healthcare professional, and make sure you have time away from the healing process. Therapy is important, but it’s important to maintain activities that are just for fun too.

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