This Video Game Might Defeat Depression

The idea of gaming on a screen as a particular help to depressed patients, specifically elderly ones, isn't a new one. Back in 2014, research found that a kind of game called a "neuroplasticity-based computerized cognitive remediation-geriatric depression treatment" (nCCR-GD, in case that made your eyes cross) showed distinct uses when treating low mood in older people who weren't really responding to antidepressant medications. The nCCR-GD games, though, weren't exactly Mario Kart. They were specially designed cognitive challenges involving complicated word lists and images of moving balls across a screen.

The good news was that these games, lacking in narrative or basic fascination though they were, showed good results. As Bustle reported at the time that the games were designed to engage with the "executive functions" of the brain, some of the most complicated of our mental processes. Explaining executive processes can be complicated, but neuroscientist Professor Adele Diamond in the Annual Review of Psychology gives a good working definition:

"Executive functions (EFs; also called executive control or cognitive control) refer to a family of top-down mental processes needed when you have to concentrate and pay attention, when going on automatic or relying on instinct or intuition would be ill-advised, insufficient, or impossible... Using EFs is effortful; it is easier to continue doing what you have been doing than to change, it is easier to give into temptation than to resist it, and it is easier to go on 'automatic pilot' than to consider what to do next."

She also points out that there are three different kinds of executive function: inhibition, working memory, and cognitive flexibility. Inhibition helps us use self-control, working memory keeps information available for us to make decisions, and cognitive flexibility lets us do complex tasks like planning or reasoning. It's this area that the particular games targeted, and new research indicates that this wasn't just a one-off.

Executive function may sound like an excellent fancy way to look at the brain's complex decision-making, but what has it got to do with depression? A lot, as it turns out. Studies have shown that people with depression have less executive function; one in 1999, for example, gave depressed and non-depressed tasks that would use the three different bits of executive function, and found that they were poorer at all three of them. It's also worse in people with chronic depression than ones with brief episodes.

So how does poor executive function fuel depression? A good outline comes from a review of the science back in 2002 in the French journal L'encephale. The three bits of executive function, the scientists explained, have direct links to problems common to depressive people. If you don't have proper inhibition control, you might take in information that's actually irrelevant and construe it poorly. If you can't maintain decent short-term memory, you're less able to be able to cope with sudden stressors, and can't get yourself out of depressing situations quickly enough. And if you can't plan properly, you're more likely to be miserable about getting negative feedback on anything, rather than using it as motivation and planning to be better.

It can also be a self-fulfilling cycle. Real problems with executive function, wrote Nordic scientists in 2004, "may have a negative impact on everyday functioning" and fuel further depression: why can't I just make a simple decision? Why is my head so foggy? So is the solution gaming?

The new study out this week is radically different from the one in 2014. For one, it doesn't make up a game for specific use; it used Project: EVO, by Akili Interactive, a game custom-designed to help neuroscientific outcomes, particularly in areas of executive functioning. It's a game that requires very swift decision-making in a make-believe world, requiring people to pay attention only to specific images and not to others. It's also competitive; as the game progresses and players get more proficient, it gets harder. (It's also cute: one game includes guiding aliens through a canyon and avoiding obstacles.) In 2015 it showed real potential helping the attention of kids with ADHD, and now this research shows it could also be applied to people with depression.

The Project: EVO study was done using people of 60 and over because, the researchers emphasized, being unable to focus because of worries and depression seems to be more of an issue for that age group. They compared people using Project: EVO with others given a standard antidepressant and a control group given a placebo. The results showed that, for people with more than mild depression, EVO provided better results for mood — but they added a necessary note of caution. The video game is meant to be used in conjunction with therapy, and people in the study needed to be monitored to make sure they did it; it wasn't as successful if they were just left to their own devices to download and play it. (Many didn't bother.)

The use of Project: EVO as a therapy is yet to be approved by the FDA, so it's not widely available just yet. And you've got to remember that these studies focused exclusively on the elderly, so the worth of games to people in younger age groups might not be as applicable. More science is needed, but it's entirely possible that one day your therapy prescription will come with a hook-up to something involving brightly-colored aliens on a screen.