SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient - Powered by the Science of Games - Jane McGonigal (2015)
Part 1. Why Games Make Us Superbetter
Chapter 4. You Can Make the Leap from Games to Gameful
Your Mission
Smash the boundaries that keep your gameful strengths separate from your real life.
So far we’ve looked at findings from more than one hundred scientific studies that reveal the natural gameful abilities we all possess: to control our attention, thoughts, and feelings; to connect and bond with virtually anyone; and to supercharge our willpower and determination.
But not everyone who plays games will succeed in translating these strengths from games to daily life. In fact, many gamers seem to suffer—academically, socially, or in their physical and mental health—as a result of excessive play, leading many to worry about “video game addiction.” How is it possible that some frequent game players benefit from play while others struggle?
It’s a paradox I’ve spent years researching, and I’m not the only one. Consider the following headlines. These are all actual results from peer-reviewed research on the impact of playing video games.
“Study Shows Videogames Linked to Depression and Lower Life Satisfaction”1
“Study Shows Frequent Gamers Experience Greater Levels of Happiness and Life Satisfaction”2
“Gaming Linked to Lower Grades, More Drug Use in Teenagers and College Students”3
“Video Game Play Linked to Higher Grades, Less Drug Use in High School and College Students”4
“Videogames Linked to Poor Relationships with Friends, Family”5
“Videogames Improve Family Relationships, Particularly Between Fathers and Daughters”6
It’s maddening, isn’t it? I’ve read literally hundreds of scientific papers on this topic, and many of them convincingly argue that playing games will make you more depressed, anxious, and socially isolated. But many more just as convincingly argue that playing games frequently will make you happier, healthier, and more ambitious, with stronger social support to boot.
It’s not that either group of researchers is wrong. They’re both right.
When you examine all the factors behind the diverging results, as I have, again and again you’ll come across one reason why only some gamers learn how to effectively apply these strengths in real-world contexts, such as work, school, health, or family. So what makes the difference?
It’s not, surprisingly, a matter of which games you play, or how much time you spend playing them. Instead, it depends entirely on why you play games.
Do you play to escape your real life, or do you play to make your real life better?
(If you’re not sure which you do, keep reading—this chapter will help you figure it out.)
If you typically play games to escape your real life—that is, to ignore your problems, to block unpleasant emotions, or to avoid confronting stressful situations—you will have a very difficult time translating your game skills to real life. An escapist approach to play really does increase depression, worsen social isolation, and make you less likely to achieve real-life goals.7 That’s because the more stressful your life gets, the more you play games—and the less time and effort you put into action that could help solve your real-life problems. Your problems therefore get worse, so you spend more time gaming to escape them. It’s a vicious cycle.
If you know someone who is addicted to games, they are almost certainly playing with an escapist mindset. In fact, researchers have found that “the use of games to escape daily life” is the number-one factor that predicts excessive or pathological game play. 8
However, if you play with purpose—with a positive goal, such as spending quality time with friends and family, learning something new, or energizing yourself after a long day—you are much more likely to bring gameful ways of thinking and acting into everyday contexts. You’re not playing to avoid problems—you’re playing to bring benefit. You clearly see the connection between gaming and its impact on your daily life, so you’re better able to activate your gameful strengths in real-world contexts.
Researchers have found that this kind of purposeful play builds self-confidence and real-world problem-solving skills.9 More important, it has the opposite impact of escapism: it helps you be happier, better connected, and more successful in real life.10
The difference between struggling and flourishing turns out to be quite simple. You don’t have to play different games, or even spend less time playing games, to benefit. You simply have to stop thinking of games as a distraction from real life and start thinking of them as a source of genuine strength, skills, and power. It sounds almost too easy to be true, but the research is persuasive. Let’s take a look.
Although virtually all gamers experience a deep level of immersion when they play, it turns out there are actually two different kinds of immersion: self-suppressive immersion and self-expansive immersion.11
When you self-suppress, you’re trying to prevent bad thoughts, feelings, or experiences. You’re avoiding rather than seeking.
Almost everyone self-suppresses from time to time, even though it’s not the healthiest psychological coping mechanism. Some people self-suppress by reading a juicy novel, or completing a hard workout, or binge-watching a television show. Any escapist activity can be self-suppressive, helping us mentally block out a stressful reality we’re trying to avoid.
More dangerously, many people self-suppress with addictive substances, such as alcohol, drugs, or food. This kind of habit can spiral quickly out of control: addiction only adds to the problems and stress you’re trying to suppress, so you spend even more time trying to escape them.
Even people who self-suppress rarely, or who try to escape through a relatively benign activity like reading or running, may experience a downside to this coping technique. While self-suppression works in the short term, leading to a temporary improvement in mood and well-being, it hurts us in the long term. Every time we succeed in feeling better by escaping reality, we become less likely to face our stress or challenges in the future. We reinforce the idea that the fastest way to feel better is to avoid rather than to engage. Over time self-suppression actually diminishes our sense of self-efficacy and control over our lives. We no longer see ourselves as people who can effectively solve our own problems.12
When you self-expand, on the other hand, you’re trying to promote positive thoughts, feelings, and experiences. You’re actively creating something good in your life. You focus on what you want more of, not on what you want less of. Self-expansive activity looks exactly like self-suppressive activity: reading a book for an hour, going for a five-mile run, playing a video game all afternoon. You can’t tell whether someone is self-suppressing or self-expanding just by looking at what they’re doing, or how much time they spend doing it. You can find out only by asking about their motivation and mindset.
If someone has a negative motivation—“I don’t want to deal with anyone right now” or “I just don’t want to think about it”—they’re self-suppressing. If they have a positive motivation, like learning something new, improving a skill, achieving a goal, reenergizing, or strengthening a relationship, they’re self-expanding.
Self-expansive activity is a healthy and positive coping mechanism, even though it also involves ignoring “real life” for a while. That’s because when you self-expand, you build confidence and self-efficacy. You start to look at your favorite leisure activities—whether they’re sports, games, hobbies, or other pastimes—as powerful tools you can use to get stronger and improve your life. This self-efficacy spills over into daily life. When you feel successful at creating positive thoughts, feelings, and experiences for yourself in your leisure time, you are more likely to put in the effort and creativity to seek positive outcomes in challenging everyday situations.
In some cases, however, the line between self-expansion and self-suppression seems unclear, particularly when it comes to highly immersive video games. In Chapter 1, for example, we looked at the use of virtual reality games like Snow World to block pain, or video games like Tetris to prevent flashbacks. Are these uses self-suppression? The goal, after all, is to avoid physical pain or mental anguish, which sounds like negative motivation. But ultimately, it boils down to how players think about what they’re doing. If they feel powerful and proactive, then their game play is self-expansive. If they think, I have the ability to control how I feel right now, or I have the power to influence whether I suffer traumatic flashbacks, they have a positive motivation. They are building self-efficacy. But if they are simply seeking refuge—I can’t deal, this game is my only escape—they are indeed self-suppressing. By playing with this self-suppressive mindset, they diminish their own capacity to solve problems and improve their lives.
In edge cases like this, players must understand that they are using games to tap into their own strengths, not to avoid their problems. The behavior may be the same, but the mindset is different—and the mindset is what determines whether gameful strengths will be used effectively not only in play but in all of daily life.
So what exactly do you have to do to move from a self-suppressive mindset to a self-expansive mindset? It’s quite easy—you simply need to identify the benefits you seek from games, then consciously embrace play habits that give you what you seek. This purposeful approach to play is all it takes for your gameful strengths to flourish.
If your favorite games are sports or puzzles, or board or card games, you probably have some benefits in mind already. Playing sports not only improves physical health but also builds character and contributes to emotional well-being. Puzzles are widely considered to be a good way to stay cognitively sharp as we age. Board and card games are often praised for promoting family together time, or as a way to enjoy face-to-face interaction with friends. Basically, if your favorite kind of game is anything but a digital game, you likely can already identify some benefits, because nondigital games are for the most part accepted by society as a healthy and positive activity.
However, even if you derive great pleasure from playing your favorite digital games, you may not have a very good idea of how exactly they are building up your real-life strengths (beyond what you’ve learned in the first three chapters of this book, that is). That’s because for the past three decades, discussion about video games has mostly focused on their potential harms rather than their potential benefits.
Fortunately, in 2014, the scientific journal American Psychologist published an extensive analysis of “The Benefits of Playing Video Games.”13 This paper summarizes the findings from seventy other scientific studies, including many of the studies you have already read about in this book.
So far, in our discussion of the benefits of playing video games, we’ve focused on the ones that directly contribute to your ability to be stronger and more successful in the face of stress and challenge. But there are many others. Knowing these additional benefits can help you play with greater purpose. So here they are for your consideration. Which of these benefits ring true to your own experience? (If you’re not a frequent game player, you can share this list with any passionate gamers in your life and see which ring true for them.)
COGNITIVE BENEFITS
Games can make you smarter, particularly fast-paced action and racing video games like Call of Duty, Forza, and Grand Theft Auto. Individuals who frequently play action video games enjoy the following cognitive benefits:
· Improved visual attention and spatial intelligence skills, which predict higher achievement in science, technology, engineering, and mathematics
· Faster and more accurate decision making in high-stress, time-sensitive contexts
· Improved ability to track multiple streams of information simultaneously—up to three times as much information as an infrequent game player
· More efficient neural processing generally—the brain uses fewer resources during difficult tasks14
Strategic games, such as StarCraft, Mass Effect, and Final Fantasy, also improve concrete problem-solving skills that predict academic success and higher achievement in daily life. These benefits include:
· More effective information gathering
· Faster and more accurate evaluation of options
· Stronger ability to formulate and follow strategic plans
· Greater flexibility in generating alternative strategies or goals15
Finally, all genres of video games have been linked to greater creativity. Kids who spend more time playing games—including games with violent content—score higher on tests of creativity that involve storytelling, drawing, and problem solving.16
It’s worth noting that significant scientific evidence for the cognitive benefits of traditional, entertainment-focused video games is considerably greater than that for so-called brain-training games that are marketed specifically as improving cognitive function. In fact, in 2014, seventy neuroscientists cosigned a public statement calling attention to the fact that in the peer-reviewed scientific literature, brain-training games—the best-known example being Lumosity games—have not been found to produce long-term cognitive benefits.17 More important perhaps, studies that have directly compared the benefits of mainstream video games like the sci-fi puzzler Portal and the fantasy role-playing game World of Warcraft to brain-training games have found that the traditional video games improve cognitive performance significantly more than the brain trainers.18 The researchers I’ve talked to about these results suggest a simple explanation: traditional video games are more complex and harder to master, and they require that the player learn a wider and more challenging range of skills and abilities. Therefore, if you are particularly interested in cognitive benefits, I encourage you to play ordinary video games that are challenging and new to you, and not to spend your limited game play hours on simple “brain trainers.”
EMOTIONAL BENEFITS
Playing video games helps change your mood and improve your emotional state, particularly puzzle games such as Angry Birds and Bejeweled and platform games such as Super Mario. Playing your favorite games gives you the power to
· Improve mood immediately
· Ward off anxiety
· Experience more frequent positive emotions, such as delight, curiosity, surprise, pride, wonder, and contentment19
Video games also help you learn to manage difficult emotions. This is especially true of very challenging, scary, or emotionally intense games, such as BioShock, Resident Evil, and Silent Hill. Frequent players of these games become
· Better able to deal with frustration and anxiety in high-pressure situations
· More skillful at controlling extreme emotions like fear and anger20
Gamers even develop some unusual emotional “superpowers.” Perhaps the most surprising power has to do with dreaming. People who frequently play first-person games (which graphically show you the game world from the point of view of the hero, like Minecraft, Halo, and Portal) develop two rather amazing skills:
· They can halt nightmares in their tracks, controlling themselves in their dreams the way they control a character in a video game.
· They experience more frequent “lucid dreaming,” or dreams in which they realize they’re dreaming and purposefully enjoy the dream—for example, the opportunity to fly.21
SOCIAL BENEFITS
Multiplayer and massively multiplayer video games can teach important social skills, beyond the ally-building skills we examined in Chapter 2. People who frequently play team-based games, such as Call of Duty, League of Legends, and Team Fortress, show
· Stronger cooperative mindsets in daily life
· Improved communication and collaboration skills 22
Meanwhile, people who frequently play games that require them to organize groups and lead others in like-minded efforts, such as Guild Wars and World of Warcraft, are rated by others as
· Better leaders
· More effective motivators
They are also more likely to engage in civic behavior, such as volunteering and raising money for charity.23
These are just a few of the benefits that you can purposefully reap by playing games. The key to adopting a self-expansive mindset is to be perfectly clear on why you play. What are you seeking, and how does it benefit you in daily life?
This question has many good answers—answers that are potentially as unique and varied as the 1.23 billion people on this planet who play video games for at least one hour per day. What’s your answer?
Here’s a quest to help you find out. It’s designed specifically for people who frequently play games (of any kind, including sports, board games, and card games). However, if you’re not a frequent game player, you can replace “games” with any kind of “hard fun”—that is, any favorite hobby or pastime that regularly challenges you to learn and improve. If you don’t have any hard fun hobbies yet, you can skip this quest for now.
If you have a gamer in your life who you worry may be playing excessively, use this quest to start a conversation with them about how to play with purpose. It’s the first and most important step to getting a negative gaming habit under control.
QUEST 14: Play with Purpose
Playing with greater purpose is easy. Just follow this simple three-step method.
1. Choose a game. Name a game that you often play.
2. Find the benefit. What’s one benefit you think you get from playing this game? It might be a skill or talent you build, or a positive change in how you feel, think, or interact with others. (For ideas, review the benefits listed in this chapter!)
3. Connect it to a purpose. What real-life goal, or what situation in daily life, could this benefit help you deal with more effectively?
It may feel awkward at first to answer these questions, especially if you’re used to thinking of games as just “fun” or a waste of time. But give it a shot!
Examples: For inspiration, here are some SuperBetter players’ responses to this quest:
Nancy, 64, Colleyville, Texas
The game: Criminal Case on Facebook.
The benefit: “I like the feeling of making progress and solving the crimes. I feel mentally quite sharp!”
The purpose: “I can have more confidence in my memory, which puts me in a better mood and helps me feel less shy in social settings.”
Jacob, 23, Pittsburgh
The game: “I usually play FIFA [a soccer video game] after work.”
The benefit: “I have more energy after I play. It’s like a jolt to my system.”
The purpose: “After about thirty or forty minutes of playing, I can ‘switch gears’ and be better company for my girlfriend. She gets the best of me instead of the worst of me.”
Merilee, 38, Indianapolis
The game: “I play Just Dance on the Wii with my kids.”
The benefit: “I’m getting exercise on days that I don’t have any free time for myself.”
The purpose: “I’m staying fit even when I’m busy, plus I’m helping my whole family be physically active, which is important to me.”
Joshua, 13, Edmonton, Alberta, Canada
The game: “My favorite game is Minecraft.”
The benefit: “I get to be creative. I can make whatever I can imagine!”
The purpose: “When I have to be creative for school projects, I never draw a blank. I’m good at thinking up new things to make because I practice all the time in Minecraft.”
Now it’s your turn. Choose a game, find the benefit, and connect it to a purpose.
Quest complete: Were you able to complete the three steps? If so, well done. You’re starting to realize the powerful strengths and skills you’re building when you play—and knowing your strengths is the first and most important step toward using them in daily life.
The more you play with purpose, the more resilience you’ll have against all kinds of self-suppression in the future. Like all cognitive habits, self-suppression can become hardwired into your brain. Each time you self-suppress, you strengthen the neural networks that urge you to escape again in the future.
Learning to keep this cognitive habit in check is important, because self-suppression is closely related to another psychological behavior that can wreak even more havoc on your life: experiential avoidance. Also sometimes referred to as experiential escape, it’s an unwillingness to accept or directly deal with distressing thoughts or emotions, coupled with attempts to escape or avoid anything that might trigger distressing thoughts and emotions in the future.24
Here are some examples of experiential avoidance: A young woman experiences anxiety on a turbulent flight; for years afterward, she avoids taking long-distance trips and goes to extreme lengths to avoid flying. A son feels guilty whenever he visits his aging mother in her assisted living apartment, so he stops visiting her. In both of these cases, instead of learning to manage their anxiety or discomfort, the person simply tries to avoid its trigger. The more they try to escape potential distress, the more positive experiences and relationships they are likely to miss out on in the future.
This kind of escapist mindset can lead to profound depression, social isolation, and even self-harm. At the very least, being unwilling to do things that might potentially trigger a negative thought or feeling severely restricts and limits your goals, ambitions, and life experiences.
Experiential avoidance is something you’ll learn more about in Chapter 7, when we talk about “bad guys” and how confronting them regularly can make you stronger and braver. For now, it’s enough to know that playing with purpose will help you develop the psychological habits necessary to avoid escapism of any kind and to live with greater purpose, even in the face of risk, adversity, or challenge.
There’s one more important thing to understand about self-suppression or escapist game play: it often reaches a tipping point. Eventually, beyond a certain limit, avoiding the reported negative consequences of excessive video game play, such as more depression and anxiety, lower grades, and social isolation, becomes very difficult.
What is the tipping point? I’ve spent five years investigating this issue, looking at everything from military studies of how much time troops spend playing video games, to player surveys of when their play starts to feel detrimental to their health and happiness. Here’s what I’ve found, again and again: at around twenty-one hours a week of digital game play, things start to go south. Twenty-one hours a week is the tipping point.25
People who play video games three or fewer hours per day tend to reap the benefits of play. They report having a good balance between their game pursuits and their real-world goals. However, for both children and adults, playing more than three hours a day takes too much time away from nongame work, study, physical activity, and relationships. These areas of life start to suffer, and the vicious cycle of self-suppressive play kicks in.
However, here’s the good news: once you get your gaming hours under twenty-one hours per week, the benefits start kicking back in. This is a crucial finding. If you are seeking a practical intervention for yourself or for someone you care about, you don’t have to eliminate games or even reduce them severely. You just need to get the total hours per week below twenty-one. For gamers who worry about playing too much, this change in habit is far less intimidating than giving up games completely.
Playing fewer hours per week won’t automatically switch someone to a self-expansive mindset. However, it will get them safely under the self-suppressive tipping point—which will ultimately make it much easier to stop escaping and to develop a healthier relationship to immersive play.
Despite what we now know about the harms of escapism, a whopping 41 percent of frequent game players still say they “play video games to escape daily life.”26 No wonder so many gamers have not yet made the leap from games to gameful! They’re convinced that games are just a distraction. This belief is not only incorrect—it’s actively harmful. Another study of game addiction found that “playing without a sense of purpose to the activity” was the best predictor of problematic or excessive game play.27
Well-meaning parents, spouses, and educators make the situation even worse by admonishing gamers to “put down the game and do something real,” or to “stop wasting so much time.” This kind of nudging, while well intentioned, conditions gamers to believe that play has no purpose, no meaningful connection to success in daily life. This kind of artificial psychological barrier makes it almost impossible to develop a self-expansive mindset.
If you have an avid game player in your life, the best thing you can do for him or her is to start a conversation about the benefits of play and the psychological strengths of gamers. Instead of asking him or her to put the game away, here are some powerful questions to ask:
· What are you most proud of achieving in this game so far? How did you accomplish that? What strengths or skills did it take?
· What makes this game hard? What are your strategies for winning? How did you come up with those strategies?
· How long have you been trying to complete this level or mission? What keeps you going? Where do you find the motivation to not give up?
· What do you think this game makes you good at? Is there another part of your everyday life where you could apply the same skill or talent to solve a problem?
· I read today that gamers are better at [X] than nongamers. Did you know that? Do you think that’s true for you?
And then the most powerful question to ask any gamer (because connecting is always better than escaping):
· Can I play with you?
I’ve made it my mission to explain the difference between playing to escape and playing with purpose to as many gamers as possible—through my TED talks, my first book, in interviews, on Twitter, and anywhere else I can reach them. Through this work, I’ve had the opportunity to meet many gamers—and parents and spouses of gamers—who, simply by changing their mindset, have been able to make the leap from just playing games to being gameful in everyday life.
Paul’s story, relayed to me by his father, is typical. At fifteen, Paul seemed addicted to online video games. He attended classes at his Chicago-area high school, but he ignored his schoolwork, preferring to play League of Legends every night until three in the morning. His physical health deteriorated from lack of sleep. His GPA dropped to a D+ average. His parents tried to intervene, taking away his computer, but it backfired: Paul didn’t come home at night and found other places to play. His father told me that the situation seemed hopeless.
Then one day Paul’s father showed him a video of one of my talks. They started a conversation about the psychological strengths that gamers develop—strengths that Paul surely had. His dad asked him how he might use these strengths for good in the real world. From this conversation alone, Paul began to make big changes. He didn’t stop gaming, but he became curious about what he could achieve with his gameful strengths—particularly his determination, his online research skills, and his team leadership.
Paul started using these strengths to set and achieve real-life academic goals. He took a gameful approach to college applications, approaching each step in the process like a quest. He planned and celebrated every “achievement” he unlocked, from finding five colleges he could picture himself happy at, to collecting three letters of recommendation, to finishing a first draft of a personal essay. He assembled a team of people to help him in his college quests, including his high school counselor, his parents, and graduated classmates. Today, Paul is thriving as an engineering major at Dartmouth—still playing games every night, but not until three in the morning. As his dad proudly told me, “It’s all because he finally understood, and because we as his parents finally understood, that his love of games isn’t a weakness. It’s a source of strength.”
Paul’s story is a dramatic one. Most people don’t need to make such a 180-degree turnaround in their relationship to games. However, almost everyone can benefit from understanding the huge difference it makes in our lives when we stop playing to waste time or forget our troubles and start playing with purpose.
Amelia McDonell-Parry, thirty-six, a writer in New York City, is a great example of how even small efforts to connect game strengths with daily life can lead to big positive changes. Amelia spent the summer of 2013 playing the wildly popular pattern-matching game Candy Crush Saga for hours on end. She played so often, in fact, that she regularly experienced visual flashbacks. “I close my eyes,” she said, “and I see the Candy Crush playing field. Candy Crush combos infiltrate my dreams.”
Amelia wanted to make those hours count for something more than a high score, so she decided to think about what the game had taught her about her strengths and weaknesses. The most important lesson she learned, she decided, was this: “Don’t be afraid to ask others for help.” She describes her “aha!” moment:
Friends who also play Candy Crush can give you additional lives and help get you access to the next set of levels, if you can put aside your pride and ask for it. At first this made me uncomfortable. I generally don’t like asking others for assistance and prefer to figure things out on my own. Having an issue with an article I’m writing? I troubleshoot it myself. Need to put together a piece of IKEA furniture? I don’t care that the directions say it’s a two-person job! I’m doing it by my lonesome! Having a really rough day? No, I don’t want to talk about it, I just want to cry in a corner by myself, thanks. But sometimes in life, you need a shoulder to cry on, a tidbit of advice, an extra set of hands, or a spare Candy Crush life from that Facebook friend you haven’t seen or spoken to in ten years. Don’t be afraid to ask for any of these things when you need them.28
Amelia’s breakthrough realization was that she could do in her daily life exactly what she learned to do so effectively in her favorite game. Asking for help and cultivating allies was a skill the game taught her, and it didn’t remain limited to the game. This is a quintessential example of making the leap from games to gameful.
The most convincing evidence I’ve seen that almost anyone can bring gameful strengths to daily life—even individuals who rarely have time to play games!—is the SuperBetter community. There hundreds of thousands of people have learned how to bring their gameful strengths to real-world challenges. They’ve harnessed their natural gameful abilities—to control their attention, to turn anyone into an ally, and to supercharge their willpower and determination—to bring more motivation, creativity, positive emotion, and social support to their most important real-life goals.
You’ve completed Part 1 of the book, which means you are now ready to make this same leap. You understand the science of games. Now it’s time to actively use that science to change your life. It’s time to play SuperBetter.
MISSION COMPLETE
Skills Unlocked: How to Make the Leap from Games to Gameful
· Being gameful means bringing the strengths and skills you develop during game play to real-life goals and challenges.
· Not every gamer is successful in transferring their gameful strengths to daily life. The biggest obstacle? An escapist mindset, or playing games to avoid or forget about real life.
· The solution is to play with purpose: identify the benefits you get from games, and seek them out every time you play.
· Make a list of benefits you seek when you play. They might include specific positive emotions you like to feel, cognitive skills you want to develop, or ways you want to strengthen your relationships.
· Identify the skills and abilities that you develop by playing your favorite games, and look for opportunities to use those strengths in everyday life.
· If you have an avid game player in your life, talk to them about their gameful strengths. Share with them some positive research on games. Encourage them to see their love of games as a source of strength, not a weakness.
· To maximize benefits and minimize potential harm, keep video game play—or any escapist activity—to twenty-one hours a week or less. Leave plenty of time to enjoy and take full, real-world advantage of your improved mood, energy levels, relationships, cognitive skills, and self-confidence.