SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient - Powered by the Science of Games - Jane McGonigal (2015)
Part 3. Adventures
ADVENTURE 3. Time Rich
Take this adventure if . . .
· You feel like the day isn’t long enough to do everything you want.
· You could have more of any one thing, it would be more free time.
· You want to learn to slow down time, so you can use it more effectively.
This adventure includes:
· 10 quests
· 6 power-ups
· 3 bad guys
How to play:
· Complete one quest a day, until you finish all 10 quests.
TIME RICH QUEST 1: Learn What It Means to Be Time Rich
We all have the same twenty-four hours a day. By that measure, no one person should be “time richer” or “time poorer” than anyone else. But in fact, some people do experience what economists call time affluence. It’s the feeling that you have abundant time to spend on all the things that matter most to you. When you’re time affluent, no matter how busy you are, you feel like you always have enough time for your family, your health, and your passions.
But many more people experience time poverty, the feeling that you never have enough time to spend on your personal goals and priorities.1 When you’re time poor, it doesn’t matter how motivated you are—you constantly feel deprived of the chance to put time and energy into your passions.
If you’re like most people in the United States today, you’re more likely to feel time poor than time rich. This adventure is designed to help you change that.
People who are time rich are happier, healthier, and more productive. They experience less chronic stress, and they dedicate more time each day to pursuing their personal goals and dreams. They have closer relationships. They volunteer and help others more. They make smarter choices about what to eat, how much to exercise, and how long to sleep.2 All this makes perfect sense: if you feel time rich, you’ll spend time much more freely and generously with yourself. In this way, time really is just like money.
Becoming time richer can make a huge and positive difference in your life. Economists have shown that time affluence is a better predictor of every kind of well-being (mental, physical, emotional, and social) than material affluence. People who feel time rich experience less stress, more happiness, closer relationships, and better physical health than people who feel time poor. These benefits accrue regardless of whether you have a lot of money. In fact, if you want to lead a better life, faster, economists recommend trying to increase your time wealth rather than your monetary wealth.3
But here’s the strange thing about time affluence: it doesn’t actually correspond to how much “free time” you objectively have. Except with individuals who work multiple jobs in order to stay above the poverty line, and those who have no control over unpredictable and frequently changing work schedules, perceived time affluence is almost completely unrelated to how many minutes or hours per day people have for personal pursuits or freely chosen activities.4 Studies have found that most people who have a ton of free time don’t feel time rich; they just feel bored or restless. On the other hand, many people with incredibly busy schedules and hardly a minute unaccounted for feel extremely time rich. Despite barely having a minute to themselves, they will tell you they have all the time in the world. So what makes the difference?
It turns out that, for the most part, time affluence is not related to a person’s schedule but rather to a huge range of tiny mental, physical, emotional, and social habits. Little choices you make each day—how you sit, how you commute, even how fast or slowly you breathe—influence your perception of how much time is available to you. Meanwhile, the tiniest social interactions and seemingly trivial decisions (like “Which thirty-second video should I watch online today?”) can make you feel dramatically time richer or time poorer.
This adventure will teach you the habits of the time rich. Over the next eight quests, you’ll learn eight different techniques for increasing your time affluence without changing how much free time you actually have. These techniques have been developed and tested by researchers at Yale, Harvard, Stanford, Wharton, UC Berkeley, and other leading business schools and psychology departments.
What to do: Simply accept this challenge: “Over the next ten days, I will accumulate a small fortune of time to spend on the things that matter most to me!”
TIME RICH QUEST 2: Get Rich with Power
“Time is money”—so goes the common saying. But according to a team of psychology researchers at the University of California at Berkeley, a more apt saying would be “Time is power.”
People in positions of power, such as CEOs, often feel time rich. The UC Berkeley researchers wanted to find out why. Is it because powerful people actually have more free and abundant time? Or does having power change our perception of time, helping us use it more effectively, regardless of how much free time we actually have?
To investigate this question, the researchers conducted a series of five experiments in which they cleverly increased and decreased participants’ feelings of power while asking them to evaluate how much time they had to do the things that were most important to them in daily life.
Here are some of the power-increasing techniques they tested:
· High-power seating: Adjust your seat higher than you normally sit.
· Power memory: Remember a time when you had the power to make an important decision or impact someone else’s life.
· Power stance: Raise your arms over your head as high as you can, plant your feet firmly and widely on the ground, and stick your chest up and out. (You may be familiar with this technique from Harvard Business School professor Amy Cuddy’s widely cited “power posing” research.)5
As it turned out, all three of these psychological techniques successfully increased both feelings of power and time affluence. And there was a direct relationship between the two. The bigger the increase in perceived power, the more time participants said they had to pursue their own goals.6
Why did it work? The researchers theorized that feeling powerful increases our sense of control over all aspects of our lives—and control over time is just one aspect.
“Of course, in reality, the powerful don’t control time,” the Berkeley researchers wrote in a study published in the Journal of Experimental Social Psychology. “Unlike other resources, such as food or money, time is constantly being spent and can never be replaced.” However, believing you control your own time does increase the likelihood that you will spend time on your own personal goals. “In this way,” the researchers wrote, “the powerful really do have a monopoly on time.”
Making yourself feel more powerful, even just for a moment, can help you discover time for yourself that you didn’t realize you had. This is the first step to becoming time richer.
What to do: To gain some of the time you deserve, choose one of the three high-power techniques used in the Berkeley study, and practice it right now.
TIME RICH QUEST 3: Discover the Time Gift Paradox
It sounds counterintuitive, but it’s true: giving time away to someone else will make you feel time richer.
A team of Yale, Harvard, and Wharton researchers conducted a series of four experiments to test this theory. They found that spending as little as ten minutes helping someone else—for example, proofreading someone’s essay or writing a supportive letter to a child in a hospital—increased time affluence significantly. In fact, giving time away made the study participants feel more time rich than participants who actually, objectively, got time richer—that is, participants who received a “time windfall,” or an hour of unexpected free time to do whatever they wanted.
The researchers argued that this surprising effect stems from the fact that helping others makes us feel powerful. And as you already know from Quest 2, people who feel powerful also feel time rich.7
What to do: Your quest for today is to spend ten minutes helping someone else. Any kind of help will do. Help a coworker do a task at work or clean up around the house, or write a thoughtful letter to someone who needs to hear encouraging words. If you think you don’t have time to complete this quest, just remember: giving away ten minutes of your free time will make you feel even more time rich than receiving sixty minutes of free time. In other words, this is a trade well worth making.
TIME RICH QUEST 4: Get Rich with Awe
Awe is the positive emotion we feel when we’re humbled by something bigger or greater than ourselves. You might feel awe looking at a natural wonder, like a waterfall or the Grand Canyon. You might feel awe listening to a massive choir, with its hundreds of voices working together to make something beautiful. You might feel awe watching an athlete do something no one has ever done before, breaking a record and changing our entire perspective on what is humanly possible.
Awe is one of the most pleasurable and motivating positive emotions. It’s also, researchers at Stanford University recently discovered, the single emotion most closely linked to time affluence.
In a series of three experiments, the Stanford psychologists tested the impact of awe on perceptions of time availability. They discovered that participants who felt awe for just a moment or two (triggered by watching a video of a natural wonder, for example) felt they had more time available later in the day for their own goals, were less impatient, and were also more willing to volunteer time to help others. All three changes are signs of increased time affluence.8
Why would awe change our feelings about time? The Stanford researchers explain that when we feel awe, we experience time differently. We experience it as slow and expansive rather than rushed and limited. “Awe focuses people’s attention on what is currently unfolding before them,” they wrote in the journal Psychological Science. “Focusing on the present moment elongates time perception.”
In other words, awe makes seconds and minutes literally feel longer. And this expansive, elongated experience of time makes us feel like there is simply more of it.
So how can you take practical advantage of this scientific finding? It’s easy: just try to stimulate a little bit of awe each and every day. The researchers tested two main techniques for provoking awe, both of which you can easily replicate at home.
What to do: The first way to provoke awe is to watch a video of something awesome. That might mean watching a video of one of the world’s best surfers charging a giant wave, or a panda giving birth to triplets, or a scene of a massive social protest, or a volcano erupting, or images of a distant galaxy collected by powerful telescopes. Whatever gives you goose bumps or makes you feel humbled by its greatness, that will do the trick.
The second way to provoke awe is to write for one or two minutes about something awesome you experienced or witnessed in the past. Here are the exact instructions that the Stanford researchers used in their studies, so you can replicate the effect: “Awe is a response to things perceived as vast and overwhelming that alters the way you understand the world. Write about a personal experience that made you feel this way.” You don’t have to write a long essay! A few sentences will work just fine.
To complete this quest, pick either of these two awe-provoking techniques and do it today.
TIME RICH QUEST 5: Avoid Social Jet Lag
Do you know your chronotype? If not, you may inadvertently be throwing away some of the best hours of your day.
A chronotype is a biological preference for when to sleep and when to be active. Types range from “extreme early” to “extreme late,” and everything in between. Extreme early types are the so-called early birds, able to wake up at sunrise and be mentally and physically active right away. Extreme late types, on the other hand, are night owls. They aren’t ready to perform at their best until ten a.m. or so. But they are mentally sharp and physically energized well into late evening, much more so than early types.
Your chronotype changes over the course of your life. Most people are extreme late types when they’re teenagers and extreme early types when they’re seniors. During the years in between, chronotypes are harder to predict. They vary based on what scientists call our clock genes: the bits of DNA that help determine our most comfortable waking and sleeping rhythms.
Why do chronotypes matter? If your biological clock doesn’t match your social clock—the traditional start times for school and work—then you will be unable to think or perform at your best. Physiologically and mentally, being off your biological clock is a state very much like jet lag. You feel sluggish and sleep-deprived and have difficulty concentrating. Hence scientists call it social jet lag. Researchers estimate that currently more than half of the U.S. working population and a whopping 80 percent of high school students suffer from social jet lag—resulting in huge costs to workplace productivity and making it harder for most students to succeed.9
Social jet lag has physical consequences. People who suffer from it are more likely to be obese, more likely to smoke, and more likely to become dependent on high-caffeine products and other stimulants. That’s because they’re in a constant state of sleep deprivation and body clock misalignment—and so they use sugar, nicotine, and caffeine as a crutch to get through the day or night.10
Social jet lag has emotional consequences as well: it is thought to contribute to depression and flare-ups of mental illness, due to the stress it puts on the brain and body.11
So what is the solution? As science writer Stefan Klein, author of The Secret Pulse of Time, advises: “We should stop seeing calendar times as a corset we have to squeeze into. We need to move away from the one-size-fits-all model of time, and recognize and respect the fact that each person has—and needs—an individual rhythm and inner time.”12
In practical terms, this means adjusting school and work schedules. For example, many schools have experimented with starting an hour or two later. Results from such experiments prove that such adjustments can indeed dramatically improve performance and quality of life. One school in Minneapolis, for example, found that starting school at 9:40 a.m. instead of 8:40 a.m. improved the average grade for all students by a full letter, and absenteeism fell by half. Workplaces have also experimented to positive effect, allowing employees to flexibly choose start times and scheduling important group meetings no earlier than ten a.m. to accommodate later chronotypes.
Let’s be realistic: you aren’t going to be able to implement sweeping social change in the next twenty-four hours. But you can take stock of your own chronotype and start scheduling your life as close to your biological rhythms as possible.
What to do: Identify your chronotype. Are you an early type, a late type, or somewhere in between?
If you naturally fall asleep by ten p.m., you’re extreme early. If you can’t sleep until after midnight, you’re extreme late. In between, and you’re . . . in between. Once you know your chronotype, make it a point to schedule your most important activities at the right time for you. Whenever you have a choice, schedule exams, meetings, presentations, first dates, workouts, study sessions, and any physically or mentally demanding activity in your chronotype sweet spot—typically no earlier than nine to ten hours after you naturally want to fall asleep, and no later than three hours before you naturally want to go to bed.
Paying attention to your chronotype will help make sure that you have the mental focus and physical energy when you need them most—giving you more “good hours” every day.
TIME RICH QUEST 6: Make Your Day Longer
To make the day seem longer, do something for the first time.
Eat a new food. Meet a new person. Visit a new place. Learn a new fact. Try a new exercise. Play a new game. Go to a shop you’ve never been to before. Listen to a song you’ve never heard before.
According to Dr. David Eagleman, a neuroscientist at Baylor College of Medicine and an expert on the subjective experience of time, doing anything for the first time changes how your brain processes the passing minutes and hours. Specifically, it slows time down. 13
Here’s why: the more predictable and familiar an experience is to you, the less work your brain has to do to understand it. If you’ve seen it before or done it before, your brain can take a shortcut, drawing on its previous learning to process what’s happening. This is good for saving mental energy but terrible for accumulating time riches. That’s because the less work your brain has to do, the faster time flies. If your brain processes an event quickly, it thinks the event happened quickly. Time seems shorter, more compressed—the opposite of what you want and need to feel time rich.
Fortunately, you can take advantage of this phenomenon by forcing your brain to slow down and take in new information. Doing something for the first time requires it to process everything more slowly—and therefore you will experience time as moving more slowly. And the more slowly time moves for you, the more abundant it will feel.
What to do: Do one thing you normally do every day differently. Brush your teeth with your nondominant hand. (That is, if you’re right-handed, brush your teeth with your left hand.) Or walk backward from your bedroom to the kitchen, instead of forward. Or eat your breakfast with your eyes closed. Making a small change in your routine will make time slow down ever so slightly—which means you’ll be more likely to take time for your most important priorities and goals later in the day.14
TIME RICH QUEST 7: Get Rich with Oxygen
Perhaps the easiest way to start feeling more time rich, especially when you’re under pressure, is to take long, slow breaths for five minutes.
Researchers at the Stanford University Graduate School of Business conducted a series of laboratory experiments—and found that this simple action changed time perception dramatically. According to a study published in the Journal of Consumer Psychology, “Subjects who were instructed to take long and slow breaths for five minutes,” they wrote, “not only felt there was more time available to get things done, but also perceived their day to be longer.”15 People who took shorter, quicker breaths, on the other hand, were much more likely to feel time poor.
Why does this technique work? The body influences the mind: quick breathing tells your brain that you’re rushing, hurried, and stressed. Slow breathing, however, tells your brain that you have all the time in the world.
What to do: Set a timer for five minutes. Focus on taking long, slow breaths the entire time. Return to this technique as a power-up whenever you need it.
TIME RICH QUEST 8: Get Rich on the Go
How you get from A to B each day is a major factor in how time rich or time poor you’ll feel.
According to research from the University of North Carolina at Chapel Hill, people who drive are significantly time poorer than people who walk, bicycle, or take public transportation. Crucially, this is true even when drivers spend less time commuting each day than someone who walks, bikes, or takes public transportation. Driving itself, and not the time spent doing it, seems to create feelings of time poverty.16
Why is this the case? UNC’s study of nearly one thousand commuters showed that driving was the most stressful mode of travel. Driving, particularly during heavy rush-hour traffic, also provokes negative emotions such as frustration, anxiety, and anger. Increased stress and negative emotions are both associated with increased feelings of time poverty. (Remember from Time Rich Quest 2 that when you feel powerless, you feel time poor.)
On the other hand, other forms of travel—especially walking and bicycling—promote reduced stress and feelings of self-efficacy. They increase mindfulness, or active and compassionate attention paid to our thoughts, feelings, and surroundings. Increased self-efficacy and mindfulness are associated with increased time affluence.
So what can you do, in the next twenty-four hours, to take advantage of this research? Any change you can make to your commute to decrease the time you spend driving and increase the time you spend walking, bicycling, or taking public transportation will help make you feel time richer. This is true even if your new commute takes longer than driving.
Every small change helps. For example, park farther away and spend ten minutes walking to work at the end of your commute. Or see if you can change your commute time to avoid the most stressful driving periods. Or carpool, so you can reduce the number of days you feel the strain of driving yourself. (As an added bonus, driving others can help you feel powerful—which may balance out the impact of driving on your time affluence!)
Another option—one that may be easier for you—is to adopt mindful driving habits. The mindfulness experts at Wildmind Buddhist Meditation recommend the following simple changes:
· Turn off the radio.
· Slow down, and try driving at or just below the speed limit. This will free up the energy (and eliminate the tension) you otherwise spend constantly trying to push the speed limit and pass other vehicles.
· Take one or two deep breaths at every stop sign or red light.17
These habits will decrease stress and increase mindfulness, helping you reap some of the benefits of getting time richer on the go.
What to do: Try making a small change in how you get from A to B over the next twenty-four hours. If you’re not going anywhere today, complete this quest by making a plan to make a small change!
TIME RICH QUEST 9: Choose Your Own Quest!
Today’s quest is . . . do whatever you want!
That’s right. This quest has no instructions, other than take five minutes today to do something, anything, of your own choosing.
Take a nap. Call your mom. Lift some weights. Window-shop online. Play a game. Go enjoy a view. Whatever it is, it should be something you weren’t already planning to do today.
Why it works: Research shows that freely and spontaneously chosen activities increase time affluence, while routine or obligatory activities decrease it.18 This makes sense: whenever you exercise control over how to spend your time, it reminds you of how much power you have to make time for what’s important.
Of course, you can’t (and shouldn’t) avoid routines and obligations. But if you do only what is routine and obligatory, you’ll eventually feel less and less in control of your time. Making a free and spontaneous choice about what to do reminds you of the power you have over your own time—even if it’s only for a few minutes!
So make a free choice about how to spend five minutes today. By doing so, you’ll actively shift your attention from what you have to do to what you want to do—and that’s a huge component of feeling time rich.
You have total control over your quest for the day. Do whatever you want for five minutes!
TIME RICH QUEST 10: Measure Your Time Wealth
Congratulations! You’ve learned eight powerful techniques for increasing your time affluence. But how will you know that these techniques are working? Time affluence is a lot harder to measure than monetary riches. You still only have twenty-four hours a day, after all, no matter how time rich you feel.
To measure your time wealth, you’ll need to do what psychologists do. They use several different specially designed surveys to measure time affluence and its opposite, time poverty, such as the Perceived Time Availability Index, the Material Affluence and Time Affluence Survey, the Time Constriction Index, and the Future Time Perspective Scale.
You don’t have to take the full surveys to get a sense of your growing time wealth.
Here are ten of the most important questions from these measurement tools. You can use these questions as a way to check in, periodically, with yourself. Are you feeling time rich or time poor this week?
How many of these statements do you agree with?
· My life has been too rushed.
· There have not been enough minutes in the day.
· I’m pressed for time.
· I’m not in control of my time.
· Time is slipping away.
How many of these statements do you agree with?
· I have had enough time to do the things that are important to me.
· I have lots of time in which I can get things done.
· I have plenty of time in my future.
· I am in control of how I spend my time.
· Time is boundless.
If you agree with more of the time poverty than time affluence statements, make an extra effort to activate your Time Rich power-ups (listed below). If you agree with more of the time affluence than time poverty statements, then congratulations—you’re building up real time wealth.
Your Time Rich Power-ups
GIVE YOURSELF A POWER BOOST
To increase feelings of power and time affluence, use one of the three proven techniques from Time Rich Quest 2.
· High-power seating: Adjust your seat higher than you normally sit.
· Power memory: Think of a time in the past when you had the power to make an important decision or impact someone’s life.
· Power stance: Plant your feet, raise your hands, and lift your chest.
GIVE SOMEONE TEN MINUTES OF YOUR TIME
Help someone else for ten minutes today (Time Rich Quest 3). It gives you a greater feeling of time affluence than a windfall of one hour of unexpected free time!
Make time feel long and expansive by watching an awe-inspiring video, or spend two minutes writing about a time when you felt humbled and awed by something bigger than yourself (Time Rich Quest 4).
DO SOMETHING FOR THE FIRST TIME
Slow down your experience of time by making your brain work a little bit harder: do something for the first time or do something you normally do just a little bit differently (Time Rich Quest 6).
Take long and slow breaths for five minutes (Time Rich Quest 7). It will slow down your entire day, helping you find more time to do the things that are most important to you.
MAKE A FREE AND SPONTANEOUS CHOICE
Carve out a block of five minutes to do something spontaneous (Time Rich Quest 9). Show yourself that you really are in control of how you spend your own time.
Your Time Rich Bad Guys
Time poverty is the feeling that there aren’t enough hours in the day to do what you want. It fogs your mind and makes you time-stingy, preventing you from spending the free minutes and hours you do have on the things that matter most: your health, your dreams, your closest relationships. Battle this bad guy with any of your time rich power-ups!
SOCIAL JET LAG
This bad guy puts your mind and body’s natural rhythms out of sync with your daily responsibilities. Even if you can’t change your overall schedule, you can still fight this bad guy (as in Time Rich Quest 5). Whenever possible, schedule the activities that are most important to you at the right time for you. If you are comfortable with speaking up, advocate for flexible start times, or fairer meeting times, at your school or workplace. And in the future, when you have the choice, actively seek out a schedule that better matches your chronotype.
MINDLESS, STRESSFUL COMMUTING
The more stress and distraction you experience during your daily commute, the more time poor you’re likely to feel. Fight this bad guy by changing how you commute (as in Time Rich Quest 8). If you drive, switch to walking, bicycling, carpooling, or public transportation. Even if your commute takes longer, you will feel time richer. If this is not feasible, practice mindful driving—turn off the radio, slow down slightly and drive at the speed limit, and take deep breaths at stop signs or red lights. And if you already have a more mindful method of commuting, or don’t have a commute, even better—no need to fight this bad guy!
About the Science
This book is based on five years of research, including a randomized, controlled study of the SuperBetter method with the University of Pennsylvania; a clinical trial of the SuperBetter method with Ohio State University Wexner Medical Center and Cincinnati Children’s Hospital, which was funded by the National Institutes of Health; and a literature review of more than one thousand peer-reviewed, scientific papers on the topics of game-related psychology and neuroscience, post-traumatic and post-ecstatic growth, and resilience, particularly as it is related to positive emotion, physical activity, and social support. The most relevant papers—roughly five hundred—are cited in the endnotes of this book.
To make it easier for you to explore the science yourself, I have created a directory of these studies online at Showmethescience.com. Wherever possible, I have linked to the free, public version of the full scientific paper. Academic publishing, unfortunately, often requires a subscription or university affiliation to access the research; where this is the case, I have linked to descriptions of the research as well as to the original study. I will continue to update these resources as additional research into the psychology and neuroscience of games become available.
For scientifically curious readers, I want to provide a more detailed description of the University of Pennsylvania and Ohio State University Wexner Medical Center studies. How did these collaborations come about? What were the goals of the studies? What were the methods? Who were the participants, and what were the results? While the University of Pennsylvania study was completed in 2013, and its findings recently published, the OSU trial is ongoing. Updates to the trial, as well as any further studies conducted and scientific papers published, will be available at Showmethe science.com.
Please note: None of the researchers or doctors who conducted the SuperBetter studies at the University of Pennsylvania, Ohio State University Wexner Medical Center, or Cincinnati Children’s Hospital have any financial interest in video games in general or SuperBetter in particular; nor were they compensated in any way for conducting this research.
THE UNIVERSITY OF PENNSYLVANIA SUPERBETTER STUDY
“We need something new and creative to help people with depression, because there are still many people who don’t benefit from existing therapies and medications,” said Ann Marie Roepke, a clinical psychologist and doctoral candidate at the University of Pennsylvania’s Positive Psychology Center, when I asked what inspired her to conduct a randomized, controlled study of SuperBetter. “I was struck by SuperBetter’s playful, lighthearted approach. It’s not often that you see something so fresh and new come along.”
I first met Roepke at a scientific conference in Philadelphia in 2011, where she was presenting her work on post-ecstatic growth, a concept she pioneered. (Her talk was how I first discovered the idea!) Meanwhile, I was presenting my games research at a panel about technology and psychological health. We spent several hours talking about our work, and I told her my personal SuperBetter story. We immediately realized that we had a great many overlapping research interests. In particular, we both shared a passion for developing and testing novel interventions to help encourage post-traumatic—and I now know, post-ecstatic—growth.
We stayed in touch for more than a year, sharing our latest research and looking for the right way to team up. Eventually, the perfect opportunity arose: Roepke found two colleagues at Penn who were interested in helping her conduct a formal study of SuperBetter’s effectiveness for treating depression.
To help Penn prepare for this study, I teamed up with two collaborators at SuperBetter Labs, science writer Bez Maxwell and data scientist Rose Broome, to create a special set of depression-related power-ups, bad guys, and quests. The three of us also helped the Penn researchers design the study—how long it would last, how often we would encourage participants to play, and what questions we would ask. But the actual trial, including all recruitment, data collection, and data analysis, was conducted independently by the research team at the University of Pennsylvania. This was to ensure maximum scientific validity. I found out the results of the trial only when the Penn researchers prepared their independent report for presentation at the annual Association for Psychological Science conference.
The study was set up as a thirty-day randomized, controlled trial. Two-thirds of the participants were given access to the SuperBetter method, while the other third were put on a wait list. This allowed the researchers to compare the effects of playing SuperBetter against other possible factors in getting better, such as time passing or receiving treatment in the form of therapy or medication.
The playing group was instructed to spend ten minutes a day with SuperBetter. They were also encouraged to continue any other treatment they were already engaged with, including therapy or prescription medication. Roughly one half of the participants reported that they were currently in therapy or taking antidepressants.
We enrolled 236 participants in total. All the participants were eighteen or older, and all met the criteria for clinical depression. They were recruited online at a popular self-help website, Authentic Happiness. They were not compensated in any way. This was very important for us—we wanted to learn how SuperBetter works for typical players, so we avoided giving them any kind of special motivation or reward that ordinary SuperBetter players don’t have.
We also wanted to find out how different approaches to getting SuperBetter might work differently, so we divided the SuperBetter group into two subgroups. One was given a set of power-ups, bad guys, and quests specific to depression and anxiety. The other was simply set loose in the SuperBetter world and given a set of the game’s most popular power-ups, bad guys, and quests (as judged by number of activations by other SuperBetter users). This included content related to self-compassion, physical activity, and social resilience. Our hypothesis was that both groups with access to SuperBetter would do better than the wait-list group, but that the players receiving depression-specific content would do even better.
Both groups took four psychological surveys—one at the beginning, and the others every two weeks until the conclusion of the study. This included a follow-up survey two weeks after the official thirty-day period of play or waiting. The study has recently completed the scientific peer-review process and has been published in the journal Games for Health.1 Here’s what we learned.
SuperBetter players experienced significantly greater relief from symptoms of depression than the wait-list participants. By the end of the study, on average, the players had six fewer symptoms of depression, while the wait-list group had two fewer. The players also had significantly less anxiety, developed more self-efficacy, experienced stronger social support, and reported higher overall life satisfaction. In short the SuperBetter players felt better, faster,in every way we measured. Moreover, they kept getting better even after the thirty-day period; two weeks after they stopped playing, they were still experiencing the same rate of improvement. They continued to get less depressed and anxious, to develop greater self-efficacy, and to feel more supported, at a rate that was faster and more significant than participants on the wait list. This suggests a possible “upward spiral” effect: once you start getting superbetter, it’s easier to keep getting superbetter. (For those of you interested in statistics, the Cohen’s effect size for SuperBetter at the end of six weeks was d = 0.67, which is a very strong result. An effect size higher than 0.2 means something had a small effect on an outcome, while 0.5 or higher means it had a moderate effect on an outcome, and 0.8 is considered a large effect. So SuperBetter had a moderate to large impact on players’ well-being.)
What else did we find out? Lots! One of the factors we investigated was whether SuperBetter worked differently for individuals who were also in therapy or taking prescription psychiatric medication, such as antidepressants. We found that they experienced similar results regardless of whether they were engaging in another form of treatment. We take this as an indication that SuperBetter works well in conjunction with traditional treatment and therefore does not need to be considered an alternative to therapy or medication. At the same time, strong evidence suggests that it can offer significant benefits to individuals who, for whatever reason, have chosen not to or are unable to pursue therapy or medication.
We also observed that the playing group logged into the online version of SuperBetter an average of twenty times over the course of thirty days. This was an interesting result, because although we recommended a daily check-in with the game, a daily check-in did not ultimately prove necessary to have significant benefit. Something closer to every other day was enough to make a positive difference.
Finally, we noticed that the players who were simply set loose in the SuperBetter environment and given a popular set of power-ups, bad guys, and quests improved even better and faster than players who were given a depression-specific set! Both groups improved significantly, more so and faster than the wait-list group. But the group that was not asked to focus specifically on their depression did the best of all. This was a fascinating and unexpected finding. There are several possible explanations for it. The one that the Penn researchers consider most likely is that the most popular SuperBetter content might be popular for a reason—namely, that it works really well. The players who received the most popular power-ups, bad guys, and quests as suggestions, therefore, were particularly well set up for success. (This, by the way, is the reason why I have included so many of them in this book!) Another possibility is that it’s more empowering to have lots of creative options for how to get better than to be prescribed one particular approach. This is actually more typical of how most people use the SuperBetter method. They decide for themselves which power-ups, bad guys, and quests are right for them.
Despite these promising findings, the Penn study should be looked at as a starting point for evaluating the SuperBetter method and not as a final or definitive answer to the question “Who can SuperBetter help?” The results were both positive and, statistically speaking, significant. However, as we note in the scientific paper, several factors about the study limit the conclusions we can draw from it. For example, the study size—236 participants—is fairly large for a first-time study of a novel psychological intervention, but even larger studies would provide more compelling evidence. We also know that because we recruited participants who were already seeking self-help solutions for depression, they may have been more motivated to get better than the general population of people who suffer from depression and therefore better able to benefit from SuperBetter. A future study that enrolls participants using other methods—for example, by offering screenings for depression to a wider population not already seeking solutions—might provide a better understanding of how much self-motivation is needed to benefit from the method.
Another limiting factor is that we followed participants for only six weeks; therefore, while the results show that most players experienced significant benefits, this particular study provides no evidence either way as to whether or for how long the benefits last, beyond the initial two-week follow-up. Finally, as is common in studies seeking to study “natural usage”—that is, studies in which participants are not paid or otherwise compensated—the study lost quite a few users by the end of the six weeks to attrition, particularly in the wait-list group. (That is, some participants never came back to answer later surveys.) Complete data sets were collected from 63 participants; partial data sets were collected from another 102 participants. For this reason, it’s worth considering again the possibility that the SuperBetter method may only appeal to or work for individuals who are actively seeking solutions and who are particularly motivated to get better. This would confirm what we’ve observed among the more than 400,000 users of the online version: the method seems to be the most effective for people who are actively struggling with a very difficult personal challenge and therefore may be more motivated and open to trying something new.
After the study was completed and presented at two scientific conferences, I asked Roepke what she thought accounted for SuperBetter’s demonstrated effectiveness. She offered several theories. First, she zoomed in on its “playful, lighthearted approach.” She said: “We all sometimes take ourselves and our thoughts too seriously. By reframing things in gameful ways, SuperBetter can help us gain some perspective and separate ourselves from unhelpful thoughts.”
She also cited the underlying science as a crucial element to the game. “Research psychologists have made really wonderful and useful discoveries,” she said, “but the field needs people to help translate hard-to-access, hard-to-read journal articles into something more approachable. SuperBetter does this by taking important research and translating it into power-ups, bad guys, and quests.”
She also thinks the secret identity and epic wins are a key part of its power to create positive change. “The idea of a heroic journey is really important and compelling,” she said. “Stories are central to our lives. We understand others by the stories they tell, and we come to understand ourselves by the stories we tell. SuperBetter offers us a powerful and fun way to change the story. Instead of telling ourselves a story about victimhood or tragedy, we can tell a story about adventure and redemption.” That, to her, was potentially the most important piece of SuperBetter. “It reminds us that we can be the hero of our own story.”
THE OHIO STATE UNIVERSITY STUDY
“Can we turn doctors’ advice and medical guidelines into a game, so patients have an easier time following it?” That’s the idea that Lise Worthen-Chaudhari, a research scientist and faculty member at the College of Medicine at Ohio State University, wanted to explore when she reached out to me in the summer of 2010.
Worthen-Chaudhari has been in the field of rehabilitation research for twenty years, and she knew that most patients typically have a difficult time keeping up with all their doctors’ recommendations at home. She wanted to find something that could help patients remember their doctors’ advice, and improve their ability to follow it consistently.
She also knew that when family members are aware of the recommendations, a patient is more likely to follow them successfully. But too often caretakers feel overwhelmed and anxious and forget the advice they’ve heard. So Worthen-Chaudhari wondered what could help family members feel more empowered to help their loved ones get better, faster.
She conducted a review of innovations in patient care, specifically looking for a tool that would engage patients over a long rehabilitation period and create a stronger support system. “After looking at everything,” she explained to me. “SuperBetter is the only thing I’ve found that seems to be doing both effectively.”
Her timing was incredibly fortuitous—I had just begun to develop a digital version of the SuperBetter method with my collaborators at the social gaming startup Social Chocolate. With Worthen-Chaudhari’s help, we were able to start interviewing medical practitioners at OSU immediately for their input on how to improve the SuperBetter method and how to make it more useful for both patients and doctors. We embarked on a collaboration that, over a three-year period, helped us strengthen the design and incorporate specific medical guidance for players using the game for concussions and traumatic brain injury recovery.
As a result of our ongoing collaboration, we were awarded a research grant from the National Institutes of Health. We were tasked with conducting a pilot study of SuperBetter in a clinical setting—in official terms, a phase-one clinical trial. Patients would use the SuperBetter method for six weeks; their doctor would play as their ally.
You’ll notice that both the Penn and the OSU studies tested a relatively short play period (thirty days and six weeks in duration, respectively). That decision was based on our observations of and interviews with other SuperBetter players at large; most of them, we were finding, experienced the majority of emotional and social gains, and the biggest shift in their thinking, within the first thirty days of play.
For the pilot study, OSU enrolled twenty patients from Cincinnati Children’s Hospital. Aged thirteen to twenty, they were all dealing with difficult recoveries from a mild traumatic brain injury or concussion. They were introduced to SuperBetter by their doctor and given a quick tutorial on how to use the digital version. They were then encouraged to get their “daily SuperBetter dose”—three power-ups, one bad guy battle, and at least one quest—every day for the next six weeks of their treatment. They were also given a starter list of ten power-ups they might find useful (such as wearing sunglasses inside to protect against bright lights), twenty bad guys they might encounter (such as difficulty concentrating or dizziness), and daily quests (such as “Find one fun activity you can do for at least twenty minutes that doesn’t hurt your brain—such as drawing or listening to a favorite movie with your eyes closed”). Based on their symptoms and recovery progress, they were sent new, personalized suggestions from their doctor for additional power-ups, bad guys, and quests several times throughout the study. The patients were not compensated for their participation; expenses of up to $40 were reimbursed to cover their transportation to two follow-up interviews.
The primary purpose of this clinical trial was to assess the feasibility of the SuperBetter method for use in hospitals—in other words, to find out if doctors and patients would be able to use it effectively, and if both groups would report a positive experience with it. By all measures, it was a success.
The qualitative data collected over a four-month period showed that all twenty patients were able to learn the method quickly and implement it effectively at home. Roughly 75 percent were able to achieve the recommended dose of play throughout their six-week trial.
The most common sentiment among patients was that “SuperBetter helped me do more of the important things I need to do to take care of myself.” Indeed, simply introducing the idea of a game into a clinical conversation was observed to increase patient interest and attention to their doctors’ medical advice. “When you bring up the game, they react with surprise,” according to Worthen-Chaudhari. “It’s consistently delightful. It piques their interest. A teenager’s not even listening to you and all of a sudden they register what you’re saying. It’s an extremely positive result.”
The data also showed that the game helped the patients’ primary caretakers, mostly parents. They were able to learn the language of power-ups and bad guys quickly and reported playing the role of allies in the game consistently through the duration of the study. The most frequent response from caretakers in follow-up interviews was that SuperBetter provided them with a feeling of “relief”—that they worried less about their loved ones’ ability to successfully recover, and that they had more positive interactions with them as a result.
The OSU research team reported that medical practitioners were able to learn the method quickly and were effective in translating their advice and treatment plans into power-ups, bad guys, and quests.
In addition to this qualitative observation, we used the clinical trial as an opportunity to collect quantitative data on how the SuperBetter method impacted players’ mood, quality of life, and postconcussion symptoms. Not only did participants have significantly fewer symptoms of postconcussion syndrome by the end of the study, they also were significantly less depressed and more optimistic. Their rates of improvement for depression and optimism were similar to those in the Penn study, helping to show that an even wider range of people can benefit from the SuperBetter method. One particularly interesting finding was that the participants who had the most severe depression before playing benefited the most from the game. Four out of five participants with severe depression at the start of the trial had improved to “nondepressed” by the end.
Crucially, despite the possibility that game play can trigger postconcussion symptoms such as headache, nausea, and exhaustion, none of the participants reported that playing SuperBetter triggered such symptoms. Worthen-Chaudhari summarizes the findings: “The data clearly suggest that SuperBetter works as a powerful complement to traditional medical care.”
The next step will be to conduct a controlled version of the clinical trial, similar to the Penn study. This will allow us to compare the experiences of patients who do not have access to SuperBetter with patients who do. In the meantime, the results of the pilot study are providing guidance to medical practitioners for the best practices to adopt while engaging patients with the SuperBetter method. This is an important step for this line of research, because as Worthen-Chaudhari reports, “Many of the doctors and fellows at OSU have expressed a desire to explore using the SuperBetter method for a wider range of illness and injury rehabilitation.”