Rewire your brain through games

What follows is an excerpt from the book Superbetter.

Rewire your brain so it’s easier to motivate yourself, persevere, and succeed.

In video games, we play as heroes. We become conquering space cowboys, warrior princesses, daredevil racecar drivers, or the last survivors of a zombie apocalypse. Even in nondigital games, we strive to be the hero of the day, accomplishing epic feats that amaze. Think about scoring a last-second goal in soccer, or marching a pawn across the chessboard to win a second queen after losing your first.

But do games actually develop our heroic potential? Can games make us more likely to be an inspiration to others, and to achieve extraordinary goals in real life? The evidence suggests yes.

In this chapter, we’re going to explore how games of all kinds increase our character strengths—like grit, perseverance, compassion, and work ethic. We’ll uncover the science behind how games strengthen our real-life willpower and help us change our real-world behavior for the better. We’ll look at the neuroscience of game play—how it changes the way our brains respond to challenge and effort, making us less likely to give up when things are difficult for us. And we’ll explore why certain games make us more likely to rise to the heroic occasion when someone else is in need.

By understanding exactly how games tap into your natural determination and compassion, you can become better able to tap into these heroic qualities—anywhere, anytime.

Let’s start with a game that has a truly audacious goal: to help young people beat cancer.

At first glance, Re-Mission looks like a typical fantasy shooter game. You control a superhero robot named Roxxi, who flies through a twisting-and-turning landscape, using powerful weapons to blow up the bad guys. But despite the 3-D graphics and immersive sound effects, Re-Mission isn’t a typical video game. Look closer, and you’ll notice that Roxxi is flying inside the human body, the bad guys are cancer cells, and her weapons include chemotherapy blasters and antibiotic grenades.

Re-Mission was created by the nonprofit HopeLab for a special purpose: to improve young patients’ adherence to difficult, but life-saving, chemotherapy and antibiotic regimens.

To fight childhood cancers like leukemia, most patients will take oral doses of these medications for two to three years. It’s extremely important for patients to try to never miss a dose. Eighty percent of cases where childhood cancer comes back (instead of staying in remission) are associated with missed medication. Fewer missed doses means lower rates of infection, fever, and hospitalization—and most important, better survival outcomes.

Families and patients know this, but young people miss doses anyway, for many different reasons. They can’t stand the side effects, such as nausea and fatigue. They get busy with school or sports as they start to feel better, making it harder to follow a strict medication routine. Or after years of treatment, they subconsciously rebel and forget to take the drugs, because they are just “sick of being sick.”

Re-Mission was designed to prevent these lapses, by helping young patients feel more optimistic and motivated to take their medications. As senior HopeLab researcher and UCLA professor of medicine Steve Cole told me, “Thirty percent of kids miss twenty percent of doses or more. Those kids have twice the risk of having a rebound of the leukemia. This is a completely avoidable risk. We have to somehow get across the message: No matter how bad the disease is, you are fundamentally in control of your health, and no one can save your life if you don’t do your part.”

Cole and his collaborators hoped that patients would become more committed to their treatment plans if they learned more about chemotherapy in the empowering context of a video game. These lessons were integrated right into the game play. For example, when the virtual patient in the game skips a chemotherapy dose, Roxxi’s chemo-blaster weapon starts to malfunction, misfiring every third shot. Skip another chemotherapy dose, and more virtual cancer cells survive each blast. Skip again, and cancer cells become drug-resistant, further increasing the challenge of each level.

So did it work? Yes, overwhelmingly. In a clinical trial, patients who played Re-Mission for as little as two hours had greater medication adherence for three months.1

Electronic pill-cap monitors showed that the game players took 16 percent more antibiotic doses over a three-month period than nonplayers. This means the game effectively eliminated a whopping half of the typically missed doses. And when patients’ blood was drawn and tested, Re-Mission players had 41 percent higher doses of the cancer-fighting medication in their bodies. They were significantly more successful in keeping up with treatment—and therefore more likely to stay in remission.2 (The trial was conducted with 375 patients, aged 13 to 29, at 34 medical centers across the United States.)

Interestingly, a full quarter of the study participants reported that they rarely played video games before the trial. Another third had previously played just one or two hours per week. In other words, these were not hard-core gamers who were benefiting from the game. The game worked equally well for novice or infrequent game players as it did for lifelong players—and it is continuing to work for patients worldwide. As a result of this successful clinical trial, Re-Mission has been distributed to more than 250,000 cancer patients. And recently HopeLab released six follow-up cancer-fighting games online, including Stem Cell Defender and Nanobot’s Revenge. (They are free to play at

HopeLab’s games are an incredible, potentially life-saving resource. But even if you aren’t battling cancer, the Re-Mission research offers a powerful, life-changing insight: motivation alone is far less important to success and willpower than you think.

Before the cancer patients played Re-Mission, they were already fighting for their lives—presumably a highly motivating state. This was not a group that simply needed more motivation. They had it in spades, yet they nevertheless regularly failed to do the things they knew could dramatically improve their chances for a cure.

Somehow the video game Re-Mission intervened in a way that converted mere motivation into a much more powerful psychological resource. But what is that resource? And how did the game create it so quickly?

This is exactly what the HopeLab team was wondering after they saw the success from their first clinical trial. Originally, they had hypothesized that thirty hours of play would be necessary to make a positive impact on medication adherence. They were amazed when just two hours made such a significant difference. And they had expected players to need continual reinforcement and reminders from the video game every day in order to keep up their behavior change. Yet it turned out that playing the game just once was enough. It was truly a surprising result. What could explain such long-term, real-life behavioral changes after such a short time of virtual play?

The key to solving this puzzle was found in another set of data that the researchers collected during the clinical trial. They weren’t just monitoring medication adherence. They also tracked psychological changes during the trial. Players and nonplayers reported the same levels of motivation, stress, cancer symptoms, and physical side effects, but the game players differed remarkably in one area. They reported feeling significantly more powerful, optimistic, and able to positively impact their own health than nonplayers.

Psychologists call this state of mind self-efficacy. It’s the belief that you, yourself, can effect positive change in your own life.

Self-efficacy is not the same thing as self-esteem, which is a more general positive feeling of self-worth. Self-efficacy means having confidence in the concrete skills and abilities required to solve specific problems or achieve particular goals. It is usually context-specific: you might have high self-efficacy at work but low self-efficacy about public speaking or losing weight.

Self-efficacy is the crucial difference between having lots of motivation but failing to follow through, and successfully converting motivation into consistent and effective action. With high self-efficacy, you are moreWith high self-efficacy, you are more likely to take actions that help you reach your goals, even if those actions are difficult or painful. You also engage with difficult problems longer, without giving up. But with low self-efficacy, no matter how motivated you are, you’re less likely to take positive action—because you lack belief in your ability to make a difference in your own life.

So where did the Re-Mission players’ new self-efficacy come from? Well, all games are intentionally designed to increase players’ feelings of competence, power, and skillful ability over time—in other words, to build up their self-efficacy. Like all video games, Re-Mission challenges players to achieve a difficult goal: navigating through a complex, 3-D space and destroying all the virtual cancer cells before time runs out. This goal requires skill, practice, and effort. Players of Re-Mission, like players of all games, are typically unsuccessful at first. But quickly, with repeated effort and as they learn how the game works, they start to improve their skills and strategies. Eventually they master a few challenges. And because it’s a video game, it gets harder. The challenges get more difficult and complex with each new level. This constantly escalating challenge requires a willingness from players to keep trying, even when they fail. It instills a belief that if they keep practicing and learning, if they put in the hard work, they will eventually be able to achieve more difficult goals.

This is the classic path to increased self-efficacy: accept a goal, make an effort, get feedback on that effort, improve a concrete skill, keep trying, and eventually succeed. You don’t need a game to set off on this path. But because it is the very nature of games to challenge and improve our abilities, they are an incredibly reliable and efficient way to get there.

And here’s the good news: once you have a feeling of self-efficacy about a particular problem, it tends to persist. It’s a lasting mindset shift, permanently changing what you believe you are capable of and what goals you believe you can realistically achieve. And this is exactly why Re-Mission worked so well. The game created a new source of self-efficacy for young patients, in a situation where it is easy to otherwise feel powerless or overwhelmed. Instead of seeing chemotherapy as a negative experience they were forced to undergo, they came to see it as a powerful weapon they were fully in control of. They understood exactly how it worked, and they weren’t afraid to use it!

This shift in mindset alone—from powerless to powerful, from feeling weakened to feeling successful—was enough to supercharge the players’ willpower and determination throughout the long course of treatment.

Self-efficacy is increased anytime you learn a new skill or master a new challenge. So let’s increase your self-efficacy right now—with another quest!

QUEST 11: The Power Breath

You’ve probably tried deep, slow breathing to calm yourself down. But there’s actually a more useful breathing technique, one that can reduce stress, decrease pain, increase concentration, halt migraines, and prevent panic attacks.

What to do: Breathe in while you count slowly to 4. Exhale while you count to 8.

In for 4, out for 8. Repeat for at least one minute. This is a bit more challenging than it sounds! The trick is to always exhale for twice as long as you inhale.

Give it a try right now. You don’t have to do a full minute right away. Try to do it just once: in for 4, out for 8. Got it?

Okay, now try to do it twice in a row.

Good? Now try three in a row. If you can, count a little bit slower, and draw the breath out even more.

Excellent! You’ve mastered the trick. When you can keep this up for at least one full minute, you will be able to help yourself feel better, almost immediately, in many different stressful or painful situations.

Why it works: Breathing at this rhythm increases your heart rate variability,3 the slight differences in the length of time between your heartbeats, from one to the next.

The more variation, the better. In the long term, high heart rate variability protects against stress, anxiety, inflammation, and pain. In the short term, increased heart rate variability has a huge impact on your nervous system. It shifts your body from what scientists call sympathetic stimulation (which, when activated by stress, pain, or anxiety, triggers a fight-or-flight mode) to parasympathetic stimulation (a calm-and-connect mode).4

Just by changing how you breathe for one minute, you can shift your entire nervous system from a stressful state to a highly relaxed state. Muscles relax, heart rate decreases, digestion improves, and state of mind improves. If you’re feeling any kind of bad, this powerful shift is sure to help.

But you’re not finished with this quest yet! I want you to think of two different situations where this power breathing technique could help you feel better, immediately. For example, I personally use this technique to stop migraines in their tracks, and to calm my anxiety during turbulence on flights. A collaborator of mine at Nike uses it to relieve muscle cramps after tough workouts. SuperBetter players have reported using the power breath technique to control their tempers with their kids, to battle the nausea of morning sickness, to fight insomnia, before going into a stressful meeting, and even to put themselves in the mood to make love. How will you use it?

What to do: Predict two situations in your life where power breathing for one minute could help. Make a decision now to use this technique the next time you find yourself in that situation.

Quest complete: That’s it—congratulations! You’ve increased your self-efficacy when it comes to battling stress, anxiety, discomfort, or pain. You’ve learned a new skill, and you’ve anticipated two specific problems it can help you solve. You’ve got a superpower—and you know exactly how and when to use it.

Hopefully, you’re starting to see how self-efficacy is created—and how it can supercharge your ability to do what’s difficult. However, there’s still one puzzling thing about the Re-Mission clinical trial results. It makes sense that participants in the study would develop more confidence and belief in their video game skills by playing Re-Mission. Playing a video game makes you better at that particular game and probably other games as well. But how did confidence in their ability to beat a video game translate into confidence to beat cancer in real life? It’s a hell of a lot harder to win the battle against a real life-threatening disease than it is to destroy virtual bad guys on a computer screen.

To solve this mystery, we need to turn to the neuroscience of video games. Because it turns out that while there are many ways to increase confidence in individual skills, nothing primes the brain for general self-efficacy—or the belief that you have the ability to conquer any problem you put your mind to—faster or more reliably than video games.

Video games create a rush in the brain as pleasurable and powerful as intravenous drugs. It was the first major breakthrough in the neuroscience of gaming, and it was rather shocking. The year was 1998, and a group of British scientists had just found that playing video games leads to a massive increase in the amount of dopamine, the “pleasure” neurotransmitter, in the brain.5 To their astonishment, they found that the increase in dopamine from game play was equal to the boost experienced when scientists injected amphetamines intravenously into the same study participants.

Games impact the brain in nearly an identical fashion to highly addictive drugs?! On the face of it, this finding might seem alarming—particularly given that, depending on the study, anywhere from 1 to 8 percent of video game players consider themselves at least periodically “addicted” to their favorite games.6 (The most common percentage reported in these studies is 3 percent; in Chapter 4 we’ll look at the factors that can lead to excessive game play and the most effective techniques for treating it.) Indeed, if you’re already familiar with the neurotransmitter dopamine, you’ve probably heard about it in the context of addiction. The pleasurable effects of many drugs, from nicotine to cocaine, are thought to stem from the large amount of dopamine they release in the mesolimbic pathways, the “reward circuitry” of the brain.

But the mesolimbic pathways are involved in many brain processes, not just pleasure and addiction. Dopamine in this region also stimulates memory, motivation, learning, emotion, and desire. In fact, for the vast majority of people, in the course of ordinary everyday life, increased dopamine in the reward circuitry is not a sign of addiction. More commonly, it’s a sign of increased motivation and determination.7

Here’s how it works. Every time you consider a possible goal, your brain conducts a split-second, unconscious cost-benefit analysis of whether it’s worth the effort to try to achieve it.8 How you conduct this analysis depends less on the facts of the situation than on how much dopamine is present in your brain.

When you have high dopamine levels in the reward circuitry, you worry less about the effort required, and you find it easier to imagine and predict success. This translates into higher determination and lower frustration in the face of setbacks. Meanwhile, when dopamine runs low in the reward circuitry—something that happens during a period of clinical depression, for example—you weigh more heavily the effort required, often magnifying it, and you discount the importance of your goals.9 You also tend to anticipate failure rather than success, which can lead you to avoid challenges altogether.10

Obviously, then, when you’re tackling a new goal or facing a tough obstacle, it’s a huge benefit to have high levels of dopamine. And the benefit extends beyond motivation and determination. High dopamine levels in the reward circuitry are also associated with faster learning and better performance.11 That’s because when we’re goal-oriented, we pay more attention to what we’re doing. We also respond more quickly and effectively to feedback, which makes it easier to learn and improve. This is the neurological basis of self-efficacy: high motivation to achieve a goal, combined with the increased determination and faster learning required to master new skills and abilities. This powerful combination makes you more ambitious and justifiably more optimistic about your odds of success.

For many video game researchers (and video game players!), these neuroscience findings make perfect sense. Gamers, after all, spend on average 80 percent of the time failing when they play their favorite games.12 Without the dopamine rush during game play, surely they would give up much sooner. But the high level of dopamine in the reward circuitry ensures that gamers stay focused, motivated, and determined to succeed. Meanwhile, thanks to the faster learning that occurs with continuous dopamine release, gamers are more likely to improve their skills and eventually achieve their goals.

No wonder frequent gamers work so hard, hour after hour, at their favorite games. Their brains are being primed for increased self-efficacy with every move they make. Scientists know that dopamine is released every time we anticipate feedback from a goal-oriented action—whether in daily life or in games. We get a rush of excitement to find out how we did. It just so happens that when we play video games, we take so many goal-oriented actions, so quickly, and get such immediate feedback, that the dopamine rush is as powerful as amphetamine drugs.

It’s not always beneficial to be optimistic and determined. In some contexts, a predisposition to try harder for more unlikely or difficult rewards can be counterproductive or even pathological—particularly when greater effort is unlikely to actually help. When it comes to gambling, for example, where luck is more of a factor than hard work, this mindset can lead to terrible consequences. Or in the case of a dopamine rush created by a drug like cocaine or nicotine, extreme motivation to achieve a reward (more of the drug) can lead to a dangerous discounting of the health costs involved with actually getting what we want.

But in many more everyday contexts, especially where hard work is likely to produce better results—such as trying to learn something new, completing a difficult assignment, training for a sport, rehabilitating from an injury, or even just trying to pull ourselves out of depression—a neurological bias toward effortful action can produce powerful and positive results.

But does the dopamine rush translate from video games to real-life challenges and problem solving? Do games rewire our brains to be more motivated and work harder only when we’re playing? Or can we translate our increased ambition and self-efficacy to the rest of our lives?

Researchers have found that frequent video gamers do indeed put more effort into difficult problem solving outside their favorite games. One recent study showed that gamers exhibited “a dispositional need to complete difficult tasks” and “the desire to exhibit high standards of performance in the face of frustration.”13 When given a series of easy puzzles to solve and difficult puzzles to solve, frequent game players spent significantly more time on the difficult puzzles. Infrequent players, on the other hand, gave up much faster and showed less interest in mastering the challenging task. Overall, the researchers reported, gamers showed much higher persistence and perseverance. They showed a habitual thirst for challenge and a striving to succeed even under difficult circumstances.

What accounts for this trait development? Previous studies (not on video games) show that individuals who engage successfully in any task requiring high effort will continue to extend high effort in future tasks. Working hard and then achieving our goal primes us—neurologically, with more dopamine—to work harder. It’s the same biochemical process of addiction, but it’s a virtuous rather than a vicious cycle.

As a result of these findings, scientists have proposed that higher dopamine levels in the brain may actually be the most important driver of a solid work ethic.14 This is a crucial rethinking of one of the most universally valued and admired character strengths. Work ethic is not a moral virtue that can be cultivated simply by wanting to be a better person. It’s actually a biochemical condition that can be fostered, purposefully, through activity that increases dopamine levels in the brain. This explains precisely how challenging video games—like Re-Mission—could prime us to tackle other everyday challenges with higher effort and more determination.

Adding further evidence to this theory, another recent study suggests that frequent video gamers’ brains are indeed changed in a long-term way by the heightened dopamine response. A team of twenty-five scientists from Germany, Belgium, France, the U.K., and Canada reported together that frequent gamers—defined as people who play at least nine hours a week on average—have higher gray matter volume in the “left ventral striatum,” part of the reward-processing area of the brain.15 More gray matter, in general, means that the brain is bigger and more powerful. More gray matter in the left ventral striatum, in particular, means you have more cognitive resources to devote to motivation, determination, optimism, and learning.

It’s possible that people who are naturally more motivated by challenge and who are better learners are more attracted to video games—rather than video games increasing these strengths over time. However, most neuroscientists who study games believe this is not the case. They attribute differences between the brains of frequent and infrequent game players to neuroplasticity, or the ability of the brain to rewire itself and strengthen different regions based on frequent activity.16 Daphne Bavelier, Ph.D., and her cognitive neuroscience laboratory at the University of Geneva, Switzerland, for example, have been studying the effect of action video games on brain plasticity and learning. After more than a decade of research, she believes that games lead to significant neural reorganization, resulting in increased attention, faster decision making, and more effective learning.17 Indeed, Dr. Bavelier has identified video games as potentially the single most effective intervention for increasing neuroplasticity in adults.18

Judy Willis, M.D., is another neuroscientist who believes in the power of games to rewire players’ brains for the better. A former chief resident at UCLA’s neurology clinic, she spent fifteen years seeing patients in her own pediatric neurology practice. Today she works with schools and educators to teach cognitive habits that lead to lifelong success and psychological well-being. Her primary strategy: provide students with daily experiences of self-efficacy, including frequent video game play.

“Neurons that fire together, wire together,” she likes to say, quoting one of the basic principles of neuroscience.19 The more you repeat a thought pattern, the stronger the neural networks that drive it become. And the stronger the neural networks, the more likely you are to repeat that thought pattern in the future. The pattern becomes easier to access, with neurons firing up to one hundred times faster—and because the patterns are repeated so often, the neural networks are less vulnerable to cognitive decline over time.

This means that the self-efficacy we experience when we play games frequently is not just a belief, according to Dr. Willis. It’s a way of thinking that is hardwired into the brain—a result of repeated activation of specific neurological circuits that train the brain to be motivated by challenge, rewarded by feedback, and more resilient in the face of temporary failure. “This is why nothing builds a success mindset faster or more effectively than video games,” Dr. Willis told me. “When you have constant opportunities to try different strategies and get feedback, you get more frequent and more intense bursts of dopamine. Not only do you get minute-to-minute pleasure, but the mindset starts changing in long-term ways. Your brain starts looking at things that weren’t achievable before and starts to think they might be achievable with a little effort. It expects to learn and improve and eventually succeed, because that’s what it’s used to doing.

“When you’re constantly experiencing successful goal achievement,” she explains, “your brain’s cost-benefit analysis changes entirely. You can overrule your brain’s default mode that wants you to avoid wasting energy on difficult tasks or challenging goals. Your brain adapts to seek out more challenge, to be less afraid of failure, and to be more resilient in the face of setbacks.”

Fifteen years’ worth of neuroscience research on games adds up to one big idea: if you want to change your brain for the better—to turn motivation into self-efficacy, to learn faster, and to cultivate more resilience—play more games. Or at the very least, provoke your brain with challenging learning opportunities in the same ways that good games do.

If you love this findings as much as I do, make sure to share this excerpt!