How to Get SuperBetter

Jessica Gross | Longreads | September 2015 | 18 minutes (4,658 words)

In 2009, while game designer Jane McGonigal was writing her first book, Reality Is Broken, she hit her head. The concussion didn’t heal. A month later, she was still plagued by intense physical discomfort and was told to avoid reading, writing, video games, alcohol, and caffeine. She became depressed and anxious, and had suicidal thoughts for the first time in her life.

By then, McGonigal had been researching games, and how the skills they build can help improve our real lives, for nearly a decade. She realized she ought to put her findings into practice. She designed a recovery game called “Jane the Concussion Slayer,” which involved recruiting allies (her sister and her husband) and identifying “bad guys” (symptom triggers) to avoid, “power-ups” (little boosts, like eating walnuts) to seek out, and quests to complete. That game became SuperBetter, which invites players to choose a specific challenge to overcome and, in the process, develop “gameful” abilities.

McGonigal’s new book, SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver, and More Resilient, takes readers through the game, as well as research supporting its efficacy and the theory behind it. We spoke by phone about games’ benefits and limitations, how playing games affects the brain, and what she’s using SuperBetter to tackle now.

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You cite some fascinating studies in this book. One that I found particularly surprising, from Stanford’s Virtual Human Interaction Lab, was that watching an avatar who looks like you work out and show physical improvement makes you more likely to go exercise yourself. Was that surprising to you?

It wasn’t surprising. By the time that study came out of the Stanford Lab, they had done many studies of avatars and how they impact how we think and act in real life. There was, for example, a finding that if you play with an avatar that is highly attractive, you are more confident flirting afterward. The only thing that does surprise me is that this hasn’t been commercialized more quickly, because everybody is looking for that extra motivation to do the things we want to do, like exercise more.

Yes, I loved that flirting study. Though I did wonder, did people still feel so confident after they had gone out and flirted, or did they get unrealistic expectations from playing this game and going out into the real world?

That’s an interesting question—unrealistic expectations. There is nothing in the research literature about whether then they got rejected later and felt it was sad. [Laughter] It was really based on their subjective confidence and how they rated their own attractiveness.

But it’s interesting that you raise that question, because in the skepticism that I’ve faced in my research and some of the projects I’ve designed, there is a lot of that sentiment: Do games set you up with a false sense of capability, so that if you tried to be that ambitious or that optimistic or that creative in everyday life, you would face a terrible rude awakening? That is something between criticism and cynicism, I think, which comes from assuming that games are a kind of fantasy world that make you feel powerful and capable, but that there’s no actual skills and abilities being developed.

That’s one of the biggest myths that I try to overturn. I try to help people connect their skills and abilities in games to real everyday skills and abilities, to see that through line. That’s what SuperBetter is all about: identifying that connection so that you can take advantage of it. In fact, the number one predictor of addiction or pathological gaming is thinking there is no relationship between games and real life. That cluster of studies about addiction was one of the most important findings that I came across in the five years that I was researching that book.

Can you talk a bit about how you came to write Superbetter?

Well, in the middle of writing my first book, Reality Is Broken, I hit my head and got a severe concussion that didn’t heal properly. I had to stop writing and I missed my deadline with the publisher. That book was all about how games make us happy and how they help us feel productive and purposeful and connected—all these things that I was not feeling during my recovery.

I thought, my God, I’ve been writing this book for a year. If all that is true, I have to be able to use this in a practical way in my own life right now. I should be able to do something about my recovery and how painful it is and how depressed and anxious I am. I need this research to be more practical, I need this research to actually translate into what do I do because I am depressed and anxious and suffering. What can I do with games to get better?

Once I created the game, SuperBetter, I was sharing it with others and talking about it and wanting to be able to explain to people why it worked. So that’s where the second book comes from. We did clinical trials with the University of Pennsylvania and with Ohio State University to show that the game does work for most people in these ways that we measured and controlled. But I also needed a theory behind it. I think that’s the most effective science: you have controlled studies that show a phenomenon, but then you also have research that provides a theory as to why that would work. It’s one thing to show that this game is working, and it’s another to be able to say, well, I can look at five hundred aggregated studies that help explain the different reasons why. So the book came out of wanting to be able to do that, and hopefully inspire people to either make other games or use other games in the same way.

I was surprised to learn that playing games actually changes your brain chemistry. You write that it creates a rush as pleasurable and powerful as intravenous drugs.

Yes, right. This is one of the main messages of the book: that the games you already play can benefit you, or the games that you yell at your spouse or your kids to stop playing can benefit them, if you play in the right time and in the right ways.

One of the early findings from the neuroscience of gaming, around 20 years ago, I think, was when they first started seeing what a big dopamine rush was involved with video games. It was as much of a dopamine rush as when somebody injects methamphetamines. The effect is pretty clear: the more dopamine you have flowing and are able to access, the more motivated and goal-oriented you are. And you tend to discount the effort required to achieve your goal, and focus more on the benefits of achieving your goal. So if you are very low dopamine, that’s what we see in clinical depression: No matter how many goals they think about or how many future good things they try to imagine, they don’t have the dopamine necessary to feel action-oriented.

This is one of the things that happens with traumatic brain injury and with concussion: your brain chemistry changes so that you literally can’t imagine anything positive in the future. That’s why I was having suicidal ideation. No matter what goals you try to set for yourself, your brain is just like, “Oh, don’t do it, it’ll never work, it’ll never pay off.” Whatever happiness you try to imagine in the future, your brain just doesn’t believe you. No dopamine, no hope, no motivation.

This helps explain why gamers never give up and why you can see a player trying to tackle the same stupid level fifty times in a row and they still have hope. “I think I’m gonna do it next time, I just gotta give it one more try.” They don’t want to go to sleep, they don’t want to quit. The dopamine is really firing them up.

There are benefits besides that. We know that a high level of dopamine primes your brain to continue thinking in that pattern. So if you are playing a game and can step away and use that dopamine high to tackle a real-life challenge, that’s actually really productive, right? You can think about priming your brain for a hard day of real-life challenges with something like Tetris, Candy Crush Saga, or whatever is your thing.

Why this happens is that every time we take an action that has a possible consequence, we can either be successful or we can fail and learn why we failed. In both cases, the brain releases a little hit of dopamine: it is the learning and motivation chemical. Games are just constantly taking action. If I rotate this piece, will it fit? If I fire at this angle, will it hit? If I go this way, will my opponent be able to follow? You are constantly making predictions and taking actions that you get immediate feedback on. That explains why video games, in particular, give us this incredible dopamine rush: there are really very few other activities that require us to be constantly taking actions that can pay off or making a prediction that we’re going learn something from. You do that for hours when you play games, so your dopamine is just through the roof.

In the context of a game, the environment is very safe: there are no stakes at all. But in real life, of course, there are. It seems like a fundamental psychological barrier that could prevent somebody from making the leap from games to reality is pessimism.

Right. But what we’re really trying to do is convince people to adopt a challenge mindset. We’re not asking them to be foolhardy, we’re not even asking them to be optimistic all the time. I talk about it as realistic optimism or flexible optimism. You want optimism when it’s helpful.

It’s not beneficial to be totally motivated and goal-oriented all the time, especially if you’re in an environment where you have no control over the outcome, like gambling. In that context, it’s dangerous, right? So it’s not always good to have this gameful mindset. It’s good in situations where your actions can have a significant impact on your experience and/or the outcome of whatever challenge you’re facing. This comes down to choosing your challenge.

Since you’re talking about balance and nuance, I appreciated your repeated focus, in the book, on not repressing negative emotions. That it would be absurd to have a challenge of, say, not grieving anymore.

Right. The SuperBetter method is all about developing psychological flexibility, it’s all about being able to look the negative in the face and live with it. One of the really truly life-changing experiences that people can have when they play SuperBetter is thinking about their bad guys and trying to evaluate whether the bad guys truly have any power over their lives or not.

A lot of times people who have anxiety think they need to cure their anxiety and then they’ll be able to go back to school or travel or date. Whereas one of the things that we encourage in SuperBetter, and that is encouraged by the clinical psychologists who want you to have psychological flexibility, is to ask yourself whether anxiety is really a problem. How much control should it have? Is it necessary for you to be comfortable when you do things, or can you live with the anxiety because your goals are more important to you than feeling comfortable all the time?

The whole chapter on bad guys is really about being okay with not being happy or comfortable or pain-free all the time. These negative feelings are not an excuse to stop pursuing your goals. In video games, you don’t expect to reach your goal without having to deal with a lot of bad guys. They’re going to be trying to stop you and block you and make you weaker or take your resources, and you’re never going to win the game by running in the opposite direction. You have to face them and struggle with them and make progress in spite of them.

You write about the difference between playing games to enhance your life and to escape it. Could that bridge the gap between that qualitative distinction and the quantitative finding you cite, that when you play games for more than three hours a day, it starts to be harmful? Because it would seem that you could want to escape real life and simultaneously play games less than three hours a day.

The reason we seem to see negative impacts pop up at about 21 hours a week are that in most populations, when you start to play more than that, there are significant opportunity costs. You are playing games instead of doing other things that are also important, whether it’s physical activity or spending time with people in your life who aren’t playing the same game or advancing toward work goals, career goals, community involvement goals. So it’s literally just about how much time there is in a day, and once you are spending a certain amount of time on this particular leisure activity, you are risking opportunity costs.

But there are exceptions. They have shown that you can play longer for benefit in extremely stressful or unique situations. If you are in the hospital or on bed rest and can’t go anywhere, you can play meaningfully for eight hours a day and have benefit rather than drawback. There have been studies of adults going through really stressful divorce periods and both kids and adults in the family using games to connect with each other, ignoring the rest of the world of their lives for a limited period of one or two months. And that intense bonding makes up for the fact that they’re not putting time into physical activity or school or work. So there are exceptions to the rule. But the quantitative aspect just comes from the need to lead a balanced life.

If you are playing to escape, it’s very hard to stay under that 21-hour-per-week limit, because the more you have those negative feelings you’re trying to escape, the more you want to play. And the more that you play, the less likely you are to do anything to actually improve the situation and not have those feelings. It’s very hard, if you’re playing with an escapist mindset, to limit yourself, because the game seems like the cure. “I’m going to keep playing because I’m not feeling anxious, I’m not feeling lonely.” And there is a narrowing window. Whereas when you play with purpose, the game is never the thing that you’re pursuing. And you can’t get addicted to feeling creative, you can’t get addicted to having strong relationships with your parents.

I kept thinking of 12-step programs as I was reading, because it seems like so many of the tools used in that methodology have parallels with the world of games as you describe it—like counting the days you’ve been sober and getting a chip, or completing items in the step work: what you might call “quests.”

Yes. I think if you look at a lot of social constructs that have been successful for a long period of time and work for a lot of people, you will often find gameful elements to their design. Organized religion, I think, is another example. And of course you have team sports.

This is not because they were designed that way on purpose—people didn’t say, “We need to gamify recovery,” or “We need to gamify religion”—but because games fulfill certain psychological needs. We’ve been playing games for thousands of years; we can trace games all the way back to the beginning of civilization. We tend to feel powerful and effective and capable and connected with other people when we play them.

Can you talk about religion specifically?

I think you’re really looking at the desire to be connected to something bigger than yourself, to have this sense of purpose and meaning in your daily actions, to find opportunities to help others in concrete ways. A lot of religions create structures in which you are given this opportunity to do good for others systematically, to define your purpose, to declare that you have a purpose.

The idea that games could create genuine feelings of meaning and purpose was very controversial in my first book. People got upset about the idea that the “Halo” games created a sense of meaning and purpose when all you’re doing is shooting at aliens. Some readers got really aggravated by my assertion that the feeling of meaning and purpose is real, the feeling of being connected and the collective effort is real.

But even though it’s all taking place in a virtual reality that arguably does not accrue any benefit in lifting people out of poverty or whatever it might be, that doesn’t mean that the feeling isn’t real, that the psychological experience of belonging or meaning or purpose isn’t real. It’s a fine line to walk, and it’s why SuperBetter has been a rewarding experience for me. Because we found that the most successful people are actually the ones who mentor other players through the system. By playing the game, they really did help other people with real life challenges. So it’s about bridging that gap between the feeling of meaning and purpose and connecting it to a truly elevated meaning and purpose.

In a critical Slate piece that came out in 2011, after the publication of your first book, Heather Chaplin writes about how, in playing SuperBetter, you took on a secret identity and enlisted friends and family to call you for reports. She writes, “I felt sad when I read this. What, you couldn’t just pick up the phone? You needed to jump through all those hoops just to talk to your friends?”

It was a very intellectual argument from somebody who has never been in a situation like this. The way I had to look at it, she doesn’t have empathy for people in this situation because she probably has not been in that situation. Every day, I hear from somebody who says, “I was never able to talk to anyone about my depression until I had the SuperBetter language.” Or, “For the first time in my life, I told my brother that I’m actually depressed, and this is the first family member who ever knew that I was dealing with this.” I mean, it’s just so patently clear that it actually helps that you can’t be too bothered by somebody who has an intellectual disagreement with something that, one, they haven’t actually tried and, two, they may never have needed to try.

The app has been shown to work best for people who have the most urgent and desperate challenges. We’ve just seen this again and again in every possible way you could see it. In our clinical trial funded by the NIH, it was the people who had the worst depression scores at the start who benefited most from it. So the Slate article, to me—you could have an intellectual opinion about whether something should feel like a game or not, but from a very practical standpoint, when people are suffering the most deeply, whether it’s with depression or anxiety or physical pain or existential struggle, and the game has helped them, I think that transcends intellectual or abstract opinions. I think more people will relate to the idea that it can be hard to ask for help, but that it’s easy to invite someone to play a game. I’m pretty sure more people relate to that idea than have some kind of intellectual opinion that you shouldn’t need help asking for help.

But that article goes to show there is something that gets people angry when you talk about games being important and real. In fact, a lot of game developers don’t get that excited about the idea either. When you talk about documenting the benefits of playing video games, a lot of game designers will say, “Games are art. Art doesn’t need justification. We make these beautiful worlds and we design these beautiful puzzles and challenges and tell these beautiful stories, and that doesn’t need justification. We don’t ask people to justify literature. We don’t ask people to justify music.” I definitely stand on one side of that issue, which is I am a very practical person—I identify as a Buddhist—and I think that the most important thing you can do is try to alleviate suffering. It’s very practical thinking about how people seem to suffer less when they are playing games, and why is that, and can we use that to alleviate suffering in other aspects of our lives. That can aggravate people for all kinds of reasons.

I attended and spoke at the Game Developers Conference, the annual meeting of game developers, for around ten years. And the last talk that I gave, about two years ago, I was kind of yelling at the industry because I felt that there was an empathy gap with players. By failing to acknowledge that games do impact player’s real lives, for better and for worse, we are failing the people we make games for, and most people actually care deeply about whether games impact us or not and if so how. So I got up and ranted about how I felt like we were too disconnected from the reality that most people are not thinking about games as art, and they’re not thinking about abstract intellectual arguments about games, but they’re really thinking, “How can I be happier, how can I be healthier, is this a problem, is this a problem for my kids?” And we do have a responsibility to do scientific research on these questions, and maybe more so than other art forms because of how much time people are spending on them. Ninety-seven percent of people under 18 in the U.S. are playing for more than an average of an hour a day. We need to have empathy for those people and really try to understand how they’re using games.

You write that through your recovery from your concussion, and playing this game, you developed the ability to turn people down and not people-please so much in order to focus on the things that you find fulfilling.

I think there is something about the particular experience that I went through of being in bed and not being able to do anything. As I started to get better, I would be able to think clearly for certain periods of time, so maybe I’d have an hour or two to do what was most important to me. At that time, I started telling people, “I can only think for two hours today, and so I can’t do that because I have got to work on my book,” or whatever it was. When your resources actually get that limited, it’s much easier to protect them. I think a lot of times we go around thinking we have unlimited resources, and it’s not until you’ve had a traumatic experience of some kind, or a truly existential challenge to your perception of what you’re capable of, that you realize time and energy are limited resources. That’s actually very common for people who experience posttraumatic growth: the ability to set priorities and set boundaries.

And now, I don’t do anything I don’t anything I don’t want to do. [Laughter] Which doesn’t mean that now I’m only going to do things for Jane. I wound up prioritizing helping certain people in my life. I am now much more likely to say I can’t do an interview or I can’t go do a panel or I can’t write an article for your issue because I want to read a draft of my husband’s new novel, and that’s more important to me.

I know that you used the SuperBetter method to recover from your concussion, and then also for marathon training and going through IVF. I was curious if you are still playing and if there’s a goal that you’re working on at the moment?

There’s a two-part answer. The first part is what we seem to see with this method is that it’s the kind of thing that you can draw on when you need it, but you don’t need to walk around every day for the rest of your life saying, “What are my three power-ups today, what’s my quest, what’s my bad guy?” That’s not something you have to do every day, forever, to get the benefits. It’s really when you are facing a new and significant challenge that you have this skill set that you can draw on.

So the most recent experience that I had where I felt like, “Okay, I really need to get superbetter,” was actually when my babies were born. They were 10 weeks early and they were in the NICU for two months. They were three pounds when they were born. It was scary. One of them went through everything you can go through—blood transfusions and spinal taps. It was very overwhelming.

That’s a situation where you feel really hopeless and helpless and maybe like you failed: “Why did they come so early, and was it my fault?” So my husband and I both used SuperBetter during the time that they were in the NICU. Pretty soon—I mean, by day two—I got out my notebook and was making lists of my quests and power-ups. We started making our list of allies, too: “What’s the name of this nurse and when is she on?” We did the whole SuperBetter thing through it, and it was extremely helpful. We even had new secret identities, which help bring out the signature strength that is needed right now for this challenge. So I became Mama Bear, because I really wanted to be that strong, protective mom that I had never been before, because these are my first babies, and try to focus on that strength.

They turned six months two days ago and they’re at home, doing great. A lot of people will tell you that long NICU stays are traumatizing and they are, they’re terribly traumatizing, because so many things go wrong and you feel helpless and you watch your little baby and you can’t even hold them for the first three days. It’s just horrible. But my husband and I both feel like we are stronger, better parents for having gone through that than we would have been. We had to start this whole parenting process realizing, “Wow, I’m not in control, things aren’t going to be perfect.” I feel strong, as a parent, and I can face anything.

And even as you talk about it, you can still hear that voice in your head that’s like this sounds ridiculous: “Wait, these little babies were in their little incubators and you can’t hold them and you’re playing a game?” It sounds possibly ridiculous. But it’s all about having a concrete set of practices that help you draw on those strengths. When you’re really having a hard time, the more concrete the practices, the better, because you’re not going to be thinking clearly or be at your full, hundred-percent capacity. So having a method with very clear practices—identify your power-ups, identify your bad guys, have a quest every day—the fact that these practices are so clearly concrete is really what makes it possible to use it when you’re confronting this kind of a crisis or challenge.