The Israeli army has announced that by the end of the year all new infantry soldiers will play a computer game designed to prevent post-traumatic stress disorder. The US military is also reported to be testing the game.
Blocking out the details of a traumatic event is thought to be one of the causes of PTSD. The game is designed to train soldiers not to do this.
“On a psychological level, a soldier that does not process threats in real time is more likely to develop PTSD later on in life,” says Yair Bar-Haim at Tel Aviv University. “Flashbacks, overstimulation and an attempt to avoid anything that resembles the traumatic experience are all results of the inability to properly process events as they unfold.”
The roll-out is based on the game’s success in a small trial. It’s not the first time a game has been shown to tackle PTSD. A 2015 study showed that playing Tetris after a traumatic experience could prevent the onset of flashbacks. But the new game seems to work differently.
“Soldiers who did not pay attention to threats on a computer screen were at greater risk of PTSD“
The game itself is simple. Players must press a key whenever a dot appears on the screen next to one of two images. One of the images is always threatening – angry faces and negative words like “explosions” and “wounded”–and the other neutral.
The game is based on previous work by Colin MacLeod at the University of Western Australia, who was one of the first to use such a game to test for attentional biases in people with anxiety disorders. People react more quickly to dots that appear next to images they are already looking at, he says. So, if someone is slower at responding to dots near threatening images, it suggests they are avoiding them.
Bar-Haim adds a twist. Rather than testing for bias against threatening images, his game trains soldiers to focus on them.
That’s because preliminary work in 2008, which tracked infantry soldiers from basic training to deployment, “found that soldiers who did not pay attention to potential threats on a computer screen were at greater risk of developing PTSD after actual combat”, Bar-Haim says.
To develop the technique, Bar-Haim teamed up with the Israel Defense Forces’ Medical Corps, the Walter Reed Army Institute of Research – the US Department of Defense’s largest biomedical research facility – and the US National Institutes of Health.
They then asked 719 Israeli soldiers to play the game in four, 10-minute sessions, as part of an advanced training programme. In July 2014, 14 months later, the same troops were involved in the Israel-Gaza conflict. The team measured symptoms of PTSD in the four months following combat. They found that after 50 days of intense fighting, only 2.6 per cent of the soldiers who had played the game developed PTSD compared with 7.8 per cent of their peers (Psychological Medicine, doi.org/bmk6).
That a single round of training showed an effect after 14 months is surprising, says Bar-Haim. “Given the nature of the training we thought it might be necessary to provide booster sessions imminently prior to combat,” he says. “However, the effects are deep and basic.”
Bar-Haim says that the training procedure targets a very specific neuro-functional system involved in threat monitoring – and that neuroimaging shows that such training, even if brief, can induce changes in both brain structure and function. “More research is needed to elucidate the underlying mechanisms of change in our preventative intervention,” he says.
MacLeod thinks the results are exciting. The value of such cognitive training could extend across a wide range of situations where people are exposed to traumatic events, he says.
However, there may be long-term consequences of heightening a person’s attention to threats, he warns – especially when soldiers return to civilian life. “Perhaps the training should be reversed once deployment has been completed.”