The story of Tetris: from video game to therapy

We explore the latest scientific study that extols the mental-health benefits of clearing those digital lines

The longevity of Tetris in its original, no-frills format is an extraordinary phenomenon. Jochen Tack / Alamy Stock Photo

In the 2011 documentary film Ecstasy of Order, the world's best Tetris players go head to head, demonstrating their skills and declaring their devotion to the biggest-selling video game of all time. For former world champion Harry Hong, the connection is a profound one. "When I'm in the zone," he says, with his trusty Nintendo controller in hand, "I'm pretty much as one with the game. In sync … just flowing."

Scientists have long been fascinated by the state of "flow" to which Hong refers, how Tetris manages to induce that state, and whether playing the game could have any therapeutic value. The latest study, conducted at the University of California and published in a paper last month, found that it could reduce feelings of anxiety during periods of uncertainty. "And because Tetris is so simple," says Professor Kate Sweeny, who oversaw the study, ­"almost anyone can get to a place where they're getting auditory and visual rewards every time they clear a line." The idea of a video game having beneficial effects on our mental health runs somewhat contrary to established wisdom, but a growing body of evidence suggests that with Tetris, at least, that may be the case.

The early history 

The story of Tetris has been told many times: of how Russian programmer Alexey Pajitnov came up with it while working at Moscow's Academy of Sciences; how it became the first video­ game to be exported from the then USSR to the United States; and how its bundling with the Nintendo Game Boy endeared it to millions of people. Even during the game's inception, its addictive properties were apparent; Pajitnov's boss, a clinical psychology researcher, noticed that he himself was being affected by the game's "emotional dynamics", and after seeing how workers in his lab were becoming obsessed with it, he destroyed all the disk copies he could find. But Tetris's potential could not be suppressed. The game had got its claws into us, blocking out our surroundings and inducing "flow".

"There are two elements that create flow," Sweeny says. "Firstly, that the activity challenges us at the right level, so it doesn't overwhelm us and doesn't bore us. The other is to present us with goals and for us to know where we are in terms of meeting them. Video games do these things really well; they give us constant feedback on our progress and get harder as we get better at playing them."

As our Tetris game improves, we can almost enter an auto­pilot state, where behaviour that was once conscious becomes automatic. Watching the current world champion, Joseph Saelee, 16, play Tetris on his YouTube channel is like witnessing a state-of-the-art machine, as he flips and rotates the pieces at extraordinary speeds.

The mental health benefits 

In 2014, researchers at the University of Plymouth in the United Kingdom and Queensland University of Technology in Australia studied how this temporary transportation of the human mind could reduce cravings for cigarettes, food and alcohol. At the time, Professor Jackie Andrade noted what she described as the "Tetris effect". "Craving involves imagining the experience of consuming a particular substance," she said, "[but] it's hard to imagine something vividly and play Tetris at the same time." Last year, another study conducted across a number of European universities and institutions sought to discover whether symptoms of post-traumatic stress disorder could be alleviated by playing Tetris. It could, researchers concluded, "substantially improve the mental health of those who have experienced psychological trauma". They described Tetris as a "cognitive therapeutic vaccine".

Tetris is not unique in offering a style of gameplay that can induce that sense of "flow". A game such as World of Warcraft offers a similarly slow hike in difficulty as you become more adept, along with regular rewards that keep you coming back for more. But while absorption in games of Tetris might potentially be therapeutic, we are regularly warned that immersing ourselves in storyline-driven games can carry the threat of addiction. "There are video games that are so absorbing they pull your identity into them," Sweeny says. "But when I play something like Candy Crush Saga [a game with similarities to Tetris], it's just enough to pull my attention away from whatever I'm worried about. But not so far that I can't drag myself out when I need to."

Anyone who suffers from anxiety and has undergone cognitive behavioural therapy will be aware of the phenomenon of "avoidance behaviour", and how people tend to engage in that behaviour instead of tackling the problems that might be causing them stress. In that sense, is Tetris not just an unhelpful distraction from real life? "There are certain circumstances where flow could be an avoidance tactic," Sweeny admits. "But the worry that takes us over when we're waiting for news [such as exam results] can interrupt our sleep, our concentration and our social engagement. If you need to dial that back just a little, some avoidance – in controlled doses – might not be the worst thing."

A psychologically potent creation

The longevity of Tetris in its original, no-frills format is an extraordinary phenomenon. According to cognitive scientist Dr Tom Stafford, it provides proof of the ­immersive power of games that don't have lifelike graphics. But last week, Tetris made a step into the 21st century with the release of Tetris Effect, a PlayStation game named after the phenomenon noted by scientists that aims to capture that sense of total absorption by using virtual-reality effects.

As you clear lines of Tetris blocks away, mesmeric visuals and sound effects create what one reviewer has described as "a meditative salve for this savage world". With rates of anxiety rising in many countries, is it perhaps the gaming industry's ambition to transport us from harsh realities and replace unpleasant feelings with soothing audio-visual tranquillisers?

“Some games I’ve come across were developed by people who have had psychology training to try to create a state of flow,” Sweeny says. “But games in general are kind of an escapism strategy, and the line between flow and addiction – well, it’s probably a fairly thin one.”

There's little doubt that ­Tetris is a psychologically potent creation. But, as with so many things, moderation is perhaps the key.