How Can Video Games Cause Panic Attacks? 1. Effects of an Auditory Stressor on the Human Brainstem
Judith L. Lauter - jlauter@sfasu.edu
Elizabeth Mathukutty
Brandon Scott
Human Neuroscience Laboratory
Stephen F. Austin State University
Nacogdoches TX 75965
Popular version of paper 2aPP7
Presented Tuesday morning, October 27, 2009
158th ASA Meeting, San Antonio, TX
It has been reported informally that action video games can cause anxiety and even panic attacks in some players. This is completely consistent with formal, physiological research on action games, which has shown they evoke many of the clinical signs of anxiety and panic: elevated heart rate, respiratory changes, flushing of the skin, altered sleep patterns, etc.
But we have very little information about exactly how games do this what are the important features of the game environment that create these changes? What are the specific effects on the brain? How are those effects communicated throughout the brain and the body? How many brain and body functions are involved? Are there individual differences in attraction to and reaction to action games, and if so, are some individuals at greater risk for extremely negative reactions while playing games?
This study is the first in a series of experiments designed to answer some of these questions. The project makes use of the AXS Battery (Lauter 2000), an approach that allows us to study dynamic relations linking many levels of the nervous system, along all three dimensions of body/brain organization (right-left, top-bottom, front-back) in a way that is individually specific. Using the battery, we can describe neurological fingerprints that let us determine the neurological style of how a persons brain and body work together.
One very important division of the brain where these dynamic fingerprint relations can be studied is the brainstem. The brainstem is an older section of the nervous system that links the top of the brain with the rest of the body. The brainstem is important for many functions including heart rate, breathing patterns, sleep patterns, attention and arousal, balance (including feelings of vertigo and nausea), facial expression, tension in jaw muscles (with direct effects on the temporomandular joint, or TMJ), eye movements, speech production, and processing of visual and auditory information.
To support these crucial functions, the brainstem needs to be steady, resistant to most external as well as internal perturbations. It is not subject to conscious control a positive thing, because among other things, it has to keep the heart and diaphragm working smoothly even during sleep and coma. Audiologists use a test called the auditory brainstem response (ABR a response to a simple series of repeating clicks, collected by means of a few EEG-type electrodes placed on the head) to assess hearing in individuals who cannot not respond to a standard hearing test, such as sleeping babies; and neurologists use the same test to assess brainstem function in general, for prognosis in coma.
In this study, we measured responses to ABR clicks (presented through earbud-type earphones) while subjects (11 females, 1 male) also listened to one of two sounds presented through separate, over-the-ear headphones. The additional sounds were either: 1) the sound of calm breathing, or 2) the sound of erratic, stressed breathing, recorded by the same male who did the calm breathing. The erratic-breathing sound was modeled on the soundtrack of an action video game in which the character was portrayed as running, wounded, and frightened.
ABR recordings were collected in an off-on-off series of five 4-min blocks per subject. During blocks 1, 3 and 5, the calm-breathing sound was presented, and during blocks 2 and 4, the erratic-breathing sound was presented. The dependent variable reported here is the amplitude of ABR peak V, generated at the top of the brainstem.
The results, represented by sample individual curves shown in the figure below, were both surprising and striking. During the two erratic-breathing blocks, there was a highly significant decrease in ABR peak V amplitude compared to the calm-breathing blocks. This reduction was seen not only when results were averaged over the group of subjects as a whole, but also in the data for every subject, an unusual finding for almost any physiological response.
Figure 1. Sample results for five subjects
At the same time, there were definite individual differences in the magnitude of the change, and this included suggestions of a gender difference. For the 11 females, the mean percent decrease in peak-V amplitude ranged from 9% to 29% (mean of around 16%), while the percent decrease seen in the one males response (lowest curve in Fig. 1) was more than 5 standard deviations larger than the female mean (erratic breathing suppressed the males peak-V amplitude by as much as 57%).
We interpret the significant change in ABR peak-V amplitude during erratic as opposed to calm breathing as indicating that the erratic-breathing sound is perceived by the brain as a kind of Danger, Will Robinson! alerting signal, a warning that something is not right. The fact that the response to the ABR clicks was reduced suggests that brain mechanisms for selective listening were called into action to turn down the response to the ABR clicks, in order to focus attention on the erratic-breathing warning signal.
The obvious question is, what else occurs in brain and body when these sounds are heard? Are the changes limited to the auditory system, or is brainstem function in general affected by these alarm-bell sounds, with implications for heart, breathing, motor control, etc.? Are the changes made even more dramatic when erratic breathing sounds are accompanied by additional features typical of action games, such as loud explosions, weapons firing, and rapid visual-pattern changes in both central and peripheral vision, all presented in the context of escalating demands for rapid decisions and ever faster motor-reaction times? And would the gender differences suggested in these data be replicated in other subjects?
The AXS Battery will let us explore all these questions. In future experiments we will examine the effects of these breathing sounds on other aspects of physiology and behavior, including heart rate and blood pressure, galvanic skin response, eye movement coordination, inner-ear physiology, and speech production. In addition, other AXS-Battery tests will be used to look upstream of the brainstem, to identify the source and nature of changes in cerebral cortex that translate into the neural commands that bring about these radical adjustments in the usually-steady brainstem.
It will be crucial in future testing to keep track of individual differences. Our prior experience using the AXS Battery to study individuals with different types of disorders, as well as normally-functioning children and adults, will make it possible not only to specify such differences but also to draw meaningful conclusions about the patterns that we find.
For instance, our research on the three principal brain types created as the result of prenatal exposure to sex hormones (for a popular summary see Lauter, 2008, How is Your Brain Like a Zebra? www.zebrabrain.com) suggests that each of the three brain types (found in females as well as males) will have a very different reaction to action video games. The polytropic brain type (created under conditions of zero to very low hormone exposure) will not be attracted at all to violent games, and may even be repelled by their erratic, rapid, loud stimuli and their violence.
The focal brain type (resulting from very high levels of prenatal hormone exposure) should be just the opposite. For focal brains, the general arousal of violent games may actually serve as a kind of self-medication, helping correct their signature condition of a quiet cortex, and working to establish a more normal level of brain physiology affecting many features of cortex, brainstem, body, and behavior. The need in these brains for extra-high levels of external stimulation may actually make action games addictive for them.
Finally, individuals with the middle brain type (created under moderate levels of prenatal hormone exposure) may be those most at risk for anxiety and panic reactions during game playing. Because of reduced capacities for handling the left-brain types of sensory stimuli and motor performance that are typical of action games, middle-brains may be especially prone to being over-stimulated by game environments. As game demands push them into a state of sensory/motor/emotional/cognitive overload, it is natural that they would experience feelings of anxiety and panic. Thus warnings on game packages may need to acknowledge the dramatic physiological individual differences that contribute to the way each gamer responds to the game.
The experiments continue, and this game is definitely not over. Stay tuned.