They started as simple blocks of light.
VIDEO GAME SOUND EFFECTS
But few predicted they heralded a revolution in entertainment.
Video games had arrived.
An entire generation has now grown up
immersed in virtual worlds becoming ever more realistic.
Play is fundamental to who we are
and we're just doing it through technology now.
Really, games are whatever you want them to be.
And like TV and film before them, they're not without controversy.
Video games stand accused of making us violent...
..or causing addiction.
But is any of this true?
Horizon enters this explosive digital world...
..to uncover the evidence.
Can video games really turn us into aggressive monsters?
We found that playing a violent game increased aggressive behaviour.
When you think about what causes violence or aggression,
there isn't just one kind of straw that breaks the camel's back.
Can they cause addiction?
So there's one specific form of impulsivity
or self-control that is impaired in pathological gamers.
What are video games really doing to our brain?
Do I show with the study that we are aggressive after we play video games?
I did not show that, that's not the conclusion of the study.
And could there even be hidden benefits to gaming?
In the future, a physician, instead of writing down a drug,
writes down a tablet game, times two months.
Horizon goes behind the hype and the headlines to discover
if video games are really that bad.
The video game industry is a phenomenon that spans
continents and generations.
Globally, the games industry is enormous.
We're talking a multi-multi-billion dollar industry
and the UK's game industry is the biggest in Europe.
I think there's a sort of mainstream perception
that gamers are this very certain demographic of sort of,
you know, young, male, aged 18-35, but that's just not true any more.
There are now more gamers over 35 than in any other age group.
Nearly half of them are female
and their popularity is still on the rise.
Teenagers, children, you know,
older people who are playing it
on their smartphones and tablets.
Really, it's so diverse now that, increasingly,
there's something for every taste so, you know,
my mom plays certain types of games, I play different ones.
A lot of people wouldn't consider women, girls,
younger children to be gamers but they're part of that.
Yet when video games hit the headlines,
they're often portrayed as a corrupting influence.
So, I write about video games every single day
and I have done for about five years now.
If you look at traditional media, tabloid media,
even kind of more traditional forms of media, television, radio,
video games only kind of bubble up
when something controversial happens.
An early and notorious example of this controversy was Carmageddon.
SCREAMING TYRES SCREECH
It was released in 1997 at a time
when 3D graphics were turning video games into immersive virtual worlds
and Carmageddon attracted widespread condemnation
for its violent content.
You could complete a race not just by winning the race
but also by killing all the pedestrians in the level with you,
which, yeah, ruffled some feathers.
Vilified in the media, banned and censored in several countries,
Carmageddon topped gaming charts worldwide.
And that popularity was a harbinger of what was to come.
Today, many of the best-selling titles
engage players in worlds filled with violence.
At the end of the day, it's not real.
These characters that you ran over in the game, they're just bonus
points for you to win the race, you know, they don't mean nothing.
These are digital people, they're not real.
You know, the blood that comes up on the screen isn't real.
But can exposure to virtual violence actually change
the behaviour of the player?
Does playing a violent game make you violent?
This is Professor Craig Anderson,
a psychologist at Iowa State University.
In the 1990s, he set out to discover whether playing a violent
video game could make the player aggressive in the real world.
The study of aggression is fascinating
and it's really dominated what I do for about the last 20 years.
We were looking to see if playing one kind of video game or another
for a brief period of time would have any impact on emotion.
We kind of noticed that games were starting to include more
aggressive scenes, more violent scenes.
As video games became more popular and more violent,
psychologists increasingly turned their attention
towards their possible effects on the player.
Professor Brad Bushman of Ohio State University has worked
extensively with Craig Anderson for the past 15 years.
Video games are different from most forms of violent media.
One way is you have to pay attention to what's happening.
You can't zone out when you play a video game.
You're directly tied to a violent character.
If it's a first-person shooting game,
you have the same visual perspective as the killer.
In a violent video game, you're directly
rewarded for behaving in a violent and aggressive way.
You know, you shoot a character and maybe you hear "Nice shot.
"You are tied for the lead!"
GUNSHOTS
Researchers wanted to know if this level of immersion
would lead to acts of aggression in the real world.
Dr Doug Gentile is a colleague of Craig Anderson.
The proper definition of aggression is intentional harm to
someone who would rather not be harmed.
Well, in the laboratory, it's difficult because, ethically,
we can't actually let children hit or hurt each other
so we have to have it set up in a way that they think they're
hurting someone else but they're actually not injuring anyone else.
We might set up a situation where the research participant believes that
they are doing something that will harm another person
but there usually isn't actually another person being harmed
because, again, of ethical concerns.
In a typical experiment,
subjects play either a violent or non-violent game.
Straight after, their aggression levels are measured using
specially devised laboratory tests.
One might use a task called the competitive reaction time task.
What you do is you tell the participant, "OK, you and this other
"person are going to be competing on a series of reaction time trials.
"When this button turns red,
"your task is to click the mouse button as fast as possible.
"Whoever wins, nothing bad happens to you.
"Whoever loses gets a blast
"of sort of obnoxious noise over the headphones.
"And you get to choose how severe the punishment is,
"this noise blast is, for this other person."
The severity of punishment the winner chooses to inflict is
the measure of aggression.
And studies conducted by research groups across the world have
used different tests to quantify the effects
of playing violent video games.
Electric shocks,
eating hot chilli sauce,
a hand plunged into iced water
have all been used to measure levels of aggression.
So, it didn't really matter whether you gave somebody electric
shocks or noise blasts or hot sauce or put their hand in ice water.
Playing violent video games increases aggression anywhere
from about 4% to 9%.
But really what does that mean?
It means that we've shifted the dynamics of the situation
so that a child, or an adult for that matter,
who walked into the room, not likely to say something unkind or
behave aggressively in any way, now the odds are a little higher
that if something provoking happens, the odds have shifted.
They're more likely to give a more aggressive response
to that situation.
A growing body of research was pointing to
an increase in a person's inclination to act
aggressively just after playing a violent game.
But Anderson and Bushman wanted to go one step further.
They wanted to test whether exposure to virtual violence could
change the way we react to violence in the real world.
We conducted a study with 257 college students.
Some of them were randomly assigned to play a very violent,
graphically violent video game for about 20 minutes,
others played a non-violent game for an equivalent amount of time.
This group of 30 volunteers are undergoing a similar test.
And we had two measures of physiological arousal.
One was heart rate, the other was skin conductance.
These measurements are markers of stress, excitement or fear.
DEVICE BEEPS
Half the volunteers play a violent shooting game.
The rest, a simple ball-rolling game.
After they played the video game,
we showed them real clips of actual violent scenes.
These were not Hollywood productions.
You know, somebody stabbing somebody in a prison
or getting in a fight in a courtroom
or a police officer shooting somebody or violence on the street.
The images of real violence are too graphic to broadcast on television.
For some, it makes disturbing viewing.
WOMAN GASPS
What?!
Others have a more ambiguous reaction to it.
MAN CHUCKLES
And again, we're recording skin response and these other things
while they're watching these scenes of real violence.
The question the team hoped to answer was simple -
would the group playing the violent video game be less disturbed
when seeing violence in the real world?
What we found was that those who had just played a violent game had
less of a physiological reaction to the scenes of real violence than
did people who had played an equally interesting but non-violent game.
With this small group, the effect is similar.
When the people who had played the non-violent game watched
the violent images, their stress levels rose on average by 80%.
But for those who had played the violent game,
stress levels increased much less - just 12%.
Bushman and Anderson published their findings,
claiming that people who had just engaged in virtual violence
were less disturbed by images of violence in the real world.
Proof, it seemed, of the negative effects of video games.
So, playing the violent video game desensitised them
to violence in the real world.
You've been exposed to so much violence that you become numb to it.
Desensitisation effects tend to, in some sense, remove some of the
inhibitions against actually behaving aggressively,
and tends to lead to the person to think of aggressive solutions.
"Here's how I'm going to handle this situation.
"I've been threatened or I've been offended in some way",
and the way that you handle that is you retaliate.
The different studies into how people behave after playing
violent games had uncovered some evidence of two separate
effects on players - an increase in aggressive thinking
and desensitisation,
making them more accepting of real-world violence.
It's like a double whammy.
You put them together and it sets the stage
for later aggressive behaviour in violent game players.
HEAVY METAL MUSIC PLAYS
Now, what's really interesting is
when we think about what happens in the school.
So, I'm in school, I get bumped.
How you interpret that and what you find is that aggressive kids
and kids who have been exposed to a lot of video game violence
tend to very quickly assume that that bump was intentional,
that that harm was intended.
They see it as a threat and then they respond to it as a threat.
What's interesting is that aggression that happens
in the school hallway looks nothing
like what they practised in the games.
Children are not copying.
It changes the way you think
and you carry the way you think with you everywhere in the world.
A review of the evidence by the American Psychological Association
published in August 2015 largely supports this work.
So are the headlines that link games to real-world violence
correct after all?
Not everyone is convinced.
Chris Ferguson is associate professor of psychology
at Stetson University.
To him, if video games are making us more aggressive, there should be
one very obvious consequence - a rise in violent crime.
We, as a society, have consumed more and more violent video games.
Youth violence has gone down in the exact opposite
direction of what people thought we would probably see.
The latest figures show youth violence in the US fell by 83%
in the two decades leading up to 2013.
It's a period of time that also includes
an explosion in violent video game popularity.
And it really doesn't matter how you look at the figures,
whether you're looking at younger kids or older kids or adults,
whether you're looking at bullying, whether you're looking
at general youth violence, whether you're looking at gun violence.
The thing is we don't really know why that is.
Of course, human behaviour is very complicated,
whether it's something that's at large in society,
whether it's a change in parenting practices,
whether it's a change in schools, we just don't know.
But while it's impossible to claim that gaming
has caused a reduction in crime,
a close analysis of the figures reveals one possible correlation.
When very popular violent video games are released in society,
there's almost an immediate decline in youth violence in society,
and typically the way that we think about this is in terms
of a theory that's called routine activity theory
and routine activity theory basically suggests that
if you take a group of individuals who are already highly prone
to aggression, so you take a bunch of young guys,
and you give them something else to do,
then by sheer fact that their time is occupied, that takes them away from
scenarios in which they are likely to engage in violence
or aggression or bullying or things like that.
The theory suggests that
if people stay inside and play violent video games,
they have less opportunity to act aggressively out in the real world.
Ferguson also ran his own studies into aggression.
He used the standard measures like noise blasts and iced water.
He wanted to know just how big a part video game violence really
played in the laboratory measures of aggression
and whether anything else might be responsible.
Despite coming at it, really, at a number of different ways,
I've been really unable to find that violent video game is
predictive of these types of behaviour related to violence
that society is interested in.
What we tend to find is that family environment is a factor that predicts
youth violence, that mental health, like depression,
seems to be a factor that is involved in youth violence.
Obviously, antisocial personality traits and such.
So the question really is do violent video games cause
violence by themselves but are they one of the risk factors that
may be involved in promoting violent behaviour?
The answer from the evidence that we've seen with our studies
seems to be that no,
violent video games are not one of the risk factors
for violent behaviour in kids.
Ferguson is not alone in his conclusions.
A growing group of academics believe video games
have little effect on players.
Family background, poverty, mental health,
even simply being male are thought, by some,
to be more closely correlated to aggression than video games.
Yet this division within the academic community
is rarely mentioned in the media
and scare stories continue to dominate the news.
So if there is a particular story where someone who can be shown
to have played a video game, at some point does something bad,
and perhaps a newspaper wants to make that link,
then that might make a better story than a study that comes out
that perhaps tentatively proves that video games can be
responsible for something positive.
There's a lot of data on the relationship between violence
and video games now and we're not seeing that it makes people
less social or it makes people more violent.
I do think that there's probably some bias rooted in
misunderstanding that dates back to an older lens on the game industry.
Games which involve violence are a small part of video games
in general and I think it's a bit insulting to people who
play video games to say,
"You don't know how to contextualise this violence but we do."
From books and board games to home consoles, Ian Livingstone
has been involved with the game industry for over 40 years.
His credits include Tomb Raider.
I think the people who write these sensationalist headlines
are probably people who have never played a game in their lives.
Only 5% of games have an 18 rating,
95% of content is perfectly family-friendly.
Games are being made by everybody, male and female, young and old,
and there are those same people who are actually playing games
so it's strange to me that something that has such a cultural
and economic and social impact is portrayed as the dark arts.
Tim Schafer began making games in the 1990s.
His many credits include the award-winning Grim Fandango
and Secret Of Monkey Island.
For the most part, I think anything people say about violence
in video games they also said about comic books and movies.
I really don't think it's that different
and I think as people get used to video games being around
and as the first generation of kids who grew up with video games
becomes adults, they'll realise it's not as scary
and threatening as they think it is.
People sometimes get a bit sort of pent up
when they're playing certain games but those high emotions happen
when you're watching a football match or you're arguing about politics
and those sort of...
That kind of stuff evaporates in a matter of minutes.
So if experiences in everyday life can lead us to feel temporarily
aggressive, could something similar be happening with video games?
Dr Andrew Przybylski is a research fellow
at the University Of Oxford.
He specialises in the psychology of motivation.
What makes us act the way we do?
There are a wide range of things that could cause aggression.
We could see other people aggressing,
we could have resources taken away from us,
someone in our family group can be threatened
or we could be frustrated in traffic.
When you think about what causes violence or aggression,
there isn't just one kind of magic bullet
or one kind of straw that breaks the camel's back.
Przybylski and his colleagues decided to try
a different kind of experiment.
They set out to investigate whether something else in
a video game might cause gamers to act more aggressively...
..using one of the least violent games there is.
Tetris is a puzzle game where little blocks,
there are seven different kinds of blocks, they tend to fall from
the top of the screen down and your object is to clear lines as you play.
Tetris is not known for its ability to incite aggression
but it does have an evil twin...
..called Bastet.
The game starts normally like any game of Tetris would where you get...
I've been assigned a 2x2 piece.
At least when I start, the pieces seem to make sense until I get to
a point where I have a real chance of kind of closing the loop so to speak.
I very desperately right now need a piece that is very narrow.
In Tetris, the pieces are selected at random.
But Bastet doesn't play fair.
It contains an algorithm that can work out
the worst possible piece for the player to receive next.
So, about 2% of the time, it will give me a randomly selected piece
I need and 70% of the time, it will give me the worst
possible piece, and so it's just enough to kind of string you along
and give you hope, but not enough
to allow you to finish any lines, per se.
Przybylski conducted a study in which participants played
either Tetris or Bastet.
Before playing, all of them experienced
the discomfort of immersing a hand in ice-cold water for 25 seconds.
After playing, they were offered a choice.
Right before they left the lab, we asked them, as a final question,
"How long should the next participant
"put their hand in the cold water for?"
and what we found was, on average,
those who played the Bastet version,
the version that made you feel very incompetent,
they tended to assign about seven more seconds of the hand
in four degrees Celsius water
than those who played the normal version of Tetris.
This increase in aggression can't have anything to do with violence.
Przybylski's theory is that it's caused by something else -
frustration.
Might frustration explain some of the results that we've
observed in older studies?
It's definitely one of the, kind of, potential consequences of our work.
It's entirely possible that games do make people feel kind of aggressive.
The question is, what is it about the game that does?
Is it a temporary thing or is there a reason to be
concerned about this over the longer run?
Is there some kind of build-up of aggression
after repeatedly playing a video game?
A lot of research doesn't address this.
GAME CHARACTER GROANS
Three decades of psychological research into how playing
violent video games affects our behaviour
have failed to produce scientific consensus.
But could a definitive answer
lie within the brains of gamers themselves?
Rene Weber is a professor of neuroscience
at the University Of California, Santa Barbara.
He's conducted a study into what's happening in a person's brain
at the very moment they're playing a violent video game.
We had people in a brain imaging scanner, and while they were
in the scanner, they played a first-person, violent shooter game.
And while they played, we scanned their brains and then afterwards,
we analysed the distinct pattern of playing, such as
violent interactions or non-violent interactions -
searching for your way out of this maze
or engaging an opponent and killing this opponent.
VIRTUAL GUNSHOTS
Weber wanted to see how the brain responds to virtual violence
as it happens.
No-one had tried this before.
I went into the study and thought,
there's no way that we'll ever see a consistent pattern
because just by the nature of the stimulus, it's a
very complex stimulus, there's a lot of auditory, visual information.
You have to make decisions in almost every second of gameplay,
so I thought it would be a really hard study to do.
Amid the noise, one clear response began to emerge.
From previous studies, Weber knew violence would usually
cause this area to activate - the amygdala.
It's involved in processing our emotions, like fear,
but when he observed gamers in the scanner, Weber saw
a different section light up, part of the anterior cingulate cortex.
It connects the reasoning areas of the brain
to parts responsible for our emotions.
It appeared to suppress
the amygdala's normal response to violence.
In any instance of violent engagement,
we saw pretty much the same pattern in all but one participant.
That's amazing.
It looks like that there is an active suppression of the more
emotional processing centres in your brain.
Whenever his subjects committed an act of virtual violence,
Weber observed the reasoning parts of their brain
suppressed their normal emotional response.
So here, finally, was clear evidence that playing a violent video game
has an effect on our brain.
But is this particular brain response
exclusive to aggressive behaviour?
Simone Kuhn is a professor of neuroscience
at the Max Planck Institute in Berlin.
She has observed that this brain pattern
isn't unique to playing video games.
You can also find a reduction of amygdala
when people voluntarily suppress emotions.
I mean, if you just see somebody crying
and you don't want to feel this, you reduce your amygdala activation.
That just means you are regulating emotions.
It isn't even specific for aggression, to my opinion,
but always occurs whenever you try to modulate your emotional response.
The brain pattern that Weber observed
in his scans is not unusual.
It's involved in regulating our emotions
in many different situations.
It doesn't prove that a video game
can make us violent in the real world.
So, do I show with this study, with this pattern,
now I've found that we are aggressive after we play
a video game, or we are desensitised after playing a video game?
I did not show that. That's not a conclusion of the study.
So even looking inside the brain
at the very moment we're playing a violent game
hasn't provided conclusive evidence of a link to violent behaviour,
and the question of whether video games can cause real-world violence
remains as controversial as ever.
But there's far more to games than just guns and gore.
95% are rated as suitable for under-18s.
It's a combination of art and technology,
which is brought together through incredible artists, and animators,
and computer programmers, and storytellers, and music, which
allows a player to take control, so that is quite a complex process.
As we see technology improving and increasing, ultimately, it really
means that there's just more types of games for more types of people.
Video games can create a whole new world...
..or tell a sweeping, cinematic story.
A video game asks you to become that character.
The narrative will shape around you
and you have agency in the world that you're observing,
and I think that feels like, to me,
an art form for the 21st century.
To me, a great game is just a game that takes you somewhere,
that really transports you to another world, and pulls you in there
and makes you feel like you forget about everything
except for that world, and you don't want to leave it,
and when you're out of it, you kind of miss it.
Globally, over 1.2 billion people regularly escape into the video game
world, and in some countries, they have become more than a pastime.
Korea's obsession with the internet is really recent.
In South Korea, residential clinics have been set up to wean children
off extreme gaming habits, diagnosed as pathological behaviours.
In other words, addiction.
The fear of creating a generation addicted to video games
is one that's also found a voice in our own media.
So, is this threat real?
GAME SOUND EFFECTS
Professor Mark Griffiths is a psychologist
at Nottingham Trent University.
He's a world-renowned expert on compulsive behaviour and addiction,
and there's one particular aspect of behaviour he looks for.
When it comes to video game playing, I think most people's continued
and repetitive behaviour depends on the reward systems are there.
Obviously, you can get the rush and the buzz of playing,
you can get excited and aroused.
You can have the psychological rewards of knowing that you've done
something in the game, you've played a particular strategy, and you've done something,
you've defeated somebody, beaten somebody.
GAME CHARACTER: Watch out! Fire down below!
I mean, now, particularly when we talk about online gaming,
most of those, it's not about the individuals any more,
it's about playing with a group, a guild, a clan. Somebody else.
Of course, when you get socially rewarded, when everyone in your clan
or your guild says, "That was a really good move that you did there,
"we wouldn't have got this particular quest done
"if it hadn't been for you," that can also make people feel good.
In addicts, the overwhelming need for reward negatively affects
behaviour and can even change the brain itself.
CHARACTER: You'll have plenty of time to stand around
when you're dead!
Dr Valerie Voon is a neuropsychiatrist
at the University of Cambridge, specialising in addiction.
There's very good evidence that pathological video gamers
- and we also now call them internet gaming disorder - that those
subjects do have impairments and what we call delay discounting,
and all that really means is that they have this
preference for an immediate, smaller reward over being able to
delay their gratification for a larger reward. That's delayed.
This is someone who might prefer to video game
because they're getting some kind of immediate reward
over the longer term reward of going to school or studying for exams.
Today, Sophie Bunton is visiting Dr Voon's laboratory.
She is an avid video gamer.
I play about 20 hours a week.
I mainly play action games, adventure games, and I try
and play a lot of multiplayer games with my friends.
Occasionally, I do find myself accidentally playing
games for up to maybe six hours.
You go on and then you are playing away, then you quickly look at
the clock and you are like, "Oh, my goodness, that's been five hours.
"What am I doing?"
So, is Sophie's gaming just a harmless pastime
or is she becoming addicted?
To find out, she is taking two tests at Dr Voon's laboratory.
The first is a specially-designed psychological questionnaire.
Here we ask a person, "do you prefer a smaller amount today, so £11 now,
"or are you able to wait for a larger amount
"at a later date, £19 in 30 days?"
And you make a choice between these two.
What we see is that in those with pathological video gaming,
an increase in delay discounting, meaning they have a preference
for this immediate reward over the delayed reward.
And that is quite different compared to the healthy volunteers.
The test will reveal
whether Sophie can wait for bigger rewards in the future
or if she is happier with a smaller amount as long as she gets it now.
Addicts tend to favour immediate reward over long-term gain.
Sophie, even though she plays the game excessively,
what we see is that her delay discounting score is actually
very much bang on in the healthy volunteer group.
Even with a gaming habit that Dr Voon classifies as excessive,
Sophie shows a normal response to reward.
But there is another possible effect that may show
if she is becoming addicted.
To look for this,
the team are taking an MRI scan of Sophie's brain.
There is one specific form of impulsivity or
self-control that is impaired in pathological gamers.
We have previously run a study looking at waiting impulsivity,
so these are people who might respond before they are supposed to.
So this is someone like Usain Bolt, taking off at the starting line
before the starter pistol goes off.
Compulsive gamers, when anticipating a reward,
have brains that are literally more likely to jump the gun.
In this task, she sees a cue,
presses a button as quickly as possible,
and depending on how quickly she responds, she might get money.
By pressing a button, Sophie is rewarded
when the cross changes to a green star.
The scanner monitors her brain as she waits for it to appear.
In addicts, there is a build-up of activity in one key area.
We see that this increase is in a region called
the medial orbital frontal cortex, which is involved
in how much you value a reward or a goal
and it helps you change and make your choice depending on that value.
We can see that if you are more impulsive, you are more likely
to have greater activity in that region
compared to if you are less impulsive.
In the scanner,
Sophie is faced with the prospect of reward after reward.
By analysing how her brain responds, Dr Voon will discover
whether or not Sophie is showing signs of addiction.
How did Sophie do? She plays the game excessively.
Her brain activity is very much bang in the middle of this,
which is exactly what you would expect
if she is a healthy volunteer.
So, if some people can game for 20 hours a week
and still be free of these markers of compulsive behaviour,
just how common is true addiction?
So, for me, I genuinely think that the prevalence of video game
addiction is probably less than 1%.
I don't care whether it hits a child, a teenager or an adult,
for somebody to be genuinely addicted to video games,
I would expect that this is an activity that they do spend
almost every waking hour doing, engaging in that activity.
They are doing it to the neglect of everything else.
We should not confuse excess with addiction.
It is possible that video games can cause addiction,
but it is likely only very few are at risk.
It is about everything in moderation.
We talk about games being, you know,
this particular game is very addictive.
But we don't necessarily mean that in the sort of actual
scientific sense of addictive.
You know, we sort of bandy that word around quite a lot just
to mean that it is a good game.
Play is something animals do to learn, to let off steam.
Play is fundamental to who we are
and we are just doing it through technology now.
The thought that video games may be able to teach through play
has even entered the education system.
You look at games such as Minecraft.
This is a game that encourages creativity, build your own world.
You know, we have teachers using this for educational purposes
in schools, for young children to express themselves
with their creativity and their freedom.
And in the last few years, new science has emerged that suggests
video games may be a powerful tool to help all of us learn new skills.
This is Underground.
It is the brainchild of Dr Henk ten Cate Hoedemaker.
The setting of the game is that it is a cave environment
and our little robot and a girl... left behind in that environment,
and it is your task to bring them back to the world upstairs.
It looks like a normal video game, but appearances can be deceptive.
This is no ordinary game controller...
..and Dr Hoedemaker isn't a video game designer.
I am a gastrointestinal surgeon, being actively involved with
laparoscopic surgery for a long time, since the early days.
Laparoscopy is more commonly known as keyhole surgery.
It requires exquisite dexterity on the part of the surgeon.
Training is vital.
But giving surgeons a way to practise that is anything like
the real thing is difficult.
The problem with simulators is that they simply ask you to do
a simple mechanical task. So you do tasks without a reason -
placing material from the left to the right,
from the right to the left and vice versa,
and there's no mental challenge in it.
Dr Hoedemaker became aware of reports that younger surgeons
brought up playing video games
appeared to have better keyhole surgery skills.
This gave him an idea that led to Underground...
..a video game designed to train surgeons.
The game tries to copy all the basic difficulties in laparoscopy.
So the first one is that you have to work from a 2D screen,
so you have absolutely no depth perception.
The second one is that all your instruments
make an opposite direction.
If you move the handle to the right,
the tip of your instrument moves to the left.
The other one is that you don't feel an awful lot with a rigid instrument,
so if you touch tissue, you don't feel a lot and normally,
with your hand, you can feel whether tissue is soft or hard or whatever.
But it is not just what you are doing with the tools that is
important. In Underground, as when performing surgery, forgetting
to keep an eye on the wider environment can result in disaster.
The likeliness of damaging tissue,
that's called collateral damage
and it should be avoided as much as possible.
So the game is very good in that, so it makes you aware of your situation.
It has been shown that those who do well in Underground also do
better in tests of keyhole surgery skills.
And it opens up a surprising possibility -
could playing video games actually be good for us?
This is the University Of Geneva.
And this is Professor Daphne Bavelier.
My area of expertise is neuroscience
but in particular how the brain learns, the human brain learns.
We have been looking deep into how we could use video games to help
people to learn better and faster.
Her interest in video games as a learning tool began
with a chance discovery.
A young undergraduate in my lab was asked to programme
an experiment about attention and visual attention
in people that are deaf.
The experiment tested how much visual information
a person could take in.
To find the limit of a subject's visual ability,
it was designed to be challenging.
Nobody was expected to achieve a full score,
but Professor Bavelier's student ran into a surprising problem.
And he kept complaining that his code was buggy
because he was performing at 100% correct.
I finally stepped down to the lab and he confessed that he hadn't been
running random subjects, but he had been running his friends.
At that point, the key question was who his friends were.
They just happened to all be part of the same video game club at the time.
There was nothing wrong with the code.
Professor Bavelier and her student had stumbled across a fundamental
difference between the visual abilities of gamers and non-gamers.
To demonstrate, members of the public are going to take
a test used by Professor Bavelier in her studies.
In this experiment, we ask subjects to monitor objects as they move.
That is a way for us to measure the attentional capacity of that person.
The test presents the subject with a mixture of smiling faces.
Most are yellow, but anywhere between
one and six of them can be blue.
All the faces then change to yellow.
When they stop, a question mark appears over one of them.
Subjects have to say
whether they think the face was originally yellow or blue.
You could try following them with you gaze,
but if you do that, you can only track one.
The issue is that we are asking you to track two or three or four
or maybe six and at that point,
it is really very a highly demanding task at paying attention to objects.
On screen now are lots of yellow faces and six blue ones.
The task is to keep track of all six blue faces after they turn yellow.
So, was this face originally yellow or blue?
In this demonstration,
32 members of the public took Professor Bavelier's test.
On average, those who played video games were better at correctly
identifying the blue faces at every stage.
The difference peaks at four,
and this is significant as it was once thought this was
the maximum number of objects a person was capable of tracking.
If you pay attention, you're going to be able to track four of them,
but it is going to be very hard for you to keep track of eight of them.
In the case of these people that were playing action video games,
we could show that they can track about six, which is quite an increase
on that first-thought hard-core limit of attentional capacity.
Professor Bavelier's chance discovery
had revealed something extraordinary.
The students who regularly played fast action video games
were able to keep track of more objects in the real world.
But what is it in action video games
that gives players this extra ability?
These are games that require very, very focused attention over a target.
A lot of the shooter games require you to be very accurate
with your aim, but at the same time
also to continuously monitor your environment
for any new event that may happen,
whether you have to pick up a health pack or there is a sniper coming on.
And so you have this constant demand of shifting, very focused attention
and very divided attention and that shift is actually quite demanding.
So training that shift, we think, is really important.
Fast-paced action games appear to have an unexpected benefit...
..enhancing our ability to process visual information.
And it has opened up an exciting new field of possibilities.
Around the world, the hunt is on to find the hidden
benefits of video games.
Professor Simone Kuhn has turned her attention to a game that
tested the navigational abilities of the player.
We recruited about 48 subjects, divided them
randomly into two groups.
One group was asked to play the video game Super Mario 64
and the other group was asked to do nothing.
And we basically put them into an MRI scanner before
and after the training phase of two months and looked at brain changes.
Professor Kuhn wanted to see
whether playing the game would cause changes in the brain.
MARIO: Here we go!
Specifically, in the volume of particular areas.
In general, more volume means the brain can get more active in that area.
So if you have an active brain area for long,
this tends to increase in volume.
An increase in volume indicates that part of the brain has grown.
Could this really be achieved by playing a video game?
We indeed found brain growth.
We found increases in the right hippocampus, over here, which is
a brain region is particularly involved in spatial navigation,
in orienteering in your world.
Another brain region that increased
in that experimental group was the prefrontal cortex on the right side.
That's an area related to strategic planning.
And the last regional is called the cerebellum.
That's particularly renowned to be involved
in fine motor tuning, in a way.
I mean, really handling the joystick well.
Professor Kuhn discovered that playing the Super Mario 64 game
had caused three areas of the brain to grow.
This is an example of what neuroscientists call brain plasticity.
It's the ability of the brain to reorganise, and in some cases
grow, in response to incoming information from the senses.
Professor Kuhn believes the game had this effect,
because it forces the player to navigate in a very particular way.
On the upper screen you see a 3-D view of the world where
your avatar walks around.
On the bottom screen you see a map-like view that indicates where
your position is and, say, where the star is that you need to collect.
And you need to integrate these two perspectives,
which I think facilitates navigation processes, and therefore
enhances brain regions that are related to spatial processing.
This study is part of a growing body of work that has led
Professor Kuhn to a far-reaching conclusion.
We've been struggling for a long time to find tasks that people can
play to improve cognition. We have largely failed.
Videogames seems to be better,
because people train the same function in very different
contexts, and then are better able to transfer it into real life.
This, I think, is something we should use,
and we should use for all age groups.
The work of Daphne Bavelier and Simone Kuhn suggests that
playing video games can improve our cognitive abilities.
No matter how old we are.
It's an enticing proposition.
Could video games be used to help combat mental decline as we age?
At the University of California in San Francisco,
Professor Adam Gazzaley researches whether video games might improve
the cognitive abilities of older players.
He worked with the video game designers
to create a game called NeuroRacer.
The design of the video game was based on our research
showing that older adults had impairments
in cognitive control abilities.
Across the broad range of skills, attention, working memory,
multitasking.
And the hypothesis that I had
was that if you put pressure, through game mechanics,
on one of these abilities, like multitasking,
which we know older adults are really impaired at,
that we would be able to improve that ability.
The game appears to be very simple -
just steer a car along a road.
But there's a twist.
Our participants had two tasks going on at the same time.
They were driving a car into a 3D road
and they had to maintain the car on the road, left, right, up,
if they were going up the hill to give it more gas, pull-back,
so it took a lot of attention to keep the car right in the sweet spot.
While that's happening, another task was going on.
Signs would appear and they had to press the button as rapidly
and accurately, only to a target sign, like the green circle.
Not a red circle or green pentagon.
And what the game demanded them to do
was to try to do both of those tasks at the same time.
The game became progressively more difficult as the subjects improved.
Gazzaley believed that challenging players in this way
could lead to brain growth.
We had older adults play the game for 12 hours,
over the course of a month.
One hour a day, three times a week for four weeks,
and then come back into the lab.
And what we're able to show is, first, that their ability
to multitask on the game, which was very deficient,
improved to a level that exceeded that of 20-year-olds
who played it on a single visit.
But it wasn't just the players' multitasking skills that increased.
Their attention span and working memory had also improved.
We also showed that other skills, that were not directly
targeted by the game, also improved.
So, this is a phenomena that we call transfer,
and it's the ability to improve skills
that were not directly trained,
but clearly related to the challenges that were taking place in the game.
Professor Gazzaley has found measurable results
in the laboratory,
but could any of us experience similar benefits
playing a normal, off the shelf video game?
This group of older volunteers are about to try playing
a video game for the first time.
It's a racing game that, although not designed by a scientist,
will still challenge the players.
They agreed to play it over a period of five weeks,
each clocking in around 15 hours.
Oh, you've to be awful quick, haven't you?
Each volunteer took two tests to assess their attention span
and working memory skills before and after their five weeks of gaming.
Across the group, there was an average increase in their working
memory score of almost 30%,
and a similar result for attention span.
I feel as if I'm progressing, I'm trying wee things myself.
It's keeping my mind...
starting to tick over, nice and gentle.
To know that there can be some improvement at my age, you know?
So, maybe I should keep doing this, eh?
It appears that learning to play a video game
can be of benefit for some older people,
as long as they're able and willing to play the game,
and continue to do so.
And Adam Gazzaley believes that we're only just beginning
to tap the positive potential of video games.
I'm really intrigued with the idea that, in the future,
a physician, let's say a psychiatrist or neurologist,
might reach into their pocket, while in clinic,
and pull out their pad, and instead of writing down a drug,
writes down a tablet game, times two months,
and uses that as a therapy, as a digital medicine.
The video game industry continues to grow.
What I'd like is more and more people coming to understand
and utilise, and create games for themselves.
Technology will continue to make them more sophisticated.
Virtual reality is another element by which games are going to be
ever more immersive.
They may always divide scientific opinion...
You're learning to look for enemies,
if you're playing a lot of violent games.
That's what you're practising,
that's what the brain is getting good at, is looking for a threat.
There is no evidence that you will go on to be criminal.
There is no evidence that you will go on to actually get into fights
that your teacher sees.
There is no evidence that you're more likely to be violent
to your partner.
No, there's no connection.
..but they're undoubtedly here to stay...
I mean, they rival some Hollywood movies in terms of pure cost.
..and we're only just beginning to understand how video games
might benefit each and every one of us.
We've reached the level that we have a lot of excitement
about its potential, and now we're going for larger studies
to actually see that real-world impact.
Subtitles by Ericsson