Esports performance involves complex interactions between a number of cognitive skills, including reaction time, accuracy, and audio/visual procession. It also requires game-specific strategy, teamwork, and communication.But what happens when things don’t go as planned or a gamer gets tilted? This is where mindfulness can play a role. With mindfulness strategies, players are able to become more in tune with themselves and their feelings, enabling them to manage and respond to those emotions.

Mindfulness can help significantly with improved emotional regulation by improving emotional understanding. One study found that those with autism and ADHD spent significantly more time playing video games than neurotypical children (Mazurek et al., 2013). Individuals of all kinds may experience alexithymia, but this is much more common in those with psychosomatic disorders which inherently demonstrates a decrease in interoception (internal physiological sense). Alexithymia is currently understood as “a cluster of cognitive traits, which include difficulty identifying feelings, difficulty describing feelings to others, externally oriented thinking, and limited imaginative capacity.” A 2015 study by Ricciardi and colleagues includes data supporting the idea that individuals who experience mental health problems have a much higher rate of alexithymia than the 10% rate reported in the general population:

• Psychosomatic disorders – an approximately 40%−60% rate of alexithymia

• Anxiety disorders – 13%−58%

• Depressive disorders – 32%−51%

• Eating disorders – 24%−77%

Players who have difficulty with control or understanding of emotions can experience negative impacts on performance, attention, and teamwork. Closely related to emotional intelligence and regulation is interoception, or a sense of how the body feels and functions. When interoception is lacking, as when emotional intelligence is lacking, players may experience increased stress and anxiety, as well as decreased performance, confidence, coping skills, and emotional regulation. To learn more about interoception, consider reading the following: https://ehpi.org/courses/interoception-and-gaming/.

Mindfulness strategies have shown some utility in improving both alexithymia and interoception. This piece will explore some easy-to-implement strategies.

Meditation is an excellent way to improve mindfulness, and can be performed in a variety of ways, from breathing exercises to mantras to exercises. What all of these practices have in common is intention: “Meditation is the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2006). As a mindfulness strategy, meditation can be used throughout the day to offer benefits in everyday life as well in competitive performance.

In a 2020 study, researchers looked into the effect of meditation on both the endurance performance and executive (cognitive) functions of athletes. Forty-six athletes aged 18-25 were divided into a control and experimental group where the experimental group received 30 minutes of meditation, twice per week for five weeks. The sessions addressed the concepts and components of mindfulness as well as mindful breathing, mindful meditation, body scanning, mindful yoga, and mindful walking. Researchers looked at endurance performance, mindfulness levels, basic information processing, and executive functions (planning, working memory, attention, and flexible thinking) using a variety of measures.

Results from this study demonstrated that individuals who performed meditation had significantly higher mindfulness levels, exhaustion duration (that is, longer time-to-exhaustion), and accuracy. Accuracy was measured by identifying and reacting to a color shown on a computer screen. This measure is relatively generalizable to gaming populations. Researchers Sanger and Dorjee suggest that “mindfulness training for older adolescents enhances their task-relevant inhibitory control of attention and irrelevant interference” which may promote increased accuracy within games which have a lot of stimuli to focus on. Exhaustion duration is also an extremely important aspect when it comes to gaming as esports is an endurance sport requiring long periods of focus and engagement and this research shows how meditation can increase the time playing before exhaustion sets in (Nien et al., 2020).

Headspace App: https://www.headspace.com/headspace-meditation-app

Calm App: https://www.calm.com/app/meditate

Great Meditation YouTube: https://www.youtube.com/c/GreatMeditation/featured

Spotify Meditation Podcast: https://open.spotify.com/show/5AmxgFEt7L7gArcTI0v6df?si=5fa83034e12b489e

Yoga is a practice in which a set of mental and physical exercises are completed using certain postures, breathing techniques, and meditation. Yoga has been widely adopted to promote wellbeing and a more holistic approach to health, incorporating a degree of conscious intention into physical health practices (Woodyard, 2011).

In a meta-analysis by Pascoe and colleagues, researchers sought to identify whether yoga was an effective treatment for regulating the sympathetic nervous system. Researchers evaluated 42 articles that included 2944 participants in which yoga was the intervention. Outcome measures consisted of heart rate, blood pressure, heart rate variability, mean arterial pressure, inflammation (C-reactive protein, interleukins) or cortisol. Though there are many forms and styles of yoga, the common elements consist of controlled breathing, meditative techniques, and physical postures.

The results of the study show that participants in yoga experienced improved regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system through a decrease in all of the following measures: cortisol, resting heart rate, resting diastolic and systolic blood pressure, mean arterial pressure, cholesterol, fasting blood glucose, and low-density lipoprotein. Results did not find a change in inflammation levels, triglycerides, and HDL. Each of these results demonstrate the positive effects that yoga has on both mind and body.

In another study by Kauts and colleagues, researchers looked at 800 adolescent students who were divided between two groups. The control group did not receive any intervention while the experimental group completed an hour daily of yoga in the morning for 7 weeks. Results were gathered from a pre and post academic performance test that students would complete. Results demonstrated that those who performed yoga for the 7 weeks performed better on the academic test.

Focused and controlled breathing allows the body to take in more oxygen and circulate improved blood flow which are both well understood to improve performance, cognition, focus, endurance, and recovery. Diaphragmatic breathing is one form of controlled breathing which has been widely used to help with a variety of issues one may be experiencing.

Diaphragmatic breathing is defined by Xiao Ma as “a form of breathing which involves contraction of the diaphragm, expansion of the belly, and deepening of inhalation and exhalation, which consequently decreases the respiration frequency and maximizes the amount of blood gasses” (Ma et al., 2017). The diaphragm is the main muscle used in breathing, but there are several other accessory muscles which want to help out, which are not as efficient in delivering a strong respiration. It is important to focus on your breathing as other accessory muscles may take over and are not as effective in helping us to feel like we just got a full breath. When practicing our breathing and working to achieve a full breath then we are now using much more of our lung capacity therefore distributing more oxygen throughout the body.

A study by Ma and colleagues looked at 40 individuals to determine if deep breathing had an effect on cognition or stress. Participants were divided between a control and experimental group and performed a pre and post test. The experimental group completed 20 sessions, implemented over 8 weeks. Results determined that participants in the experimental group had decreased stress and negative affect as well as increased attention.

Another recent study was conducted looking at the effectiveness of diaphragmatic breathing relaxation training (DBRT) for improved sleep quality among nurses working during COVID-19. The study looked at 151 nurses who were to complete diaphragmatic breathing relaxation training (DBRT) where they measured sleep quality, anxiety, and depression utilizing the Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Participants were assessed before the intervention and then again following 2 weeks where participants were required to do 30 minutes of DBRT. Results demonstrate that DBRT is a useful treatment for improving sleep quality and reducing anxiety (Liu, 2021).

This study can easily be related back to esports gamers as both parties work in a fast-paced, high-pressure environments for long periods while also potentially running on less sleep than the average person. Results are particularly useful for gamers who have trouble falling asleep or staying asleep, as diaphragmatic breathing was shown to  reduce daytime napping and lower fatigue, resulting in better sleep continuity.

For an easy follow-along guide to box breathing, which can be used in conjunction with diaphragmatic breathing, try this.

It may come as no surprise that counseling is one of the best ways to combat stress, anxiety, and many other psychological and psychosocial issues. Psychotherapy, also known as talk therapy, allows individuals to work with a licensed therapist who will withhold any judgment and listen with understanding while also providing thought-provoking questions, ideas, and strategies to better understand themselves and function at their best.

Cognitive-Behavioral Therapy (CBT) is a common form of therapy where short-term, skills-focused treatment is done to alter maladaptive emotional responses by changing the patient’s thoughts and/or behaviors. Recently, a 2018 meta analysis reviewed 41 studies looking at a variety of disorders and determined that CBT was associated with significant improvements in anxiety, depression and quality of life when compared to placebo (Carpenter et al., 2018).

In a study by Wagner and colleagues, researchers compared face-to-face CBT to internet-based CBT. Results demonstrated positive effects for reducing depression in both treatments, but they did find that upon discontinuation of treatment those in the internet-based CBT group maintained their symptom reduction following 3 months whereas the face-to-face group participants’ depressive symptoms significantly worsened. This suggests internet-based treatment may be effective in both the short- and long-term.

 Similar to counseling, journaling can be an effective way to express thoughts or feelings. Journaling has no right or wrong way to do it, but just like everything else it should be done with a goal in mind. When struggling to find purpose or being happy, write about gratitude. When struggling with confidence, write words of affirmation. When struggling to fall asleep due to a racing mind then writing those thoughts down can give a sense of relief and help stop the cycle of those thoughts. Lastly, reflecting upon the day and focusing on a few positives/successes, a negative/failure, and a goal for tomorrow can be helpful. This allows for deeper thoughts about why certain things may have been successful or failed and what can be changed when preparing for tomorrow.

In a 2018 article by Smyth and colleagues, researchers looked at the effects that emotion-focused and reflective writing also known as positive affect journaling (PAJ) would have on adults. They had a total of 70 participants with high levels of anxiety who were divided evenly into a control and experimental group. The control group received their “usual care” while the experimental group completed web-based writing sessions for 15 min, 3 days per week for 3 months. The outcomes measured throughout the study consisted of anxiety, depression, perceived resilience, self-reported physical health and functioning, perceived stress, positive/negative emotions, life satisfaction, and social support using a variety of assessments.

Results show that those in the journaling group experienced reduced mental distress, anxiety, and perceived stress as well as greater perceived personal resilience and social integration. This data demonstrates the positive effects that journaling can have as there are few times we are solely taking time to be self reflective and by taking only 15 minutes this can have profound effects on how we feel.

Ultimately, all of the strategies discussed above are all great ways to help decrease stress, anxiety and burnout, increase attention, cognition, accuracy, endurance, and interoception while also improving sleep quality, resilience, and regulation of the sympathetic nervous system. These benefits prove that there is a pretty high payoff on performance and overall life satisfaction by taking only a short amount of time to really focus on your mental health and well being.

It is unrealistic to expect that a player will want to do all of these. However, by introducing a variety of options and allowing players to have ownership of the choice, players are more likely to find one or more solutions that help them. Similar to any other learned skill, it takes practice and consistent effort to really notice the benefits, but can make many positive changes in the lives of gamers.

Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI database of systematic reviews and implementation reports, 13(10), 21–29

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728

Concerto, C., Rodolico, A., Avanzato, C., Fusar-Poli, L., Signorelli, M. S., Battaglia, F., &Aguglia, E. (2021). Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Predict the Severity of Internet Gaming Disorder in an Italian Adult Population. Brain sciences, 11(6), 774. https://doi.org/10.3390/brainsci11060774

Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice. 2006;10(2):144–156. doi: 10.1093/clipsy.bpg016.

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Kauts, A., & Sharma, N. (2009). Effect of yoga on academic performance in relation to stress. International journal of yoga, 2(1), 39–43. https://doi.org/10.4103/0973-6131.53860

Liu, Y., Jiang, T. T., Shi, T. Y., Liu, Y. N., Liu, X. M., Xu, G. J., Li, F. L., Wang, Y. L., & Wu, X. Y. (2021). The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study. Sleep medicine, 78, 8–14.

Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017).

The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874

Mazurek, M. O., & Engelhardt, C. R. (2013). Video game use in boys with autism spectrum disorder, ADHD, or typical development. Pediatrics, 132(2), 260–266. https://doi.org/10.1542/peds.2012-3956

Nien, J. T., Wu, C. H., Yang, K. T., Cho, Y. M., Chu, C. H., Chang, Y. K., & Zhou, C. (2020). Mindfulness Training Enhances Endurance Performance and Executive Functions in Athletes: An Event-Related Potential Study. Neural plasticity, 2020, 8213710. https://doi.org/10.1155/2020/8213710

Nourian, M., Nikfarid, L., Khavari, A. M., Barati, M., & Allahgholipour, A. R. (2021). The Impact of an Online Mindfulness-Based Stress Reduction Program on Sleep Quality of Nurses Working in COVID-19 Care Units: A Clinical Trial. Holistic nursing practice, 35(5), 257–263.

Pascoe, M. C., Thompson, D. R., & Ski, C. F. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology, 86, 152–168. https://doi.org/10.1016/j.psyneuen.2017.08.008

Ricciardi, L., Demartini, B., Fotopoulou, A., & Edwards, M. J. (2015). Alexithymia in Neurological Disease: A Review. The Journal of neuropsychiatry and clinical neurosciences, 27(3), 179–187. https://doi.org/10.1176/appi.neuropsych.14070169

Sanger K. L., Dorjee D. Mindfulness training with adolescents enhances metacognition and the inhibition of irrelevant stimuli: evidence from event-related brain potentials. Trends in Neuroscience and Education. 2016;5(1):1–11. doi: 10.1016/j.tine.2016.01.001.

Smyth, J. M., Johnson, J. A., Auer, B. J., Lehman, E., Talamo, G., & Sciamanna, C. N. (2018). Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR mental health, 5(4), e11290. https://doi.org/10.2196/11290.

Teper, R., & Inzlicht, M. (2013). Meditation, mindfulness and executive control: the importance of emotional acceptance and brain-based performance monitoring. Social cognitive and affective neuroscience, 8(1), 85–92. https://doi.org/10.1093/scan/nss045

Terlizzi EP, Zablotsky B. Mental health treatment among adults: United States, 2019. NCHS Data Brief, no 380. Hyattsville, MD: National Center for Health Statistics. 2020.

Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. Journal of affective disorders, 152-154, 113–121. https://doi.org/10.1016/j.jad.2013.06.032

Woodyard C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga, 4(2), 49–54. https://doi.org/10.4103/0973-6131.85485