Introducing C-B-E-R-T, or What I Learned from being in Escape Rooms

It is ironic to say so, but the times that I spent last year in three different escape rooms undoubtedly, I believe, has helped me cope better with our current locked-in circumstances. It has also given me strategies to assist the people I see in my clinical psychology practice.

These are particularly challenging times for those of us who are in the mental health field. Although my clinical office is closed, I still am able to have remote sessions with many of my clients via computer and internet connection. The American Foundation for Suicide Prevention (AFSP) recently shared new survey findings that reveal people experience anxiety (53%) and sadness (51%) more often now than before the coronavirus pandemic. According to a survey in Forbes, 45 percent of adults (53% of women and 37% of men) say the pandemic has affected their mental health, and 19 percent say it has had a "major impact." The rates are slightly higher among women, Hispanic adults and black adults.

Not only do I have to take care of others in these unprecedently confusing weeks and months; but l, too, have heightened concerns and fears about myself and my family members, wondering daily what comes next. At times, I will remember that when I was a child, we lived in fear, especially during the summers, of contracting polio; one of my first cousins did contract a mild case, but, luckily, the Salk vaccine halted further spread. I was not alive during the horrible influenza epidemic that swept the world in 1918 killing an estimated 50 million people. A great-great aunt in my wife's family lost her only two children because of that deadly virus. Within months, it had killed more people than any other illness in recorded history.

When I recall times in the past of polio, pandemics or even war when there was heightened panic, I do feel some sense of relief. This is a time of relative affluence; despite the isolation, my wife and I live in comfortable surroundings with ample food and unlimited access to music, news, movies, social media, and learning opportunities that previous generations could hardly imagine. As one writer noted, "today’s middle class lives better than the royalty of not so long ago."

Yet, even before the coronavirus, human misery seems to be everywhere. The World Health Organization estimates that depression is currently the fourth biggest, costliest, and most debilitating disease in the world. In any given week, 1/10 of the adult population is suffering from clinical depression, and one in five people will suffer from it at some point in their lifetime. Why, even in relatively good times, do so many people suffer psychologically? Why do so many people compare and evaluate themselves so critically, focusing on what they're lacking? Why do humans find it hard to be happy?

Researchers, such as Dr. Loretta Breuning, have studied the brain and nervous system and have concluded that the primary voice in our heads is not an upbeat, pursuit of happiness message. Instead, the default mode consists of a nagging, always-on, defeatist voice that never shuts up. Our minds did not evolve to make us feel good; instead, our minds evolved to help us survive in a world fraught with danger. If our Stone Age relatives were stoned or awash in the body's natural happy chemicals such as oxytocin, they would have perished. Instead, optimal amounts of the stress chemicals adrenaline and cortisol were released which were lifesaving. These hormones activated "fight or flight" response systems and raised blood pressure and heart rate; they helped to regulate body functions and maintained fluid balance and blood pressure. Thus, the default setting was safety and survival first; the focus was not on joy or happiness.

Given that our natural predisposition is to focus on threats, and given that people stew on a problem, our bodies continuously releases cortisol: and chronic elevated levels can lead to serious issues according to the Mayo Clinic. The threat chemical, cortisol, can last for hours, making us feel the threat is happening now. Too much cortisol can suppress the immune system, increase blood pressure and sugar, decrease libido, produce acne, contribute to obesity and more. In short, according to Dr. Russ Harris, author of The Happiness Trap, the human mind has evolved to think in such a way that it naturally creates psychological suffering.

Lest you conclude the situation is only ominous, here is the exciting and encouraging part of the mind story. Happiness is just a neurochemical spurt away. You see, the brain also produces four of the most potent neurochemicals which create happy feelings, and you need all of them to feel good: endorphins, dopamine, oxytocin, and serotonin. In her book Meet Your Happy Chemicals, Dr. Breuning explains that the brain only releases happy chemicals in limited bursts for specific aims. It did not evolve to release them all the time. If happy chemicals flowed all the time, they could not do their jobs. If you expect all the happy chemicals all the time, you're going to be disappointed; these chemicals evolved to ebb and flow, not to make you feel good at will or constantly. In short, happiness is a surge of dopamine, serotonin, oxytocin or endorphin. These brain chemicals evolved to do a job, not to surge all the time.

Now for the even better news: researchers have discovered that there is a great deal of flexibility and neuroplasticity in the mind. In short, the brain is not fixed and unchangeable. It is a dynamic organ and can change its architecture throughout life, by wiring and rewiring itself. As the eminent neuroscientist Dr. Daniel Siegel has said, "When neurons fire, you can get them to rewire." We can wire ourselves to enjoy more happy chemicals and relieve more unhappy chemicals. Our old wiring was built by accidents of experience in evolution and in our youth. It will shape our ups and downs until we can build a new place for our electricity to flow. It's not easy being a mammal, but we're lucky to live in a time when our operating system is increasingly well understood; and we can build new neural pathways to our happy chemicals. One of the ways is to recall peak episodes in our life when we felt particularly joyous; Mihaly Csikszentmihalyi, in his 1990 seminal book, calls such optimal experience "Flow."

This is where escape room experience becomes relevant: when I thought of the time that I felt in flow and happier than I had felt in months if not years, I was recalling going with my family to an escape room for entertainment! For those unaware of the concept of escape rooms, they became popular in North America, Europe and East Asia in the 2010s. Essentially, a group of people is locked into a room (which may actually be a series of rooms) and has 60 minutes to find the way out. Simple... but not too simple. To escape the room, the group must face the daunting task of solving different puzzles and finding different clues that are linked one to the other. By doing this, the group can eventually find the key that will open the door to freedom. If they can't do it...well, better luck next time.

As fate would have it, I have been to three different escape rooms in the last few years, and each time my group was able to get out of the confined space before the time ran out. I and others in my group enjoyed the teamwork, and we were delighted that each person contributed in their own way with their unique skills and talents to help solve the mystery. We savored the experience and self-congratulated ourselves with photos and prizes. There was a lot of humor that was involved, and we found that escape rooms could be so much fun! Solving puzzles increased our brains' production of one or more "happy neurotransmitters" that regulate our mood. Solving puzzles also helped us to regulate stress because, surprisingly, puzzle solving can help us to relax. This is due to the shift in focus that happens when we are puzzle solving. So, if you're stressed, an escape room could be the perfect solution!

Because success in an escape room requires five or more players at a time, it becomes a team effort which one study by S. Nicholson in 2015 has shown can also release "happy hormones" by boosting skills in communication, project management, problem solving, critical and lateral thinking, attention to detail, perseverance, and dealing with complex challenges. Many have also noted that an escape room is great for practicing patience. The situation in the room is very rushing as you only have one hour to complete the task, but it forces participants to have patience in a time of stress and anxiety. It also encourages other skills which release "happy hormones" such as orienting to the immediate environment and being in the here and now, not standing still yet staying focused and using all five senses, being curious and seeking novelty, talking to each other but also listening, keeping track of stuff and organizing objects neatly, and being positive and even playful.

In short, I firmly believe that the escape room experience with focus, teamwork, problem-solving, etc., provided an almost constant thunder shower of happy chemicals!!

I want to propose the hypothesis that there are some simple interventions based on escape room experiences to help those who are feeling depressed, alone—and in an actual "get me out of here" situation. I am advocating a new type of Cognitive Behavioral Therapy that I would call CBERT for Cognitive Behavioral Escape Room/Endorphin Releasing Therapy.

I realize that an escape room is not everyone's cup of tea. For people who panic or get easily frustrated or angry, who tend to overthink or get too fixated on a particular detail, who have difficulty managing time and/or thinking strategically, escape rooms may seem a tortuous ordeal. It is precisely this type of person, I believe, who is suffering from depression, despair, helplessness, loneliness, poor self-image and other related mental issues during the present long periods of isolation during the COVID-19 pandemic.

I also realize that rewiring the brain and creating new cells (neurogenesis) takes time and repeated practice. It is not possible to control our environments in a way that ensures a steady flow of happy chemicals. Notwithstanding, if you want to grow new neurons, if you want to keep your brain vital and resilient, you need to expose yourself to lots of stimulation and savor the experience as was the case in the Escape Room. According to Psychology Today, there is strong evidence of a virtuous cycle (the opposite of a vicious cycle) operating when it comes to experiencing positive feelings. Savoring positive experiences can reset your ability to be happy. With focused attention, you are reinforcing the happiness circuitry in your brain and the rest of your mind, which leads to better health which leads to more happiness, ad infinitum. For those of us in locked-in situations, this means reading good books, doing puzzles, engaging in stimulating conversation, playing, looking for challenges, trying to achieve goals that are difficult but not out of reach, exercising as much as possible, trying new recipes, letting go and singing and dancing, laughing regularly, learning new languages or skills, exposing yourself to new music and art, and just generally using your imagination and doing things that give us a sense of control.

In short, we want to be more like children, approaching every moment with an attitude of openness, eagerness, freedom from preconceptions, and joie de vivre. That means looking for fascinating, fulfilling activities. As we know only too well, during this pandemic crisis, many of us feel fatigued and tired; when life is boring, or responsibilities weigh us down, or we feel helpless or depressed, one does a lot of sleeping.

Here is where there is connection to the escape room experience: One of life's gifts is an "aha" moment. We all have these moments of awareness when we hear or see something that gives us sudden realization, inspiration, or insight. In the escape rooms, I think we had lots of "aha" moments. They give us a burst of happy hormones, along with the recognition that life can be beautiful. There is incredible pleasure when the proverbial light bulb goes on, yet at the same time there should be recognition that you have been asleep until now (as far as that idea is concerned). We live for those feelings of waking up because they provide the clarity we need to give direction to our lives.

Now that we are all experiencing being in real-life escape rooms, remember these moments of clarity and being fully awake. Decide that you can change, that things can be different. No matter how old you are, you can change. Whether or not we exercise that ability is one of life's great battles and therefore the struggle of life is really the struggle to be awake. The usual resting state of our minds is slightly edgy. But if we wake up and pay closer attention, there are plenty of things to bring us joy, wonder, gratitude, and a range of positive emotions.