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hard-core gamers who were benefiting from the game. The game worked equally well for novice or infrequent game players as it did for lifelong players—and it is continuing to work for patients worldwide. As a result of this successful clinical trial, Re-Mission has been distributed to more than 250,000 cancer patients. And recently HopeLab released six follow-up cancer-fighting games online, including Stem Cell Defender and Nanobot’s Revenge. (They are free to play at www.re-mission2.org.)

      HopeLab’s games are an incredible, potentially life-saving resource. But even if you aren’t battling cancer, the Re-Mission research offers a powerful, life-changing insight: motivation alone is far less important to success and willpower than you think.

      Before the cancer patients played Re-Mission, they were already fighting for their lives—presumably a highly motivating state. This was not a group that simply needed more motivation. They had it in spades, yet they nevertheless regularly failed to do the things they knew could dramatically improve their chances for a cure.

      Somehow the video game Re-Mission intervened in a way that converted mere motivation into a much more powerful psychological resource. But what is that resource? And how did the game create it so quickly?

      This is exactly what the HopeLab team was wondering after they saw the success from their first clinical trial. Originally, they had hypothesized that thirty hours of play would be necessary to make a positive impact on medication adherence. They were amazed when just two hours made such a significant difference. And they had expected players to need continual reinforcement and reminders from the video game every day in order to keep up their behavior change. Yet it turned out that playing the game just once was enough. It was truly a surprising result. What could explain such long-term, real-life behavioral changes after such a short time of virtual play?

      The key to solving this puzzle was found in another set of data that the researchers collected during the clinical trial. They weren’t just monitoring medication adherence. They also tracked psychological changes during the trial. Players and nonplayers reported the same levels of motivation, stress, cancer symptoms, and physical side effects, but the game players differed remarkably in one area. They reported feeling significantly more powerful, optimistic, and able to positively impact their own health than nonplayers.

      Psychologists call this state of mind self-efficacy. It’s the belief that you, yourself, can effect positive change in your own life.

      Self-efficacy is not the same thing as self-esteem, which is a more general positive feeling of self-worth. Self-efficacy means having confidence in the concrete skills and abilities required to solve specific problems or achieve particular goals. It is usually context-specific: you might have high self-efficacy at work but low self-efficacy about public speaking or losing weight.

      Self-efficacy is the crucial difference between having lots of motivation but failing to follow through, and successfully converting motivation into consistent and effective action. With high self-efficacy, you are more likely to take actions that help you reach your goals, even if those actions are difficult or painful. You also engage with difficult problems longer, without giving up. But with low self-efficacy, no matter how motivated you are, you’re less likely to take positive action—because you lack belief in your ability to make a difference in your own life.

      So where did the Re-Mission players’ new self-efficacy come from? Well, all games are intentionally designed to increase players’ feelings of competence, power, and skillful ability over time—in other words, to build up their self-efficacy. Like all video games, Re-Mission challenges players to achieve a difficult goal: navigating through a complex, 3-D space and destroying all the virtual cancer cells before time runs out. This goal requires skill, practice, and effort. Players of Re-Mission, like players of all games, are typically unsuccessful at first. But quickly, with repeated effort and as they learn how the game works, they start to improve their skills and strategies. Eventually they master a few challenges. And because it’s a video game, it gets harder. The challenges get more difficult and complex with each new level. This constantly escalating challenge requires a willingness from players to keep trying, even when they fail. It instills a belief that if they keep practicing and learning, if they put in the hard work, they will eventually be able to achieve more difficult goals.

      This is the classic path to increased self-efficacy: accept a goal, make an effort, get feedback on that effort, improve a concrete skill, keep trying, and eventually succeed. You don’t need a game to set off on this path. But because it is the very nature of games to challenge and improve our abilities, they are an incredibly reliable and efficient way to get there.

      And here’s the good news: once you have a feeling of self-efficacy about a particular problem, it tends to persist. It’s a lasting mindset shift, permanently changing what you believe you are capable of and what goals you believe you can realistically achieve. And this is exactly why Re-Mission worked so well. The game created a new source of self-efficacy for young patients, in a situation where it is easy to otherwise feel powerless or overwhelmed. Instead of seeing chemotherapy as a negative experience they were forced to undergo, they came to see it as a powerful weapon they were fully in control of. They understood exactly how it worked, and they weren’t afraid to use it!

      This shift in mindset alone—from powerless to powerful, from feeling weakened to feeling successful—was enough to supercharge the players’ willpower and determination throughout the long course of treatment.

      Self-efficacy is increased anytime you learn a new skill or master a new challenge. So let’s increase your self-efficacy right now—with another quest!

      QUEST 11: The Power Breath

      You’ve probably tried deep, slow breathing to calm yourself down. But there’s actually a more useful breathing technique, one that can reduce stress, decrease pain, increase concentration, halt migraines, and prevent panic attacks.

      What to do: Breathe in while you count slowly to 4. Exhale while you count to 8.

      In for 4, out for 8. Repeat for at least one minute. This is a bit more challenging than it sounds! The trick is to always exhale for twice as long as you inhale.

      Give it a try right now. You don’t have to do a full minute right away. Try to do it just once: in for 4, out for 8. Got it?

      Okay, now try to do it twice in a row.

      Good? Now try three in a row. If you can, count a little bit slower, and draw the breath out even more.

      Excellent! You’ve mastered the trick. When you can keep this up for at least one full minute, you will be able to help yourself feel better, almost immediately, in many different stressful or painful situations.

      Why it works: Breathing at this rhythm increases your heart rate variability,³ the slight differences in the length of time between your heartbeats, from one to the next.

      The more variation, the better. In the long term, high heart rate variability protects against stress, anxiety, inflammation, and pain. In the short term, increased heart rate variability has a huge impact on your nervous system. It shifts your body from what scientists call sympathetic stimulation (which, when activated by stress, pain, or anxiety, triggers a fight-or-flight mode) to parasympathetic stimulation (a calm-and-connect mode).⁴

      Just by changing how you breathe for one minute, you can shift your entire nervous system from a stressful state to a highly relaxed state. Muscles relax, heart rate decreases, digestion improves, and state of mind improves. If you’re feeling any kind of bad, this powerful shift is sure to help.

      But you’re not finished with this quest yet! I want you to think of two different situations where this power breathing technique could help you feel better, immediately. For example, I personally use this technique to stop migraines in their tracks, and to calm my anxiety during

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