This Video Game Could Help Your Child Manage Anger and Stress

Ten years ago, researchers at Boston Children’s Hospital carefully crafted a video game that could respond to the physical state of the player in real-time through biofeedback. The more flustered a player gets, the worse they perform in the game.

A small clinical trial published in Frontiers of Psychiatry in September has shown that the game is effective at helping children regulate their anger and stress, both while they are playing the game and after.

If replicated on a larger scale, the study's findings could help the accessible (even fun) tool become part of a treatment plan for kids who struggle with anger—either in addition to psychotherapy or psychiatric medication or, perhaps, in lieu of it.

How the Game Works

The Regulate and Gain Emotional Control (RAGE-Control) game is based on the Japanese company Taito arcade game Space Invaders, released in 1978.

In the researchers' take on the classic game, the player is catapulted into outer space where they shoot at enemy spacecraft, asteroids, and try to navigate a nebula. The biofeedback component uses a pulse oximeter on the player's wrist to tracks their heart rate as they play.

Heart rate turned out to be a good way to incorporate biofeedback into the game. When a player gets stressed or angry at the game, their heart rate goes up. If it exceeds the baseline by seven beats per minute (bpm), it starts to directly affect gameplay by the player progressively shooting less or shooting blanks.

Once a player becomes aware of those signals and responds to them, they'll notice a difference: the calmer and more concentrated they are, the better they will perform in the game.

It Helped Children Over Time

For the clinical trial, the researchers worked with 40 children between the ages of 10 and 17 who were all attending an outpatient psychiatry clinic. All the children had recorded difficulties with anger management.

During the study, the kids went to their usual therapy session with a cognitive-behavioral expert. At the end of their session, they were split into two groups to play the video game.

Half of the kids played RAGE-Control with the biofeedback, and the other half played it without it. However, they still wore the heartbeat monitoring bracelet that wasn't actively affecting their gameplay. No one in the study, including the participants or researchers, knew which kids were in which group.

The kids played various rounds of the game, then chatted with the therapist about what helped them lower their heart rate. After the therapy and gaming sessions, the kids were asked to answer questionnaires about their feelings. They were also assessed by their parents and their therapists.

When the researchers reviewed the results of the surveys and learned which kids had been in the biofeedback group and which were not, they noted that the kids who had played the game with biofeedback had a drop in their heart rates over time. Their caregivers also reported improvements in the child's anger management and behavior.

The more that a child's heart rate dropped, the more improvement there was in their behavior—a positive, direct correlation.

The Power of Gaming

Kahn’s team saw an opportunity to harness kids' motivation to do well in video games as a means to help kids learn to regulate their emotions while still reacting to a fast-paced virtual challenge.

“We wanted to help kids build a sense of regulation while they were engaged in something challenging," Jason Kahn, PhD, a researcher at Harvard Medical School and a lead author of the study, tells Verywell. "We usually get frustrated, upset, or angry while we're doing something that's hard. So, we wanted to let kids practice regulation during those moments."

Khan says that video games are a great way to achieve this not only because kids like to play them, but because games "provide the same types of tensions that we see every day, just in miniature.”

Of course, it certainly doesn't hurt that kids are interested and eager to play. “Video game-based interventions are hopefully both accessible and can make sure children stay engaged throughout treatment,” Kahn says, adding that access is a challenge in terms of helping kids get the care that they need. "It's equally hard to get them to stick with interventions that work.”

Anger and irritability are also often trans-diagnostic symptoms in many mental health disorders. Kahn says that the researchers are hopeful that a game like theirs would help many kids.

Lasting Results

The experiment also showed the potential for lasting improvements in the kids' tempers after they had played the game.

What's key in these findings is that the kids did not necessarily feel less angry; rather, they were able to control their anger more effectively. In fact, reports of anger by the kids did not change much between the biofeedback and non-biofeedback group.

After 10 gaming and therapy sessions, the parents of the participants reported overall greater improvements in aggression and oppositional behavior.

Joseph Gonzalez-Heydrich, MD, a senior attending psychiatrist in the department of psychiatry and behavioral sciences at Boston’s Children's Hospital and a lead author of the paper, tells Verywell that the team also looked for opportunities to let the kids translate their new anger management skills into their social interactions—in which they may similarly become frustrated.

That's where the parents came in. The researchers trained the caregivers on playing RAGE-Control, then had the kids observe them.

“Then, rather than show frustration or anger if their mother was not scoring points, they would need to calm themselves down enough to then teach her how to do the relaxation exercise while engaged in the video game just as they had,” Gonzalez-Heydrich says.

This component of the experiment boosted the effect of the anger control therapy that both groups of kids in the study received.

A New Frontier of Child Psychology

Biofeedback as a concept can be tricky for kids—and even adults—to grasp. However, if it's taught in an accessible way, it can be an effective therapeutic technique.

“Managing aggression is challenging as it often happens unexpectedly when no guidance is available,” Michel Mennesson, MD a psychiatrist at Newport Institute, tells Verywell. “Creating through biofeedback a reward for staying calm when frustrated provides reinforcement of what is needed when it is needed. It addresses the body activation that takes place in moments of rage that are rarely seen in an office.”

Mennesson, who was not involved in the study, says that this approach "certainly makes more sense than over medicated young brains,” adding that the trial's findings still have to be confirmed by research using a large population and that it would need to include both interventions, including the therapy and the biofeedback.

Caroline Carney, MD, Magellan Health’s Chief Medical Officer, tells Verywell that the study's findings suggest that accessible, oftentimes portable, games of this kind could be adjuncts to traditional treatment.

However, whether that effect will be lasting, "meaning that the kids are able to truly learn to self-regulate outside the study setting and without using the technology," she says, still needs to be studied.

That said, Carney hopes that by learning to recognize their anger and regulate it, kids will be able to avoid the potential negative consequences of poorly controlled anger and stress.

According to Kahn, the most exciting part of the team's research is the ability to reach beyond the clinic. “Video games are commonplace in kids' homes and the ability to take them and turn them into tools that make kids healthier is very promising," Kahn says.

RAGE-Control has already become a commercial program called Mightier that is available to families. Kahn says that the researchers are currently collecting data and talking to more families about how Mightier works and hope to get more diverse data.

They're also talking to professional game developers about how they could put the ideas behind RAGE-Control into games that will help kids work on these skills—and have a great time doing it.