Debbie Nicholson

“RAGE Control” computer based intervention to help children obtain emotional control

What would you say if a child with serious anger problems could be help by playing a simple video game that sharpens the child’s ability to manage their emotions, after all children love video games.

View slideshow: Signs and symptoms of anger

Dr. Jason Kahn, PhD and Dr. Joseph Gonzalez-Heydrich, MD, at Boston Children’s Hospital had noticed the same thing in children with anger control problems are usually not interested in psychotherapy, (talking to a psychologist) but are enthusiastic when it comes to playing video games. “RAGE Control” a video game developed at Boston Children’s Hospital designed to motivate children to teach emotional control and how to apply it during a challenging task.

“RAGE Control” (Regulate and Gain Emotional Control) inspired by the classic video game Space Invaders. In this game kids shoot at enemy space ships while trying to avoid hitting the friendly ones. A clip is attached to the player’s pinky to monitor their heart rate which is displayed on the screen. When the heart rate rises above a certain level, players lose their ability to shoot at enemy spaceships. When the rate goes back down to their resting rate once again they can fire up those laser beams and shoot at those enemy ships trying to invade planet earth.

Dr. Gonzalez-Heydrich, chief of Psychopharmacology at Boston Children's and senior investigator on the study explains "The connections between the brain's executive control centers and emotional centers are weak in people with severe anger problems.” "However, to succeed at RAGE Control, players have to learn to use these centers at the same time to score points."

Peter Ducharme, MSW, a clinical social worker at Boston Children's and lead first author of study states “We want people to be able to problem-solve in this game, figure out what works.” We believe that with targeted practice, people can learn how to control their emotional reactions,” according to

To qualify for the study, the children had to have a normal IQ and not need a medication change during the five-day study period.

The study compared two groups of 9- to 17-year-old children admitted to the hospital's Psychiatry Inpatient Service who had high levels of anger.

One group consisting of 19 children received standard treatment for their anger which included cognitive behavioral therapy presentation of relaxation techniques and social skills training for five consecutive business days.

The second group consisted of 18 children who received the same treatments as the first group but spent the last 15 minutes of their psychotherapy session playing RAGE Control.

The group that played the video game after five session were significantly better at keeping their heart rate down, clinically significant reduction in anger scores in the State Trait Anger Expression Inventory Child and Adolescent (STAXI-CA) particularly on the following areas; intensity of anger at a particular time, frequency of angry feelings over time and expression of anger towards others or objects.

Also, the game players showed a decrease in in suppressed, internalized anger that reached marginal statistical significance. In contrast, the standard-treatment group showed no significant change from baseline on any of the above measures.

Just how did this video game therapy rank among the gamers? The kids gave it a 5 to 6 out of a 7 rating for helpfulness. “According to Duchame the kids had reported having better control of their emotions when encountering day to day frustrations on the unit.

More Studies

The investigators are now conducting a randomized, controlled clinical trial of RAGE Control in the outpatient clinic at Boston Children's that adds a cooperative component. The children team up with a parent for 10 game sessions at the clinic; if either the parent's or the child's heart rate goes up, neither of them can shoot, forcing them to help calm each other.

The research team plans another clinical trial to test whether letting children take RAGE Control home, to play with parents and siblings will increase its effect.

When it comes to children that are too young for the video game a solution is in the works. Dr. Kahn is leading a team effort in the development of toys to enhance emotional regulation skills in children too young for RAGE Control. These toys include racing cars that stop if a child gets too excited and, for even younger children, a cooperative game where children try to help each other stack blocks (if heart rate goes up, the table becomes wobbly and the blocks topple).

The best part of all the children enjoys the game and there are no undesirable side effects from medications.

More information on behavior problems in children is available online at University of Michigan Health System.