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Controlling emotion key to this game

Children’s Hospital team says play can tame anger

Players attach a clip to their pinky finger to monitor their pulse and emotional state during the game. Players attach a clip to their pinky finger to monitor their pulse and emotional state during the game. (Wendy Maeda/Globe Staff)
By June Q. Wu
Globe Correspondent / August 23, 2010

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It is alien versus man, but with a twist.

To win the game, players must first conquer their emotions — or at least their heart rates.

Inspired by the arcade classic “Space Invaders,’’ researchers at Children’s Hospital Boston have developed a prototype of a video game they believe can be used in therapy to help children develop anger management skills.

During the game, players attach a clip to their pinky finger to monitor their pulse, used as a proxy for their emotional state. Only when their pulse dips below their resting rate can they fire the laser beams at the white alien spaceships descending upon Earth.

“We want people to be able to problem-solve in this game, figure out what works,’’ said Peter Ducharme, a clinical social worker at the hospital’s department of psychiatry who is running the study. “We believe that with targeted practice, people can learn how to control their emotional reactions.’’

Anger management skills can be acquired through practice, not unlike learning how to regain the use of a limb after a stroke, the researchers believe.

And children and adolescents for whom traditional psychotherapy techniques, including muscle relaxation and visualization exercises, has been ineffective are far more likely to respond to treatment when an alien invasion is at stake, they say.

“These kids do not want to go to therapy, but they will spend hours trying to master the game,’’ said Dr. Joseph Gonzalez-Heydrich, chief of Children’s psychopharmacology program leading the study.

And the games do not come with the host of unwelcome side effects that can accompany antipsychotic drugs, such as high cholesterol or weight gain, he said.

The researchers have recruited 20 patients, ages 8 to 17, to play the game, dubbed “RAGE Control’’ or Regulate and Gain Emotional Control, in the preliminary phase of the clinical study. Targeting youths with high aggression levels who have not improved with conventional therapy, the researchers are testing whether a shooting game is the answer.

It may seem counterintuitive, but the researchers say the youths have responded well thus far.

“When you’re stressed and frustrated, you don’t have time to think about relaxing imagery,’’ said Jason Kahn, a postdoctoral fellow who helped design the prototype. “In this small-scale demanding environment, the game keeps going, and they have to regain control and keep playing.’’

Ducharme coaches the trial patients through the game, teaching them deep breathing techniques to bring down their heart rate. What he calls the “3-3-6 method’’ — breathing in for three seconds, holding for three seconds, and exhaling in six seconds — has been an effective strategy.

The researchers track the patients’ video-game performance over five consecutive days, plotting heart rate against time.

Only two patients have completed the game-based therapy at this point, and both have demonstrated better control over their emotional reactions to the stress the game triggers, said Gonzalez-Heydrich, also an assistant psychiatry professor at Harvard Medical School.

While the exact cause of anger management problems has not been pinpointed, Gonzalez-Heydrich said it is probably due to a combination of both physiological and environmental factors.

“It’s 100 percent nature and 100 percent nurture,’’ said Dr. Ross Greene, a Harvard Medical School clinical psychology professor at Cambridge Health Alliance not involved with the study.

Existing practices, Greene said, rely too heavily on prescribing medication and teaching parents, who often spur many of the children’s behavioral episodes, to be firmer disciplinarians.

Greene, who advocates collaborative problem solving, said the experimental video game therapy may be limited in helping children deal with adults.

“The idea offers some promise for helping the kid,’’ Greene said. “In the case of challenging behavior in kids, it does take two to tango, and adults don’’t always act like video games.’’

The game prototype is still rudimentary, the Children’s researchers say, and more features will be added as the clinical trial progresses.

Malfunctioning laser guns are next on the schedule. They will be introduced to add real-time frustration. The researchers also plan to alter the game for several children to play together to better simulate a real-life situations that involve interacting with people.

“If they’re getting better at controlling their physiological reactions in the game, they should be better able to control their reactions outside of the game,’’ Ducharme said.

June Q. Wu can be reached at jwu@globe.com.