A decade ago, researchers at Harvard Medical School and Boston Children’s Hospital started working to find a new therapy for children who have problems with emotional regulation. They wanted it to be a coping mechanism that was scientifically proven, and that kids would be excited to engage in.
They developed an app called Mightier that uses video games and a heart rate monitor to allow children to practice the skills they need to identify their emotions, reduce anxiety and calm down.
“They were working with lots of kids and families in Boston Children’s Hospital who needed more help with emotional regulation than they got just through therapy, and they did randomized trials with them to test it out,” said Emily Stone, a licensed social worker and lead clinical strategist at Mightier. “The families that used the app were reporting reduced outbursts and oppositional behavior from kids, which also decreased parents’ stress.”
With the positive results under their belt, Mightier was brought “out of academia” in 2018 and started selling directly to families all over the country through their website. Since then, the app has been used by more than 100,000 children, many of whom have been diagnosed with ADHD, autism spectrum disorder or oppositional defiant disorder.
The app includes about 30 mobile-based video games, which kids gravitate toward because they’re both fun and familiar — racing games, puzzle games and games that are similar to ones they’ve played on their own gaming consoles or phones.
“There’s a lot of educational software out there that are like, math or reading,” said Stone. “But these are fun play-based games that kids gravitate toward. Kids can also look for something that speaks to them as they choose a game, like animals or racing.”
How it works
While the child plays a game, they wear a heart rate monitor on their arm. When the game gets difficult, the child’s heart rate often increases as they get frustrated. When that happens, the game adjusts by doing exactly the opposite of what you might expect. The game gets even more difficult to play.
In Crossy Ninja, a game where the player has to slice flying fruit while walking back and forth on a bridge, a heart rate in the “red zone” causes the character to pick up speed, making it harder to slice fruit. In Return of Invaders, players protect their planet by firing at invading ships, but while in the heart rate red zone, they can’t control the direction of their fire. And in Super Best Ghost Game, the player controls a growing group of ghosts through different levels of puzzles. Most of the screen gets covered up while in the red zone.
“When a kid is playing a game and it suddenly gets harder, we know they want to go back to playing normally,” said Stone. “So they’re incentivized to use methods they’ve learned to calm down, which brings their heart rate back down and the game back to normal.”
Those calming skills can be coping mechanisms the kids have learned in therapy or methods that are recommended by the Mightier app itself.
When children are in therapy sessions, the atmosphere is often calm and they’re just recalling stressful situations as they relate them to the therapist, rather than experiencing them in the moment. Because of that, the coping mechanisms therapists suggest can feel too abstract for kids to grasp. Mightier addresses that issue by incentivizing them to use calming methods in a moment of stress and then immediately seeing results when the techniques work.
Stone said children who use the Mightier app often play the games during their therapy session so the therapist can help them identify their anxiety as their heart rate goes up, observe them using calming techniques to bring their heart rate back down and then reinforce how those skills can be used when they’re in a “tricky situation” in their real lives.
“We would never say Mightier is a replacement for therapy,” said Stone. “This is just another tool in the toolbox for people to use along with therapy, especially for kids who are in treatment and need additional skills to help.”
How does the app get to kids who need it?
The Mightier app has been available for purchase through the website since 2018. It can be used on many mobile phones and devices, although Mightier will also send a device if needed. The games, calming techniques, heart rate monitor and a companion app for parents are available through a subscription fee that costs between $28 and $40 per month depending on the plan .
Stone said they’ve also worked with doctors, therapists and insurance providers to make the app available to kids who need it. And just recently, Mightier has partnered with the Wisconsin Children’s Long-term Support System, which means that families who qualify for Medicaid can receive funding to pay for the Mightier device and monthly subscription fee.
“We’ve known for a long time that kids aren’t getting what they need in mental health, and the pandemic has made that more clear to everyone,” said Stone. “Working with CLTS helps more families get this tool sent right to their home that they can use along with services they’re already getting.”