European Child & Adolescent Psychiatry

, Volume 28, Issue 1, pp 111–122 | Cite as

Is REThink therapeutic game effective in preventing emotional disorders in children and adolescents? Outcomes of a randomized clinical trial

  • Oana A. David
  • Roxana A. I. CardoșEmail author
  • Silviu Matu
Original Contribution



Therapeutic games represent a promising solution for addressing emotional difficulties in youths. The aim of the present study was to investigate the effectiveness of the REThink game, in helping children and adolescents, to develop psychological resilience. Therefore, 165 children aged between 10 and 16 years were randomly assigned in one of the three groups: 54 participants in the REThink condition, 55 participants in the Rational Emotive Behavior Education condition, and 56 participants in the waitlist condition. Results indicated that the REThink intervention had a significant impact on emotional symptoms (a moderate-effect size, d = 0.46) and on depressive mood (a large-effect size, d = 0.84). Furthermore, REThink had a significant impact on children’s ability to regulate their emotions, with a significant effect on emotional awareness (d = 0.64), and on the ability for emotional control (d = 0.69). In conclusion, the implications of the REThink game are discussed in relationship with resiliency building programs designed for youths.

Trial registration NCT03308981.


Therapeutic game Internalizing disorders Randomized-controlled trial Rational emotive behavioral therapy 



This work was supported by a grant awarded to Oana A. David from the Romanian National Authority for Scientific Research, CNCS—UEFISCDI [Grant Number PN-II-PT-PCCA-2013-4-1937].

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

787_2018_1192_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


  1. 1.
    WHO|Child and adolescent mental health. In: WHO. Accessed 23 Oct 2017
  2. 2.
    Office of Applied Studies, Substance Abuse and Mental Health Services Administration (2004) The NHSDA report. Availability of illicit drugs among youths. SAMHSA, Rockville, MDGoogle Scholar
  3. 3.
    Copeland WE, Miller-Johnson S, Keeler G et al (2007) Childhood psychiatric disorders and young adult crime: a prospective, population-based study. Am J Psychiatry 164:1668–1675. CrossRefGoogle Scholar
  4. 4.
    Costello EJ, Mustillo S, Erkanli A et al (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844. CrossRefGoogle Scholar
  5. 5.
    Lehrer JA, Shrier LA, Gortmaker S, Buka S (2006) Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics 118:189–200CrossRefGoogle Scholar
  6. 6.
    Schieve LA, Boulet SL, Kogan MD et al (2011) Parenting aggravation and autism spectrum disorders: 2007 national survey of children’s health. Disabil Health J 4:143–152CrossRefGoogle Scholar
  7. 7.
    Granic I, Lobel A, Engels RC (2014) The benefits of playing video games. Am Psychol 69:66–78. CrossRefGoogle Scholar
  8. 8.
    Smit F, Cuijpers P, Oostenbrink J et al (2006) Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 9:193–200Google Scholar
  9. 9.
    Weisz JR, Sandler IN, Durlak JA, Anton BS (2005) Promoting and protecting youth mental health through evidence-based prevention and treatment. Am Psychol 60:628–648. CrossRefGoogle Scholar
  10. 10.
    Bijl RV, de Graaf R, Hiripi E et al (2003) The prevalence of treated and untreated mental disorders in five countries. Health Aff (Millwood) 22:122–133. CrossRefGoogle Scholar
  11. 11.
    Patulny R, Muir K, Powell A et al (2013) Are we reaching them yet? Service access patterns among attendees at the headspace youth mental health initiative. Child Adolesc Ment Health 18:95–102CrossRefGoogle Scholar
  12. 12.
    Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS et al (2014) Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet 384:980–1004. CrossRefGoogle Scholar
  13. 13.
    Mukolo A, Heflinger CA, Wallston KA (2010) The stigma of childhood mental disorders: a conceptual framework. J Am Acad Child Adolesc Psychiatry 49:92–103. Google Scholar
  14. 14.
    Brezinka V (2008) Treasure Hunt-a serious game to support psychotherapeutic treatment of children. Stud Health Technol Inform 136:71–76Google Scholar
  15. 15.
    Fernández-Aranda F, Jiménez-Murcia S, Santamaría JJ et al (2012) Video games as a complementary therapy tool in mental disorders: playMancer, a European multicentre study. J Ment Health 21:364–374CrossRefGoogle Scholar
  16. 16.
    Bul KCM, Kato PM, Van der Oord S et al (2016) Behavioral outcome effects of serious gaming as an adjunct to treatment for children with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Med Internet Res 18:e26. CrossRefGoogle Scholar
  17. 17.
    Cheek C, Fleming T, Lucassen MF et al (2015) Integrating health behavior theory and design elements in serious games. JMIR Ment. Health 2:e11. CrossRefGoogle Scholar
  18. 18.
    Ellis A (1995) Changing rational-emotive therapy (RET) to rational emotive behavior therapy (REBT). J Ration-Emotive Cogn-Behav Ther 13:85–89.<207::aid-jclp2270110302>;2-1 CrossRefGoogle Scholar
  19. 19.
    Ellis A, Bernard ME (2006) Rational emotive behavioral approaches to childhood disorders. Kluwer Academic\Plenum Publishers, New YorkCrossRefGoogle Scholar
  20. 20.
    Vernon A (1997) Applications of REBT with children and adolescents. In: Yankura J, Dryden W (eds) Special applications of REBT: a therapist’s casebook. Springer Publishing Co., Inc., New York, pp 11–37Google Scholar
  21. 21.
    Vernon A (1998) The PASSPORT program: a journey through emotional, social, cognitive, and self-development, grades 9–12. Research Press, ChampaignGoogle Scholar
  22. 22.
    Gonzalez JE, Nelson JR, Gutkin TB et al (2004) Rational emotive therapy with children and adolescents a meta-analysis. J Emot Behav Disord 12:222–235CrossRefGoogle Scholar
  23. 23.
    Trip S, Vernon A, McMahon J (2007) Effectiveness of rational-emotive education: a meta-analytical study. J Cogn Behav Psychother 7:81–93Google Scholar
  24. 24.
    David D, Cotet C, Matu S et al (2018) 50 years of rational-emotive and cognitive-behavioral therapy: a systematic review and meta-analysis. J Clin Psychol 74:304–318CrossRefGoogle Scholar
  25. 25.
    Merriefield C, Merriefield R (1979) Call me Ret-man and have a ball. Institute for Rational Living, New YorkGoogle Scholar
  26. 26.
    David OA, Predatu RM, Cardoş R (2018) A pilot study of the REThink online video game applied for coaching emotional understanding in children and adolescents in the therapeutic video game environment: the feeling better resources game. J Evid Based Psychother 18:57–67. CrossRefGoogle Scholar
  27. 27.
    David D (2010) Retmagia şi minunatele aventuri ale lui Retman. Poveşti raţionale pentru copii şi adolescenţi (Retmagic and the wonderful adventures of Retman. Stories for children and adolescents). RTS Cluj, Cluj-NapocaGoogle Scholar
  28. 28.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586CrossRefGoogle Scholar
  29. 29.
    Goodman R, Meltzer H, Bailey V (1998) The strengths and difficulties questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry 7:125–130CrossRefGoogle Scholar
  30. 30.
    Biesecker GE, Easterbrooks MA (2001) Emotion regulation checklist for adolescents. Adapted from shields, AM and Cicchetti D (1997) unpublished manuscript, Tufts UniversityGoogle Scholar
  31. 31.
    Hughes EK, Gullone E, Watson SD (2011) Emotional functioning in children and adolescents with elevated depressive symptoms. J Psychopathol Behav Assess 33:335–345CrossRefGoogle Scholar
  32. 32.
    Ellis LK (2002) Individual differences and adolescent psychosocial development. Unpublished doctoral dissertation, University of Oregon, EugeneGoogle Scholar
  33. 33.
    Ellis LK, Rothbart MK (2001) Revision of the early adolescent temperament questionnaire. Poster Present. 2001 Bienn. Meet. Soc. Res. Child Dev. Minneap. MinnGoogle Scholar
  34. 34.
    David D, Montgomery GH, Macavei B, Bovbjerg DH (2005) An empirical investigation of Albert Ellis’s binary model of distress. J Clin Psychol 61:499–516CrossRefGoogle Scholar
  35. 35.
    Zecca C, Riccitelli GC, Calabrese P et al (2014) Treatment satisfaction, adherence and behavioral assessment in patients de–escalating from natalizumab to interferon beta. BMC Neurol 14:38CrossRefGoogle Scholar
  36. 36.
    von Baeyer CL (2006) Children’s self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manag 11:157–162CrossRefGoogle Scholar
  37. 37.
    Cohen J (1988) The effect size index: d. stat power anal behav sci, 2nd edn. Lawrence Erlbaum Associates, New Jersey, pp 20–26Google Scholar
  38. 38.
    Mychailyszyn MP, Brodman DM, Read KL, Kendall PC (2012) Cognitive-behavioral school-based interventions for anxious and depressed youth: a meta-analysis of outcomes. Clin Psychol Sci Pract 19:129–153. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Oana A. David
    • 1
  • Roxana A. I. Cardoș
    • 1
    Email author
  • Silviu Matu
    • 1
  1. 1.Department of Clinical Psychology and Psychotherapy, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental HealthBabeş-Bolyai UniversityCluj-NapocaRomania

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