Serious games have emerged as a promising strategy to address mental health concerns, particularly for adolescents, by combining entertainment with validated therapeutic approaches. Compared to traditional video games developed primarily for recreational purposes, serious games are designed by using established principles from cognitive behavioral therapy or acceptance and commitment therapy to support cognitive and emotional skills.

Like conventional video games, serious games can immerse users in fictional worlds through a combination of auditory, visual, and tactile stimuli that then help engage them in therapeutic cognitive, behavioral, or emotional learning processes. Typically, they incorporate an overarching storyline, accompanied by player dialogues, in-game feedback, mini-games or quizzes, and other gaming elements to simulate real-life situations. These games can be designed to prevent or treat mental health conditions, including anxiety, depression, posttraumatic stress disorder, autism, and attention-deficit/hyperactivity disorder (ADHD), and to supplement existing therapies, emotional development education, and standardized academic evaluations.

For practicing clinicians, therapeutic video games connect evidence-based strategies with patient engagement. “Video games create a safe environment where clients can explore complex emotional themes and practice real-life coping mechanisms,” notes Megan Connell, PsyD, ABPP—a board-certified clinical psychologist specializing in neurodivergent care for women and girls. “Games offer a diverse range of experiences where patients can process challenges through an interactive medium.”

Now, one of them can even be prescribed: EndeavorRx, the first and only video game to be approved by the US Food and Drug Administration (FDA) for children between 8 and 17 years of age with primarily inattentive or combined-type ADHD. The basis of EndeavorRx is for users to guide alien avatars traveling on flying saucers through dynamic worlds with changing landscapes and moving obstacles.

It’s designed to challenge users’ ability to pay attention to multiple things at once, improving their ability to focus and filter out distractions. Powered by a proprietary adaptive algorithm, EndeavorRx continuously adjusts its difficulty to personalize the treatment experience for each patient, which maintains engagement by encouraging them to perform better during each game. With a prescription of up to 25 minutes of play, 5 days a week, for at least 4 consecutive weeks, EndeavorRx has been shown to improve attention capacity in 73% of children.

EndeavorRx should not, however, be considered a stand-alone treatment for ADHD or a replacement for standard medication. Rather, it should be incorporated as one component of a broader treatment plan that may include medication, educational programs, and/or therapy.

Beyond FDA-authorized software, commercial off-the-shelf video games—not explicitly built for therapeutic purposes—are nonetheless increasingly being evaluated as low-cost and accessible mental health interventions. “We utilize indie games like Gris quite a bit,” says Connell, referring to a video game where users guide the main character as she processes a deeply emotional loss. “Each level explores a different aspect of grief, finding yourself, and discovering your own purpose while confronting challenges.”

Eudaimonic video games, like Gris, aren’t designed as mental health treatments but can evoke meaning and improve mood through self-growth experiences that directly address emotional states. In addition to enhancing resiliency to stress, frustration, or sadness through meaningful and reflective scenarios, these video games could function as therapeutic tools for promoting relaxation and emotional well-being.

Even video games like Dark Souls, which was originally created for entertainment purposes alone, may have eudaimonic effects. This combat-focused action role-playing game is incredibly challenging, even for experienced players, and requires characters to die repeatedly as part of the core experience. Yet, research examining the themes present in an online forum dedicated to the game suggests that individuals respond favorably to this dynamic and view it as useful for coping with difficult emotional experiences, like depression. By forcing players to sit with frustration, Dark Souls teaches players to practice perseverance, even when their depression tells them to give up, through frequent failures accompanied by rewarding moments of achievement and victory, while also prompting existential reflection and providing community.

Like EndeavorRx, Dark Souls, Gris, and other nonprescription video games can complement established treatment approaches for their respective indications rather than serve as a replacement for standard treatment. This caveat is particularly important for users who turn to these games to escape from or avoid negative moods, as their overuse can contribute to problematic or excessive gaming rather than help players develop and apply real-world coping skills.

Many existing serious games are limited by a one-size-fits-all design that requires all players to interact under the same rules, with minimal adaptation to individual differences. To overcome this limitation, AI tools are being explored for their potential to create personalized and realistic environments that adapt, in real time, to changes in the players’ behavior during gaming. Additional customizations can be based on the players’ learning styles, personal strengths, and challenges to make the gaming experience more personalized and engaging.

Virtual gaming experiences can also be enhanced with immersive technologies like virtual reality, which blurs the lines between reality and the digital world to create a more realistic experience that allows players to focus their attention on targeted stimuli. For example, the PainWaive game combines a brain-monitoring headset with the game application to help users learn how to consciously regulate brain activity linked to chronic nerve pain. PainWaive and similar digital therapeutics offer a nonpharmacological alternative that can reduce reliance on addictive prescription opioids.

Incorporating physiological sensors to monitor heart rate, skin conductance, or brain activity also adds a useful layer—providing feedback to users and feeding back into game parameters. As these tools evolve, clinicians emphasize that their integration into the clinic must remain thoughtful. “Any intervention can be helpful or harmful; it depends on how you want to wield it and use it,” Connell concludes.