New app augments evidence-based therapy for traumatized children

A new mobile game app created by Allegheny Health Network  mental health professionals  and students at the Entertainment Technology Center at Carnegie Mellon University helps traumatized children by letting them use their tablets or smart phones to practice the life skills they’ve learned in the therapist’s office.

 With the tagline “Change how you think; change your life,” the TF-CBT Triangle of Life game is designed to help children age 8-12 better understand their thoughts, feelings and behaviors, and move toward a better quality of life. During this game, the player takes the role of the lion in a jungle story, guiding other animals toward more positive experiences and relationships.

 The Triangle of Life is based on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the strongest evidence-based treatment for helping traumatized children heal. TF-CBT was developed by Judith Cohen, MD and Anthony Mannarino, PhD, along with Esther Deblinger, PhD, of the New Jersey CARES Institute.

 “The Triangle of Life app gives us a new and engaging way to teach traumatized children healthy cognitive coping skills,” Dr. Cohen said. “Today kids are savvy users of tablets and smartphones, and an app provides a new tool for therapists to implement TF-CBT in a fun way.”

 The app is a product of the collaboration between the Allegheny Health Network and the Carnegie Mellon University’s Entertainment Technology Center <>  and Disruptive Health Technology <>  Institute focusing on developing medical apps.

 “TF-CBT Triangle of Life is a telling example of how new technologies can assist clinicians with better engaging patients in their care. In a unique endeavor, world-class researchers and experienced therapists joined forces with graduate students highly skilled in programming and digital art, all being motivated by their passion to improve the life of traumatized children”, said Alan Russell, PhD, Chief Innovation Officer at Allegheny Health Network and Highmark Distinguished Career Professor at CMU.

 The idea for Triangle of Life sprang from a retreat engaging a multidisciplinary group of clinicians, researchers and payers interested in exploring new technologies that could improve outcomes for traumatized youth. They agreed to pursue the creation of a mobile game that would teach kids how to replace negative thoughts with positive ones, support therapists in explaining TF-CBT concepts, and make it easy and fun for kids to “practice” between therapy sessions.

 Available free on itunes and as an iOS app, Triangle of Life earned an Honorable Mention in the United Nations Alliance of Civilization’s 2014 PEACE app awards, which recognize digital games and gamified apps as venues for cultural dialogue and conflict management.

 Children who have experienced traumatic events such as physical or sexual abuse, domestic or community violence, the traumatic death of a parent or other significant person, war or bullying, face significant challenges in childhood and adulthood. In childhood they may suffer from nightmares, anxiety, disordered sleep and behavior problems. Research shows that in adulthood they are at significant risk of developing depression, drug and alcohol problems, and poor physical health.

 TF-CBT is used by child mental health professionals throughout the state and nation, and around the world, from Arkansas to Zambia.

 In TF-CBT, we encourage children to talk about their traumatic experience, while also helping them move forward with their lives,” Dr. Mannarino said. “The Triangle of Life app is a wonderful tool to reinforce the relationship skills that children learn in therapy, and strengthen the new ways of thinking that will help them approach life’s challenges.”

 Drs. Mannarino, Cohen and Deblinger are the authors of two books about TF-CBT which have been translated into seven languages. Drs. Cohen and Mannarino jointly received the Passion Award from the American Academy of Child and Adolescent Psychiatry for their work in developing effective treatments for children exposed to traumatic events.

 The Carnegie Mellon Entertainment Technology Center graduate students who designed and implemented Triangle of Life are Etaba Assigana, Eric Chang, Seungsuk Cho, Vivek Kotecha, Bing Liu, Hannah Turner, Yan Zhang, mentored by Dr. Michael Christel and Dr. Scott Stevens.