CopeWellResearch behind
the activities.
Research on games, writing, and mindfulness helped us choose the activities in CopeWell. Here is what the studies found and where their findings stop. CopeWell itself has not been clinically tested.
Reading list updated October 3, 2026. This is a selected reading list, not a complete review of all research.
Brief online skills need their own safety evidence
In a 2022 randomized trial, adults with frequent suicidal thoughts were offered a brief online program teaching four DBT skills alongside ongoing care. The group offered skills training had a higher risk of self-harm than the usual-care group over 18 months.
This finding concerns the particular program and population studied. It does not show that all DBT or all apps are harmful. It does mean that taking selected skills out of a therapy program is not enough to establish safety or benefit.
For CopeWell: Our activities have not been clinically validated. They are not a suicide-prevention program or a substitute for treatment. You can stop any activity, and human help is available. Clinical review and appropriate evaluation are still needed.
Simon and colleagues, JAMA, 2022Visual puzzles, urges, and recovery
A 2015 study followed 31 university students for a week. Participants assigned to play Tetris for three minutes reported lower craving intensity immediately afterward. The cravings included food, substances, and activities.
The limit: This was a small study of students, not a trial of addiction treatment. It studied Tetris, not our untimed block game. It does not show that CopeWell prevents relapse or changes long-term health.
Our design choice: Offer a visual puzzle with a clear task and an easy way to stop. That is an idea informed by the research, not a proven treatment.
Skorka-Brown and colleagues, 2015A newer alcohol-craving pilot
A 2026 study followed 40 women reporting alcohol misuse for two weeks. Four minutes of Tetris was compared with waiting four minutes. Momentary craving decreased more among participants with greater recognition of drinking-related harm and readiness to change. Average daily craving and drinking did not decrease.
For CopeWell: This supports investigating a brief visual task during an urge. It does not establish addiction treatment, detox support, relapse prevention, or a benefit from our games.
Hahn and colleagues, 2026ADHD: research on a specific attention game
The 2020 STARS-ADHD trial randomized 348 children aged 8–12 to a purpose-built digital intervention, AKL-T01, or a digital control. After four weeks, the intervention improved the trial’s objective attention-test measure compared with the control.
The limit: This was a specific therapeutic program, used for 25 minutes a day, five days a week. It was not a test of casual block puzzles, adults, or CopeWell. Better performance on an attention test does not by itself establish broad improvement in daily life.
Our design choice: Clear goals, immediate feedback, and control over sound and motion. These are usability choices we want to test with people with ADHD, not a claim that CopeWell treats ADHD.
Kollins and colleagues, 2020 · STARS-ADHDOCD: when play can become a ritual
NICE recommends cognitive behavioral therapy including exposure and response prevention (ERP) for OCD. ERP involves facing triggers while reducing compulsions, including mental rituals and attempts to neutralize thoughts.
The limit: That guidance does not establish puzzle games as OCD treatment. We have not established that CopeWell reduces OCD symptoms.
Our design implication: We should not encourage someone to play, count, or repeat a task until a thought feels safe or “just right.” That is a precaution drawn from the treatment principles, not a result from a CopeWell study. If play becomes a required ritual, discuss it with your clinician. Stopping with an unfinished board is allowed.
NICE OCD treatment recommendationsWriting and mental health
A 2022 review of 20 randomized trials found potential benefits from journaling. The studies used different writing methods, populations, and measures, and the authors highlighted limitations in the evidence.
The limit: Structured writing in a study is different from an open journal in an app. Benefits are not assured, and writing about difficult experiences can feel uncomfortable.
Our design choice: Offer free writing and optional short prompts. No requirement to revisit painful events or finish a reflection.
Sohal and colleagues, 2022Noticing and describing
Dialectical behavior therapy, or DBT, includes mindfulness, distress tolerance, emotion regulation, and interpersonal skills. The Department of Veterans Affairs describes these as parts of a broader treatment approach.
The limit: A short app activity is not DBT treatment. It cannot inherit the outcomes of a full therapy program.
Our design choice: A quiet moment invites you to notice an ordinary object, sound, or surface and describe its details. Eyes open is fine. There is no need to change your breathing.
VA overview of dialectical behavior therapyHow the guided activities connect to DBT
These are original, shortened practice activities. The connections below explain our design choices. No individual activity or combination has been tested for clinical benefit in CopeWell.
DBT programs combine multiple skills with treatment support. The VA DBT program and curriculum describe the broader structure, including mindfulness, distress tolerance, interpersonal skills, STOP, and pros and cons. Behavioral Tech’s emotion-regulation teaching describes checking the facts and coping ahead. The VA urge-surfing guide explains noticing a craving without immediately acting on it. These are teaching sources, not trials of our app.
Pause & Choose
Design connection: STOP and urge-surfing ideas. Pause, step back, notice, and choose a next action. Not a promise that an urge will end or that the activity prevents harm.
Weigh My Options
Design connection: Distress-tolerance pros and cons. Consider benefits and costs of a decision that can safely wait. Not a tool to weigh whether to harm yourself or another person.
Collect Thoughts
Design connection: Observe, describe, and name emotions. Describe an event, a feeling, a need, and an optional action. The app does not interpret or diagnose what you write.
Know / Guess / Don’t Know
Design connection: Checking the facts. Practice distinguishing observations and interpretations in fictional scenes. It cannot decide whether your own concerns are true.
Both Can Be True
Design connection: Dialectical thinking and validation. Explore two perspectives in fictional situations. It does not ask you to accept mistreatment or dismiss a feeling.
Say It Clearly
Design connection: Interpersonal effectiveness. Draft a request or boundary. This is not the full DBT communication protocol, and nothing is sent.
Cope Ahead
Design connection: Coping ahead. Rehearse an everyday plan and a backup. Not trauma exposure, crisis planning, or withdrawal management.
Quiet noticing
Design connection: Present-moment observation. Notice an ordinary detail around you. No prescribed breathing or requirement to turn inward.
The online-skills trial above is part of this evidence picture. More activities and a DBT label do not establish better outcomes. A clinician can help decide which practices fit an individual and when to stop or adapt them.
Relief, enjoyment, and treatment are different
We want the app to feel useful and satisfying. We still need to test whether people understand it, find it helpful, and can leave it easily. Showing a clinical benefit would require appropriate studies of CopeWell itself.