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increase motivation. Engaging a patient’s motivation is frequently necessary in health care because patients are often required to undergo procedures or engage in behaviors that are painful and aversive on the one hand (e.g., undergoing chemotherapy) or boring and mundane on the other (e.g., taking pills, exercising on a regular basis). These procedures I thank Chris Ferguson and the comments of three anonymous reviewers for their extremely helpful editorial advice. Correspondence concerning this article should be addressed to Pamela M. Kato, Patient Safety Center, University Medical Center Utrecht, Huispost Q05.4.300, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail: pkato@umcutrecht.nl Review of General Psychology © 2010 American Psychological Association 2010, Vol. 14, No. 2, 113–121 1089-2680/10/$12.00 DOI: 10.1037/a0019441 113 and behaviors are often necessary to maintain and improve health or even to cure the patient’s disease. The focus of attention on an engaging distraction is also thought to be a key factor in explaining how individuals manage aversive symptoms through video game play. The repetitive nature of video game play is thought to be a key mechanism that promotes learning in games as well (Rosas et al., 2003). What seems clear is that these mechanisms are usually activated in games within the context of play. To understand how games can engage and affect patients and doctors, it is important to understand how theorists have conceptualized play. Play usually has the following attributes: (a) It is usually voluntary; (b) it is intrinsically motivating, that is, it is pleasurable for its own sake and is not dependent on external rewards; (c) it involves some level of active, often physical, engagement; and (d) it is distinct from other behavior by having a make-believe quality (Rieber, 1996, p. 44). Psychoanalytic theorists viewed play as a means for children to experience catharsis, or a release of tension and fears in a safe context (Freud, 1968). Play is therefore often conceptualized as a means of stress management. Thus, play as stress management probably has a key role in helping patients manage aversive or shameful aspects of their illness through playing video games. Symbolic interactionist theorists viewed play among children as a means for them to understand their social world (Mead, 1982). Children’s role-playing games (e.g., playing “cops and robbers” or “house”) help them understand different social roles that people have in society. Role playing also helps players develop their sense of empathy, or understanding the feelings and viewpoints of different people. Role playing is clearly a means of play that makes simulations in training medical personnel an appealing way to learn. They can act out dangerous scenarios in a simulated environment so that they can try out their professional roles and make mistakes without fear of real-world consequences. If we thought about video games as play for adults, we could create a research program that examined the relationship between video game play and social skills such as perspective taking and empathy; psychosocial functioning such as self-confidence, happiness, relaxation, and achievement motivation; and cognitive skills such as attention, planning, spatial reasoning, and creativity. Researchers who develop and evaluate the impact of serious games should acknowledge theories of play as a pathway to learning, not just among children, but among adults as well. Reviewed Studies Commercially Available Video Games for Health Since the early 1980s, there have been reports in the literature of commercially available video games used for therapeutic purposes in different patient populations (Redd et al., 1987; Szer, 1983). Most of the early reports are directed toward children because the average game player was quite young and video games were largely targeted toward this market. As these gamers grew older, video games became more sophisticated and the market broadened for an older audience (Kent, 2001). This is reflected in the broader age range of the target audiences of video games for health more recently as well. Below, the use of commercially available video games with patients in a pediatric setting is reviewed. These studies represent some of the earliest reports of the use of commercial games in a therapeutic context with patients in the hospital. Also included is a review of a recent report on the use of a video game application for anxiety management with children. Next, the history of commercial games used for physical therapy and as exercise is reviewed. It is interesting to note that the earliest applications of video games in health occurred because someone clever made an innovative interface so that the typically sedentary games could be used to motivate patients to engage adolescent and adult patients in physical therapy and physical activity. These innovations are needed less and less as modern commercial games and console systems now have innovative hardware interfaces that require the user to be physically active. The application of these games to health is described as well. Nausea in pediatric cancer. Commercially available video games have been shown to have therapeutic effects on side effects associated with the treatment of cancer. These side effects include nausea, vomiting, anxiety, and