Anxiety disorders are the most common mental health problem during childhood and adolescence. It is estimated that approximately 13% of children and adolescents ages 9 to 17 experience some kind of anxiety disorder.

Anxiety affects normal day-to-day activities and causes considerable emotional and physical distress as well as impaired academic and social functioning. The recommended treatment approach for anxiety is overwhelmingly Cognitive Behavior Therapy (CBT). CBT helps children learn to handle their fears and worries by modifying the ways they think and behave. Techniques included in CBT are relaxation, positive self-talk, and coping behaviors. Bridge Over Worried Waters is essentially a CBT program in a box that incorporates all of these techniques.

To start the game, players place a Worried Waters raging river sheet in front of them. Then they choose a Situation card that describes an anxiety-producing situation. Players then decide on an appropriate Solution card to use as a positive strategy to address the anxiety in the situation. Solution cards include:

• Self-Talk Cards−challenge self-defeating thoughts by replacing negative thoughts with positive, optimistic thoughts.
• Relaxation Cards−calm down by using deep breathing, progressive muscle relaxation, guided imagery, and meditation.
• Coping Cards−distract by diverting attention away from anxious feelings to fun or effortful activities.

When the situation has been successfully solved with one of the Solution cards, the player then tosses the Situation card into the "Worried Waters", and the Solution card is used to create the foundation or top of a bridge. The object of the game is to build a bridge that carries the player across the "Worried Waters" to the safety of the other bank by successfully using the CBT techniques they have learned in the Solution cards. Players actually build a bridge using the two types of Solution cards (see above) for supports and the bridge roadway. The support cards stay upright using stands provided with the game.

There are both competitive and cooperative versions for 2-5 players. In the competitive version, players will each separately construct a bridge with 5-7 cards. In the cooperative version, players all help one another build one bridge that may be more than one level high or very long with up to 20 cards.