Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment

BACKGROUND

Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients.

OBJECTIVE

This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy.

METHODS

This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment.

RESULTS

This study started in March 2022 and the recruitment is expected to close in August 2024.

CONCLUSIONS

This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56315.

Predicting hostility towards women: incel-related factors in a general sample of men

Hostility towards women is a type of prejudice that can have adverse effects on women and society, but research on predictors of men's hostility towards women is limited. The present study primarily introduced predictors associated with misogynist involuntary celibates (incels), and then investigated whether loneliness, rejection, attractiveness, number of romantic and sexual partners, right-wing authoritarianism, and gaming predicted hostility towards women among a more general sample of men. A total of 473 men (aged 18-35, single, heterosexual, UK residents) recruited via Prolific answered the hostile sexism subscale, the misogyny scale, the self-perceived sexual attractiveness scale, the right-wing authoritarianism scale, the game addiction scale for adolescents, the adult rejection-sensitivity scale, the UCLA loneliness scale, and self-developed questions regarding number of sexual and romantic partners, and time spent gaming. We found a strong positive relationship between right-wing authoritarianism and hostility towards women, as well as a strong convex curvilinear relationship between attractiveness and hostility towards women. The number of sexual partners showed a moderate concave relationship with hostility towards women. We did not find sufficient support for a relationship between gaming and hostility towards women, and there was no support that loneliness, rejection, or romantic partners predicted hostility towards women among a general sample of men. Our study supports right-wing authoritarianism and self-perceived attractiveness as potential strong predictors in understanding men's hostility towards women in the wider community. Pre-registration: https://osf.io/ms3a4.

Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial

BACKGROUND

Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive.

OBJECTIVE

This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging.

METHODS

Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses.

RESULTS

Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95% CI 0.27 to -2.13; P<.01), quality of life (estimate 7.08, 95% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate -1.96, 95% CI -3.33 to -0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001).

CONCLUSIONS

Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042.

Trustworthy High-Performance Multiplayer Games with Trust-but-Verify Protocol Sensor Validation

Multiplayer online video games are a multibillion-dollar industry, to which widespread cheating presents a significant threat. Game designers compromise on game security to meet demanding performance targets, but reduced security increases the risk of potential malicious exploitation. To mitigate this risk, game developers implement alternative security sensors. The alternative sensors themselves become a liability due to their intrusive and taxing nature. Online multiplayer games with real-time gameplay are known to be difficult to secure due to the cascading exponential nature of many-many relationships among the components involved. Behavior-based security sensor schemes, or referees (a trusted third party), could be a potential solution but require frameworks to obtain the game state information they need. We describe our Trust-Verify Game Protocol (TVGP), which is a sensor protocol intended for low-trust environments and designed to provide game state information to help support behavior-based cheat-sensing detection schemes. We argue TVGP is an effective solution for applying an independent trusted referee capability to trust-lacking subdomains and demands high-performance requirements. Our experimental results validate high efficiency and performance standards for TVGP. We identify and discuss the operational domain assumptions of the TVGP validation testing presented here.

Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study

Background

One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR.

Objective

The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students' PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity.

Methods

A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures.

Results

The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; η²p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants' perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; η²p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load.

Conclusions

The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits.

Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review

BACKGROUND

Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention.

OBJECTIVE

This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents.

METHODS

This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search.

RESULTS

From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%).

CONCLUSIONS

This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas.

Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study

BACKGROUND

Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol.

OBJECTIVE

This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting.

METHODS

In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated.

RESULTS

In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets.

CONCLUSIONS

This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health.

Mindfulness programs for problematic usage of the internet: A systematic review and meta-analysis

Introduction

Problematic usage of the internet (PUI) is an umbrella term for a range of uncontrolled, excessive, and potentially harmful online behaviors. Recently, numerous studies have examined the potential of mindfulness programs (MPs) for reducing PUI. We conducted a comprehensive systematic review and meta-analysis in this emerging field.

Methods

We searched eight databases from inception to October 18, 2022, with no language restrictions. We included randomized controlled trials (RCTs) and nonrandomized trials (NRTs). The primary outcome was change in self-reported PUI, the secondary outcome was change in screen time.

Results

Of 3,473 identified records, 19 RCTs and 20 NRTs with a total of 1,549 participants were included. Participation in an MP was associated with large reductions in PUI in between-group analysis in RCTs (k = 19; g = -1.67; 95% CI -2.15, -1.19) and in within-group pre-post analysis in all studies (k = 35; g = -1.67; 95% CI -1.99, -1.36). Screen time showed a medium reduction in within-group pre-post analysis (k = 10; g = -0.65; 95% CI -0.90, -0.41). The effects for PUI remained significant in a series of sensitivity analyses, such as excluding low quality studies, excluding outliers, adjusting for publication bias, or using follow-up data. Heterogeneity between studies was high and the overall quality of evidence was rated low.

Discussion and conclusions

MPs are probably effective in reducing PUI and might be effective in reducing screen time. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials with long-term follow-ups to confirm results.

Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study

Background

Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D.

Objective

We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study.

Methods

During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available).

Results

The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1%, SD 1.3%), of whom 105 (41.8%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7%) when compared to other exercise sessions (1104/3658, 30.2%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min).

Conclusions

Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D.

Appetitive conditioning with pornographic stimuli elicits stronger activation in reward regions than monetary and gaming-related stimuli

Appetitive conditioning plays an important role in the development and maintenance of pornography-use and gaming disorders. It is assumed that primary and secondary reinforcers are involved in these processes. Despite the common use of pornography and gaming in the general population appetitive conditioning processes in this context are still not well studied. This study aims to compare appetitive conditioning processes using primary (pornographic) and secondary (monetary and gaming-related) rewards as unconditioned stimuli (UCS) in the general population. Additionally, it investigates the conditioning processes with gaming-related stimuli as this type of UCS was not used in previous studies. Thirty-one subjects participated in a differential conditioning procedure in which four geometric symbols were paired with either pornographic, monetary, or gaming-related rewards or with nothing to become conditioned stimuli (CS + porn, CS + game, CS + money, and CS-) in an functional magnetic resonance imaging study. We observed elevated arousal and valence ratings as well as skin conductance responses for each CS+ condition compared to the CS-. On the neural level, we found activations during the presentation of the CS + porn in the bilateral nucleus accumbens, right medial orbitofrontal cortex, and the right ventral anterior cingulate cortex compared to the CS-, but no significant activations during CS + money and CS + game compared to the CS-. These results indicate that different processes emerge depending on whether primary and secondary rewards are presented separately or together in the same experimental paradigm. Additionally, monetary and gaming-related stimuli seem to have a lower appetitive value than pornographic rewards.

The Effect of a Novel Video Game on Young Soccer Players' Sports Performance and Attention: Randomized Controlled Trial

Background

Currently, the fusion of technology and sports is inevitable. The integration of various systems and devices has brought about significant transformations in established sports practices, impacting not only the rules but also physiological, biomechanical, and even psychological aspects.

Objective

The purpose of this study was to analyze the effect of an attention intervention through a video game on young soccer players.

Methods

Twelve young male soccer players (age: mean 8.5, SD 1 years) were divided into 2 groups: a control group (CG; n=10) and an experimental group (EG; n=10). During the 6-week training program, the EG received attention training through a video game twice a week for 15 minutes per session. Pre- and postintervention measurements included a specific decision-making soccer test and interviews with coaching staff. Additionally, success in the video game, muscular activity, and sweat levels were monitored.

Results

The EG demonstrated a significant improvement in video game success following the intervention program, as indicated by the achieved level (P<.001). However, no significant differences were found between groups regarding electromyographic (EMG) activity (P=.21) and sweating (P=.20). Prior to implementing the attention training program, both groups exhibited similar data for variables related to decision-making and execution mechanisms (≤10%). Only 2 decision-making variables exceeded 10% but remained below 15% (Shot_D=13.35%; Marking_with_Ball_D=-12.64%). Furthermore, changes in attacking action variables were more pronounced in execution-related variables, except for dribbling and fixing. Conversely, in defensive action variables, changes were greater in decision-related variables, except for marking with the ball and marking without the ball.

Conclusions

Our findings reveal that incorporating a specific attentional video game into a soccer training program enhances decision-making compared to a program without the video game. Therefore, it is advisable for practitioners to consider using this tool due to its high efficiency in terms of economic and temporal costs, particularly in improving a key psychological variable.

Playing online videogames-more than just entertainment? A qualitative study of virtual social participation in persons with spinal cord injury

Introduction

Spinal cord injury (SCI) affects many aspects of life, physically, emotionally and socially. Engaging in online videogames holds the potential to facilitate increased social interactions for individuals with SCI. The aim of this study is to increase our understanding of the experiences people with SCI have with using online videogames as an arena for social participation.

Methods

A focus group interview was conducted with seven participants with SCI, aged 15-35, all experienced in using online videogames as a method of socializing. The data was analyzed using thematic analysis.

Results

The participants highlighted that playing online videogames way of maintaining social connections and expanding their social network. However, they faced challenges due to limited knowledge and negative attitudes from others regarding use of videogames as a social arena. Three main themes were developed from the findings: "Disabling social barriers", "Attitudes towards gaming" and "Gaming-connecting people".

Conclusion

Healthcare professionals should consider videogames as a leisure activity and facilitate their use, recognizing their potential for social interaction and well-being. Prioritizing activities that promote social interaction is crucial for good health.

A Serious Game (MyDiabetic) to Support Children's Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study

BACKGROUND

Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications.

OBJECTIVE

This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring.

METHODS

The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management.

RESULTS

The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes.

CONCLUSIONS

The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.

Less Is More: Higher-Skilled Sim Racers Allocate Significantly Less Attention to the Track Relative to the Display Features than Lower-Skilled Sim Racers

Simulated (sim) racing is an emerging esport that has garnered much interest in recent years and has been a relatively under-researched field in terms of expertise and performance. When examining expertise, visual attention has been of particular interest to researchers, with eye tracking technology commonly used to assess visual attention. In this study, we examined the overt visual attention allocation of high- and low-skilled sim racers during a time trial task using Tobii 3 glasses. In the study, 104 participants were tested on one occasion, with 88 included in the analysis after exclusions. Participants were allocated to either group according to their fastest lap times. Independent t-tests were carried out with sidak corrections to test our hypotheses. Our results indicate that when eye tracking metrics were normalised to the lap time and corner sector time, there was a difference in the relative length of overt attention allocation (fixation behaviour) as lower-skilled racers had significantly greater total fixation durations in laps overall and across corner sectors when normalised (p = 0.013; p = 0.018). Interestingly, high- and low-skilled sim racers differed in where they allocated their attention during the task, with high-skilled sim racers allocating significantly less overt attention to the track relative to other areas of the display (p = 0.003). This would allow for higher-skilled racers to obtain relatively more information from heads-up display elements in-game, all whilst driving at faster speeds. This study provides evidence that high-skilled sim racers appear to need significantly less overt attention throughout a fast lap, and that high- and low-skilled sim racers differ in where they allocate their attention while racing.

Therapeutic Uses of Gaming in Mental Health: An Untapped Potential

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Gaming motivation and well-being among Norwegian adult gamers: the role of gender and disability

Introduction

Digital gaming is a popular and often social activity, also among adults. However, we need more knowledge of the social dynamics of gaming and its potential benefits for one's well-being. The current study aimed to examine gaming motivation, time spent gaming, and gaming performed together with friends, family, or romantic partner and how these aspects relate to expanded social network and well-being among men and women with and without disability.

Methods

Regular players of the popular game Fortnite Battle Royale (FBR; N = 278, 48.5% women, Mage = 32.38) completed an online questionnaire assessing their motivations for playing FBR (social motivation, achievement motivation, novelty motivation), time spent gaming, whom they usually play with, their psychological well-being, and FBR's impact on their life and social network. Differentiated statistical analyses on gender and disability were performed.

Results and discussion

The results showed that time spent gaming and social motivation to play were associated with larger social networks for all participants (strongest for women). More time spent gaming FBR was also associated with a positive impact on life for those with a disability. Social motivation to play was positively associated with a positive impact on life for men and those without a disability and increased well-being for women. Novelty motivation, which concerns experiencing new features in the game, was associated with a positive impact on life for women and with a decrease in well-being for those with a disability. This study demonstrated that gaming can be an essential social arena associated with positive outcomes for men, women and disabled people, who-when socially motivated-may expand their social networks through gaming.

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial

BACKGROUND

Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education.

OBJECTIVE

The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS.

METHODS

This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist.

RESULTS

In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator.

CONCLUSIONS

Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

Does parents' perceived style of setting limits to gaming matter? The interplay between profiles of parental mediation and BIS/BAS sensitivity in problematic gaming and online gambling

INTRODUCTION

Parents try to prevent possible negative outcomes associated with gaming by setting rules on their adolescent's gaming behavior (i.e., restrictive mediation). Parents can use either more autonomy-supportive or more controlling styles to communicate those rules. Using a person-centered approach, this study aims to, first, identify profiles of parents' perceived degree of restrictive mediation in gaming and styles of communicating these rules (i.e., autonomy-supportive and controlling); second, to examine how adolescents in different profiles differ in terms of maladaptive gaming outcomes (i.e., problematic gaming, simulated, and online gambling); third, to investigate the moderating role of gaming frequency and adolescents' personality (i.e., behavioral inhibition system [BIS] sensitivity and behavioral activation system [BAS] sensitivity) in the associations between the parental profiles and the outcomes.

METHODS

The study used quantitative, cross-sectional survey data from Belgian adolescents (N = 1651, mean age = 14.00 years, 51.2% boys), collected between November 2021 and February 2022 in schools.

RESULTS

Cluster analysis yielded four profiles of perceived restrictive mediation: an exclusively controlling one, an autonomy-supportive one, one where parents used a perceived mix of both communication styles, and one where there was an overall perceived lack of restrictive mediation. Adolescents in the controlling profile displayed the most maladaptive outcomes. Some of the associations between the parental profiles and the outcomes were stronger for more frequent gamers and for adolescents scoring higher on both BIS and BAS sensitivity.

CONCLUSION

Associations between the parental profiles and gaming outcomes were theoretically meaningful, yet small in terms of effect size.

Examining Cybersexism in Online Gaming Communities: A Scoping Review

Cybersexism in the context of online gaming communities, as epitomized by the Gamergate incident back in 2014, has been an issue for a while for gamer women, yet it has not received proper attention. In this scoping review, we have aimed to assess its main characteristics, its consequences for gamer women, its triggers and predictors, and related prevention and mitigation policies provided by the existing research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines were applied to the design of the scoping review. Empirical studies were accessed via database searches. The following databases were prospected: Scopus, ProQuest, Web of Science, PsycINFO, PubMed, and ACM from March to May 2021. A total of 33 studies were included in the final analysis after database searching, filtering, and snowballing. Most of the selected studies (66%, n = 22) were focused on the manifestations of cybersexism in gaming communities, with gender-driven trash-talking being the main one. The main drivers and triggers behind cybersexist behaviors were also the research topic in 66% (n = 22) of the studies and the consequences and coping strategies were studied in 52% (n = 17) of the articles. Furthermore, 12% (n = 4) of the studies assessed policies and actions to prevent cybersexism. Cybersexism and its manifestations are a reality that conditions gamer women, provoking avoidance and ultimately withdrawal from gaming and, therefore, creating inequality, impairing full digital citizenship, and widening the digital gender gap.

Red box, green box: A self-report behavioral frequency measurement approach for behavioral addictions research

Behavior frequency measures in behavioral addictions research fail to account for how engagement in the activity relates to each respondent's personal circumstances. We propose a "Red Box, Green Box" method, an alternative to conventional self-report behavior questions. Participants report two distinct time-based values: (1) Green box: time spent engaged in the activity during 'free' time, and (2) Red box: engagement in the activity at times when the respondent should be doing something else (e.g., studying, working, sleeping, exercising, etc.). Some practical examples of the 'red box, green box' method are provided. This method may help to calibrate behavioral frequency for each respondent and yield clearer insights into displacement effects and risks associated with frequency of use. We suggest some future research directions to test the feasibility and utility of this approach in different implementations.

Vitality structures in 'addictive' game design

For decades, research on technology use and mental health has been based on the assumption that identifiable structures of 'design' are psychologically relevant for their users. This has been central especially for the nosological emergence of 'behavioural addictions', which currently involve two formal diagnoses involving technology: problems related to playing gambling games (gambling disorder) and videogames (gaming disorder). Alas, the research on identifying 'addictive' design structures has suffered from major construct validity issues. To make progress across those issues, I draw from the history of 'vitality affects' in psychiatry and introduce vitality structures as a design-phenomenological framework that can help researchers conceptualise clinically (and non-clinically) relevant 'bonds' between entities of game design and corresponding player phenomenology. Vitality structures are not natural kinds to be discovered but pragmatic constructs to be created and used: they are useful as long as they communicate what is both identifiable and empirically prevalent. As a demonstration of practice, I propose working conceptualizations of three vitality structures, which surface in videogames that have been prevalent sources of self-identified problems among gaming treatment-seekers. Systematic programs of research for identifying relevant vitality structures across technological, psychological, and psychiatric contexts can lead to construct-valid and replicable design effects.

Gender Moderates the Relationship Between Avatar Customization and Enjoyment in Popular Video Games

Using online survey methods (n = 153), this study investigates whether exposure to different levels of customization in games will increase the experiences of enjoyment, both directly and indirectly, through the experience of avatar embodiment, as well as whether these relationships are influenced by gender identity. Results indicate a positive relationship between level of exposure to customization and enjoyment for women-identified participants. These outcomes may provide insight into gendered preference in gaming, potentially providing an avenue by which to make games more inclusive to women gamers.

Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study

Background

Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects.

Objective

This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives.

Methods

A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis.

Results

Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games.

Conclusions

This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.

A Serious Game ("Fight With Virus") for Preventing COVID-19 Health Rumors: Development and Experimental Study

BACKGROUND

Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors.

OBJECTIVE

This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders.

METHODS

This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named "Fight With Virus" as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved.

RESULTS

We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games.

CONCLUSIONS

Compared to traditional media, serious games can effectively improve midelders'/elders' cognitive abilities while they face a health rumor. The gameplay effect is related to the individual's age and educational background, while income and gender have no impact.

Effect of a Mobile Game-Based Intervention to Enhance Child Safety: Randomized Controlled Trial

BACKGROUND

Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population.

OBJECTIVE

This study aimed to investigate the potential of a mobile game-based safety education program in improving children's safety and psychosocial outcomes.

METHODS

Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models.

RESULTS

No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3.

CONCLUSIONS

Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries.

TRIAL REGISTRATION

ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/17756.