Effects of the video game 'Mindlight' on anxiety of children with an autism spectrum disorder: A randomized controlled trial

Effects of game-based digital interventions for mental disorders: A meta-analysis

With increasing research attention on game-based digital interventions for mental disorders, a number of studies have been conducted to explore the effectiveness of digital game-based interventions on mental disorders. However, findings from previous research were inconsistent. Thus, we conducted a comprehensive meta-analytic review of the effectiveness of game-based digital interventions for mental disorders. By searching the articles in databases, we identified 53 studies in which 2433 participants were involved, and 282 effect sizes were extracted. Among the 53 studies, 14 employed within-group (pre/post) designs, and the remaining 39 utilized controlled trial designs. Using a three-level random-effects meta-analytic model, a medium effect size of game-based digital interventions (g = 0.47, 95 % CI: 0.33, 0.61) was revealed in the controlled trial designs and a close-to-medium effect size (g = 0.45, 95 % CI: 0.32, 0.58) was found in the within-group (pre/post) designs, indicating close-to-medium-sized efficacy of game-based digital interventions for mental disorders. Moderator analyses showed that age in the controlled trial designs had contributed to the heterogeneity in previous studies, suggesting that interventions might be more effective for the elderly. However, given that only a limited number of studies were focused on the elderly, more studies with older participants should be conducted in the future to provide more robust evidence and explore the mechanisms of how digital gaming interventions can be more effective in improving mental disorders symptoms.

Mental health app boost my mood (BMM) as preventive early intervention for adolescents with (sub)clinical depressive symptoms

BACKGROUND

Depression is a common mental disorder. Detecting (sub)clinical depressive symptoms in adolescents at an early stage and offering a low-threshold early intervention can minimize the risk of serious and/or long-term depression. As such, a digital intervention can be a low-threshold preventive and early intervention. This study aims to examine whether the Boost My Mood (BMM)-app is a suitable preventive early intervention for adolescents with (sub)clinical depressive symptoms.

METHODS

This naturalistic single-arm evaluation study (N = 50) was conducted in adolescents aged 16-21 with (sub)clinical depressive symptoms. Furthermore, the BMM-app was studied in relation to anxiety, worrying, stress, and sleeping problems. An exploratory objective was to determine whether positive expectations and social support are related to app use.

RESULTS

The study showed a significant decrease in not only depressive symptoms, but also anxiety, worrying and stress while using the BMM-app. Sleeping problems did not significantly decrease over time while using the BMM-app. The degree of use of the BMM-app and telling significant others about using the BMM-app were both not related to a decrease in depressive symptoms. The BMM-app was used significantly more when the adolescent had told relatives about their depressive symptoms.

CONCLUSIONS

A digital intervention, such as the BMM-app, can be a low-threshold preventive and early intervention for adolescents with (sub)clinical depressive symptoms. Beneficial effects of the BMM-app were reported on depressive symptoms as well as other aspects of quality of life, such as anxiety, worrying, and stress. Whereas several factors may have played a role in the current findings on depressive symptoms, there are reasons to assume that part of the reduction in symptoms could be attributed to the BMM-app. Although no causality can be assumed, this study is a first step in the implementation of preventive apps in mental health care.

Two Physiotherapy Methods to Improve the Physical Condition of Children with Autism Spectrum Disorder

This study presents two simple physiotherapy programs that were implemented for five weeks and showed positive changes in balance, coordination, and motor skills in kindergarteners with ASD. Physiotherapy programs in a gym and games on a smart board with balance plates and an unstable base were applied to improve the physical condition of children with ASD. Thirty children with ASD (4-6 years old) attending special needs kindergarten were enrolled in the study. Three tests were used to assess participants' physical condition before and after the study: the modified Berg Balance Scale, the Imbalance Coordination Sample, and the Bruininks-Oseretsky Motor Proficiency Test (BOTMP). The resulting mean change, calculated from each group's scores, shows that the participants who received physical therapy sessions at the smart board had the greatest change of 1.58 points. It shows that the opportunity to play games on a smart board motivates children with ASD to work harder; therefore, it is a simple and easy way to engage children in different types of physical exercise. A slightly smaller change of 1.51 was obtained in the group that received gym sessions. However, working in the gym was more psychologically challenging for the children with ASD due to their lack of desire and motivation. Both methods are relatively simple and easy to apply at home; therefore, parents can make a significant contribution to improving children's physical condition and that can be an effective tool to assist these individuals with activities in daily life.

Meta-analysis of Psychotherapy for Autistic Youth

In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.

Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

Challenges With the Use of Digital Sham: Systematic Review and Recommendations

BACKGROUND

Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component.

OBJECTIVE

The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx.

METHODS

We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed.

RESULTS

Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported.

CONCLUSIONS

Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials-in early-phase studies-to help identify DTx active components and-in late-phase studies-to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials.

Effect of Biofeedback-Based Interventions on the Psychological Outcomes of Pediatric Populations: A Systematic Review and Meta-analysis

We performed a systematic and meta-analytic review of biofeedback-based interventions on psychological outcomes among pediatric populations. The literature search for this study was conducted in eight databases, including PubMed, the Cochrane Library, Scopus, CINAHL, Embase (OVID), Web of Science, PsycINFO (all via Ovid SP), and Google Scholar. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies that was developed by the Joanna Briggs Institute. We analyzed the effects of biofeedback-based interventions on psychological outcomes in the pediatric population by following the Preferred Reporting System for Systematic Reviews and Meta-Analysis. This systematic review and meta-analysis included nine studies with a total sample size of 658 children. In this study, EEG, EMG, and heart rate variability biofeedback were utilized to treat psychological symptoms in children. All studies focused on anxiety, with only one studying depression. As a result, it was found that all types of biofeedback effectively reduced children's anxiety levels. It was recommended that biofeedback-based interventions should be used to reduce children's anxiety.

Autism Spectrum, Hikikomori Syndrome and Internet Gaming Disorder: Is There a Link?

The aim of this study is to review the available literature investigating the relationship between hikikomori, a pathological condition characterized by severe social withdrawal or isolation, autism spectrum disorder (ASD) and Internet gaming disorder (IGD). Studies on the relationship between ASD and IGD have found significant positive correlations between these two conditions. Individuals with ASD would appear to be at risk of developing a problematic use of the Internet, which, to the right extent, would represent a useful tool for social interaction and cognitive development. Even subjects with hikikomori, in whom rarefied interpersonal relationships and social isolation could be balanced by the use of online connections, appear to be at high risk of developing IGD. On the other hand, the finding of significant autistic traits in populations with hikikomori could lead to considering this psychopathological condition as a particular presentation of autism spectrum, a hypothesis that requires further investigation.

The Use of Binaural Based Spatial Audio in the Reduction of Auditory Hypersensitivity in Autistic Young People

Individuals diagnosed with autism spectrum disorder (ASD) are characterised as experiencing impairments in social-emotional interaction and communication, alongside frequently displaying repetitive behaviours and interests. Further to this, they are often described as experiencing difficulties in processing sensory information, with particular prevalence within the auditory modality. Provoked by common environmental sounds, auditory hypersensitivity can result in self-regulatory fear responses. Rather than a physiological pain reaction, literature suggests that these hypersensitivities are resulting through irrational fear of the sounds. This investigation evaluates the use of binaural based spatial audio as a rendering technique for delivering realistic simulations of averse stimuli within a virtual reality (VR) exposure based computer game intervention for auditory hypersensitivity in autism. Over multiple experimental sessions, 20 autistic participants experiencing auditory hypersensitivity were exposed to either spatial audio or stereo renders of target stimuli during the intervention. Measurements of self-reported emotions displayed significant reductions in associated negative emotional reactions to target stimuli for all participants. However, significant improvements were experienced by those listening to spatial audio simulations. Moreover, tracked voluntary interactions with exposure based game-mechanics increased as the study progressed. Providing further evidence of increased tolerance towards averse auditory stimuli.

Digital Interventions for Emotion Regulation in Children and Early Adolescents: Systematic Review and Meta-analysis

Background

Difficulties in emotion regulation are common in adolescence and are associated with poor social and mental health outcomes. However, psychological therapies that promote adaptive emotion regulation may be inaccessible and unattractive to youth. Digital interventions may help address this need.

Objective

The aim of this systematic review and meta-analysis was to synthesize evidence on the efficacy, feasibility, and acceptability of emotion regulation digital interventions in children and early adolescents aged 8 to 14 years.

Methods

Systematic searches of Web of Science, MEDLINE, PsycINFO, EMBASE, Education Resources Information Centre, ACM Digital Library, and IEEE Xplore up to July 2020 identified 39 studies, of which 11 (28%) were included in the meta-analyses (n=2476 participants). A bespoke tool was used to assess risk of bias.

Results

The studies evaluated digital games (27/39, 69%), biofeedback (4/39, 10%), virtual or augmented reality (4/39, 10%), and program or multimedia (4/39, 10%) digital interventions in samples classified as diagnosed, at risk, healthy, and universal. The most consistent evidence came from digital games, which reduced negative emotional experience with a small significant effect, largely in youth at risk of anxiety (Hedges g=–0.19, 95% CI –0.34 to –0.04). In general, digital interventions tended to improve emotion regulation, but this effect was not significant (Hedges g=0.19, 95% CI –0.16 to 0.54).

Conclusions

Most feasibility issues were identified in diagnosed youth, and acceptability was generally high across intervention types and samples. Although there is cause to be optimistic about digital interventions supporting the difficulties that youth experience in emotion regulation, the predominance of early-stage development studies highlights the need for more work in this area.

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis

BACKGROUND

Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.

OBJECTIVE

This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.

METHODS

We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.

RESULTS

Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low-quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03).

CONCLUSIONS

This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis

BACKGROUND

Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings.

OBJECTIVE

This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies.

METHODS

A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine "Google Scholar," and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games).

RESULTS

From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003).

CONCLUSIONS

Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969.

Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions

Mental health problems in childhood and adolescence (e. g., attention deficits, problems in emotional understanding and subclinical levels of anxiety) are reported to develop further in adulthood and/or to increase the risk of developing mental health disorders in adulthood. Although it is important to provide treatment or prevention interventions for children and adolescents in order to reduce the risk of the further development of mental health problems, the pharmacological and behavioral treatments for this age group have limitations (e.g., limited access, unsustainable treatment effects and the lack of engagement in intervention). In order to overcome the limitations of conventional treatments, the use of digital technology, especially video games for this age group, is suggested. In order to be accepted as clinical interventions, objective evidence for the therapeutic effects of digital therapeutic that used video games to treat or prevent targeted mental health problems are required. Thus, this review aims to explore whether game-based digital therapeutics (DTx) for children and adolescents showed therapeutic effects on targeted mental health problems. As game-based DTx are suggested to show sustained therapeutic effects and the transfer of cognitive functions, it also reviews the maintenance of the therapeutic effects of DTx and the extent of the transfer of cognitive functions. Game-based DTx that are developed to treat or prevent mental health problems (e.g., attention deficit, depression) in children and adolescents are found to show therapeutic effects on targeted mental health problems despite the limitations (e.g., small sample size, limited investigation of the sustainability). This review would contribute to the understanding of whether there is objective evidence of the therapeutic effects of digital therapeutics using video games that deliver treatment or prevention interventions for mental health problems in children and adolescents.

So your patient is a gamer: an exploration of benefits and harms

PURPOSE OF REVIEW

The appropriate amount and type of screen time for children remains a persistent topic of discussion between parents and pediatricians. During the COVID-19 pandemic, screen time has considerably increased. The need to quarantine and utilize remote learning prompted our review of the basis for current screen time recommendations and more recent research.

RECENT FINDINGS

The broad stroke of recent research points to an association of increased video game screen time with sedentary lifestyle and its related harms. However, there also are specific instances where video games have been found to be therapeutically useful for certain populations.

SUMMARY

In light of these findings, it is prudent for the pediatrician to explore more of the 'why' of video game use as opposed to purely the 'how much'. Given the future beneficial therapeutic uses of some video games, clinicians should keep their eyes on this space for its continued development.

Interventions with Serious Games and Entertainment Games in Autism Spectrum Disorder: A Systematic Review

The use of serious games and entertainment games was compared as adjuvant tools for intervention in Autism Spectrum Disorder (ASD). A comprehensive search was performed in the MEDLINE, PsycINFO, Scopus, and Web of Science databases. From 295 studies, 53 studies were selected and included in this review. Overall, studies showed improvement after intervention, regardless of the type of video games, mostly for social skills and behavior. However, these changes should be regarded with caution, as they are limited to the tests applied. Furthermore, neither the entertainment nor the serious approach had a therapeutic impact on emotional resilience, representing the current gap in the field. Thus, even considering the limitations, our study is important because it shows that both categories have strengths.

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.29137]

BACKGROUND

Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.

OBJECTIVE

This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.

METHODS

We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.

RESULTS

Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (<i>P</i>=.70) and no intervention (<i>P</i>=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (<i>P</i>=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (<i>P</i>=.03).

CONCLUSIONS

This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

Reductions of Anxiety Symptoms, State Anxiety, and Anxious Arousal in Youth Playing the Videogame MindLight Compared to Online Cognitive Behavioral Therapy

Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible. MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT) to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up. Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n = 60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment. ClinicalTrials.gov Identifier: NCT02326545.

The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.32331]

BACKGROUND

Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings.

OBJECTIVE

This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies.

METHODS

A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games).

RESULTS

From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (<i>P</i>=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (<i>P</i>=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (<i>P</i>=.003).

CONCLUSIONS

Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs.

CLINICALTRIAL

PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969

The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health

Objective: Applied games are considered a promising approach to deliver mental health interventions. Nonspecific factors such as expectations and motivation may be crucial to optimize effectiveness yet have not been examined so far. The current study examined the effect of expectations for improvement on (1) experienced fun and positive affect, and (2) in-game play behaviors while playing MindLight, an applied game shown to reduce anxiety. The secondary aim was to examine the moderating role of symptom severity and motivation to change.

Materials and Methods: Fifty-seven participants (47 females; 17–21 years old) preselected on anxiety symptoms viewed a trailer in which MindLight was promoted as either a mental health or an entertainment game. These trailers were used to induce different expectations in participants. Participants subsequently played the game for 60 minutes. Before playing, participants filled out questionnaires about their general anxiety symptoms, motivation to change, state anxiety, affect, and arousal. While playing, in-game behaviors and galvanic skin response (GSR) were recorded continuously. After playing, state anxiety, affect, and arousal were measured again as well as experienced fun.

Results: Participants in both trailer conditions showed increases in state anxiety, arousal, and GSR. Expectations did not influence experienced fun and positive affect, nor in-game behaviors. In addition, no moderation effects of motivation to change and symptom severity were found.

Conclusion: Experiences and engagement with MindLight were not influenced by expectations, motivation to change, and symptom severity. For future research, it is recommended to examine individual differences in these effects, and long-term and more distal outcomes and processes.

Annual Research Review: Immersive virtual reality and digital applied gaming interventions for the treatment of mental health problems in children and young people: the need for rigorous treatment development and clinical evaluation

BACKGROUND

Mental health problems in children and young people are common and can lead to poor long-term outcomes. Despite the availability of effective psychological interventions for mental health disorders, only a minority of affected children and young people access treatment. Digital interventions, such as applied games and virtual reality (VR), that target mental health problems in children and young people may hold a key to increasing access to, engagement with, and potentially the effectiveness of psychological treatments. To date, several applied games and VR interventions have been specifically developed for children and young people. This systematic review aims to identify and synthesize current data on the experience and effectiveness of applied games and VR for targeting mental health problems in children and young people (defined as average age of 18 years or below).

METHODS

Electronic systematic searches were conducted in Medline, PsycINFO, CINAHL, and Web of Science.

RESULTS

Nineteen studies were identified that examined nine applied games and two VR applications, and targeted symptoms of anxiety, depression, and phobias using both quantitative and qualitative methodologies. Existing evidence is at a very early stage and studies vary extensively in key methodological characteristics. For applied games, the most robust evidence is for adolescent depressive symptoms (medium clinical effect sizes). Insufficient research attention has been given to the efficacy of VR interventions in children and young people.

CONCLUSIONS

The evidence to date is at a very early stage. Despite the enthusiasm for applied games and VR, existing interventions are limited in number and evidence of efficacy, and there is a clear need for further co-design, development, and evaluation of applied games and VR before they are routinely offered as treatments for children and young people with mental health problems.

Online Videogames Use and Anxiety in Children during the COVID-19 Pandemic

Videogames use has constantly increased among children and adolescents, with uncertain consequences on their health. This study aimed to assess the prevalence of videogames use and addiction in a sample of Italian children during the COVID-19 pandemic and their association with anxiety symptoms. One hundred and sixty-two children (M/F:78/84; age range: 8–10 years; average age 9.4 ± 0.7 years) completed the Videogame Addiction Scale for Children (VASC), the Test of Anxiety and Depression (TAD) and the Children’s Anxiety Meter—State (CAM-S). Demographic variables and data on the access to electronic tools and games preferences were also collected. Overall, 96.3% of the study participants stated to have access to one or more device. They reported a low risk of videogame addiction (VASC score (mean ± SD): 46.7 ± 15.4), a moderate level of trait anxiety (TAD score (mean ± SD): 135 ± 16.8) and a low state anxiety (CAM-S score (mean ± SD): 2.2 ± 2.1). Males reported to spend more time on videogames, to perceive higher self-control and to be more influenced by reinforcement mechanisms; females described higher levels of trait anxiety. In the regression analysis, state anxiety was a predictor of videogame use and addiction (p = 0.01). Further research is needed to confirm these data and to maximize the developmentally positive effects of videogames and preventing the negative consequences.

Video Games for the Treatment of Autism Spectrum Disorder: A Systematic Review

Video games are a promising area of intervention for children diagnosed with Autism Spectrum Disorders (ASD). However, reviews on this topic are scarce. This review on studies exploring video games for the treatment of ASD followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and its protocol was registered in PROSPERO. PubMed, PsycInfo, Embase, WebOfScience and clinicaltrials.gov databases were searched. Twenty-four articles were included in the review. Video game-based interventions were effective for alleviating ASD symptoms, albeit with small effect sizes. High rates of acceptability and adherence to treatment were obtained. Conclusion: Video games are a promising area for improving the treatment of children with ASD. Exploring commercial video games is one of the lines for future research.