Serious Games as a Therapeutic Tool in Pediatric Urology: A Review of Current Applications and Future Directions

This paper examines the use of serious games that integrate engaging gameplay with educational and therapeutic benefits with a particular focus on their application in urology. The study reviews both domestic and international cases to evaluate the current practices and implications of these digital therapies. While serious games have been widely utilized in the treatment of pediatric cancer and psychiatric disorders-areas that require long-term care and management-their application in urology, in particular pediatric urology, has been limited. Although digital therapies like serious games are still emerging in the field of urology, they hold promise as effective supplements to traditional treatments while offering new options for managing a range of urological conditions. Pediatric conditions such as bedwetting, urinary incontinence, and dysuria, which often benefit from long-term training and habit formation, are particularly well-suited to this approach. By helping pediatric patients better understand and manage their symptoms, serious games can play a supportive role in the treatment process and have shown positive medical outcomes. This paper reviews the definitions and therapeutic effects of serious games, analyzes their current use in the medical field, and argues for their increased application in treating pediatric urinary conditions.

Psychometric Properties of the Spanish Motives for Online Gaming Questionnaire in a Sample of College Students

This study investigates the psychometric properties of the Spanish version of the Motives for Online Gaming Questionnaire (MOGQ). We explored the factor structure and construct validity of the MOGQ through its relationships with gaming disorder symptoms (IGD-20) and impulsivity traits. We also analyzed if sociodemographic variables and gaming habits were related to gaming motives. An online cross-sectional survey was completed by 845 college students. Structure validity was examined using a combination of exploratory and confirmatory factor analyses, which supported a bifactor model composed of a general motivation factor and six uncorrelated factors (a mixed factor composed of escape and coping, competition, recreation, skill, social, and fantasy). Omega-hierarchical and omega coefficients were used to determine reliability of the MOGQ. The scale presented acceptable reliability for the general factor (ωh = .79) and the specific factor scores (social ω = .79, escape/coping ω = .81, competition ω = .79, skill ω = .84, fantasy ω = .82, and recreation ω = .70). Positive associations were observed between the MOGQ and the IGD-20 symptoms, with escape/coping (r = .48) and fantasy (r =.40) showing the strongest ones. Null or low correlations were observed with impulsivity traits. Motives to play varied significantly across genders. These findings provide evidence that the Spanish version of the MOGQ is a reliable and valid tool to assess motives to play online games.

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.

Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial

BACKGROUND

Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line.

METHODS

The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3).

DISCUSSION

The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents.

TRIAL REGISTRATION

The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

Putting the Gaming Experience at the Center of the Therapy-The Video Game Therapy® Approach

Video games have been increasingly used as a form of therapy for various mental health conditions. Research has shown that video games can be used to treat conditions such as depression, anxiety, PTSD, and addiction. One of the main benefits of video games in therapy is that they can provide a sense of engagement and immersion that traditional therapy methods may lack. Additionally, video games can teach valuable skills such as problem solving, decision making, and coping strategies. Video games can also simulate real-life scenarios, allowing individuals to practice and improve social skills in a safe and controlled environment. Furthermore, video games can provide feedback and track progress objectively and quantifiably. This paper proposes an approach, the Video Game Therapy^® (VGT^®) approach, where game experience is put at the center of the therapy in a tailored way, connecting the individual patient's personality, the therapy's goals, and the suggested type of video game through the Myers Briggs Type Indicator (MBTI).VGT^®'s core assumption is that playing video games could facilitate patients in reaching conditions where traditional methodologies and therapeutic approaches could work best. VGT^® was elaborated according to the Adlerian therapy vision and, consequently, the different phases of Adlerian therapy and VGT^® match. Despite the use of video games in psychotherapy might have some adverse effects in specific cases, VGT^® is currently used in three associations with positive results in promoting emotional experimentation and literacy, social feeling, sense of identity, and activating cognitive processes. Future developments include expanding the use of VGT^® further to validate such results from a statistical point of view.

Experiences of Mental Health Practitioners With Empathy Computer Games

Several learning games designed for nursing training exist. Yet, there is a gap in understanding what makes learning games efficacious. The current study examined the reactions of 12 mental health nurses, therapists, social workers, and counselors during and after playing four computer games designed to induce empathy for persons with mental health disorders. Thematic analysis revealed that games accurately embodied emotional and cognitive experiences of the intended disorders. Analysis also indicated shortcomings, including games falling short in their usefulness for understanding depicted disorders. Participants indicated that the games changed their attitudes and beliefs. Findings suggest that learning games can be useful for nursing students and trainees, as well as patients' friends and family members. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 25-31.].

From Battleground to Playground: The Video Game Avatar as Transitional Phenomenon for a Transgender Patient

The language and theories of Winnicott offer a lens for examining the importance of play in the development of the queer, transgender, and/or gender-nonconforming patient and the safety that virtual spaces-specifically, video games-provide for this play. While much of the literature posits the primary therapeutic value of virtual space as the site of psychic battle, interaction with a video game avatar can also be understood as an act of queerness-as-play, a potential cornerstone of healthy identity formation that may otherwise be precluded. An example of this paradigm is given in the case report of a twenty-year-year-old transwoman who used her video game avatar as a tool in her therapeutic progress during her medical transition. For effective psychotherapy to take place, both patient and clinician must have a capacity to play. With this in mind, the clinician might best visualize the virtual space not as a battleground, but as a playground.

Biochemical Correlates of Video Game Use: From Physiology to Pathology. A Narrative Review

In the last few decades, video game playing progressively became a widespread activity for many people, in childhood as well in adulthood. An increasing amount of literature has focused on pathological and non-pathological correlates of video game playing, with specific attention towards Internet Gaming Disorder (IGD). While many neurobiological studies in this field were based on neuroimaging, highlighting structural and functional brain changes among video game users, only a limited number of studies investigated the presence of biochemical correlates of video gaming. The present work aims to summarize and review the available literature about biochemical changes linked to video game use in IGD patients as well as non-pathological users, and the differences in between. Results may shed light on risks and benefits of video games, providing directions for further research on IGD treatment and, on other hand, on the potential role of video games in therapeutic or preventive protocols for specific conditions.

Effectiveness of the REThink therapeutic online video game in promoting mental health in children and adolescents

Although evidence-based interventions exist, estimates suggest that about 60% percent of children and adolescents with mental health disorders do not receive the treatment they need. In this context, one expanding strategy for increasing access to mental health care for children and adolescents is the use therapeutic, or serious, games. REThink is one such therapeutic game, developed to offer a CBT-based prevention that was documented in a controlled trial to develop psychological resilience in children and adolescents, aged between 10 and 16, helping them learn healthy strategies for coping with dysfunctional negative emotions such as anxiety, anger and depression. This study aims to test the effectiveness of the REThink therapeutic online video game in promoting emotional health in children and adolescents in a pilot study. Participants (N = 31), aged between 10 and 16 years, were recruited on a volunteer basis from a school. Emotional problems, irrational beliefs, negative automatic thoughts, rational beliefs, and problem solving abilities were assessed pre- and post-using the therapeutic game. We also measured participants' satisfaction with the game. Results obtained show improvements in terms of emotional problems of the youths, their irrational beliefs, negative automatic thoughts and high levels of intervention satisfaction. of this study are in support of the previous findings suggesting that the REThink online game can be a valuable tool for large-scale mental health efforts aimed at the prevention of emotional disorders in children and adolescents, in accordance with evidence-based prevention protocols.

A "Proof of Concept" Randomized Controlled Trial of a Video Game Requiring Emotional Regulation to Augment Anger Control Training

Emotional dysregulation leading to clinically significant anger and aggression is a common and substantial concern for youth and their families. While psychotropic medications and cognitive behavioral therapies can be effective, these modalities suffer from drawbacks such as significant side effects, high rates of attrition, and lack of real-world skill translation. Regulate and Gain Emotional Control (RAGE-Control) is a video game designed as an engaging augment to existing treatments. The game facilitates emotional regulation skill building through practice modulating physiological arousal while completing a challenging inhibitory task. We compared reduction in anger, aggression, oppositionality, and global severity between two treatment conditions: Anger Control Training (ACT) augmented with RAGE-Control and ACT with a sham version of the game, in a pilot double-blind randomized controlled trial. To begin to understand mechanisms of change, we examined heart rate during game play over the course of the study and explored associations between symptom changes and heart rate changes. Materials and Methods: Forty youth with clinically significant anger dyscontrol (age 10-17) were randomly assigned to 10 sessions of ACT with RAGE-Control or ACT with sham video game. Results: Both treatments similarly reduced self-reported anger. However, ACT with RAGE-Control led to larger improvements in aggression (CI: -17 to -1.0, ES: 0.55, p = 0.015); oppositionality (CI: -9.0 to -7e-6, ES: 0.48, p = 0.032); and global severity (CI: -1.0 to -5e-6, ES: 0.51, p = 0.023) relative to sham. Participants in the RAGE-Control group saw a decrease in median heart rate during game play (β = 1.2, p < 0.001). Larger pre to post decreases in heart rate were significantly associated with larger pre to post decreases in aggression and oppositional behaviors. Discussion: Augmenting ACT with RAGE-Control reduced behavioral expression of anger, but not the experience of angry feelings, as compared to ACT with a sham version of the game. Increased heart rate control, demonstrated by reduction in median heart rate during gameplay, was associated with decreased aggression and oppositional behavior. Together these findings support that augmenting traditional treatment with technology facilitating heart rate control through skill practice translates to enhancements in real-life behavioral change. Therefore, further exploration into engaging skill-focused games such as RAGE-Control is warranted. Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01551732.

Therapeutic and Preventive Use of Video Games in Child and Adolescent Psychiatry: A Systematic Review

BACKGROUND

Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents.

METHODS

Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included.

RESULTS

Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted.

CONCLUSION

Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.

Relationships Among Violent and Non-Violent Video Games, Anxiety, Self-Esteem, and Aggression in Female and Male Gamers

This study examines the differences in anxiety, self-esteem, and aggression levels between players of violent and non-violent video game and its connection to gender and age. This survey-based research utilizes survey data from 851 video gamers. The study included 61% men and 39% women. The ages of the participants ranged from 18 to 45. Participants were administered an anonymous survey including demographics, a questionnaire for video game habits, Rosenberg's self-esteem scale, a state anxiety inventory (STAI-S), and the Buss-Perry Aggression Questionnaire (BPAQ). The results revealed significant differences between males and females, as well as between younger and older gamers. Despite the majority of research showing a positive relationship between violent video game exposure and aggression levels, the results suggest that of the preference for a violent video game over a non-violent one is not, in itself, a cause for increased anxiety, self-esteem, and aggression levels.

Smartphone and video game use and perceived effects in a community mental health service

BACKGROUND

Gaming is a growing area and there are conflicting reports on its harms and benefits. There is also increasing interest in the use of gaming clinically.

AIMS

This research aims to enhance our understanding of video and smartphone game use, and perceptions, among outpatients attending an Irish general adult mental health service.

METHODS

An anonymised, opportunistic survey of outpatients attending an Irish general adult mental health service was completed. Respondents were self-selecting and self-administering of the survey.

RESULTS

The response rate was 13% (n = 93). Younger patients were significantly more likely to own a smartphone (p = 0.00). Those who played videogames were significantly younger than those who did not (p = 0.00). Younger age groups were significantly more likely to have heard of (p = 0.00), and used (p = 0.01), Pokémon GO. Over 19% (n = 18) of respondents played video games. Nearly 24% (n = 16) of those with a smartphone played games on it daily. No respondents reported specifically using games for health reasons. The two individuals who found Pokémon GO usage increased their exercise levels, also reported mental health benefits from it. Individuals' gaming use and age did not significantly impact on whether they were positive or negative in their opinions towards video and smartphone games.

CONCLUSIONS

There is an opportunity to deliver interventions to Irish mental health service outpatients through smartphone and video games. Our small study suggests this to be underutilised currently. As more frequent users, perhaps younger individuals would most benefit from gamification of interventions and the use of existing games that have possible physical and mental health benefits. This requires further research.

Video Games as a Potential Modality for Behavioral Health Services for Young Adult Veterans: Exploratory Analysis

BACKGROUND

Improving the reach of behavioral health services to young adult veterans is a policy priority.

OBJECTIVE

The objective of our study was to explore differences in video game playing by behavioral health need for young adult veterans to identify potential conditions for which video games could be used as a modality for behavioral health services.

METHODS

We replicated analyses from two cross-sectional, community-based surveys of young adult veterans in the United States and examined the differences in time spent playing video games by whether participants screened positive for behavioral health issues and received the required behavioral health services.

RESULTS

Pooling data across studies, participants with a positive mental health screen for depression or posttraumatic stress disorder (PTSD) spent 4.74 more hours per week (95% CI 2.54-6.94) playing video games. Among participants with a positive screen for a substance use disorder, those who had received substance use services since discharge spent 0.75 more days per week (95% CI 0.28-1.21) playing video games than participants who had not received any substance use services since discharge.

CONCLUSIONS

We identified the strongest evidence that participants with a positive PTSD or depression screen and participants with a positive screen for a substance use disorder who also received substance use services since their discharge from active duty spent more time playing video games. Future development and evaluation of video games as modalities for enhancing and increasing access to behavioral health services should be explored for this population.

[Serious video games in pediatrics]

Playing video games has been associated with several negative effects in children. However, serious games, which are video games designed for a primary purpose other than pure entertainment, should not be neglected by pediatricians. In the field of public health, some serious games are a means to decrease drug consumption and improve sexual health behavior in adolescents. In schools, serious games can be used to change students' perception of the disease of one of their classmates, or to train students on basic life support. Serious games are also used with patients: they can distract them from a painful procedure, increase their compliance to treatments, or participate in their rehabilitation. Finally, serious games allow healthcare professionals to train on the management of various medical situations without risk. For every field of application, this review presents the rationale of the use of video games, followed by concrete examples of video games and the results of their scientific evaluation.

Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings

This paper presents the results from the application of a serious game called Stigma-Stop among a group of high school students with the aim of reducing the stigma toward mental illnesses. The video game features characters with various mental disorders (schizophrenia, depression, bipolar disorder, and panic disorder with agoraphobia) and provides information about these problems. Additionally, the game asks players about whether they have ever felt the same as the characters, if they believe the characters are psychologically well, and if they think they could help these individuals. Similarly, a variety of reactions are provided for players to choose from when they encounter the characters with these problems. A total of 552 students between the ages of 14 and 18 participated in the study, and they were randomly assigned to either the experimental group, which used Stigma-Stop, or the control group, which utilized a video game completely unrelated to mental health. Both video games were used for similar lengths of time. Following the application of Stigma-Stop, a statistically significant decrease was obtained in levels of stigma toward schizophrenia, both in terms of stereotypes and, to a greater extent, its potential dangerousness. However, this was not the case in the control group. Results thus demonstrate the video game's usefulness toward eradicating erroneous notions about serious mental disorders like schizophrenia.

Videogames as Therapy

There is a long history of using videogames in a therapeutic capacity including rehabilitation for stroke patients, people with traumatic brain injuries, burns victims, wheelchair users, Erb's palsy sufferers, children undergoing chemotherapy, children with muscular dystrophy, autistic children and individuals looking to overcome real-life challenges (including symptoms of depression) and boost their wellbeing (including boosting life satisfaction, self-efficacy and social support). This paper briefly and selectively examines a number of areas including: (1) videogames as physiotherapy and occupational therapy, (2) videogames as distractors in the role of pain management, (3) videogames and cognitive rehabilitation, (4) videogames and the development of social and communication skills among the learning disabled, (5) videogames and impulsivity/attention deficit disorders, (6) videogames and therapeutic benefits in the elderly, (7) videogames in psychotherapeutic settings, (8) videogames and health care, (9) videogames and anxiety disorders, and (10) videogames and psychological wellbeing. It is concluded that there has been considerable success when games are specifically designed to address a specific problem or to teach a certain skill. However, generalizability outside the game-playing situation remains an important consideration.

Systematic review of research investigating psychotherapy and information and communication technologies

INTRODUCTION

Information and communication technologies (ICTs) are devices, services and knowledge that reproduce, process and distribute information. Psychotherapy has been influenced by these technologies, and there is a tendency for their role to expand.

OBJECTIVE

To describe the current panorama of the scientific literature on psychotherapy and ICTs.

METHOD

This is a systematic and descriptive review. Searches were run on the electronic databases Biblioteca Virtual em Saude (BVS), PsycINFO, Scopus, PePSIC, ScienceDirect and Index Psi, using the Boolean operator AND and the descriptors psychotherapy, computers, Internet, cell phones and social networks.

RESULTS

A considerable volume of empirical research was found, published recently in many different parts of the world, especially in the United States. There is very little Brazilian research on the subject. The majority of the studies identified assess the efficacy or describe the development of techniques and psychotherapies, via ICTs, for prevention, diagnosis or treatment of mental and behavioral disorders. The psychopathology most investigated in this area is depression and it was not possible to draw conclusions on a possible trend for research into the subject to increase. The technology most investigated was the Internet and cognitive-behavioral therapy was the most common theoretical approach in these studies.

CONCLUSIONS

Systematic reviews of published studies can detect gaps in the research agenda within a specific field of knowledge.

A Feasibility Study on the Effectiveness of a Full-Body Videogame Intervention for Decreasing Attention Deficit Hyperactivity Disorder Symptoms

OBJECTIVE

The current study assessed the feasibility and effectiveness of a full-body-driven intervention videogame targeted at decreasing attention deficit hyperactivity disorder (ADHD) symptoms, specifically inattention, hyperactivity, impulsivity, and motor deficiency.

MATERIALS AND METHODS

The game was tested in a Dutch sample (N = 73) of school-aged children with elevated ADHD symptoms. Children assigned to the intervention condition played "Adventurous Dreaming Highflying Dragon," and those in the control condition played a comparable full-body-driven game without ADHD-focused training components. Games were played during six 15-minute sessions. Outcomes were teacher-rated ADHD symptoms and scores on neuropsychological tasks assessing motor skills, impulsivity, and sustained attention.

RESULTS

There was some indication of greater improvement in the intervention group in comparison to the control group in terms of teacher-rated ADHD symptoms. Both groups showed equal indication of improvement in fine motor skills, but no change was found in gross motor skills. Additionally, both groups showed a deterioration in number of hits (assessing sustained attention) on the go/no-go task. Last, the intervention group showed a greater increase in false alarms (assessing impulsivity) than the control group.

CONCLUSION

Dragon seems promising as a game-based intervention for children with ADHD. Children who played Dragon improved in several areas with only a short amount of gameplay (1.5 hours in total), and their satisfaction with the game was high. For future research, it is recommended to further inspect Dragon's influence on impulsivity and gross motor skills. Furthermore, it is recommended to disentangle, examine, and evaluate specific properties of videogames that might lead to positive behavioral change.

[New Developments in Video Games for Psychotherapy]

A literature survey on new developments in the area of video games and psychotherapy of children and adolescents was conducted. Despite the omnipresence of computers and the internet, development of therapeutic games seems rather slow. The video game Treasure Hunt was introduced in 2008 to support treatment of children with internalizing and externalizing disorders. Camp Cope-A-Lot was developed for treatment of anxious children, whereas the self-help game SPARX is directed at depressed adolescents. Rage-Control is a biofeedback game for children with anger problems. The game Zoo U aims to assess and train social skills of primary school children. Ricky and the Spider for young children with obsessive compulsive disorder is meant to support the cognitive-behavioural treatment of these patients. Clash- Back is a French game for adolescents with externalizing problems. Possible reasons for the relatively slow development of therapeutic games are the high methodological demands concerning an evaluation as well as the high costs of game development. Nonetheless, computers and the internet are bound to influence psychotherapy with children and adolescents in the long run.

Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis

INTRODUCTION

The development and use of serious games for mental health disorders are on the rise. Yet, little is known about the impact of these games on clinical mental health symptoms. We conducted a systematic review and meta-analysis of randomized controlled trials that evaluated the effectiveness of serious games on symptoms of mental disorder.

METHOD

We conducted a systematic search in the PubMed, PsycINFO, and Embase databases, using mental health and serious games-related keywords. Ten studies met the inclusion criteria and were included in the review, and nine studies were included in the meta-analysis.

RESULTS

All of the serious games were provided via personal computer, mostly on CD-ROM without the need for an internet connection. The studies targeted age groups ranging from 7 to 80 years old. The serious games focused on symptoms of depression (n = 2), post-traumatic stress disorder (n = 2), autism spectrum disorder (n = 2), attention deficit hyperactivity disorder (n = 1), cognitive functioning (n = 2), and alcohol use disorder (n = 1). The studies used goal-oriented (n = 4) and cognitive training games (n = 6). A total of 674 participants were included in the meta-analysis (380 in experimental and 294 in control groups). A meta-analysis of 9 studies comprising 10 comparisons, using a random effects model, showed a moderate effect on improvement of symptoms [g = 0.55 (95% confidence interval 0.28-0.83); P < 0.001], favoring serious games over no intervention controls.

DISCUSSION/CONCLUSION

Though the number of comparisons in the meta-analysis was small, these findings suggest that serious gaming interventions may be effective for reducing disorder-related symptoms. More studies are needed in order to attain deeper knowledge of the efficacy for specific mental disorders and the longer term effects of this new type of treatment for mental disorders.

Using a digital game for training desirable behavior in cognitive-behavioral therapy of burnout syndrome: a controlled study

Burnout is a globally increasing illness, and as a result, many forms of burnout therapy have arisen. The use of digital games can be psychotherapeutically effective because they can transform exercises that are by themselves unattractive into intrinsically motivated action. This pilot study aims to test whether a specially designed game contributes to patients learning desired behavior and achieving other specific therapeutic goals in an online cognitive-behavioral therapy (CBT)-based burnout treatment context. In total, 101 participants took part in the experiment, under four conditions: (a) Game+Therapy, (b) Therapy Only, (c) Game Only, and (d) No Game+No Therapy. Pre- and postmeasures were taken online. Results showed that the two therapy conditions (Game+Therapy and Therapy Only) showed a greater decrease in complaints and disengagement, and a stronger increase in coping skills than the nontherapy conditions (Game Only and No Game+No Therapy). As expected, the Game+Therapy condition outperformed the Therapy Only condition on combined improvement measures of burnout symptoms. However, analyses of individual measures showed no effects. It can be cautiously concluded that the therapeutic digital game may be a useful tool when embedded in a therapeutic burnout treatment program and is probably more efficient than CBT, as it is used in current practice.

Promoting Children's Health with Digital Games: A Review of Reviews

Effective, evidence-based, and interesting methods are needed for children's health promotion. Digital games can be such a method, but there is need for a summary of the evidence on the effectiveness of digital games in promoting children's health. The aim of this review of reviews was to evaluate the quality of systematic reviews, to summarize the evidence in systematic reviews and reviews related to the effectiveness of digital games in children's health promotion, and to identify gaps in knowledge. A systematic literature search was conducted in May-August 2013 from relevant databases, and 1178 references were found. In total, 15 systematic reviews and reviews met the inclusion criteria. Most of the systematic reviews were found to be medium quality on the AMSTAR checklist. Most commonly, systematic reviews and reviews evaluated active videogames. According to the results, evidence of the highest level and quality seems to support an increase in physical activity to light to moderate levels and energy expenditure, especially when playing active videogames that require both upper and lower body movements. In addition, sedentary games were shown to have potential in children's health education, especially in supporting changes in asthma- and diabetes-related behavior and in dietary habits. However, there are still several gaps in the knowledge. There is a need for further high-quality systematic reviews and research in the field of health games.

Game-based digital interventions for depression therapy: a systematic review and meta-analysis

The aim of this study was to review the existing literature on game-based digital interventions for depression systematically and examine their effectiveness through a meta-analysis of randomized controlled trials (RCTs). Database searching was conducted using specific search terms and inclusion criteria. A standard meta-analysis was also conducted of available RCT studies with a random effects model. The standard mean difference (Cohen's d) was used to calculate the effect size of each study. Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis. Four types of game interventions-psycho-education and training, virtual reality exposure therapy, exercising, and entertainment-were identified, with various types of support delivered and populations targeted. The meta-analysis revealed a moderate effect size of the game interventions for depression therapy at posttreatment (d=-0.47 [95% CI -0.69 to -0.24]). A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions. A higher effect was achieved when a waiting list was used as the control. The review and meta-analysis support the effectiveness of game-based digital interventions for depression. More large-scale, high-quality RCT studies with sufficient long-term data for treatment evaluation are needed.

Attention problems and pathological gaming: resolving the 'chicken and egg' in a prospective analysis

Pathological gaming (PG) behaviors are behaviors which interfere with other life responsibilities. Continued debate exists regarding whether symptoms of PG behaviors are a unique phenomenon or arise from other mental health problems, including attention problems. Development of attention problems and occurrence of pathological gaming in 144 adolescents were followed during a 1-year prospective analysis. Teens and their parents reported on pathological gaming behaviors, attention problems, and current grade point average, as well as several social variables. Results were analyzed using regression and path analysis. Attention problems tended to precede pathological gaming behaviors, but the inverse was not true. Attention problems but not pathological gaming predicted lower GPA 1 year later. Current results suggest that pathological gaming arises from attention problems, but not the inverse. These results suggest that pathological gaming behaviors are symptomatic of underlying attention related mental health issues, rather than a unique phenomenon.

Racial/ethnic differences in video game and Internet use among US adolescents with mental health and educational difficulties

Video game and Internet use can be associated with poor mental health and educational outcomes among adolescents. Racial/ethnic minority youth use these media more than White youth. Video game and Internet use among adolescents with mental health and educational difficulties may therefore differ by race/ethnicity in clinically meaningful ways. We analyzed a representative sample of 8th grade students in the United States from the Early Childhood Longitudinal Survey-Kindergarten (N=6,700). Stratifying by gender, we assessed racial/ethnic differences in the associations between video game and Internet use, mental health, and reading and math achievement. Significant minority-White differences were identified in associations between media use and mental health and educational achievement. Video game use was relatively high among black females with prior mental health diagnoses and Asian-American males with high internalizing symptoms. Understanding video game and Internet use among racial/ethnic minority youth with mental health and educational difficulties may improve clinical practice.

A longitudinal test of video game violence influences on dating and aggression: a 3-year longitudinal study of adolescents

BACKGROUND

In 2011 the field of video game violence experienced serious reversals with repudiations of the current research by the US Supreme Court and the Australian Government as non-compelling and fundamentally flawed. Scholars too have been calling for higher quality research on this issue. The current study seeks to answer this call by providing longitudinal data on youth aggression and dating violence as potential consequences of violent video game exposure using well-validated clinical outcome measures and controlling for other relevant predictors of youth aggression.

METHOD

A sample of 165, mainly Hispanic youth, were tested at 3 intervals, an initial interview, and 1-year and 3-year intervals.

RESULTS

Results indicated that exposure to video game violence was not related to any of the negative outcomes. Depression, antisocial personality traits, exposure to family violence and peer influences were the best predictors of aggression-related outcomes.

INTERPRETATION

The current study supports a growing body of evidence pointing away from video game violence use as a predictor of youth aggression. Public policy efforts, including funding, would best be served by redirecting them toward other prevention programs for youth violence.

The influence of television and video game use on attention and school problems: a multivariate analysis with other risk factors controlled

BACKGROUND

Research on youth mental health has increasingly indicated the importance of multivariate analyses of multiple risk factors for negative outcomes. Television and video game use have often been posited as potential contributors to attention problems, but previous studies have not always been well-controlled or used well-validated outcome measures. The current study examines the multivariate nature of risk factors for attention problems symptomatic of attention deficit hyperactivity disorder and poor school performance.

METHOD

A predominantly Hispanic population of 603 children (ages 10-14) and their parents/guardians responded to multiple behavioral measures. Outcome measures included parent and child reported attention problem behaviors on the Child Behavior Checklist (CBCL) as well as poor school performance as measured by grade point average (GPA).

RESULTS

Results found that internal factors such as male gender, antisocial traits, family environment and anxiety best predicted attention problems. School performance was best predicted by family income. Television and video game use, whether total time spent using, or exposure to violent content specifically, did not predict attention problems or GPA.

INTERPRETATION

Television and video game use do not appear to be significant predictors of childhood attention problems. Intervention and prevention efforts may be better spent on other risk factors.

Behavioral intervention technologies: evidence review and recommendations for future research in mental health

OBJECTIVE

A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes.

METHOD

This study on the findings of the technical expert panel.

RESULTS

Videoconferencing and standard telephone technologies to deliver psychotherapy have been well validated. Web-based interventions have shown efficacy across a broad range of mental health outcomes. Social media such as online support groups have produced disappointing outcomes when used alone. Mobile technologies have received limited attention for mental health outcomes. Virtual reality has shown good efficacy for anxiety and pediatric disorders. Serious gaming has received little work in mental health.

CONCLUSION

Research focused on understanding reach, adherence, barriers and cost is recommended. Improvements in the collection, storage, analysis and visualization of big data will be required. New theoretical models and evaluation strategies will be required. Finally, for BITs to have a public health impact, research on implementation and application to prevention is required.

Blazing Angels or Resident Evil? Can Violent Video Games be a Force for Good?

Violent video games have been a source of controversy in the United States and elsewhere for several decades. Considerable concern has been raised in the public and scientific communities about the alleged deleterious effects of violent games. These concerns may coincide with periodic moral panics about media's influence, particularly on youth. This paper argues that the negative effects of violent games have been exaggerated by some elements of the scientific community, fitting with past cycles of media-focused moral panics. By contrast, potential positive effects of violent video game play have been ignored in the debate on violent games. The current paper considers research in several areas, including aggression, but also the nascent research fields of visuospatial cognition, social networking, and use as educational tools. It is argued that the debate on video game violence should be broadened to include both potential negative and positive effects.