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Iannazzo LH, Hayden MJ, Lawrence NS, Kakoschke N, Hughes LK, Van Egmond K, Lum J, Staiger PK. Inhibitory control training to reduce appetitive behaviour: a meta-analytic investigation of effectiveness, potential moderators, and underlying mechanisms of change. Health Psychol Rev 2024:1-30. [PMID: 39397386 DOI: 10.1080/17437199.2024.2410018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/23/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND/AIMS Inhibitory control training (ICT) is a cognitive intervention that has been suggested to reduce problematic appetitive behaviours, such as unhealthy eating and excessive alcohol consumption. We conducted a meta-analytic review of ICT for reducing appetitive behaviours. METHODS Two meta-analyses were conducted for behavioural (objective) outcomes and self-report outcomes, along with 14 moderator analyses, and two secondary analyses investigating changes in cue-devaluation and inhibitory control. RESULTS The review included 46 articles (67 effect sizes and 4231 participants) and four appetitive health behaviours (eating, drinking, smoking, gambling). A significant effect of ICT on behavioural outcomes was found (SMD = 0.241, p .001). The self-report outcomes meta-analysis was not significant (p > .05). Secondary analyses also demonstrated greater inhibitory control (p < .05) and cue devaluation (p < .05) following ICT. CONCLUSIONS This meta-analytic review is the largest synthesis of ICT interventions for appetitive behaviours. ICT significantly reduced problematic eating behaviours when adopting behavioural outcomes, but this was not found for other appetitive behaviours. ICT also significantly improved inhibitory control and reduced cue evaluations. Further studies are required before drawing any conclusions regarding impacts on other appetitive behaviours.
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Affiliation(s)
- Lauren H Iannazzo
- School of Psychology, Deakin University, Geelong, Australia
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Melissa J Hayden
- School of Psychology, Deakin University, Geelong, Australia
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | | | - Naomi Kakoschke
- School of Psychology, Flinders University, Adelaide, Australia
- Human Health, Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, Australia
| | - Laura K Hughes
- School of Psychology, Deakin University, Geelong, Australia
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | | | - Jarrad Lum
- School of Psychology, Deakin University, Geelong, Australia
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
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Rezapour T, Rafei P, Baldacchino A, Conrod PJ, Dom G, Fishbein DH, Kazemi A, Hendriks V, Newton N, Riggs NR, Squeglia LM, Teesson M, Vassileva J, Verdejo-Garcia A, Ekhtiari H. Neuroscience-informed classification of prevention interventions in substance use disorders: An RDoC-based approach. Neurosci Biobehav Rev 2024; 159:105578. [PMID: 38360332 PMCID: PMC11081014 DOI: 10.1016/j.neubiorev.2024.105578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
Neuroscience has contributed to uncover the mechanisms underpinning substance use disorders (SUD). The next frontier is to leverage these mechanisms as active targets to create more effective interventions for SUD treatment and prevention. Recent large-scale cohort studies from early childhood are generating multiple levels of neuroscience-based information with the potential to inform the development and refinement of future preventive strategies. However, there are still no available well-recognized frameworks to guide the integration of these multi-level datasets into prevention interventions. The Research Domain Criteria (RDoC) provides a neuroscience-based multi-system framework that is well suited to facilitate translation of neurobiological mechanisms into behavioral domains amenable to preventative interventions. We propose a novel RDoC-based framework for prevention science and adapted the framework for the existing preventive interventions. From a systematic review of randomized controlled trials using a person-centered drug/alcohol preventive approach for adolescents, we identified 22 unique preventive interventions. By teasing apart these 22 interventions into the RDoC domains, we proposed distinct neurocognitive trajectories which have been recognized as precursors or risk factors for SUDs, to be targeted, engaged and modified for effective addiction prevention.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Parnian Rafei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Alex Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Patricia J Conrod
- CHU Sainte-Justine Research Center, Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Belgium
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, NC, USA; College of Health and Human Development, Pennsylvania State University, PA, USA
| | - Atefeh Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, The Hague 2512 HN, the Netherlands; Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, Netherlands
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Nathaniel R Riggs
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Lindsay M Squeglia
- Medical University of South Carolina, Psychiatry and Behavioral Sciences, Charleston, SC, USA
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Jasmin Vassileva
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, VIC, Australia
| | - Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
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Schilt T, Ruijter ES, Godeschalk N, van Haaster M, Goudriaan AE. The Use of Smartphone Serious Gaming Apps in the Treatment of Substance Use Disorders: Observational Study on Feasibility and Acceptability. JMIR Form Res 2022; 6:e34159. [PMID: 36066923 PMCID: PMC9490544 DOI: 10.2196/34159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/10/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Addiction is a worldwide problem with major health complications. Despite intensive treatment, relapse rates remain high. The prevalence of cognitive impairment is high in patients with substance use disorders (SUDs) and is associated with treatment dropout and relapse. Evidence indicates that cognitive function training in persons with SUDs may support treatment. Therefore, the use of web-based tools to test and train cognitive functions is of increasing interest. Objective The goal of this study was to determine the feasibility and acceptability of a serious gaming smartphone app to test and train cognitive functions in addition to the treatment of SUDs. Methods A prospective observational study was conducted with 229 patients seeking addiction treatment. The patients were offered 2 smartphone apps in addition to regular care: MyCognition Quotient (MyCQ) assessed cognitive functions and AquaSnap trained these functions. The feasibility was determined based on acceptance rates. The acceptability of the smartphone apps was qualitatively analyzed based on the answers to a questionnaire. Patient characteristics were compared between patients who played and did not play smartphone games. Explorative correlation analyses were performed between the playing time and cognitive assessment scores. Results Of the 229 patients who were offered the apps, 110 completed the MyCQ assessment, and 59 started playing AquaSnap, yielding acceptance rates of 48.0% and 25.8%, respectively. The group that completed the MyCQ assessment was significantly more educated than the group that did not download the apps (χ22=7.3; P=.03). The education level did not differ significantly between the group that played AquaSnap and the group that did not (P=.06). There were relatively more women in the AquaSnap playing group than in the nonplaying group (χ21=6.5; P=.01). The groups did not differ in terms of age, substance use, treatment setting, mood, or quality of life. With respect to acceptability, 83% (38/46) of the patients who filled out the questionnaire enjoyed taking the MyCQ measurement, whereas 41% (14/34) enjoyed playing the AquaSnap game. Furthermore, 76% (35/46) and 68% (23/34) rated the apps MyCQ and AquaSnap, respectively, as easy. More playing minutes was associated with decreased working memory reaction time and executive functioning accuracy. Conclusions Our study showed that the use of a smartphone app for cognitive assessment in patients with SUDs who are interested and highly educated is feasible and acceptable for the subgroup that was asked to fill out a perception questionnaire. However, the use of a smartphone app for cognitive training was less feasible for this group of patients. Improvement of the training application and enhancement of the motivation of clients are needed. Despite these limitations, the present results provide support for future research investigating the use of smartphone apps for cognitive assessment and training in relation to the treatment of SUDs.
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Affiliation(s)
- Thelma Schilt
- Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychology, Brain&Cognition, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elvira Sharine Ruijter
- Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- VU-University Medical Center, School of Medical Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nikky Godeschalk
- Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychology, Brain&Cognition, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marit van Haaster
- Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychology, Brain&Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Anna E Goudriaan
- Jellinek, Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Research and Quality of Care, Arkin Mental Health Care, Amsterdam, Netherlands
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Redlinger E, Glas B, Rong Y. Impact of Visual Game-Like Features on Cognitive Performance in a Virtual Reality Working Memory Task: Within-Subjects Experiment. JMIR Serious Games 2022; 10:e35295. [PMID: 35482373 PMCID: PMC9100375 DOI: 10.2196/35295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the pursuit of improved cognitive function through working memory training has been the subject of decades of research, the recent growth in commercial adaptations of classic working memory tasks in the form of gamified apps warrants additional scrutiny. In particular, the emergence of virtual reality as a platform for cognitive training presents opportunities for the use of novel visual features. OBJECTIVE This study aimed to add to the body of knowledge regarding the use of game-like visual design elements by specifically examining the application of two particular visual features common to virtual reality environments: immersive, colorful backgrounds and the use of 3D depth. In addition, electroencephalography (EEG) data were collected to identify potential neural correlates of any observed changes in performance. METHODS A simple visual working memory task was presented to participants in several game-like adaptations, including the use of colorful, immersive backgrounds and 3D depth. The impact of each adaptation was separately assessed using both EEG and performance assessment outcomes and compared with an unmodified version of the task. RESULTS Results suggest that although accuracy and reaction time may be slightly affected by the introduction of such game elements, the effects were small and not statistically significant. Changes in EEG power, particularly in the beta and theta rhythms, were significant but failed to correlate with any corresponding changes in performance. Therefore, they may only reflect cognitive changes at the perceptual level. CONCLUSIONS Overall, the data suggest that the addition of these specific visual features to simple cognitive tasks does not appear to significantly affect performance or task-dependent cognitive load.
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Affiliation(s)
- Eric Redlinger
- Tokyo Institute of Technology, Institute of Innovative Research / Koike & Yoshimura Lab, Tokyo, Japan
| | | | - Yang Rong
- Tokyo Institute of Technology, Tokyo, Japan
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Egashira M, Son D, Ema A. Serious Game for Change in Behavioral Intention Toward Lifestyle-Related Diseases: Experimental Study With Structural Equation Modeling Using the Theory of Planned Behavior. JMIR Serious Games 2022; 10:e28982. [PMID: 35188465 PMCID: PMC8902675 DOI: 10.2196/28982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/01/2021] [Accepted: 11/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health activities should be tailored to individual lifestyles and values. To raise awareness of health behaviors, various practices related to health education, such as interactive activities among individuals with different backgrounds, have been developed. Moreover, serious games have been used as a tool for facilitating communication. However, there have been few investigations that are based on the framework of the theory of planned behavior on the mechanisms of health-related behavioral intention change from playing serious games. OBJECTIVE We aimed to investigate the mechanisms of behavioral intention change among various age groups after an intervention using a serious game to increase awareness of lifestyle-related diseases. METHODS Adults, undergraduates, and high school students played a serious game, called Negotiation Battle, and answered a questionnaire-Gaming Event Assessment Form for Lifestyle-related Diseases-before, immediately after, and 2-4 weeks after the game. The questionnaire was composed of 16 items based on the theory of planned behavior. We used structural equation modeling to compare responses from the 3 groups. RESULTS For all 3 age groups (adults: mean 43.4 years, range 23-67 years; undergraduates: mean 20.9 years, range 19-34 years; high school students: mean 17.9 years, 17-18 years), perceived behavior control was the key factor of behavioral intention change. Immediately after the game, causal relationships between perceived behavioral control and behavioral intention were enhanced or maintained for all groups-adults (before: path coefficient 1.030, P<.001; after: path coefficient 2.045, P=.01), undergraduates (before: path coefficient 0.568, P=.004; after: path coefficient 0.737, P=.001), and high school students (before: path coefficient 14.543, P=.97; after: path coefficient 0.791, P<.001). Analysis of free descriptions after intervention suggested that experiencing dilemma is related to learning and behavioral intention. CONCLUSIONS The study revealed that the serious game changed the behavioral intention of adolescents and adults regarding lifestyle-related diseases, and changes in perceived behavioral control mediated the alteration mechanism.
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Affiliation(s)
- Mahiro Egashira
- Division of Science Interpreter Training Program, Komaba Organization for Educational Excellence, The University of Tokyo, Tokyo, Japan
| | - Daisuke Son
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Arisa Ema
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
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Martinez K, Menéndez-Menéndez MI, Bustillo A. Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review. JMIR Serious Games 2021; 9:e30482. [PMID: 34927589 PMCID: PMC8726021 DOI: 10.2196/30482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. OBJECTIVE This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. METHODS The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. RESULTS A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. CONCLUSIONS The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology.
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Affiliation(s)
- Kim Martinez
- Department of History, Geography and Communication, University of Burgos, Burgos, Spain
| | | | - Andres Bustillo
- Department of Computer Engineering, University of Burgos, Burgos, Spain
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Hong T, Cabrera J, Beaudoin CE. The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study. J Med Internet Res 2020; 22:e21652. [PMID: 33252348 PMCID: PMC7735894 DOI: 10.2196/21652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. Objective This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. Methods In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. Results A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (β=.30). Risky alcohol decisions (β=−.22) and game time (β=.18) predicted enjoyment, which, in turn, predicted intention to drink less (β=.21) and drinking refusal self-efficacy (β=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. Conclusions The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants’ intentions to drink less and beliefs that they can refuse alcohol.
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Affiliation(s)
- Traci Hong
- College of Communication, Boston University, Boston, MA, United States
| | - Joshua Cabrera
- MHMR Authority of Brazos Valley, Bryan, TX, United States
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Yap AGH, Roy RED, Lasala JRS, Tan DK, Hechanova MR, Diy WDA, Rodrigo MMT. Evaluation of a Cognitive-Behavioral Game Design-Based Mobile Game on Alcohol Use for Adolescents. Games Health J 2020; 9:353-357. [PMID: 33054488 DOI: 10.1089/g4h.2019.0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Determine the effectiveness of a cognitive behavioral game design (CBGD) based mobile game as an alcohol use intervention. Materials and Methods: Experimental design with 140 participants randomly assigned to either play a mobile game (n = 69) or watch a video documentary (n = 71). Results: Both groups displayed a decrease in intent to use and an increase in knowledge. The video intervention was superior in affecting actual use. Conclusion: Mobile game affects intent to use and is superior to the video in affecting knowledge.
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Affiliation(s)
- Anton Gabriel H Yap
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | | | | | - Divine-Kia Tan
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Ma Regina Hechanova
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
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Santana CCDAP, Freitas ATVDS, Oliveira Barreto G, Sousa De Avelar I, Mazaro-Costa R, Bueno GN, Ribeiro DC, Damasceno Silva G, Naghettini AV. Serious Game on a Smartphone for Adolescents Undergoing Hemodialysis: Development and Evaluation. JMIR Serious Games 2020; 8:e17979. [PMID: 32924950 PMCID: PMC7522727 DOI: 10.2196/17979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/30/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023] Open
Abstract
Background Adolescents with chronic kidney disease have a hard time adhering to hemodialysis as a therapy, indicating a need to establish new alternatives for motivation and adherence to treatment. Objective The objective of this study was to develop and evaluate a serious game to stimulate and motivate adolescents undergoing hemodialysis. Methods We describe the technological production followed by a qualitative analysis. We invited 8 adolescents undergoing hemodialysis in the city Goiânia, located in the midwest of Brazil, to participate. The final convenience sample included 7 (87.5% of the target population) adolescents. The process was conducted in 3 phases: creation of a serious game, evaluation of its use, and observation of its motivating effect on behavioral modification with a focus on acquiring the necessary competence for self-care. Results An app (Bim) in the modality of a serious game was developed to be used during hemodialysis; the player was encouraged to take care of a character with daily actions during his or her treatment. The game was made available to adolescents aged 10-14 years. Mobile devices were offered during the hemodialysis treatment for a period of 30-40 minutes, 3 times a week for 60 days. The usage definitions of the game were freely chosen by the participants. The qualitative evaluation of the use of the Bim app showed that it encompasses scenarios and activities that enable the exercise of daily actions for the treatment of patients. The behavioral evaluation showed that the Bim app worked as a motivating stimulus for behavioral adherence to hemodialysis requirements. Conclusions The easy-to-access app interface showed good operability for its users. The description of the character and proposed activities contributed to motivation and ability to cope with hemodialysis care.
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Affiliation(s)
| | | | | | | | | | - Gina Nolêto Bueno
- Departament of Psychology, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Diuly Caroline Ribeiro
- Faculty of Medicine, Postgraduate Program Teaching in Health, Goias Federal University, Goiânia, Brazil
| | - Gabriela Damasceno Silva
- Faculty of Medicine, Postgraduate Program Teaching in Health, Goias Federal University, Goiânia, Brazil
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Vermeir JF, White MJ, Johnson D, Crombez G, Van Ryckeghem DML. The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis. JMIR Serious Games 2020; 8:e18644. [PMID: 32773374 PMCID: PMC7445616 DOI: 10.2196/18644] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background There has been a growing interest in the application of gamification (ie, the use of game elements) to computerized cognitive training. The introduction of targeted gamification features to such tasks may increase motivation and engagement as well as improve intervention effects. However, it is possible that game elements can also have adverse effects on cognitive training (eg, be a distraction), which can outweigh their potential motivational benefits. So far, little is known about the effectiveness of such applications. Objective This study aims to conduct a systematic review and meta-analysis to investigate the effect of gamification on process outcomes (eg, motivation) and on changes in the training domain (eg, cognition), as well as to explore the role of potential moderators. Methods We searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ProQuest Psychology, Web of Science, Scopus, PubMed, Science Direct, Excerpta Medica dataBASE, Institute of Electrical and Electronics Engineers Xplore, Association for Computing Machinery, and a range of gray-area literature databases. The searches included papers published between 2008 and 2018. Meta-analyses were performed using a random-effects model. Results The systematic review identified 49 studies, of which 9 randomized controlled trials were included in the meta-analysis. The results of the review indicated that research in this context is still developing and lacks well-controlled empirical studies. Gamification in cognitive training is applied to a large range of age groups and audiences and is mostly delivered at a research site through computers. Rewards and feedback continue to dominate the gamification landscape, whereas social-oriented features (eg, competition) are underused. The meta-analyses showed that gamified training tasks were more motivating/engaging (Hedges g=0.72) and more demanding/difficult (Hedges g=–0.52) than non- or less-gamified tasks, whereas no effects on the training domain were found. Furthermore, no variables moderated the impact of gamified training tasks. However, meta-analytic findings were limited due to a small number of studies. Conclusions Overall, this review provides an overview of the existing research in the domain and provides evidence for the effectiveness of gamification in improving motivation/engagement in the context of cognitive training. We discuss the shortcomings in the current literature and provide recommendations for future research.
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Affiliation(s)
- Julie F Vermeir
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Melanie J White
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Daniel Johnson
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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11
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Flaudias V, Zerhouni O, Chakroun-Baggioni N, Pires S, Schmitt A, De Chazeron I, Llorca PM, Brousse G. Reducing Attentional Bias in Individuals With Alcohol Use Disorders With a Tablet Application: A Randomized Controlled Trial Pilot Study. Alcohol Alcohol 2020; 55:51-55. [PMID: 31724703 DOI: 10.1093/alcalc/agz080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/07/2019] [Accepted: 09/03/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Cognitive bias modification (CBM) training has been considered a promising and effective intervention tool for reducing cognitive biases toward alcohol. However, the link between the cognitive process and actual behavior remains statistically insignificant because computerized tasks do not have sufficient ecological validity and suffer from high dropout rates. The recent development of 'serious games' has shown encouraging results in maintaining adherence to health-related interventions. We aim to evaluate a CBM program using a gamified attentional bias (AB) training procedure on a touchpad for individuals with alcohol use disorders. METHODS Forty-one patients were included in this study, 33 of whom displayed an AB and were randomly assigned into the 'CBM group' (N = 18, 16.7% women) or 'Memory group'-which involved playing a memory game-(N = 15, no woman). Eight other participants (12.5% women) with no AB comprised the 'Without AB group'. Efficacy was assessed for AB, craving, and inhibition and attentional capacities before and after the program. RESULTS We observed that the reduction of AB was higher for the 'CBM group' (Mbefore = 153.61, SD = 172.21; Mafter = 18.00, SD = 77.71; t (17) = 4.21, P = 0.001) than for the 'Memory group' (Mbefore = 73.20, SD = 66.65; Mafter =42.47, SD = 113.77; ts < 1). The analysis showed that for the 'Without AB group', there was no significant difference in AB (t (7) = -2.15, P = .07) after the program. CONCLUSIONS This study demonstrated an increased reduction of AB for patients included in the CBM program on a touchpad than for patients playing only a memory game.
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Affiliation(s)
- Valentin Flaudias
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France.,Université Clermont Auvergne, EA NPsy-Sydo, 28 Place Henri Dunant BP 10448, F-63000 Clermont-Ferrand, France
| | - Oulmann Zerhouni
- Université Paris Nanterre, Laboratoire Parisien de Psychologie Sociale, 200 avenue de la République. F-92000 Nanterre, France
| | - Nadia Chakroun-Baggioni
- Université Clermont Auvergne, CNRS UMR 6024, LAPSCO, 34 Avenue Carnot F-63000 Clermont-Ferrand, France
| | - Sylvie Pires
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France
| | - Audrey Schmitt
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France
| | - Ingrid De Chazeron
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France.,Université Clermont Auvergne, EA NPsy-Sydo, 28 Place Henri Dunant BP 10448, F-63000 Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France.,Université Clermont Auvergne, EA NPsy-Sydo, 28 Place Henri Dunant BP 10448, F-63000 Clermont-Ferrand, France
| | - Georges Brousse
- Clermont-Ferrand, Pôle Psychiatrie B, CHU Clermont-Ferrand, 58 Rue Montalembert F-63001 Clermont-Ferrand, France.,Université Clermont Auvergne, EA NPsy-Sydo, 28 Place Henri Dunant BP 10448, F-63000 Clermont-Ferrand, France
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12
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Zayeni D, Raynaud JP, Revet A. Therapeutic and Preventive Use of Video Games in Child and Adolescent Psychiatry: A Systematic Review. Front Psychiatry 2020; 11:36. [PMID: 32116851 PMCID: PMC7016332 DOI: 10.3389/fpsyt.2020.00036] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Darius Zayeni
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,UMR 1027, Inserm, Université Toulouse III, Toulouse, France
| | - Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,UMR 1027, Inserm, Université Toulouse III, Toulouse, France
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13
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Carvalho DBF, Domingueti DB, Almeida Santos SMD, Dias DRC. A Game to Deal With Alcohol Abuse (Jib): Development and Game Experience Evaluation. JMIR Serious Games 2019; 7:e11151. [PMID: 31617849 PMCID: PMC6819970 DOI: 10.2196/11151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/31/2018] [Accepted: 02/10/2019] [Indexed: 11/24/2022] Open
Abstract
Background Alcohol abuse is the primary cause of (public) health problems in most parts of the world. However, it is undeniable that alcohol consumption is a practice that is widely accepted socially in many places, even being protected by law as a cultural and historical heritage. The issue of alcohol abuse is complex and urgent, and consequently, it is necessary to create innovative approaches such as the proposal explored in this study. Objective This study aimed to explore the development and evaluation of a serious game for smartphones to present a novel approach to address the issue of alcohol abuse. Methods A serious game was developed to instill the consequences of alcohol abuse into the player through experimentation in the game. In the game, the consequences of alcohol use are demonstrated by increasing the game speed that gives an illusion of fun but also leads to a premature death. The evaluation employed an assessment based on the Alcohol Use Disorders Identification Test (AUDIT) and the Game Experience Questionnaire (GEQ). The participants belonged to the university student’s house. Results The game development process has been presented, including its mechanics and gameplay. The game has the style of action and adventure games in which the player controls an indigenous avatar that can deflect or attack opponents coming his or her way. The game evaluation comprised an assessment based on 23 participants, aged 20 to 29 years. According to the AUDIT assessment, 18 participants reported having a low or nonexistent degree of alcohol dependence and 5 declared average dependence. Regarding their habit of playing games on smartphones, 9 participants declared they have this habit of playing (habitual players), and among the 14 that did not have this habit of playing (nonhabitual players), 3 participants declared not having a smartphone at all. The GEQ core assessment showed a higher positive affect among the participants with a habit of playing games, scoring 2.80 (habitual players) on a scale of 4.0 versus 1.61 (nonhabitual players), and higher tension as an opposite relationship of 0.81 (nonhabitual players) versus 0.37 (habitual players). The overall GEQ evaluation showed that the game presents a more positive than negative affect on all users, besides showing the other desirable characteristics of serious games. Conclusions We present a new way of dealing with the issue of alcohol abuse through a game designed for smartphones. It promotes an overall positive user experience, having a greater impact on users accustomed to games. The proposed approach has its niche, though it is still a minority in the evaluated population. Further research should explore new game features, such as new styles, to make the game more attractive to a wider audience, in addition to performing an in-depth study on the effects of playing it.
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Affiliation(s)
| | - Daniel Bueno Domingueti
- Federal University of São João del-Rei, Departament of Computer Science, São João del-Rei, Brazil
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14
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Khalili-Mahani N, Smyrnova A, Kakinami L. To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction. J Med Internet Res 2019; 21:e11485. [PMID: 30938685 PMCID: PMC6465981 DOI: 10.2196/11485] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 12/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual's subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage. OBJECTIVE Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors. METHODS A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0). RESULTS Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ23=20.5; P<.001), gaming (χ23=35.6; P<.001), and social networking (χ23=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted. CONCLUSIONS We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress.
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Affiliation(s)
- Najmeh Khalili-Mahani
- PERFORM Centre, Design and Computation Arts, Concordia University, Montreal, QC, Canada.,McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Anna Smyrnova
- PERFORM Centre, Department of Mathematics and Statistics, Concordia University, Montreal, QC, Canada
| | - Lisa Kakinami
- PERFORM Centre, Department of Mathematics and Statistics, Concordia University, Montreal, QC, Canada
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15
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Boendermaker WJ, Gladwin TE, Peeters M, Prins PJM, Wiers RW. Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial. JMIR Serious Games 2018; 6:e10. [PMID: 29792294 PMCID: PMC5990857 DOI: 10.2196/games.8364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/17/2018] [Accepted: 02/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train. OBJECTIVE This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition. METHODS A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. RESULTS Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. CONCLUSIONS We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.
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Affiliation(s)
- Wouter J Boendermaker
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Thomas E Gladwin
- Department of Psychology & Counselling, University of Chichester, Chichester, United Kingdom
| | - Margot Peeters
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Pier J M Prins
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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