Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial

Feasibility of a novel neurofeedback system: a parallel randomized single-blinded pilot study

Neurocognitive assessment tools have been proposed to optimize, maintain, and improve perceptual-cognitive performance. Here, we investigated the feasibility and efficacy of a novel neurofeedback system, neuroMoon (nM), on cognitive abilities compared with one of the most popular perceptual-cognitive training (PCT) tools both in sports and rehabilitation called NeuroTracker (NT). Thirty-one young athletes performed a comprehensive battery of cognitive tests from the Vienna Test System before and after a 12-session computer-based cognitive training program using nM (n = 11, age 22.6 ± 3.8 years), nM sham (CON, n = 10, age 20.3 ± 1.2 years) or NT (n = 10, age 20.5 ± 1.7 years) device. A series of repeated-measures ANOVA was performed to detect changes in cognitive abilities in response to the training. Participants had faster median reaction time in both the color-naming and word-reading conditions of the Stroop test (all p < 0.005), regardless of group. Regarding the task switching test, statistical analysis indicated faster working time and mean reaction time of the incongruent stimuli, repetition task, and shifting task (all p < 0.005), nevertheless, these changes were also regardless of group. In addition, we found fewer omitted (pre: 17.5 ± 8.3, post: 6.4 ± 1.5, d = 1.311) and more correct (pre: 261.6 ± 36.1, post: 278.6 ± 38.7, d = - 1.020) post-intervention answers in the determination test, regardless of group. Finally, participants in each group performed the digit span backward test with larger post (6.42 ± 1.54) vs. pre (5.55 ± 1.43) scores following the PCT (d = - 0.801). Overall, PCT with nM as compared with NT induced similar results in cognitive abilities suggesting its potential to be used to achieve and maintain better mental performance. However, considering that the sham stimulation also induced similar improvements in cognitive abilities, future studies should clearly determine the cognitive measures that could benefit from NF training.

Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review

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.

Effectiveness of game-based meditation therapy on neurobiological stress systems in adolescents with posttraumatic symptoms: a randomized controlled trial

Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. Prolonged activation of neurobiological stress systems as the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis can result in long-lasting maladaptive alternations. This study investigated the effectiveness of Muse, a game-based meditation intervention, on the sympathetic nervous system (SNS), parasympathetic nervous system (PNS), and cortisol basal activity and reactivity to acute stress among adolescents with posttraumatic symptoms in residential care. The intervention consisted of two gameplay sessions a week, for 6 consecutive weeks. Seventy-seven adolescents with clinical levels of posttraumatic symptoms (10-18 years old) received either Muse as an addition to treatment as usual (n = 40) or treatment as usual alone (n = 37). We expected reduced basal activity for the SNS and cortisol and increased basal activity for the PNS. As for the response to acute stress, we expected decreased PNS and increased HPA axis reactivity. The Muse group exhibited lower basal activity for the SNS and increased HPA reactivity to acute stress. There were no differences between conditions on SNS and HPA axis activity during rest and on SNS and PNS reactivity to acute stress. Game-based meditation therapy is a promising intervention for the treatment of adolescents with posttraumatic symptoms in residential care. Implications for clinical relevance and trauma-focused treatment purposes are discussed.

Alterations of autonomic nervous system and HPA axis basal activity and reactivity to acute stress: a comparison of traumatized adolescents and healthy controls

Alterations in neurobiological stress systems such as the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis contribute to the development and maintenance of psychological and behavioral problems after traumatic experiences. Investigating neurobiological parameters and how these relate to each other may provide insight into the complex mechanisms at play. Whereas the preponderance of studies focuses on either the ANS or the HPA axis separately, the current study is the first to evaluate relations between posttraumatic stress and both basal activity during rest and stress reactivity of the ANS as well as the HPA axis in a sample of traumatized adolescents and healthy controls. The traumatized sample (n = 77), based on clinical levels of posttraumatic stress, was a convenience sample that was recruited within residential institutions, was compared to a healthy control sample (n = 48) recruited within the general community. For the ANS, we expected increased SNS and decreased PNS activity during rest and increased SNS and decreased PNS reactivity to social stress among traumatized adolescents compared to healthy controls. Regarding the HPA axis, we expected increased basal cortisol levels and decreased cortisol reactivity to stress in the traumatized sample. Compared to healthy controls, traumatized adolescents exhibited significantly higher sympathetic and lower parasympathetic activation during rest and increased sympathetic reactivity to acute stress (ANS parameters). Outcomes on the HPA axis (i.e. cortisol) indicated that traumatized adolescents showed increased cortisol levels during rest and blunted cortisol reactivity to acute stress. Implications for clinical relevance and trauma-focused treatment purposes are discussed.

Role of meditation to improve children's health: Time to look at other strategies

In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness-based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.

Validity of the Empatica E4 Wristband to Measure Heart Rate Variability (HRV) Parameters: a Comparison to Electrocardiography (ECG)

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.