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

Effects of a Serious Game for Adolescent Mental Health on Cognitive Vulnerability: Pilot Usability Study

Background

Adolescent mental health is of utmost importance. E-mental health interventions, and serious games in particular, are appealing to adolescents and can have beneficial effects on their mental health. A serious game aimed at improving cognitive vulnerability (ie, beliefs or attitudes), which can predispose an individual to mental health problems, can contribute to the prevention of these problems in adolescents.

Objective

This study aimed to assess the feasibility of the prototype of a serious game called "Silver."

Methods

The prototype of the serious game was developed using a user-centered participatory design. The prototype of Silver focused on 1 aspect of a serious game for improving cognitive vulnerability in adolescents, that is, the recognition and identification of cognitive distortions. Through the game, players were required to identify and classify the character's thoughts as helpful or unhelpful. Upon successful advancement to the next level, the task becomes more challenging, as players must also identify specific types of cognitive distortions. A pre- and posttest uncontrolled design was used to evaluate the game, with a 1-week intervention phase in which participants were asked to play the game. Participants aged 12-16 years were recruited in schools. The outcomes of interest were the recognition of cognitive distortions and presence of participants' cognitive distortions. The game was also evaluated on its effects, content, and usefulness.

Results

A total of 630 adolescents played Silver and completed the assessments. Adolescents were significantly better at recognizing cognitive distortions at the pretest (mean 13.09, SD 4.08) compared to the posttest (mean 13.82, SD 5.09; t629=-4.00, P<.001). Furthermore, their cognitive distortions decreased significantly at the posttest (mean 38.73, SD 12.79) compared to the pretest (mean 41.43, SD 10.90; t629=7.98, P<.001). Participants also indicated that the game helped them recognize cognitive distortions. Many participants considered the game appealing (294/610, 48.2%) but boring (317/610, 52%) and preferred a more comprehensive game (299/610, 49%).

Conclusions

Findings from this study suggest that a serious game may be an effective tool for improving cognitive vulnerability in adolescents. The development of such a serious game, based on the prototype, is recommended. It may be an important and innovative tool for the universal prevention of mental health problems in adolescents. Future research on the effects of the game is warranted.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/17756.

Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial

BACKGROUND

During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being.

OBJECTIVE

Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being.

METHODS

A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient.

RESULTS

This study's results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05).

CONCLUSIONS

Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents' affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7.

Therapeutic games to reduce anxiety and depression in young people: A systematic review and exploratory meta-analysis of their use and effectiveness

OBJECTIVE

The development of serious games for mental wellbeing is a topic of growing interest. The increase in acceptance of games as a mainstream entertainment medium combined with the immersive qualities of games provides opportunities for meaningful support and intervention in mental wellbeing.

METHOD

We conducted a systematic review and exploratory meta-analysis to examine if aspects of the interventions influenced outcomes as measured via overall effect sizes. We employed a multilevel meta-analytic approach to accommodate the interdependency of effect sizes (18 effect sizes from 14 studies, with 2027 participants).

RESULTS

Overall, the main effect for gaming interventions on any outcome variable was small to medium sized, d = .35 (confidence interval [.23, 47], p < .001). Results revealed that the only significant moderator was the nature of the intervention. Specifically, only interventions that included a rational emotional behavioural focus significantly predicted an improvement in depression and/or anxiety in participants.

CONCLUSION

The findings reveal promising effects for therapeutic games for mental health, but replications are needed, alongside the addressing of methodological and procedural concerns.

Effects of Serious Games for Patients With Chronic Obstructive Pulmonary Disease: Systematic Literature Review

BACKGROUND

The use of serious games for rehabilitation has been an emerging intervention in health care fields, referred to as an entertaining and positive activity. Although related studies have been conducted on patients with chronic obstructive pulmonary disease (COPD), a more comprehensive study that summarizes and evaluates its effects in this area is needed.

OBJECTIVE

This review aimed to systematically evaluate the effects of serious games in promoting rehabilitation and related outcome measures of serious game-based engagement in patients with COPD.

METHODS

This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Searches were performed in the following databases: PubMed, Scopus, Embase (via Ovid), CINAHL, Science Direct, and China Biology Medicine disc. Only quantitative studies were included in this review, and the methodological quality and bias of the included studies were evaluated using related tools. Several outcomes, including clinical outcomes and serious game-based engagement outcomes, were ultimately collected in this review. The results were summarized and evaluated using descriptive methods due to significant heterogeneity.

RESULTS

In total, 11 studies were included. Serious games played a potentially positive effect on pulmonary function and exercise capacity. However, no consistent findings were reported on dyspnea and psychological status. Additionally, serious game engagement showed favorable findings on adherence, enjoyment, and acceptability. Furthermore, no serious adverse effects were identified in all included studies.

CONCLUSIONS

This review preliminarily indicated the potential benefits of serious games in promoting rehabilitation for patients with COPD, despite the limited quality of the included studies. More studies with high methodological quality are needed to further explore the effects of serious games in this field.

The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment

Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game-based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.

Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity

Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children's poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.

The effect of educational computer games on the academic resilience, academic self-regulation, and academic achievement of EFL students

Introduction

In recent years there has been an increasing interest in the field of educational computer games (ECGs). Although ECGs have been researched, more analyses still need to be performed on these variables to check their effects on language learning.

Methods

To this end, 74-third grade female state high school students from two schools in Zanjan were selected through a two-stage cluster random sampling method. The number of students in each class was 37. One of the classes (control group) was trained traditionally and the other was for one semester through the researchers-made ECGs. After completing the training, the research tools were performed as a post-test on the experimental and control groups. The data collection stage took place for about 6 months.

Results

Based on the results from the research questions, the use of training computers has been effective in increasing AR, ASR, and AA.

Discussion

It has significant implications for teachers and learners in the EFL context and opens interesting opportunities for administrators and curriculum developers to explore when planning EFL courses.

Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.43607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Learning disabilities are among the major cognitive impairments caused by aging. Among the interventions used to improve learning among older adults are serious games, which are participative electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations, such as focusing on older adults without cognitive impairments, focusing on particular types of serious games, and not considering the comparator type in the analysis.

OBJECTIVE

This review aimed to evaluate the effectiveness of serious games on verbal and nonverbal learning among older adults with cognitive impairment.

METHODS

Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Furthermore, we went through the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. The results of the included studies were summarized using a narrative synthesis or meta-analysis, as appropriate.

RESULTS

Of the 559 citations retrieved, 11 (2%) randomized controlled trials (RCTs) ultimately met all eligibility criteria for this review. A meta-analysis of 45% (5/11) of the RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no or sham interventions (<i>P</i>=.04), and serious games do not have a different effect on verbal learning between patients with mild cognitive impairment and those with Alzheimer disease (<i>P</i>=.89). A meta-analysis of 18% (2/11) of the RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (<i>P</i>=.98). We also found that serious games outperformed no or sham interventions (4/11, 36%; <i>P</i>=.03) and conventional cognitive training (2/11, 18%; <i>P</i>&lt;.001) in enhancing nonverbal learning.

CONCLUSIONS

Serious games have the potential to enhance verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of evidence, the small sample size in most of the meta-analyzed studies (6/8, 75%), and the paucity of studies included in the meta-analyses. Thus, until further convincing proof of their effectiveness is offered, serious games should be used to supplement current interventions for verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games with conventional cognitive training and conventional exercises, as well as different types of serious games, different platforms, different intervention periods, and different follow-up periods.

CLINICALTRIAL

PROSPERO CRD42022348849; https://tinyurl.com/y6yewwfa

Artificial Intelligence-Driven Serious Games in Healthcare: A Scoping Review (Preprint).. [DOI: 10.2196/preprints.39840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Artificial Intelligence (AI)-driven serious games have been used in healthcare to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state in order to plan on how to leverage them in the current and future healthcare needs.

OBJECTIVE

The current study aimed to explore the features of AI-driven serious games in healthcare as reported by previous research.

METHODS

We carried out a scoping review to achieve the above-mentioned objective. The most popular databases in information technology and health fields (e.g., MEDLINE and IEEE Xplore) were searched using keywords related to serious games and AI. These terms were selected based on the target intervention (i.e., AI) and the target disease (i.e., COVID-19). Two reviewers independently performed the study selection process. Three reviewers independently used Microsoft Excel to extract data from the included studies. A narrative approach was used for data synthesis.

RESULTS

The search process returned 1470 records. Of these records, 46 met all eligibility criteria. 60 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games in most of the studies were used for rehabilitation. The serious games in the majority of the included studies can be played by only single player. Most serious games were played on standalone devices (offline games). The most common genres of serious games were role-playing games, puzzle games, and platformer games. Unity was the most prominent game engine used to develop serious games. Personal computers (PCs) were the most common platforms used to play serious games. The most common algorithms used in the included studies were Support Vector Machine (SVM), Convolutional Neural Network (CNN), Artificial Neural Networks (ANN), and Random Forest (RF). The most common purposes of AI were the detection of disease and the evaluation of user's performance. The dataset size ranged from 36 to 795,600, with an average of about 52,124. The most common validation techniques used in the included studies were K-fold cross-validation and training test split validation. Accuracy was the most commonly used metric to evaluate the performance of AI models.

CONCLUSIONS

The last decade witnessed an increase in the development of AI-driven serious games for healthcare purposes and targeting various health conditions and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. While the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

The effectiveness of serious games in improving memory among the elderly with cognitive impairment: A systematic review and meta-analysis (Preprint)

Background

Objective

Methods

Results

Conclusions

The effectiveness and safety of serious games in improving cognitive abilities among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

Background

Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses.

Objective

This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment.

Methods

A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.

Results

Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups.

Conclusions

Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects.