In-Game Play Behaviours during an Applied Video Game for Anxiety Prevention Predict Successful Intervention Outcomes

Background

Anxiety disorders are the most prevalent and frequently diagnosed disorders in youth, and associated with serious negative health outcomes. The video game MindLight has been found to be an effective anxiety prevention program. The game incorporates three evidence-based techniques based on cognitive-behavioural principles: relaxation through neurofeedback training, exposure training, and attention bias modification. Results from two randomized controlled trials (RCTs) showed improvements in anxiety that were maintainted up to six months. These results are promising, but it remains unclear whether children improve through the therapeutic techniques that were explicitly designed into MindLight. In this study we examined how children played MindLight, to what extent they interacted with the therapeutic techniques in the game, and whether that was related to improvements in anxiety symptoms.

Method

Participants were forty-three 8 to 12-year old children with elevated levels of anxiety that participated in a RCT to test the effectiveness of MindLight. On-screen videotaped output while playing MindLight was coded for the first and last play-session to examine whether changes in in-game play behaviours from the first to the last play-session were predictive of changes in anxiety symptoms at the three-months follow-up assessment.

Results

Using hierarchical regression analyses we predicted anxiety symptoms at the three-months follow-up from the difference in in-game play behaviours from the first to the last play-session controlled for anxiety symptoms at pretest. Results showed that changes in in-game play behaviours representing therapeutic exposure techniques predicted improvements in anxiety symptoms three months later.

Conclusion

The present study provides a unique contribution to the field by demonstrating that changes in the interaction with the therapeutic techniques in MindLight predicted real-world improvements in anxiety symptoms at the three-months follow-up assessment (when children had not played the game for three months). Using observational codes, the current study provided a first step in testing the effect of the therapeutic techniques incorporated in MindLight, and towards identifying and validating game mechanics that can be used in new applied games to target anxiety symptoms or other psychopathologies with the same underlying deficits.

Contact: a.wols@psych.ru.nl

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