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.

Implicit awareness of ambiguity: a role in the development of obsessive-compulsive disorder.

The cognitive-behavioral model of obsessive-compulsive disorder proposes that obsessional symptoms are the consequence of the manner in which intrusive cognitions are interpreted [e.g., Salkovskis, P. M. (1998). Cognitive-behavioral approach to understanding obsessional thinking. British Journal of Psychiatry, 173(35S), 53-63]. The present study suggests that this may be attributable to maladaptive implicit cognitive processing, a deficit that results in the explicit awareness of ambiguity in idiographic obsessive-compulsive disorder (OCD) stimuli. The present study examines decision-making responses of low and high OCD scorers in a non-clinical undergraduate sample. Via a computer console, participants were shown sentence statements for three levels of ambiguity. They were then presented with a propositional statement for which they had to indicate agreement or disagreement for sentences of varying ambiguity. After this, the participants indicated whether they were completely confident or unconfident as regards their previous agree-disagree decisions. Results indicate that the high compared to the low OCD scoring group had less agreement and subsequent less confidence in decisions made for sentences of varying ambiguity. Response latencies partially fitted the predicted hypotheses. Consequently, an addition to Salkovskis, Forester, and Richards' [1998. Cognitive-behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(35S), 53-63] model of OCD is suggested: namely that an implicit ambiguity deficit mediates the likelihood of normally occurring intrusions developing into abnormal obsessions. Methodological limitations and future research are considered.

What is the psychological impact of self-weighing? A meta-analysis.

Many people self-weigh and many interventions addressing weight-related problems such as obesity promote self-weighing. However, while self-weighing has been associated with weight loss, there is mixed evidence regarding the psychological impact of this behaviour. The present review aimed to quantify the relationship between self-weighing and: (i) affect (e.g., anxiety, depression); (ii) psychological functioning (e.g., self-esteem); (iii) body-related attitudes and (iv) disordered eating. A computerized search of scientific databases in September 2014 and subsequent ancestry and citation searches identified 29 independent tests of the relationship between self-weighing on psychological outcomes. Meta-analysis was used to quantify the size of the association across the tests. Results indicated that there was no association between self-weighing and affect, body-related attitudes or disordered eating. There was, however, a small-sized negative association between self-weighing and psychological functioning. The age of participants, obesity status, the extent of weight loss, duration of self-weighing and study design (RCT versus correlational) were found to influence at least some of the psychological outcomes of self-weighing. The findings suggest that, for the most part, self-weighing is not associated with adverse psychological outcomes. However, in some cases the association between self-weighing and psychological outcomes may be more negative than in others.

Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence.

Control theory and other frameworks for understanding self-regulation suggest that monitoring goal progress is a crucial process that intervenes between setting and attaining a goal, and helps to ensure that goals are translated into action. However, the impact of progress monitoring interventions on rates of behavioral performance and goal attainment has yet to be quantified. A systematic literature search identified 138 studies (N = 19,951) that randomly allocated participants to an intervention designed to promote monitoring of goal progress versus a control condition. All studies reported the effects of the treatment on (a) the frequency of progress monitoring and (b) subsequent goal attainment. A random effects model revealed that, on average, interventions were successful at increasing the frequency of monitoring goal progress (d+ = 1.98, 95% CI [1.71, 2.24]) and promoted goal attainment (d+ = 0.40, 95% CI [0.32, 0.48]). Furthermore, changes in the frequency of progress monitoring mediated the effect of the interventions on goal attainment. Moderation tests revealed that progress monitoring had larger effects on goal attainment when the outcomes were reported or made public, and when the information was physically recorded. Taken together, the findings suggest that monitoring goal progress is an effective self-regulation strategy, and that interventions that increase the frequency of progress monitoring are likely to promote behavior change.