Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study.

Background: Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. Methods: This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. Results: The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. Conclusion: With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Mechanisms of change in a go/no-go training game for young adult smokers.

Objective: Smoking is a major cause of worldwide morbidity and mortality. Evidence-based intervention programs to help young adults quit smoking are largely lacking; identifying targets for intervention is therefore critical. A candidate target is inhibitory control, with previous studies on Go/No-Go trainings showing behavior change in the food and alcohol domain. The current study examined the mechanisms of change of HitnRun, a Go/No-Go game, in a smoking population that was motivated to quit. Method: A 2-armed experimental study (n = 106) was conducted and young adults (Mage = 22.15; SDage = 2.59) were randomly assigned to either play HitnRun or to read a psychoeducational brochure. Prior to and directly following the intervention period, smoking-specific and general inhibitory control, perceived attractiveness of smoking pictures, and weekly smoking behavior were assessed. Results: Results indicated that Go/No-Go training seems to decrease evaluations of smoking stimuli rather than top-down smoking-specific and general control processes. Similar reductions for weekly smoking were found in both groups. Conclusions: Go/No-Go training did not differentially influence smoking-specific inhibitory control, general inhibitory control and weekly smoking behavior. Go/No-Go training might be able to decrease evaluations of smoking stimuli, yet based on the current study we cannot rule out the possibility of regression to the mean. More research and iterative design is needed to better understand the potential role of Go/No-Go training in smoking cessation interventions, as well as exploring other evidence-based mechanisms (e.g., peer processes, self-efficacy) that might be an important addition to smoking cessation interventions for young people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Insights about Screen-Use Conflict from Discussions between Mothers and Pre-Adolescents: A Thematic Analysis.

Digital screens have become an integral part of everyday life. In the wake of the digital swell, pre-adolescents and their parents are learning to navigate seemingly new terrain regarding digital media use. The present study aimed to investigate parent and pre-adolescent perceptions of screen use and the source of conflict surrounding digital media. We employed a qualitative thematic analysis of 200 parent and pre-adolescent dyads discussing screen use. Our analysis showed five overarching themes for screen use perceptions and conflict: screen time, effects of screen use, balance, rules, and reasons for screen use. In contrast to previous studies that mainly focused on parental perceptions, we were also able to shed light on pre-adolescent perceptions of screen use and the difference in opinions with their parents. Furthermore, we found that patterns of the source of screen use conflict were oftentimes rooted in the age-old developmental tug of war between autonomy-seeking pre-adolescents and authority-seeking parents. Though navigating autonomy-granting and seeking behavior is familiar to developmental scientists, negotiating these challenges in a new digital world is unfamiliar. Autonomy support, open dialogue, and playful interaction between parents and children are needed to understand and resolve conflict of digital media use in family contexts.

A randomized controlled trial to test the effectiveness of a peer-based social mobile game intervention to reduce smoking in youth.

Smoking is a major cause of worldwide morbidity and mortality. Almost no evidence-based intervention programs are available to help youth quit smoking. We argue that ineffective targeting of peer influence and engagement difficulties are significant barriers to successful youth smoking cessation. To address these barriers, we developed the mobile game intervention HitnRun. A two-armed randomized controlled trial (RCT; n = 144) was conducted and young smokers (Mage = 19.39; SDage = 2.52) were randomly assigned to either play HitnRun or read a psychoeducational brochure. Prior to, directly following the intervention period, and after three-month follow-up, weekly smoking behavior, abstinence rates, intervention dose, and peer- and engagement-related factors were assessed. Results indicated similar reductions in weekly smoking levels and similar abstinence rates for both groups. Yet, we found a dose effect with HitnRun only: The longer participants played HitnRun, the lower their weekly smoking levels were. In the brochure group, a higher dose was related to higher weekly smoking levels at all measurement moments. Exploratory analyses showed the most powerful effects of HitnRun for participants who connected with and were engaged by the intervention. Future work should build on the promising potential of HitnRun by increasing personalization efforts and strengthening peer influence components.

Behavioral trainings and manipulations to reduce delay discounting: A systematic review.

In everyday decision-making, individuals make trade-offs between short-term and long-term benefits or costs. Depending on many factors, individuals may choose to wait for larger delayed reward, yet in other situations they may prefer the smaller, immediate reward. In addition to within-subject variation in the short-term versus long-term reward trade-off, there are also interindividual differences in delay discounting (DD), which have been shown to be quite stable. The extent to which individuals discount the value of delayed rewards turns out to be associated with important health and disorder-related outcomes: the more discounting, the more unhealthy or problematic choices. This has led to the hypothesis that DD can be conceptualized as trans-disease process. The current systematic review presents an overview of behavioral trainings and manipulations that have been developed to reduce DD in human participants aged 12 years or older. Manipulation studies mostly contain one session and measure DD directly after the manipulation. Training studies add a multiple session training component that is not per se related to DD, in between two DD task measurements. Ninety-eight studies (151 experiments) were identified that tested behavioral trainings and manipulations to decrease DD. Overall, results indicated that DD can be decreased, showing that DD is profoundly context dependent and changeable. Most promising avenues to pursue in future research seem to be acceptance-based/mindfulness-based trainings, and even more so manipulations involving a future orientation. Limitations and recommendations are discussed to identify the mechanistic processes that allow for changes in discount rate and behavior accordingly.

Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint.

Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth.

Do smokers devaluate smoking cues after go/no-go training?

OBJECTIVE: Smoking is one of the leading public health problems worldwide. The inability to quit smoking may be the result of the amplified value of smoking-related cues and inhibitory control deficits. Previous research has shown that pairing substance-related cues with no-go trials in go/no-go training reduces the value of these cues, an effect known as devaluation. The current experiment investigated the devaluation effect of go/no-go training on smoking-related cues, and compared this effect between smokers and nonsmokers. DESIGN AND MAIN OUTCOME MEASURES: 39 smokers and 43 nonsmokers were trained to respond immediately to neutral stimuli, but inhibit their reaction when smoking stimuli were presented. Before and after training, participants evaluated smoking and neutral stimuli, where part of these stimuli were subsequently presented in the training, and the other part was not used in training. RESULTS: Not responding to smoking stimuli in go/no-go training decreased subsequent evaluations of trained smoking stimuli compared to untrained smoking stimuli, thereby replicating food and alcohol studies and extending the devaluation effect to smoking-related cues. This devaluation effect was found for both smokers and non-smokers. CONCLUSION: Smoking-related cues can be devaluated in smokers and non-smokers, thereby showing the potential for Go/No-Go training in smoking cessation interventions.

When winning is losing: A randomized controlled trial testing a video game to train food-specific inhibitory control.

Overweight and obesity are major causes of worldwide morbidity and mortality. A two-armed randomized controlled trial (n = 104) examined the effectiveness of Hit n Run, a video game based on the principles of Go/No-Go inhibition training, in young adults who reported disinhibited eating. Adults (aged 18 to 30) were randomly assigned to play Hit n Run or received an informative brochure (Healthy Eating Step by Step; HESbS). Prior to and directly following the intervention week general and food-specific inhibitory control, caloric intake, and perceived attractiveness of food pictures were assessed. Results revealed no improvements in food-specific inhibitory control or caloric intake in either intervention group. Similar improvements for general inhibitory control and similar decreases in perceived attractiveness of food-related stimuli were observed for both Hit n Run and HESbS. Future research should aim to clarify how video game design can implement working mechanisms of cognitive training tasks to facilitate the development of effective game-based interventions.

A Randomized Controlled Trial to Test the Effectiveness of an Immersive 3D Video Game for Anxiety Prevention among Adolescents.

Adolescent anxiety is debilitating, the most frequently diagnosed adolescent mental health problem, and leads to substantial long-term problems. A randomized controlled trial (n = 138) was conducted to test the effectiveness of a biofeedback video game (Dojo) for adolescents with elevated levels of anxiety. Adolescents (11-15 years old) were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Initial screening for anxiety was done on 1,347 adolescents in five high schools; only adolescents who scored above the "at-risk" cut-off on the Spence Children Anxiety Survey were eligible. Adolescents' anxiety levels were assessed at pre-test, post-test, and at three month follow-up to examine the extent to which playing Dojo decreased adolescents' anxiety. The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms (not of total anxiety symptoms) in the Dojo condition compared to the control condition. Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants' expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.