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

Anxiety disorder is the most prevalent and frequently diagnosed disorder in youth, and associated with serious negative health outcomes. Our most effective prevention programs, however, have several limitations. These limitations can be addressed using game-based interventions. Results from two randomized controlled trials on the video game MindLight show improvements in anxiety that are maintained up to 6 months. The game was designed based on evidence-based therapeutic techniques; however, it is unclear if children's engagement with these techniques actually predict improvements in anxiety symptoms. An important advantage of game-based interventions is that they provide excellent opportunities to isolate therapeutic action mechanisms and test their impact on intervention outcomes. In the current study, on-screen videotaped output while playing MindLight was coded and analysed for forty-three 8 to 12-year old children with elevated levels of anxiety. Results showed that changes in in-game play behaviours representing therapeutic exposure techniques predicted improvements in anxiety symptoms 3 months later (when children had not played the game for 3 months). The current study is a first step 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.

Preventing Childhood Anxiety Disorders: Is an Applied Game as Effective as a Cognitive Behavioral Therapy-Based Program?

A large proportion of children experience subclinical levels of anxiety and cognitive-behavioral therapy (CBT) aimed at preventing anxiety disorders is moderately effective. However, most at-risk children do not seek help or drop out of programs prematurely because of stigma, lack of motivation, and accessibility barriers. Applied games have received increased attention as viable alternatives and have shown promising results, but direct comparisons between applied games and the gold-standard CBT are lacking. Our aim was to investigate whether the applied game MindLight is as effective as CBT (i.e., Coping Cat) within an indicated prevention context. We conducted a randomized controlled non-inferiority trial with a sample of 174 children (7- to 12-year olds) with elevated levels of anxiety, comparing MindLight to CBT. Anxiety was assessed with self- and parent-reports at pre- and post-program, and at 3- and 6-month follow-ups. Intention-to-treat and completers-only confidence interval approach and latent growth curve modeling showed an overall significant quadratic decrease in child- and parent-reported anxiety symptoms over time and, as predicted, the magnitude of improvement was the same for MindLight and CBT. The within-group effect sizes were small to medium at post-test (- 0.32 to - 0.63), and medium to large (- 0.60 to - 1.07) at 3- and 6-month follow-ups. Furthermore, MindLight and CBT were rated equally anxiety inducing, difficult, and appealing; CBT was rated as more relevant to daily life than MindLight. The current study adds to the growing research on applied games for mental health and shows that these games hold potential as alternative delivery models for evidence-based therapeutic techniques.

Behavioral Correlates of Prioritizing Popularity in Adolescence.

Little is known about individual differences in adolescents' motivation to achieve and maintain popularity. This study examined the moderating effects of prioritizing popularity on the associations between popularity and adjustment outcomes in late adolescence. Participants were 314 Dutch eleventh-grade students (M age = 16.83 years; 52 % male) who completed measures of popularity, prioritizing popularity, and prosocial, antisocial, and risk behaviors. It was hypothesized that associations between popularity and adjustment outcomes are stronger for adolescents who prioritize popularity. The results indicate that the combination of being popular and valuing popularity was strongly related to antisocial and risk behaviors, but not to prosocial behaviors. Adolescents' social status motivations thus play an important role in the association of popularity with antisocial and risk behaviors in late adolescence.