Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies.

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial.

BACKGROUND: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION: Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/11255.

Visualization, Self-Efficacy, and Locus of Control in a Virtual Reality Biofeedback Video Game for Anxiety Regulation.

The current study aimed to identify specific feedback mechanics and psychological processes that may contribute to positive outcomes in biofeedback applications for anxiety regulation. Specifically, using a dismantling study design, the unique impact of visualizations that directly mirror users' breathing was examined in relation to anxiety regulation as well as locus of control and self-efficacy. Following an anxiety induction, participants (N = 67) were randomly assigned to play one of two variations of a biofeedback video game. In both versions, players' in-game movement was contingent on their breathing; however, the experimental condition additionally included visualizations that directly mirrored players' breathing. Changes in self-reported state anxiety and physiological arousal were measured as well as the level of internal control and self-efficacy participants experienced while playing the game. Results showed that all participants were able to effectively reduce their anxiety and arousal, but no condition differences were found. Implementing mirroring visualizations did not contribute to individuals' ability to self-regulate nor their self-efficacy or locus of control above and beyond receiving feedback based on their in-game movement. Overall, individuals who experienced higher self-efficacy and a stronger internal locus of control were better able to regulate their anxiety, but no clear links were found with changes in self-reported physiological arousal. In light of these results, we recommend the continued exploration of the role of specific design choices and intervention components as well as underlying mechanisms of change in biofeedback interventions, especially pertaining to how individuals perceive themselves and their ability to change.

Deep-Breathing Biofeedback Trainability in a Virtual-Reality Action Game: A Single-Case Design Study With Police Trainers.

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don't shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

Reductions of Anxiety Symptoms, State Anxiety, and Anxious Arousal in Youth Playing the Videogame MindLight Compared to Online Cognitive Behavioral Therapy.

Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible. MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT) to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up. Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n = 60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment. ClinicalTrials.gov Identifier: NCT02326545.

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).

The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health.

Objective: Applied games are considered a promising approach to deliver mental health interventions. Nonspecific factors such as expectations and motivation may be crucial to optimize effectiveness yet have not been examined so far. The current study examined the effect of expectations for improvement on (1) experienced fun and positive affect, and (2) in-game play behaviors while playing MindLight, an applied game shown to reduce anxiety. The secondary aim was to examine the moderating role of symptom severity and motivation to change. Materials and Methods: Fifty-seven participants (47 females; 17-21 years old) preselected on anxiety symptoms viewed a trailer in which MindLight was promoted as either a mental health or an entertainment game. These trailers were used to induce different expectations in participants. Participants subsequently played the game for 60 minutes. Before playing, participants filled out questionnaires about their general anxiety symptoms, motivation to change, state anxiety, affect, and arousal. While playing, in-game behaviors and galvanic skin response (GSR) were recorded continuously. After playing, state anxiety, affect, and arousal were measured again as well as experienced fun. Results: Participants in both trailer conditions showed increases in state anxiety, arousal, and GSR. Expectations did not influence experienced fun and positive affect, nor in-game behaviors. In addition, no moderation effects of motivation to change and symptom severity were found. Conclusion: Experiences and engagement with MindLight were not influenced by expectations, motivation to change, and symptom severity. For future research, it is recommended to examine individual differences in these effects, and long-term and more distal outcomes and processes.

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.

Breathing Biofeedback for Police Officers in a Stressful Virtual Environment: Challenges and Opportunities.

As part of the Dutch national science program "Professional Games for Professional Skills" we developed a stress-exposure biofeedback training in virtual reality (VR) for the Dutch police. We aim to reduce the acute negative impact of stress on performance, as well as long-term consequences for mental health by facilitating physiological stress regulation during a demanding decision task. Conventional biofeedback applications mainly train physiological regulation at rest. This might limit the transfer of the regulation skills to stressful situations. In contrast, we provide the user with the opportunity to practice breathing regulation while they carry out a complex task in VR. This setting poses challenges from a technical - (real-time processing of noisy biosignals) as well as from a user-experience perspective (multi-tasking). We illustrate how we approach these challenges in our training and hope to contribute a useful reference for researchers and developers in academia or industry who are interested in using biosignals to control elements in a dynamic virtual environment.

From Wellbeing to Social Media and Back: A Multi-Method Approach to Assessing the Bi-Directional Relationship Between Wellbeing and Social Media Use.

Literature concerning the relationship between social media use and wellbeing is inconsistent in its findings, and most research has focused on time spent on social media rather than on what emerging adults do there, with whom and why. Here, we investigated whether momentary social stress affects emerging adults' social media use, and whether this social media use relates to subsequent changes in wellbeing. We implemented a multi-method paradigm utilising objective and self-report data to investigate how social stress relates to how (much) and why emerging adults use social media. We report on findings based on 114 17-25-year-old emerging adults recruited on university campus. Our findings suggest that social stress does not affect adolescents' subsequent social media use and that there is no relationship between social media use after stress and changes in momentary wellbeing. Our work illustrates the need for detailed approaches in social media and psychological wellbeing research.

An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint.

Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful.

Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study.

BACKGROUND: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual's inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. OBJECTIVE: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. METHODS: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. RESULTS: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=-0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=-0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. CONCLUSIONS: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population.

Effects of the video game 'Mindlight' on anxiety of children with an autism spectrum disorder: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: In the clinical setting, a large proportion of children with an autism spectrum disorder (ASD) experience impairing anxiety symptoms. Recently, an applied videogame called Mindlight has been developed that focuses on decreasing anxiety in children. The present study involved a randomized controlled trial (RCT) investigating the effect of Mindlight on (sub)clinical anxiety symptoms in children with an ASD. METHODS: In total, 109 children of 8-16 years old with an ASD and (sub)clinical anxiety symptoms were randomly assigned to the experimental (N = 53) or the control (N = 56) condition. Children in the experimental condition played Mindlight, children in the control condition played a commercial game (Triple Town) for 1 h per week, for six consecutive weeks. All children and parents completed assessments at baseline, post-intervention and 3-months follow-up. RESULTS: Results showed no differences in decrease of child-rated anxiety symptoms between both conditions. However, the decrease of parent-rated anxiety symptoms was significantly larger in the experimental condition. LIMITATIONS: Mechanisms of change associated with treatment outcomes were not investigated in the present study. Therefore, it remains unclear which specific or non-specific factors contributed to the decrease in anxiety symptoms in both conditions. CONCLUSIONS: The present study provided some preliminary evidence that video games are a promising new intervention vehicle for children with an ASD and anxiety, at least according to parents. However, further research on working mechanisms is needed, in order to specify to what extent and for which children with ASD Mindlight could be an effective anxiety treatment.

A Stimulated Recall Method for the Improved Assessment of Quantity and Quality of Social Media Use.

BACKGROUND: Social media are as popular as ever, and concerns regarding the effects of social media use on adolescent well-being and mental health have sparked many scientific studies into use effects. Social media research is currently at an important crossroads: conflicting results on social media use's effects on well-being are abundant, and recent work in the field suggests that a new approach is required. The field is in need of an approach involving objective data regarding use where necessary and attention to different kinds of detail such as the why and how of social media use. OBJECTIVE: We present a novel paradigm implementing a principle from educational sciences called stimulated recall and demonstrate how it can be applied to social media use research. Our stimulated recall paradigm implements a number of elements that can fill the gaps currently present in social media and well-being research. METHODS: Objective data are collected regarding users' social media behaviors through video footage and in-phone data and used for a structured stimulated recall interview to facilitate detailed and context-sensitive processing of these objective data. In this interview, objective data are reviewed with the participant in an act of co-research, in which details such as the reasons for their use (eg, boredom) and processes surrounding their use (eg, with whom) are discussed and visualized in a stimulated recall chart. RESULTS: Our ongoing study (N=53) implementing this paradigm suggests this method is experienced as pleasant by participants in spite of its personal and intensive nature. CONCLUSIONS: The stimulated recall paradigm offers interesting and necessary avenues for approaching social media use research from new angles, addressing aspects of use that have thus far remained underexposed. The answers to questions such as "Why do adolescents use social media?" "In what ways exactly do they use social media?" and "How does social media use make them feel in the moment?" are now within reach, an important step forward in the field of social media use and well-being research.

Can a Commercial Video Game Prevent Depression? Null Results and Whole Sample Action Mechanisms in a Randomized Controlled Trial.

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy - on which depression prevention programs are based - may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, M age = 17.11, SD age = 1.76, 66.4% female) were given 4 weeks to play Journey (M duration = 3 h 20 min) or the control game, Flower (M duration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth's change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

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.

A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial.

BACKGROUND: The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. OBJECTIVE: Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. METHODS: Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. RESULTS: Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. CONCLUSIONS: If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. TRIAL REGISTRATION: Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11255.

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.