1
|
Zhao L, Agazzi H, Du Y, Meng H, Maku R, Li K, Aspinall P, Garvan CW, Fang S. A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial. J Med Internet Res 2024; 26:e55569. [PMID: 38728075 PMCID: PMC11127175 DOI: 10.2196/55569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. OBJECTIVE The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. METHODS This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. RESULTS Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. CONCLUSIONS This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.
Collapse
Affiliation(s)
- Licong Zhao
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Heather Agazzi
- Department of Pediatrics & Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of South Florida, Tampa, FL, United States
| | - Yasong Du
- Department of Child & Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China
| | - Hongdao Meng
- College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, United States
| | - Renya Maku
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Ke Li
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | | | - Cynthia Wilson Garvan
- Department of Anesthesiology, College of Medicine, University of Florida, Tampa, FL, United States
| | - Shuanfeng Fang
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Ortega Morán JF, Pagador JB, Gilete Preciado V, Moyano-Cuevas JL, Rodríguez Domínguez T, Santurino Muñoz M, Sánchez Margallo FM. A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study. JMIR Aging 2024; 7:e41437. [PMID: 38596860 PMCID: PMC11007382 DOI: 10.2196/41437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 04/11/2024] Open
Abstract
Background Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living. Objective This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented. Methods The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively. Results A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved. Conclusions This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games.
Collapse
Affiliation(s)
| | - J Blas Pagador
- Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres, Spain
| | - Vicente Gilete Preciado
- Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres, Spain
- Robolab, FENTO, Universidad de Extremadura, Cáceres, Spain
| | | | | | | | | |
Collapse
|
3
|
Labrosse D, Vié C, Hajjam H, Tisseron C, Thellier D, Montagni I. An Escape Game on University Students' Mental Health During the COVID-19 Pandemic: Cocreation Study. JMIR Serious Games 2024; 12:e48545. [PMID: 38498033 PMCID: PMC10985612 DOI: 10.2196/48545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/16/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a severe impact on students' mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students' mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games. OBJECTIVE This study aims to describe the process of testing and optimizing the game "EscapeCovid" on students' mental health, to serve as a model for the cocreation of future similar interventions. METHODS The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game. RESULTS We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders' guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population. CONCLUSIONS Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user-centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players' experience, thus positively influencing their learning process and overall well-being.
Collapse
Affiliation(s)
| | - Clara Vié
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center U1219, Bordeaux, France
| | | | - Clément Tisseron
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center U1219, Bordeaux, France
| | | | - Ilaria Montagni
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center U1219, Bordeaux, France
| |
Collapse
|
4
|
Khaleghi A, Narimani A, Aghaei Z, Khorrami Banaraki A, Hassani-Abharian P. A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study. JMIR Serious Games 2024; 12:e34535. [PMID: 38446522 PMCID: PMC10955409 DOI: 10.2196/34535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF. OBJECTIVE This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients' adherence to treatments while simultaneously enhancing the app's accessibility, scalability, and outreach. METHODS Evaluations encompassed 3 methods. First, we identified the tool's potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists' presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games' playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible. RESULTS The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement. CONCLUSIONS The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings.
Collapse
Affiliation(s)
- Ali Khaleghi
- Iranian Light Source Facility, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Abbas Narimani
- Department of Computer Engineering, Imam Khomeini International University, Qazvin, Iran
| | - Zahra Aghaei
- Department of Computer Engineering, Bu-Ali Sina University, Hamedan, Iran
| | - Anahita Khorrami Banaraki
- Brain and Cognition Clinic, Institute for Cognitive Science Studies, Tehran, Iran
- Department of Cognitive Psychology and Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
| | - Peyman Hassani-Abharian
- Brain and Cognition Clinic, Institute for Cognitive Science Studies, Tehran, Iran
- Department of Cognitive Psychology and Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
| |
Collapse
|
5
|
Ming A, Lorek E, Wall J, Schubert T, Ebert N, Galatzky I, Baum AK, Glanz W, Stober S, Mertens PR. Unveiling peripheral neuropathy and cognitive dysfunction in diabetes: an observational and proof-of-concept study with video games and sensor-equipped insoles. Front Endocrinol (Lausanne) 2024; 15:1310152. [PMID: 38495786 PMCID: PMC10941030 DOI: 10.3389/fendo.2024.1310152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Background Proactive screening for cognitive dysfunction (CD) and peripheral neuropathy (PNP) in elderly patients with diabetes mellitus is essential for early intervention, yet clinical examination is time-consuming and prone to bias. Objective We aimed to investigate PNP and CD in a diabetes cohort and explore the possibility of identifying key features linked with the respective conditions by machine learning algorithms applied to data sets obtained in playful games controlled by sensor-equipped insoles. Methods In a cohort of patients diagnosed with diabetes (n=261) aged over 50 years PNP and CD were diagnosed based on complete physical examination (neuropathy symptom and disability scores, and Montreal Cognitive Assessment). In an observational and proof-of-concept study patients performed a 15 min lasting gaming session encompassing tutorials and four video games with 5,244 predefined features. The steering of video games was solely achieved by modulating plantar pressure values, which were measured by sensor-equipped insoles in real-time. Data sets were used to identify key features indicating game performance with correlation regarding CD and PNP findings. Thereby, machine learning models (e.g. gradient boosting and lasso and elastic-net regularized generalized linear models) were set up to distinguish patients in the different groups. Results PNP was diagnosed in 59% (n=153), CD in 34% (n=89) of participants, and 23% (n=61) suffered from both conditions. Multivariable regression analyses suggested that PNP was positively associated with CD in patients with diabetes (adjusted odds ratio = 1.95; 95% confidence interval: 1.03-3.76; P=0.04). Predictive game features were identified that significantly correlated with CD (n=59), PNP (n=40), or both (n=59). These features allowed to set up classification models that were enriched by individual risk profiles (i.e. gender, age, weight, BMI, diabetes type, and diabetes duration). The obtained models yielded good predictive performance with the area under the receiver-operating-characteristic curves reaching 0.95 for CD without PNP, 0.83 for PNP without CD, and 0.84 for CD and PNP combined. Conclusions The video game-based assessment was able to categorize patients with CD and/or PNP with high accuracy. Future studies with larger cohorts are needed to validate these results and potentially enhance the discriminative power of video games.
Collapse
Affiliation(s)
- Antao Ming
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Elisabeth Lorek
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Janina Wall
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Tanja Schubert
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Nils Ebert
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Imke Galatzky
- University Clinic for Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anne-Katrin Baum
- University Clinic for Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Wenzel Glanz
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sebastian Stober
- Artificial Intelligence Lab, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
6
|
Wols A, Pingel M, Lichtwarck-Aschoff A, Granic I. Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clin Psychol Rev 2024; 108:102396. [PMID: 38320420 DOI: 10.1016/j.cpr.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
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.
Collapse
Affiliation(s)
- Aniek Wols
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
| | - Michelle Pingel
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Anna Lichtwarck-Aschoff
- Rijksuniversiteit Groningen, Department of Pedagogical & Educational Sciences, Groningen, the Netherlands
| | - Isabela Granic
- McMaster University, Health, Aging & Society, Hamilton, Ontario, Canada
| |
Collapse
|
7
|
Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
Collapse
Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| |
Collapse
|
8
|
Gradi N, Chopin A, Bavelier D, Shechner T, Pichon S. Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial. BMC Psychiatry 2024; 24:56. [PMID: 38243201 PMCID: PMC10799487 DOI: 10.1186/s12888-024-05515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line. METHODS The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3). DISCUSSION The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).
Collapse
Affiliation(s)
- Naïma Gradi
- Department of Psychology, University of Geneva, Geneva, Switzerland.
| | - Adrien Chopin
- Smith Kettlewell Eye Research Institute, San Francisco, CA, USA
| | - Daphné Bavelier
- Department of Psychology, University of Geneva, Geneva, Switzerland.
| | - Tomer Shechner
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Swann Pichon
- Geneva School of Health Sciences, Geneva, Switzerland
| |
Collapse
|
9
|
Pérez-Jorge D, Martínez-Murciano MC, Contreras-Madrid AI, Alonso-Rodríguez I. The Relationship between Gamified Physical Exercise and Mental Health in Adolescence: An Example of Open Innovation in Gamified Learning. Healthcare (Basel) 2024; 12:124. [PMID: 38255013 PMCID: PMC10815218 DOI: 10.3390/healthcare12020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Interest in gamified physical activity has been driven by its potential to benefit student mental health. Integrating gamified practices for mental health improvement represents a significant innovation within multidisciplinary approaches to enhancing mental well-being. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was conducted using the Scopus and Web of Science (WOS) databases, primary sources for education-related studies. Thirteen papers were analyzed, yielding important insights into the relationship between gamified physical activity and mental health. The findings indicate that gamified physical activity positively influences adolescents' mental health and well-being. Additionally, there is a need for improved application and game design to enhance learning within school contexts. Tailoring exergames to fit specific disciplines and school-related characteristics can promote healthier mobile application usage and offer significant benefits for the mental health of young individuals. The difference between this study and previous ones is that it focuses on mobile applications for encouraging active living to improve quality of life and mental health.
Collapse
Affiliation(s)
- David Pérez-Jorge
- Department of Didactics and Educational Research, Faculty of Education, University of La Laguna, 38200 La Laguna, Spain; (M.C.M.-M.); (I.A.-R.)
| | - María Carmen Martínez-Murciano
- Department of Didactics and Educational Research, Faculty of Education, University of La Laguna, 38200 La Laguna, Spain; (M.C.M.-M.); (I.A.-R.)
| | - Ana Isabel Contreras-Madrid
- Clinical Practice Unit, Department of Dentistry, Faculty of Health Sciences, University Fernando Pessoa Canarias, 35450 Las Palmas de Gran Canaria, Spain;
| | - Isabel Alonso-Rodríguez
- Department of Didactics and Educational Research, Faculty of Education, University of La Laguna, 38200 La Laguna, Spain; (M.C.M.-M.); (I.A.-R.)
| |
Collapse
|
10
|
Vié C, Govindin-Ramassamy K, Thellier D, Labrosse D, Montagni I. Effectiveness of digital games promoting young people's mental health: A review of reviews. Digit Health 2024; 10:20552076231220814. [PMID: 38323239 PMCID: PMC10845979 DOI: 10.1177/20552076231220814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
Objectives Digital games are a popular form of entertainment for youth. They are often used as a therapy for psychological problems, a mental health promotion intervention, and a preventative measure. Systematic reviews and meta-analyses have been conducted to assess the effectiveness of mental health-related digital games. However, a synthesis considering all evaluation results to inform their development is missing. Methods We performed a review of reviews to synthetize results of previous research to describe the impact of digital games on the mental health of young people aged <30 years old. We considered systematic reviews and meta-analyses published between 2012 and 2022. Searches were conducted in Scopus, Google Scholar, Pubmed, and Cochrane library systematic reviews (CENTRAL) during October 2023. Results Our final selection included 10 systematic reviews and meta-analyses on interventions targeting youth of both sexes aged 2-29 years old across the world. In total, 218 interventions were identified. Selected articles reported different types of games, e.g., active and non-active video games, virtual reality games, serious games. Not all digital games were conscientiously evaluated, but, in general, their impact on mental health was positive. Regarding the quality, 5 studies were of high quality, 3 of moderate quality and 2 of low quality. Conclusions Overall, elements of gamification were well-accepted, but they lacked assessment through rigorous experimental conditions. Digital games for mental health are promising, but in order to be consistently effective in promoting young people's mental health and prevent psychological diseases, they should present specific features.
Collapse
Affiliation(s)
- Clara Vié
- Bordeaux Population Health Research Center, University of Bordeaux, Inserm, Bordeaux, France
| | | | | | | | - Ilaria Montagni
- Bordeaux Population Health Research Center, University of Bordeaux, Inserm, Bordeaux, France
| |
Collapse
|
11
|
Weisz JR, Fitzpatrick OM, Venturo-Conerly KE, Sternberg A, Steinberg JS, Ng MY. Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice. J Child Psychol Psychiatry 2023; 64:1720-1734. [PMID: 37222162 PMCID: PMC10667566 DOI: 10.1111/jcpp.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression. METHODS Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression. RESULTS Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal. CONCLUSIONS Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
Collapse
Affiliation(s)
- John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | | | - Ariel Sternberg
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | - Mei Yi Ng
- Department of Psychology, Florida International University, Miami, FL 33199 USA
| |
Collapse
|
12
|
Eve Z, Turner M, Di Basilio D, Harkin B, Yates A, Persson S, Henry J, Williams A, Walton G, Jones MV, Whitley C, Craddock N. Therapeutic games to reduce anxiety and depression in young people: A systematic review and exploratory meta-analysis of their use and effectiveness. Clin Psychol Psychother 2023. [PMID: 38016487 DOI: 10.1002/cpp.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
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.
Collapse
Affiliation(s)
- Zarah Eve
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Martin Turner
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Daniela Di Basilio
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Benjamin Harkin
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Alan Yates
- Department of Education, Manchester Metropolitan University, Manchester, UK
| | - Sofia Persson
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - John Henry
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, UK
| | - Ashley Williams
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, UK
| | - Geoff Walton
- Department of Information and Communications, Manchester Metropolitan University, Manchester, UK
| | - Marc V Jones
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Charlotte Whitley
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Nathan Craddock
- Department of People and Performance, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
13
|
Manning JB, Blandford A, Edbrooke-Childs J. High School Teachers' Experiences of Consumer Technologies for Stress Management During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2023; 7:e50460. [PMID: 37966873 PMCID: PMC10687684 DOI: 10.2196/50460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Stress in education is an adverse reaction that teachers have to excessive pressures or other types of demands placed on them. Consumer digital technologies are already being used by teachers for stress management, albeit not in a systematic way. Understanding teachers' experiences and the long-term use of technologies to support stress self-management in the educational context is essential for meaningful insight into the value, opportunity, and benefits of use. OBJECTIVE The aim of this study was first to understand teachers' experiences of consumer technologies for stress management. They were chosen by teachers from a taxonomy tailored to their stress management. The second aim was to explore whether their experiences of use evolved over time as teachers transitioned from working at home during lockdown to working full time on school premises. METHODS A longitudinal study intended for 6 weeks in the summer term (2020) was extended because of COVID-19 into the autumn term, lasting up to 27 weeks. Teachers chose to use a Withings smartwatch or the Wysa, Daylio, or Teacher Tapp apps. In total, 2 semistructured interviews and web-based surveys were conducted with 8 teachers in South London in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. The interviews were analyzed by creating case studies and conducting cross-case analysis. RESULTS The teachers described that the data captured or shared by the technology powerfully illustrated the physical and psychosocial toll of their work. This insight gave teachers permission to destress and self-care. The social-emotional confidence generated also led to empathy toward colleagues, and a virtuous cycle of knowledge, self-compassion, permission, and stress management action was demonstrated. Although the COVID-19 pandemic added a new source of stress, it also meant that teachers' stress management experiences could be contrasted between working from home and then back in school. More intentional self-care was demonstrated when back in school, sometimes without the need to refer to the data or technology. CONCLUSIONS The findings of this study demonstrate that taking a situated approach to understand the real-world, existential significance and value of data generates contextually informed insights. Where a strategic personal choice of consumer technology is enabled for high school heads of year, the data generated are perceived as holistic, with personal and professional salience, and are motivational in the educational context. Technology adoption was aided by the pandemic conditions of home working, and this flexibility would otherwise need workplace facilitation. These findings add to the value proposition of technologies for individual stress management and workforce health outcomes pertinent to educators, policy makers, and designers.
Collapse
Affiliation(s)
- Julia B Manning
- UCL Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
| | - Ann Blandford
- UCL Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
- UCL Institute of Healthcare Engineering, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, University College London and Anna Freud Centre, London, United Kingdom
| |
Collapse
|
14
|
Roberts SH, Bailey J. Exergaming (physically active video gaming) for mental health service users in a community mental health care setting: an ethnographic observational feasibility study. BMC Psychiatry 2023; 23:752. [PMID: 37845683 PMCID: PMC10577994 DOI: 10.1186/s12888-023-05233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND People with severe and enduring mental illness experience health inequalities with premature mortality; lifestyle behaviours are known to be contributing factors with low levels of physical activity reported. Facilitating physical activity to help maintain or improve health for those who are disadvantaged is essential. Exergaming (gaming involving physical movement) is increasingly used to improve physical activity across the lifespan and for those with a range clinical conditions; this might offer a way to increase physical activity for those with severe mental illness. The aim of this study was to explore engagement of mental health service users with exergaming to increase physical activity in a community mental health care setting. METHODS An ethnographic observational feasibility study was undertaken through participant observation and semi-structured interviews. A gaming console was made available for 2 days per week for 12 months in a community mental health setting. A reflexive thematic analysis was performed on the data. RESULTS Twenty one mental health service users engaged with the intervention, with two thirds exergaming more than once. One participant completed the semi-structured interview. Key themes identified from the observational field notes were: support (peer and staff support); opportunity and accessibility; self-monitoring; and perceived benefits. Related themes that emerged from interview data were: benefits; motivators; barriers; and delivery of the intervention. Integrating these findings, we highlight social support; fun, enjoyment and confidence building; motivation and self-monitoring; and, accessibility and delivery in community mental health care context are key domains of interest for mental health care providers. CONCLUSIONS We provide evidence that exergaming engages people with SMI with physical activity. The value, acceptability and feasibility of open access exergaming in a community mental health service context is supported. Facilitating exergaming has the potential to increase physical activity for mental health service users leading to possible additional health benefits.
Collapse
Affiliation(s)
- Seren Haf Roberts
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF144XN, UK.
| | - Jois Bailey
- Betsi Cadwaladr University Health Board, Wrexham, UK
| |
Collapse
|
15
|
Marques LM, Uchida PM, Barbosa SP. The impact of Exergames on emotional experience: a systematic review. Front Public Health 2023; 11:1209520. [PMID: 37744509 PMCID: PMC10512833 DOI: 10.3389/fpubh.2023.1209520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Gamification has proven to be a significant tool for health promotion, with a particular focus on physical activities such as Exergames, which improve not only physical, but also cognitive health. However, it is still not clear what effect the practice of Exergames has on changing the emotional experience. Purpose The objective of this systematic review is to evaluate the impact of Exergames training on emotional experience. Methods A systematic search was conducted in the PUBMED and SCOPUS databases. The relevant articles were screened independently by three researchers. Data concerning emotional measures and Exergame practice were extracted for analysis. Results The search yielded 38 articles, of which 16 were included. Exergames were found to significantly impact happiness, anxiety, depressive symptoms, mental health-related quality of life, self-worth, self-esteem, self-efficacy, perceived behavioral control, vigor, vitality, intrinsic motivation, perceived energy, and relaxation. Conclusion Our review supports the evidence that the practice of physical activity through Exergames, on the emotional experience generally generates an increase in positive emotions. In this sense, the results found support both the use of Exergames as a leisure activity that promotes wellbeing and emotional regulation, as well as for health promotion, public health, and clinical practice purposes. Our review strongly supports the notion that engaging in physical activity through Exergames generally leads to an increase in positive emotions. As a result, these findings endorse the utilization of Exergames as a leisure activity to promote well-being and emotional regulation. Moreover, Exergames hold potential for health promotion, public health, and clinical practice purposes.
Collapse
Affiliation(s)
- Lucas Murrins Marques
- Faculdade de Medicina, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sara Pinto Barbosa
- Faculdade de Medicina, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
16
|
Lukka L, Palva JM. The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment. JMIR Serious Games 2023; 11:e42173. [PMID: 37665624 PMCID: PMC10507521 DOI: 10.2196/42173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/24/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game-based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.
Collapse
Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - J Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
17
|
Estrella T, Alfonso C, Ramos-Castro J, Alsina A, Capdevila L. A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study. JMIR Serious Games 2023; 11:e46351. [PMID: 37616033 PMCID: PMC10485711 DOI: 10.2196/46351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it. OBJECTIVE The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study. METHODS An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user's basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 × 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques. RESULTS Changes in the frequency and time domain parameters of HRV and the game's performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition. CONCLUSIONS The results may indicate that playing different levels leads to an improvement in the game's final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback.
Collapse
Affiliation(s)
- Tony Estrella
- Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain
- Sport Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Alfonso
- Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain
- Sport Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Ramos-Castro
- Group of Biomedical and Electronic Instrumentation, Department of Electronic Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Aitor Alsina
- Department of Information and Communications Engineering, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Capdevila
- Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain
- Sport Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
18
|
Smith AU, Khawly GM, Jann J, Zetina APM, Padilla J, Schnall R. A Review of Serious Gaming as an Intervention for HIV Prevention. Curr HIV/AIDS Rep 2023; 20:181-205. [PMID: 37213045 DOI: 10.1007/s11904-023-00659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
PURPOSEOF REVIEW Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes. RECENT FINDINGS A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.
Collapse
Affiliation(s)
- Ariel U Smith
- College of Nursing - Population Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA.
| | - Gabriella M Khawly
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janna Jann
- College of Nursing - Population Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Ana Paola Mata Zetina
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Janeth Padilla
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Rebecca Schnall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
19
|
Altomari L, Altomari N, Iazzolino G. Gamification and Soft Skills Assessment in the Development of a Serious Game: Design and Feasibility Pilot Study. JMIR Serious Games 2023; 11:e45436. [PMID: 37494078 PMCID: PMC10413242 DOI: 10.2196/45436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/07/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The advent of new technologies has had a profound impact on the labor market, transforming the way we work and interact with each other. With the rise of digital tools and platforms, gamification has emerged as a powerful technique for enhancing productivity and engagement in various fields, including human resource management. In particular, gamification has been found to be effective in developing and assessing soft skills, which play a critical role in determining the success of individuals, teams, and organizations. OBJECTIVE We present a serious game that identifies the most sought-after skills in the job market and offers feedback, and we provide a set of guidelines for the creation of serious games. METHODS We present the serious game Among the Office Criticality (AOC). The AOC game structure involves a set of sequence analysis techniques, which is known as process mining. RESULTS The pilot study findings indicate that the game is both engaging and beneficial to subjects, suggesting that the results align with current theoretical perspectives. Furthermore, the study suggests that the obtained data can be extended to the broader population. CONCLUSIONS This study illustrates a serious game structured according to the needs of the labor market and developed to put the user at the center, using evaluation techniques consistent with the literature, with the aim of constituting an interdisciplinary approach suitable for adequately assessing users and creating value for them.
Collapse
Affiliation(s)
- Luca Altomari
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, Italy
| | - Natalia Altomari
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - Gianpaolo Iazzolino
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, Italy
| |
Collapse
|
20
|
Iuga IA, Tomoiaga CT, David OA. The REThink Online Therapeutic Game: A Usability Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1276. [PMID: 37628275 PMCID: PMC10453373 DOI: 10.3390/children10081276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Children and adolescents' help-seeking behaviors are often limited by fear, uncertainty, and stigma, as well as challenges with finding the right intervention, help, and a lack of familiarity with the process. A promising direction for the development of therapeutic interventions targeted at children is embedding them into gamified interventions, known as therapeutic or serious games. The aim of this paper is to describe the protocol of the beta REThink therapeutic game and to evaluate the usability of the game in a sample of children and adolescents. METHODS The study was delivered in schools, where 137 children and adolescents aged between 9 and 16 years old played the levels of the REThink game, followed by filling in the usability questionnaire. FINDINGS The results show above average evaluations for all levels of the game, for every dimension evaluated, namely presence/immersion, enjoyment, learning effectiveness, narratives, goal clarity, adequacy of learning material, and motivation. This study contributes to the literature on the usability of cognitive behavioral therapy-based therapeutic games for improvements in the emotion regulation abilities of children and adolescents, which can guide researchers interested in testing the REThink game in different protocols, as well to encourage its use by mental health specialists and parents.
Collapse
Affiliation(s)
- Ioana Alexandra Iuga
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania; (I.A.I.); (C.T.T.)
| | - Cristina Teodora Tomoiaga
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania; (I.A.I.); (C.T.T.)
| | - Oana Alexandra David
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania
| |
Collapse
|
21
|
Bevan Jones R, Hussain F, Agha SS, Weavers B, Lucassen M, Merry S, Stallard P, Simpson SA, Rice F. Digital technologies to support adolescents with depression and anxiety: review. BJPSYCH ADVANCES 2023; 29:239-253. [PMID: 37521105 PMCID: PMC10374830 DOI: 10.1192/bja.2022.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 01/21/2023]
Abstract
Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents' access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.
Collapse
Affiliation(s)
- Rhys Bevan Jones
- Senior Clinical Research Fellow in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, and a psychiatrist with Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Faris Hussain
- Academic Foundation Year 2 doctor with Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Sharifah Shameem Agha
- Lecturer with Cwm Taf Morgannwg University Health Board and an honorary lecturer in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| | - Bryony Weavers
- Research assistant in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| | - Mathijs Lucassen
- Senior lecturer in mental health in the Department of Health and Social Care, The Open University, UK, and an honorary senior lecturer in psychological medicine at the University of Auckland, New Zealand
| | - Sally Merry
- Professor in Child and Adolescent Mental Health in the Faculty of Medical and Health Sciences at the University of Auckland, New Zealand
| | - Paul Stallard
- Professor of Child and Family Mental Health in the Department for Health at the University of Bath, England, UK
| | - Sharon Anne Simpson
- Professor of Behavioural Sciences and Health in the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow, Scotland, UK
| | - Frances Rice
- Professor of Developmental Psychopathology in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| |
Collapse
|
22
|
Veerman LKM, Willemen AM, Derks SDM, Brouwer-van Dijken AAJ, Sterkenburg PS. The effectiveness of the serious game "Broodles" for siblings of children with intellectual disabilities and/or visual impairment: study protocol for a randomized controlled trial. Trials 2023; 24:336. [PMID: 37198687 DOI: 10.1186/s13063-023-07358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Siblings of children with disabilities also need support. However, there are only a few evidence-based interventions for these siblings. The current study aims to assess the effectiveness of a newly developed serious game for young siblings of children with intellectual disability (ID) and/or visual impairment (VI). This serious game is hypothesized to improve sibling's quality of life, adjustment to their brother's or sister's disability, and multiple aspects of psychosocial well-being. METHODS The intervention consists of a serious game called "Broodles" (in Dutch: "Broedels") that helps children to recognize and deal with thoughts, feelings, and difficult situations. The game consists of eight 20-minute levels that all have the same structure with eight game elements. Each level addresses a domain of sibling quality of life and combines animations, mini-documentaries, fun mini-games, and multiple-choice questions. In addition to the game, siblings make a worksheet after playing each level. In order to support the child, the parents or caregivers receive a short brochure with information and tips. The effectiveness of the intervention will be investigated among a sample of 154 children aged 6-9 years and their parents or caregivers, using a two-arm parallel RCT design. The experimental group will play the serious game "Broodles" over a period of 4 weeks, whereas the control group will be placed on a waiting list. Assessments will take place at three time points: pre-test (week 1), post-test (week 5), and follow-up (weeks 12-14). At each timepoint, children and parents will complete several questionnaires on quality of life and different aspects of psychosocial well-being. In addition, children will make drawings to assess the sibling relationship. Next to that, parents and children will answer closed and open-ended questions about the sibling adjustment to their brother or sister's disability. Finally, parents and children will evaluate the serious game through closed and open-ended questions. DISCUSSION This study contributes to the knowledge about sibling interventions and serious games. Additionally, if the serious game is proven to be effective, it will be a readily available, easily accessible, and free of charge intervention for siblings. TRIAL REGISTRATION ClinicalTrials.gov, NCT05376007, registered prospectively on April 21, 2022.
Collapse
Affiliation(s)
- Linda K M Veerman
- Department of Clinical Child and Family Studies; LEARN!; Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, Van der Boechorststraat 7, 1081 BT, the Netherlands.
| | - Agnes M Willemen
- Department of Clinical Child and Family Studies; LEARN!; Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, Van der Boechorststraat 7, 1081 BT, the Netherlands
| | - Suzanne D M Derks
- Department of Clinical Child and Family Studies; LEARN!; Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, Van der Boechorststraat 7, 1081 BT, the Netherlands
| | | | - Paula S Sterkenburg
- Department of Clinical Child and Family Studies; LEARN!; Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, Van der Boechorststraat 7, 1081 BT, the Netherlands
- Bartiméus, Doorn, Oude Arnhemse Bovenweg 3, 3941 XM, the Netherlands
| |
Collapse
|
23
|
Gómez-Cambronero Á, Casteleyn S, Bretón-López J, García-Palacios A, Mira A. A smartphone-based serious game for depressive symptoms: Protocol for a pilot randomized controlled trial. Internet Interv 2023; 32:100624. [PMID: 37273930 PMCID: PMC10235433 DOI: 10.1016/j.invent.2023.100624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 06/06/2023] Open
Abstract
Background Depression is the most prevalent mental disorder, with detrimental effects on the patient's well-being, high disability, and a huge associated societal and economic cost. There are evidence-based treatments, but it is difficult to reach all people in need. Internet-based interventions, and more recently smartphone-based interventions, were explored to overcome barriers to access. Evidence shows them to be effective alternatives to traditional treatments. This paper presents the protocol of a pilot study whose primary aim is to investigate the efficacy of a smartphone-based serious game intervention for patients with mild to moderate depressive symptoms. Methods This randomized controlled pilot trial protocol foresees two arms design: 1/ smartphone- based serious game intervention (based on Cognitive Behavior Therapy with particular emphasis on Behavioral Activation and Physical Activity), 2/ waiting list control group. The study is expected to recruit 40 participants (18+), which will be randomly assigned to one of the experimental conditions. The duration of the intervention is two months. The primary outcome measure will be depressive symptomatology. Secondary outcomes will include other variables such as physical activity, resilience, anxiety, depression impairment, and positive and negative affect. Treatment expectation, satisfaction, usability, and game playability will also be measured. The data will be analyzed based on the intention-to-treat and per protocol analyses. Discussion The study aims to establish initial evidence for the efficacy of a smartphone-based serious game intervention, to serve as input for a larger-scale randomized control trial. The intervention exploits advanced smartphone capabilities, such as the use of a serious game as delivery mode, with the potential benefit of engagement and treatment adherence, and motion sensors to monitor and stimulate physical activity. As a secondary objective, the study aims to gather initial evidence on the user's expectations, satisfaction, usability and playability of the serious game as a treatment.
Collapse
Affiliation(s)
| | - Sven Casteleyn
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
| | - Juana Bretón-López
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03 Instituto Salud Carlos III), C/ Sinesio Delgado, 4, Madrid 28029, Spain
| | - Azucena García-Palacios
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03 Instituto Salud Carlos III), C/ Sinesio Delgado, 4, Madrid 28029, Spain
| | - Adriana Mira
- University of Valencia, Av. de Blasco Ibáñez, 13, Valencia 46010, Spain
| |
Collapse
|
24
|
Saiger MJ, Deterding S, Gega L. Children and Young People's Involvement in Designing Applied Games: Scoping Review. JMIR Serious Games 2023; 11:e42680. [PMID: 36928258 PMCID: PMC10131627 DOI: 10.2196/42680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively. OBJECTIVE The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement. METHODS We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo. RESULTS We retrieved 1085 records, of which 47 (4.33%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43%) and co-design (16/47, 37%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints. CONCLUSIONS Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility.
Collapse
Affiliation(s)
| | - Sebastian Deterding
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, United Kingdom
| |
Collapse
|
25
|
Lucassen MF, Stasiak K, Fleming T, Shepherd M, Merry SN. Enhancing an online cognitive behavioural therapy intervention for depression: Harnessing the feedback of sexual and gender minority youth to help improve SPARX. Australas Psychiatry 2023:10398562231153061. [PMID: 36683530 DOI: 10.1177/10398562231153061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE SPARX is an online cognitive behavioural therapy self-help intervention for adolescent depression provided in serious game format. Since 2014, it has been freely available in Aotearoa New Zealand (NZ) due to funding from the NZ government. In 2020/21, feedback from sexual and gender minority youth (SGMY) was used to refine and update SPARX. METHOD Three online focus groups and follow-up email consultations involved 12 SGMY (16 to 25 years old) in NZ. A general inductive approach was used to analyse data. RESULTS SGMY had specific needs as well as preferences and four themes were identified: attend to our contextual realities; portrayals of sexual and gender minority people in games; envisaged ideals for serious gaming and appraisals of SPARX. SGMY feedback was used to improve SPARX for this unique population, with the updates launched in October 2021. CONCLUSIONS SGMY are underserved in terms of their mental health needs. Refining or tailoring existing interventions proffers a potential way forward in terms of addressing these needs.
Collapse
Affiliation(s)
- Mathijs Fg Lucassen
- Department of Health and Social Care, 5488The Open University, Milton Keynes, UK; Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- School of Health, 8491Victoria University of Wellington, Wellington, New Zealand; Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| | - Matthew Shepherd
- School of Psychology, 168219Massey University - Albany Campus, Auckland, New Zealand
| | - Sally N Merry
- Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| |
Collapse
|
26
|
Mavragani A, Lyman C, Roberts JE. Development of an mHealth App-Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation. JMIR Form Res 2022; 6:e40045. [PMID: 36512400 PMCID: PMC9795400 DOI: 10.2196/40045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process-rumination. OBJECTIVE The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. METHODS We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. RESULTS The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). CONCLUSIONS Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users' desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability.
Collapse
Affiliation(s)
| | - Cassondra Lyman
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - John E Roberts
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| |
Collapse
|
27
|
Mavragani A, Ranganath V. An Emotional Bias Modification for Children With Attention-Deficit/Hyperactivity Disorder: Co-design Study. JMIR Form Res 2022; 6:e36390. [PMID: 36485019 PMCID: PMC9789490 DOI: 10.2196/36390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 10/23/2022] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. OBJECTIVE The primary aim of this study was to collate health care professionals' perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. METHODS A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. RESULTS Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. CONCLUSIONS This study has managed to elucidate health care professionals' perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates.
Collapse
Affiliation(s)
| | - Vallabhajosyula Ranganath
- Anatomy, Office of Medical Education, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| |
Collapse
|
28
|
Xie H. A scoping review of gamification for mental health in children: Uncovering its key features and impact. Arch Psychiatr Nurs 2022; 41:132-143. [PMID: 36428041 DOI: 10.1016/j.apnu.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.
Collapse
Affiliation(s)
- Huiting Xie
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
| |
Collapse
|
29
|
Pons P, Navas-Medrano S, Soler-Dominguez JL. Extended reality for mental health: Current trends and future challenges. FRONTIERS IN COMPUTER SCIENCE 2022. [DOI: 10.3389/fcomp.2022.1034307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Virtual and augmented reality have been used to diagnose and treat several mental health disorders for decades. Technological advances in these fields have facilitated the availability of commercial solutions for end customers and practitioners. However, there are still some barriers and limitations that prevent these technologies from being widely used by professionals on a daily basis. In addition, the COVID-19 pandemic has exposed a variety of new scenarios in which these technologies could play an essential role, like providing remote treatment. Disorders that traditionally had received less attention are also getting in the spotlight, such as depression or obsessive-compulsive disorder. Improvements in equipment and hardware, like Mixed Reality Head Mounted Displays, could help open new opportunities in the mental health field. Extended reality (XR) is an umbrella term meant to comprise Virtual reality (VR), mixed reality (MR), and augmented reality (AR). While XR applications are eminently visual, other senses are being explored in literature around multisensory interactions, such as auditory, olfactory, or haptic feedback. Applying such stimuli within XR experiences around mental disorders is still under-explored and could greatly enrich the therapeutic experience. This manuscript reviews recent research regarding the use of XR for mental health scenarios, highlighting trends, and potential applications as well as areas for improvement. It also discusses future challenges and research areas in upcoming topics such as the use of wearables, multisensory, and multimodal interaction. The main goal of this paper is to unpack how these technologies could be applied to XR scenarios for mental health to exploit their full potential and follow the path of other health technologies by promoting personalized medicine.
Collapse
|
30
|
e-Estesia: A Serious Game for Reducing Arousal, Improving Emotional Regulation and Increasing Wellbeing in Individuals with Gambling Disorder. J Clin Med 2022; 11:jcm11226798. [PMID: 36431275 PMCID: PMC9699009 DOI: 10.3390/jcm11226798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Gambling disorder (GD) is associated with deficits in emotion regulation and impulsivity-related personality traits. In recent years there has been an increase in the use of serious games (SG) to address these factors with positive results. The aim of this study was to analyze the efficacy of the intervention with a new SG (e-Estesia), as an adjunct to a CBT intervention for GD. The sample comprised two groups (experimental group (n = 40) and control group (n = 64)) of patients with GD diagnosis. Both groups received 16 weekly CBT sessions and, concurrently, only the experimental group received 15 additional sessions with e-Estesia. Pre-post treatment with e-Estesia administered in both groups were: DSM-5 Criteria, South Oaks Gambling Screen, Symptom Checklist-Revised and measure of relapses, dropout and compliance of treatment. As regards the experimental group were also administered: Difficulties in Emotion Regulation Scale, Emotion Regulation Questionnaire, and Impulsive Behavior Scale. No statistically significant differences in the general psychopathological state, emotion regulation or impulsivity were found when comparing the groups. However, patients enrolled in the e-Estesia intervention had significantly less relapses and better indicators of treatment compliance than the control group. Considering these results, the use of complementary tools such as SG are useful for addressing GD.
Collapse
|
31
|
Baragash RS, Aldowah H, Ghazal S. Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions. Digit Health 2022; 8:20552076221132099. [PMCID: PMC9629585 DOI: 10.1177/20552076221132099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies. Methods To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being. Results The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions. Conclusion This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.
Collapse
Affiliation(s)
- Reem Sulaiman Baragash
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia,Reem Sulaiman Baragash, Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia.
;
| | - Hanan Aldowah
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Samar Ghazal
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| |
Collapse
|
32
|
Marinissen WN, Roskam YPHM, Staal IIE. Gebruik van een serious game als voorlichting over social media aan jongeren binnen de JGZ – een haalbaarheidsonderzoek. JGZ TIJDSCHRIFT VOOR JEUGDGEZONDHEIDSZORG 2022. [PMCID: PMC9612612 DOI: 10.1007/s12452-022-00294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Inleiding: Een serious game is een online spel met als belangrijkste doel het verwerven van inzicht. Dit doel wordt impliciet ingebouwd in het spel, zodat de speler er volledig in kan opgaan. Wij onderzochten of het inzetten van een serious game om jongeren voorlichting te geven over social media haalbaar is binnen de praktijk van de jeugdgezondheidszorg (JGZ). Methode: Er werd een serious game ontwikkeld met drie verhaallijnen. Deze game werd getest op bruikbaarheid vanuit het perspectief van jongeren, ouders en JGZ. Jongeren van 13 jaar kregen voorafgaand aan het preventieve gezondheidsonderzoek (PGO) de uitnodiging om de game te spelen. Van 127 leerlingen zijn data verkregen. Zij vulden als nulmeting twee schaalvragen in voorafgaand aan het spelen van de game, waarna de monitorgegevens van het spelen van de serious game verzameld werden en aangevuld werden met registratiedata van het PGO met de jeugdverpleegkundige. Aan het eind van het PGO werd de jongeren gevraagd nogmaals de twee schaalvragen van de nulmeting in te vullen. Zevenendertig ouders vulden een online vragenlijst in nadat hun kind de game had gespeeld. De verzamelde kwantitatieve data werden gebruikt als input voor één focusgroep met jongeren en één met jeugdverpleegkundigen om meer inzicht te krijgen in het gebruikersoordeel. Resultaten: Er is 434 keer een verhaallijn gestart, die 379 keer werd afgerond. Op basis van triggers in het spel bleek dat 73 % met risicogedrag heeft geëxperimenteerd, wat significant vaker gebeurde door jongens en onder leerlingen op het voorbereidend middelbaar beroepsonderwijs (vmbo). Bij de jeugdverpleegkundigen bood de serious game in 89 % een opening voor een verdiepend gesprek met de jongeren over online gedrag. Bij de ouders was dit 65 %. In het gesprek met de jeugdverpleegkundige gaf 44 % van de jongeren aan de game leuk tot heel leuk te vinden. In de focusgroep gaven alle aanwezige 31 jongeren aan dat ze het spel niet bij hun leeftijd vonden passen. Conclusie: Hoewel de serious game in de huidige vorm niet helemaal aansluit bij de ontwikkeling en beleving van 13-jarigen, blijkt het voor jeugdverpleegkundigen én ouders een bruikbare manier om met jongeren in gesprek te gaan over hun online gedrag.
Collapse
|
33
|
Rohrbach PJ, Dingemans AE, Spinhoven P, Van Ginkel JR, Fokkema M, Wilderjans TF, Bauer S, Van Furth EF. Effectiveness of an online self-help program, expert-patient support, and their combination for eating disorders: Results from a randomized controlled trial. Int J Eat Disord 2022; 55:1361-1373. [PMID: 35906929 PMCID: PMC9796760 DOI: 10.1002/eat.23785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Many individuals with an eating disorder do not receive appropriate care. Low-threshold interventions could help bridge this treatment gap. The study aim was to evaluate the effectiveness of Featback, a fully automated online self-help intervention, online expert-patient support and their combination. METHOD A randomized controlled trial with a 12-month follow-up period was conducted. Participants aged 16 or older with at least mild eating disorder symptoms were randomized to four conditions: (1) Featback, a fully automated online self-help intervention, (2) chat or email support from a recovered expert patient, (3) Featback with expert-patient support and (4) a waiting list control condition. The intervention period was 8 weeks and there was a total of six online assessments. The main outcome constituted reduction of eating disorder symptoms over time. RESULTS Three hundred fifty five participants, of whom 43% had never received eating disorder treatment, were randomized. The three active interventions were superior to a waitlist in reducing eating disorder symptoms (d = -0.38), with no significant difference in effectiveness between the three interventions. Participants in conditions with expert-patient support were more satisfied with the intervention. DISCUSSION Internet-based self-help, expert-patient support and their combination were effective in reducing eating disorder symptoms compared to a waiting list control condition. Guidance improved satisfaction with the internet intervention but not its effectiveness. Low-threshold interventions such as Featback and expert-patient support can reduce eating disorder symptoms and reach the large group of underserved individuals, complementing existing forms of eating disorder treatment. PUBLIC SIGNIFICANCE STATEMENT Individuals with eating-related problems who received (1) a fully automated internet-based intervention, (2) chat and e-mail support by a recovered individual or (3) their combination, experienced stronger reductions in eating disorder symptoms than those who received (4) usual care. Such brief and easy-access interventions play an important role in reaching individuals who are currently not reached by other forms of treatment.
Collapse
Affiliation(s)
- Pieter J. Rohrbach
- GGZ Rivierduinen Eating Disorders UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | | | - Philip Spinhoven
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands,Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Joost R. Van Ginkel
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Tom F. Wilderjans
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands,Leiden Institute for Brain and CognitionLeiden University Medical CenterLeidenNetherlands,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
| | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity Hospital HeidelbergGermany
| | - Eric F. Van Furth
- GGZ Rivierduinen Eating Disorders UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| |
Collapse
|
34
|
David OA, Stroian PI, Predatu R, Maffei A. State anxiety and frontal alpha asymmetry effects of the REThink online video game for children and adolescents: A six-month follow-up. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Kim SH, Kim KA, Baek J, Choi J, Chu SH. e-Health for Traumatized Refugees: A Scoping Review. Telemed J E Health 2022; 29:635-645. [PMID: 36169628 DOI: 10.1089/tmj.2022.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: High prevalence of post-traumatic stress disorder (PTSD) is reported among refugees exposed to traumatic experiences, while escaping from their home country, entering a third country, and adjusting to a new society. Electronic health (e-health) treatments have been utilized to overcome challenges such as high costs, limited access to care, and a shortage of resources faced by traumatized refugees. Objective: The aim of this scoping review was to summarize the current science on e-health to screen and treat PTSD in traumatized refugees, examine its benefits and challenges, and suggest strategies for future research. Methods: We conducted a scoping review guided by Arksey and O'Malley's 6-stage scoping review framework. Results: Of the 2,782 articles identified, 8 studies were included for the final analysis. Due to the heterogeneity of studies, the synthesis of results was not feasible. However, the findings of individual studies were examined. The most commonly used technology modality was the smartphone (n = 5). One study revealed the possibility of telephonic screening of PTSD to be equally efficacious as in-person screening, and all interventions through smartphone and the internet reported high feasibility and acceptability. Conclusion: e-Health is suggested to be a novel and scalable platform to provide mental health care in settings with limited resources. Larger and highly robust studies in refugee populations with PTSD-targeted, theory-based approaches and diverse technological formats such as video conferencing and virtual reality are warranted.
Collapse
Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea
| | - Kyoung-A Kim
- Department of Nursing, Gachon University College of Nursing, Incheon, Korea
| | - Jiwon Baek
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - JiYeon Choi
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Sang Hui Chu
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| |
Collapse
|
36
|
Mena-Moreno T, Munguía L, Granero R, Lucas I, Sánchez-Gómez A, Cámara A, Compta Y, Valldeoriola F, Fernandez-Aranda F, Sauvaget A, Menchón JM, Jiménez-Murcia S. Cognitive Behavioral Therapy Plus a Serious Game as a Complementary Tool for a Patient With Parkinson Disease and Impulse Control Disorder: Case Report. JMIR Serious Games 2022; 10:e33858. [PMID: 36083621 PMCID: PMC9508668 DOI: 10.2196/33858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/03/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Impulse control disorders (ICDs) are commonly developed among patients who take dopamine agonist drugs as a treatment for Parkinson disease (PD). Gambling disorder and hypersexuality are more frequent in male patients with PD, with a prevalence over 4% in dopamine agonists users. Although impulsive-compulsive behaviors are related to antiparkinsonian medication, and even though ICD symptomatology, such as hypersexuality, often subsides when the dopaminergic dose is reduced, sometimes ICD persists in spite of drug adjustment. Consequently, a multidisciplinary approach should be considered to address these comorbidities and to explore new forms of complementary interventions, such as serious games or therapies adapted to PD. Objective The aim of this study is to present the case of a patient with ICD (ie, hypersexuality) triggered by dopaminergic medication for PD. A combined intervention was carried out using cognitive behavioral therapy (CBT) for ICD adapted to PD, plus an intervention using a serious game—e-Estesia—whose objective is to improve emotion regulation and impulsivity. The aim of the combination of these interventions was to reduce the harm of the disease. Methods After 20 CBT sessions, the patient received the e-Estesia intervention over 15 sessions. Repeated measures, before and after the combined intervention, were administered to assess emotion regulation, general psychopathology, and emotional distress and impulsivity. Results After the intervention with CBT techniques and e-Estesia, the patient presented fewer difficulties to regulate emotion, less emotional distress, and lower levels of impulsivity in comparison to before the treatment. Moreover, the frequency and severity of the relapses also decreased. Conclusions The combined intervention—CBT and a serious game—showed positive results in terms of treatment outcomes.
Collapse
Affiliation(s)
- Teresa Mena-Moreno
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain
| | - Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain
| | - Rosario Granero
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain
| | - Almudena Sánchez-Gómez
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut D'Investigacions Biomediques August Pi i Sunyer, Institut de Neurociències Universitat de Barcelona (Maria de Maeztu Excellence Center), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Cámara
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut D'Investigacions Biomediques August Pi i Sunyer, Institut de Neurociències Universitat de Barcelona (Maria de Maeztu Excellence Center), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut D'Investigacions Biomediques August Pi i Sunyer, Institut de Neurociències Universitat de Barcelona (Maria de Maeztu Excellence Center), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut D'Investigacions Biomediques August Pi i Sunyer, Institut de Neurociències Universitat de Barcelona (Maria de Maeztu Excellence Center), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anne Sauvaget
- Movement, Interactions, Performance, University of Nantes, Nantes, France
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de Bellvitge, Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
37
|
van Lotringen C, Lusi B, Westerhof GJ, Ludden GDS, Kip H, Kelders SM, Noordzij ML. Compassionate Technology: A Systematic Scoping Review of Compassion as Foundation for Blended and Digital Mental Health Interventions (Preprint). JMIR Ment Health 2022; 10:e42403. [PMID: 37027207 PMCID: PMC10131870 DOI: 10.2196/42403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clients and more accessible and economically viable care. However, digital mental health interventions (DMHIs) have not been widely implemented in daily practice. Developing and evaluating DMHIs around important mental health care values, such as compassion, could be key for a better integration of technology in the mental health care context. OBJECTIVE This systematic scoping review explored the literature for previous instances where technology for mental health care has been linked to compassion or empathy to investigate how DMHIs can support compassion in mental health care. METHODS Searches were conducted in the PsycINFO, PubMed, Scopus, and Web of Science databases, and screening by 2 reviewers resulted in 33 included articles. From these articles, we extracted the following data: technology types, goals, target groups, and roles of the technologies in the intervention; study designs; outcome measures; and the extent to which the technologies met a 5-step proposed definition of compassion. RESULTS We found 3 main ways in which technology can contribute to compassion in mental health care: by showing compassion to people, by enhancing self-compassion in people, or by facilitating compassion between people. However, none of the included technologies met all 5 elements of compassion nor were they evaluated in terms of compassion. CONCLUSIONS We discuss the potential of compassionate technology, its challenges, and the need to evaluate technology for mental health care on compassion. Our findings could contribute to the development of compassionate technology, in which elements of compassion are explicitly embedded in its design, use, and evaluation.
Collapse
Affiliation(s)
- Charlotte van Lotringen
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Benedetta Lusi
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Gerben J Westerhof
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Geke D S Ludden
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Hanneke Kip
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| |
Collapse
|
38
|
Sriwatanathamma P, Sirivesmas V, Simatrang S, Bhowmik NH. Gamifying Cognitive Behavioral Therapy Techniques on Smartphones for Bangkok’s Millennials with Depressive Symptoms: Interdisciplinary Game Development (Preprint). JMIR Serious Games 2022; 11:e41638. [PMID: 37171845 DOI: 10.2196/41638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND There is serious concern over the annual increase in depressive symptoms among millennials in Bangkok, Thailand. Their daily routine revolves around the use of their smartphones for work and leisure. Although accessibility to mental health care is expanding, it cannot keep up with the demand for mental health treatment. Outside Thailand, multiple projects and studies have attempted to merge gamification mechanisms and cognitive behavioral therapy (CBT) to create mobile health intervention apps and serious games with positive feedback. This presents an opportunity to explore the same approach in Thailand. OBJECTIVE This study investigated the development process of gamifying CBT techniques to support game mechanics in a visual narrative serious game, BlueLine. The primary target of this research is Bangkok's millennials. In the game, players play as Blue, a Bangkok millennial who struggles to live through societal norms that influence his digital life and relationships. Through in-game scenarios, players will learn and understand how to lessen the impact of depressive symptoms via gamified interactions on their smartphones. METHODS First, this paper follows each development step of solidifying BlueLine's game structure by integrating the Activating Events, Beliefs, Consequences, Disputation of Beliefs and Effective New Approaches (ABCDE) model and narrative in games. Second, the approach to select CBT and related therapeutic elements for gamification is based on suitability to the game structure. Throughout the process, CBT experts in Thailand have reviewed these scenarios. The approach forms the base of the player's interactions throughout the scenarios in BlueLine, broken down into 4 types of gamified mechanisms: narrative, verbal interactions, physical interactions, and social media interactions. RESULTS With the game structure based on the ABCDE model, BlueLine scenarios implement gamified mechanisms in conjunction with the following CBT and related therapeutic elements: behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. In each scenario, players guide Blue to overcome his triggered dysfunctional beliefs. During this process, players can learn and understand how to lessen the impact of depressive symptoms through gamified interactions. CONCLUSIONS This paper presents the development process of gamifying CBT and related therapeutic techniques in BlueLine game scenarios. A scenario can harbor multiple techniques, including behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. BlueLine's game structure does not limit the fact that the same combination of CBT elements ties each gamified mechanism.
Collapse
|
39
|
Thunström AO, Sarajlic Vukovic I, Ali L, Larson T, Steingrimsson S. Prevalence of virtual reality (VR) games found through mental health categories on STEAM: a first look at VR on commercial platforms as tools for therapy. Nord J Psychiatry 2022; 76:474-485. [PMID: 34851240 DOI: 10.1080/08039488.2021.2003859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however little insight into the prevalence of commercially available VR games for treatment of mental health problems on commercial platforms such as STEAM, and to what extent they can be used as tools for treatment or add-on treatment of mental health problems. OBJECTIVE The aim of this study was to take a first look at the prevalence and overview of content of commercially available games. The games were found using search words related to psychiatric diagnosis or care. METHODS We performed a search for keywords related to symptoms, diagnosis, and treatment strategies of mental health problems. The search was performed November 2020 on STEAM. A scheme was created for elimination and inclusion of games, eliminating those games which were irrelevant to mental health or had triggering elements such as violence, excessive movement which could trigger nausea, horror and pornographic imagery. RESULTS In total, 735 hits were found, 565 unique games. After the games were reviewed for content via trailers, descriptions and screenshots, 32%, i.e. 182 games passed the inclusion criteria. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate. CONCLUSIONS Commercial platforms are only at the beginning of the development towards therapeutic content. Currently the quality and usability for therapeutic use is scarce but holds great potential.
Collapse
Affiliation(s)
- Almira Osmanovic Thunström
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Iris Sarajlic Vukovic
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Larson
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
40
|
Gamification for behavior change: A scientometric review. Acta Psychol (Amst) 2022; 228:103657. [DOI: 10.1016/j.actpsy.2022.103657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
|
41
|
Abbasi AZ, Azeem S, Farooq MU, Hussain K, Ting DH, Rehman U, Griffiths MD, Pakpour AH. Engagement in educational games and quality of life in early and middle childhood: evidence from a developing country. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03558-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
42
|
Peng X, Menhas R, Dai J, Younas M. The COVID-19 Pandemic and Overall Wellbeing: Mediating Role of Virtual Reality Fitness for Physical-Psychological Health and Physical Activity. Psychol Res Behav Manag 2022; 15:1741-1756. [PMID: 35860203 PMCID: PMC9289576 DOI: 10.2147/prbm.s369020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/05/2022] [Indexed: 12/11/2022] Open
Abstract
Background Virtual reality applications are made for various objectives such as business, entertainment, education, and healthcare. Anxiety, phobias, distress, disordered eating, drug addiction, panic disorder, post-traumatic stress disorder, schizophrenia, bipolar disorder, psychosis, depression, and autism spectrum disorders may benefit from virtual reality-based approaches. The 2019 coronavirus (COVID-19) pandemic has impacted the way we live, enjoy, study, sport, and socialize significantly. Virtual reality fitness technology gained much attention during the COVID-19 preventive measures time. Objective The present study explores the role of virtual reality fitness in improving overall wellbeing during the COVID-19 pandemic home isolation period in terms of physical-psychological health and physical activity. Methods A total of 2300 individuals were recruited using the snowball sampling technique to participate in the study. The primary data were collected using an anonymous web-based survey. SPSS-23 and Smart-PLS 3.2.9 software were used to analyze the data. Results The direct path coefficient analysis of the study constructs show that virtual reality fitness has (preventive measures -> virtual reality fitness -> overall wellbeing, preventive measures -> virtual reality fitness -> physical exercise, and preventive measures -> virtual reality fitness -> physical health) profound effects on the research participants’ mental and physical wellbeing of the study participants while indirect mediation analysis shows that virtual reality fitness has (preventive measures -> virtual reality fitness ->overall wellbeing, preventive measures -> virtual reality fitness -> physical exercise, preventive measures -> virtual reality fitness ->physical health) significant impacts. Conclusion Our study results concluded that house exercises through virtual reality fitness are a good substitute for public gyms and private group fitness programs during the first pandemic wave for physical-psychological and overall wellbeing. Virtual reality fitness technology can alleviate many of the challenges brought on by the epidemic, resulting in increased utilization.
Collapse
Affiliation(s)
- Xiang Peng
- College of Physical Education, Hunan City University, Yiyang, People's Republic of China.,College of Physical Education and Sports, Soochow University, Suzhou, People's Republic of China
| | - Rashid Menhas
- Research Center of Sports Social Sciences, College of Physical Education and Sports, Soochow University, Suzhou, People's Republic of China
| | - Jianhui Dai
- College of Physical Education and Sports, Soochow University, Suzhou, People's Republic of China
| | - Muhammad Younas
- School of Education, Soochow University, Suzhou, People's Republic of China
| |
Collapse
|
43
|
White BK, Martin A, White J. Gamification and older adults: Opportunities for gamification to support health promotion initiatives for older adults in the context of COVID-19. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022:100528. [PMID: 35815240 PMCID: PMC9257427 DOI: 10.1016/j.lanwpc.2022.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has increased reliance on digital service delivery, including the delivery of health promotion initiatives. Health promotion interventions need to carefully consider user engagement. Gamification is a strategy used to engage and motivate people, and evidence shows overall cautious positive results in the use of gamification for older people across a range of health areas although more evidence is needed. Gamification has been used as a strategy in COVID-19 related initiatives and there is potential to build on the evidence to further develop gamification initiatives for those living in the Western Pacific region to impact positively on healthy behaviours and health outcomes.
Collapse
Affiliation(s)
- Becky K White
- Reach Health Promotion Innovations, Perth, Western Australia
- Curtin University, Perth, Western Australia
| | - Annegret Martin
- Reach Health Promotion Innovations, Perth, Western Australia
| | - James White
- Reach Health Promotion Innovations, Perth, Western Australia
| |
Collapse
|
44
|
Wang P, Fang Y, Qi JY, Li HJ. FISHERMAN: A Serious Game for Executive Function Assessment of Older Adults. Assessment 2022:10731911221105648. [PMID: 35762827 DOI: 10.1177/10731911221105648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Executive functions (EFs) are essential for daily living activities but decline with age. Convenient assessment and timely intervention have particular significance for older adults. However, the traditional laboratory tasks of EFs are typically monotonous and inconvenient. The current study aimed to develop an interesting and convenient supplementary tool to assess EFs for older adults. According to the theory of EFs, we developed a serious game, FISHERMAN, to assess EFs. The game includes three subgames, Cautious Fisherman, Agile Fisherman, and Wise Fisherman, targeting core components of inhibition, shifting, and working memory, respectively. The current study aims to verify the reliability and validity of the game. One hundred and eight healthy older adults participated in this study and were tested through the FISHERMAN game and a battery of cognitive tests. The results show that the FISHERMAN game has high internal consistency reliability and good construct validity as well as criterion-related validity, suggesting that the game design is valid and can be used in EFs assessment for older adults. Future studies are warranted to establish the norm of the FISHERMAN game in older adults and investigate whether the FISHERMAN game can be generalized to other populations.
Collapse
Affiliation(s)
- Ping Wang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Fang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jing-Yi Qi
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Hui-Jie Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
45
|
Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
Collapse
Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| |
Collapse
|
46
|
Linardon J, Messer M, Shatte A, Greenwood CJ, Rosato J, Rathgen A, Skvarc D, Fuller-Tyszkiewicz M. Does the Method of Content Delivery Matter? Randomized Controlled Comparison of an Internet-Based Intervention for Eating Disorder Symptoms With and Without Interactive Functionality. Behav Ther 2022; 53:508-520. [PMID: 35473653 DOI: 10.1016/j.beth.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
Despite their potential as a scalable, cost-effective intervention format, self-guided Internet-based interventions for eating disorder (ED) symptoms continue to be associated with suboptimal rates of adherence and retention. Improving this may depend on the design of an Internet intervention and its method of content delivery, with interactive programs expected to be more engaging than static, text-based programs. However, causal evidence for the added benefits of interactive functionality is lacking. We conducted a randomized controlled comparison of an Internet-based intervention for ED symptoms with and without interactive functionality. Participants were randomized to a 4-week interactive (n = 148) or static (n = 145) version of an Internet-based, cognitive-behavioral program. The interactive version included diverse multimedia content delivery channels (video tutorials, graphics, written text), a smartphone app allowing users to complete the required homework exercises digitally (quizzes, symptom tracking, self-assessments), and progress monitoring features. The static version delivered identical intervention content but only via written text, and contained none of those interactive features. Dropout rates were high overall (58%), but were significantly-yet slightly-lower for the interactive (51%) compared to the static intervention (65%). There were no significant differences in adherence rates and symptom-level improvements between the two conditions. Adding basic interactive functionality to a digital intervention may help with study retention. However, present findings challenge prior speculations that interactive features are crucial for enhancing user engagement and symptom improvement.
Collapse
Affiliation(s)
| | | | | | - Christopher J Greenwood
- Deakin University, Murdoch Children's Research Institute and University of Melbourne; Royal Children's Hospital
| | | | | | | | | |
Collapse
|
47
|
Ferrari M, Sabetti J, McIlwaine SV, Fazeli S, Sadati SMH, Shah JL, Archie S, Boydell KM, Lal S, Henderson J, Alvarez-Jimenez M, Andersson N, Nielsen RKL, Reynolds JA, Iyer SN. Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion. Front Digit Health 2022; 4:814248. [PMID: 35465647 PMCID: PMC9021794 DOI: 10.3389/fdgth.2022.814248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.
Collapse
Affiliation(s)
- Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- *Correspondence: Manuela Ferrari
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarah V. McIlwaine
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sahar Fazeli
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - S. M. Hani Sadati
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Jai L. Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katherine M. Boydell
- Black Dog Institute and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Lal
- Douglas Mental Health University Institute, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | | | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | | | | | - Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| |
Collapse
|
48
|
Jankowski S, Ferreira K, Mascayano F, Donovan E, Rahim R, Birnbaum ML, Yum-Chan S, Medoff D, Marcogliese B, Fang L, Nicholson T, Dixon L. A Serious Game for Young People With First Episode Psychosis (OnTrack>The Game): Qualitative Findings of a Randomized Controlled Trial. JMIR Ment Health 2022; 9:e33526. [PMID: 35384847 PMCID: PMC9021940 DOI: 10.2196/33526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have shown the benefits of coordinated specialty care (CSC) for individuals with first episode psychosis; however, pathways to care are marred by lack of knowledge, stigma, and difficulties with treatment engagement. Serious games or video interventions may provide a way to address these factors. OBJECTIVE This study focuses on qualitative results of a randomized controlled trial comparing OnTrack>The Game (OTG) with recovery videos (RVs) on engagement, stigma, empowerment, hope, recovery, and understanding of psychosis in clients receiving CSC. Clinicians are also interviewed regarding their perceptions of the interventions and suggestions for improvement. METHODS A total of 16 clients aged 16-30 years, with first episode psychosis attending a CSC program in New York State, and 9 clinicians participated in the qualitative interviews. Interviews were analyzed using the rapid identification of themes from audio recordings method. RESULTS For clients, themes included relatability of game content, an increased sense of hope and the possibility of recovery, decreased self-stigma and public stigma, increased understanding of the importance of social support, and increased empowerment in the OTG group. Clinicians had a preference for RV and provided suggestions for dissemination and implementation. CONCLUSIONS Themes that may help inform future research in this area, particularly regarding dissemination and implementation of OTG and RV, emerged. TRIAL REGISTRATION ClinicalTrials.gov NCT03390491; https://clinicaltrials.gov/ct2/show/NCT03390491.
Collapse
Affiliation(s)
- Samantha Jankowski
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Kathleen Ferreira
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Franco Mascayano
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Effy Donovan
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Reanne Rahim
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Michael L Birnbaum
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Sabrina Yum-Chan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bethany Marcogliese
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| |
Collapse
|
49
|
Archie S, Palaniyappan L, Olagunju AT, Johnson N, Kozloff N, Sadeh E, Bardell A, Baines A, Anderson KK, Ayonrinde O, Ferrari M. Insights about Cannabis and Psychosis Using Video Games for Young People with a First Episode of Psychosis, particularly those from Black Racialized Backgrounds: Study Design. JMIR Res Protoc 2022; 11:e36758. [PMID: 35389874 PMCID: PMC9166641 DOI: 10.2196/36758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cannabis use disorder among young people with a first episode of psychosis contributes to relapse, hospitalization, and impaired functioning. However, few studies have examined what young people with early phase psychosis, particularly those from Black racialized communities, understand or appreciate about this relationship, even though they may be at risk. There are no formally tested knowledge translation strategies that disseminate these research findings for young people with emerging psychosis from Black racialized communities. Objective This study aims to conceptualize what young people with early phase psychosis/cannabis use disorder understand about the relationship between cannabis and psychosis, focusing on people from racialized backgrounds. This study also aims to assess whether the knowledge translation product, the “Back to Reality Series,” increases awareness of the impact of cannabis use on psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Methods Qualitative analysis will reveal themes from qualitative interviews about cannabis and psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Perceptions before and after exposure to the Back to Reality Series will be qualitatively analyzed. A control game will be used for comparison, and scores on a quiz after playing the Back to Reality Series will be quantitatively analyzed to establish whether the Back to Reality Series raises awareness of the effects of cannabis on psychosis. An advisory council involving young people from Black communities, family members, and clinicians will bring community perspectives to this research. Results We began recruiting participants for this study in September 2021. We will complete data collection on demographic and clinical factors, qualitative interviews, and quantitative assessments of the Back to Reality Series. Conclusions The voices of young people from racialized backgrounds will generate preliminary data to inform early psychosis programs, addressing cannabis use in this population. The findings may advance the use of a new knowledge translation product that deals with gaps in knowledge about cannabis use for people experiencing early phase psychosis, particularly those from racialized communities. International Registered Report Identifier (IRRID) DERR1-10.2196/36758
Collapse
Affiliation(s)
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, CA.,Robarts Research Institute, Western University, London, CA.,Lawson Health Research Institute, London, CA
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, CA.,Discipline of Psychiatry, The University of Adelaide, Adelaide, AU
| | | | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, CA.,Department of Psychiatry, University of Toronto, Toronto, CA
| | - Elham Sadeh
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA
| | - Andrea Bardell
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA.,Canadian Consortium for Early Psychosis Intervention, Ottawa, CA.,Department of Psychiatry, University of British Columbia, Vancouver, CA.,Ottawa Hospital Research Institute, Ottawa, CA.,Department of Psychiatry, University of Ottawa, Ottawa, CA
| | - Alexandra Baines
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA.,Department of Psychiatry, University of Ottawa, Ottawa, CA.,Ottawa Hospital Research Institute, Ottawa, CA.,Integrated Schizophrenia and Recovery Program, The Royal Ottawa Hospital, Ottawa, CA
| | - Kelly K Anderson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, CA
| | | | | |
Collapse
|
50
|
A Multimodal Approach for Real Time Recognition of Engagement towards Adaptive Serious Games for Health. SENSORS 2022; 22:s22072472. [PMID: 35408088 PMCID: PMC9002748 DOI: 10.3390/s22072472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023]
Abstract
In this article, an unobtrusive and affordable sensor-based multimodal approach for real time recognition of engagement in serious games (SGs) for health is presented. This approach aims to achieve individualization in SGs that promote self-health management. The feasibility of the proposed approach was investigated by designing and implementing an experimental process focusing on real time recognition of engagement. Twenty-six participants were recruited and engaged in sessions with a SG that promotes food and nutrition literacy. Data were collected during play from a heart rate sensor, a smart chair, and in-game metrics. Perceived engagement, as an approximation to the ground truth, was annotated continuously by participants. An additional group of six participants were recruited for smart chair calibration purposes. The analysis was conducted in two directions, firstly investigating associations between identified sitting postures and perceived engagement, and secondly evaluating the predictive capacity of features extracted from the multitude of sources towards the ground truth. The results demonstrate significant associations and predictive capacity from all investigated sources, with a multimodal feature combination displaying superiority over unimodal features. These results advocate for the feasibility of real time recognition of engagement in adaptive serious games for health by using the presented approach.
Collapse
|