Mental Health Outcomes of an Applied Game for Children with Elevated Anxiety Symptoms: A Randomized Controlled Non-inferiority Trial

• Published in: Journal of child and family studies 2020-08, Vol.29 (8), p.2169-2185
• Main Authors: Schoneveld, Elke A., Wols, Aniek, Lichtwarck-Aschoff, Anna, Otten, Roy, Granic, Isabela
• Format: Article
• Language: English
• Subjects: Alternative approaches; Analysis; Anxiety; Anxiety disorders; Behavior therapy; Behavioral health care; Behavioral Science and Psychology; Child & adolescent mental health; Child and School Psychology; Child psychopathology; Childhood; Children; Children & youth; Clinical outcomes; Clinical trials; Cognitive behavioral therapy; Cognitive Restructuring; Cognitive therapy; Cognitive-behavioral factors; Computer & video games; Educational software; Externalizing problems; Games; Health aspects; Health problems; Health status; Inferiority; Internalization; Internalizing disorders; Intervention; Maternal characteristics; Mental disorders; Mental health; Mental health services; Mothers; Original Paper; Prevention programs; Psychological aspects; Psychology; Psychotherapy; Self Efficacy; Social Sciences; Sociology; Symptoms
• ISSN: 1062-1024; 1573-2843
• DOI: 10.1007/s10826-020-01728-y

Anxiety disorders are the most prevalent mental health problems in childhood. Engaging, adequate, and appropriate prevention programs are needed. Applied games form a potential alternative delivery model and recent evidence suggests that they could be effective. The present randomized controlled non-inferiority trial investigated the beneficial effects of the applied game MindLight compared to cognitive behavioral therapy (CBT) on mental health outcomes associated with anxiety symptoms: internalizing problems, externalizing problems, and self-efficacy. In addition, we examined who benefitted most from both programs and analyzed baseline levels of anxiety, maternal mental health problems, and self-efficacy as predictors of changes in anxiety symptoms. After being screened for elevated anxiety, 174 selected children (8–12-year-old) were randomized to play MindLight or to receive a prevention program based on CBT. Study variables were assessed before and after the intervention, and at 3- and 6-months follow-up. Intention-to-treat analyses showed a significant reduction in mother-reported internalizing and externalizing problems and an increase in self-efficacy. Importantly, the magnitude of change did not differ between intervention groups. Non-inferiority analyses showed that MindLight was as effective as CBT in affecting internalizing problems and self-efficacy. However, CBT was more effective in decreasing externalizing symptoms than MindLight. Furthermore, baseline anxiety levels, maternal mental health problems, and self-efficacy did not influence the change of anxiety symptoms over time. Applied games, specifically theory-based games such as MindLight, hold potential as effective interventions for not only targeting anxiety symptoms, but also more general mental health outcomes. Highlights Applied games form an alternative delivery model of therapeutic techniques. The applied game MindLight was as effective as CBT in improving youth mental health. In both groups, internalizing and externalizing problems and self-efficacy improved. Differences in baseline mental health were unrelated to intervention outcomes.