Why Games?

The main assumption underlying our research program is that the often disappointing outcomes of prevention and treatment trials, and the emerging challenges in e-mental health initiatives, result from limitations in the delivery of evidence-based principles – not the principles themselves. Games are an effective delivery model for many reasons:

(1) Engagement: Most of our interventions impart psychoeducational information, but adolescents often find didactic lessons boring. We want to hijack kids' enthusiasm for games for purposes beyond entertainment.

(2) Motivation: The key predictor of treatment outcomes is motivation for change. Games are intrinsically motivating because they offer a strong sense of agency, opportunities for co-creation with like-minded peers, and fun.

(3) Practice: Most conventional interventions do a good job of teaching new knowledge, but don't provided much practice with emotion regulations skills, which need to be practiced. Video games can be played for extensive periods of time, can trigger a range of increasingly negative emotions, and are deeply social at this point, simulating and preparing users for real life social challenges.

(4) Stigma is a huge barrier to prevention and treatment. Games can be delivered through “stealth” approaches that avoid mental health labelling.

(5) Personalization: Conventional prevention approaches are unable to tailor interventions to the diverse needs of an at-risk population. Video games are complex systems that adjust dynamically to the players’ actions. Each player’s in-game progress adjusts the degree of difficulty and reinforcement, maintaining an optimal balance for each individual.

(6) Access and cost: Approximately 80% of youths who need mental health care receive no services. Those most in need of care have a difficult time accessing programs and cost is a major barrier to access for a large subpopulation.

The GEMH Design Framework

At this early stage, we think it's critical to develop a rigorous theoretical framework and a new methodology that stipulates how to use games to develop and test theories of psychological change, and implement prevention strategies based on its outcomes. The GEMH lab is developing this framework, with its international consortium of talented academics, clinicians, commercial game designers, and entrepeneurs. Together, we are building and refining the GEMH framework, a methodology that stipulates how to develop games, with whom to do so, the research approaches necessary for validation, and the most effective methods for dissemination of evidence-based products. We are still at the early stages of building this framework, but we'd like it to not only be relevant to anxiety and depression, but also to a wide spectrum of mental health issues (including aggressive behaviour disorders, autism, and attention deficit-hyperactivity disorder) as well as to be useful for the promotion of emotional resilience for all children and youth.

Our Methodology

Not all games tap mental health variables. To optimize our outcomes, it is critical that game components target causal mediators related to anxiety and depression. Game components -- or mechanics -- are rule-based systems that encourage a user to engage with particular properties of the game through a carefully designed feedback process. Each mechanic is a vehicle that trains a certain skill: We are interested in identifying and designing mechanics most relevant to anxiety and/or depression and emotional resilience more generally. Examples of the kinds of mechanisms we are targeting in our games, and the mechanics most relevant for training improvements in these mechanisms, are shown below.

Rigorous Scientific Testing

We are first and foremost scientists: All our game mechanics are tested for both engagement and retention potential as well as for psychological and behavioural impact. We apply an iterative testing model during which we test our design and mechanics over multiple design phases, as we develop our games. We ultimately conduct randomized controlled trials (RCTs) to establish the efficacy of our games compared to the most strict control-group standards. That means we test our games against other control games as well as comparing them to the evidence-based gold-standard interventions (CBT) currently implemented. Ultimately, we want to know whether our games significantly decrease anxiety, depression and substance use, as well as whether they promote emotional resilience skills (e.g., growth mindset) and whether these games are doing a better job than conventional intervention approaches. We register all our trials, adhere to CONSORT standards, and publish all our findings, regardless of outcomes. We are very serious about contributing to the scientific foundation of evidence-based games for mental health and we consider null findings as important to this aim as the "positive" results we obtain. 

Replicate... or not

Given the importance of independent replication of scientific studies, especially in the field of intervention science, we are  committed to sharing our games and mechanics with other researchers who seek to conduct similar research. If you are interested in testing one of our games or mechanics in your own, independently-run studies, contact us

Testing For Emotional Design

We are working to develop a standardized framework for testing our game design. We import methods from game design studies, design more generally, and qualitative methods to establish the engagement, retention and fun related to playing our games. We also test whether our designs trigger the range of emotions we are seeking to evoke.

Latest Projects View all projects

  • Project Lead Category Project Status
    Hanneke Scholten Substance Abuse Recruitment

    Designing and Testing a Video Game to Help Youth Quit Smoking

    About the project

    Smoking is one of the leading public health problems in the world. Currently, there is no evidence-based intervention program available to help youth and young adults quit smoking. Besides the lack of high-quality research, recruitment and retention of youth and young adults are two of the most challenging aspects of the implementation and evaluation of smoking cessation interventions. We argue that limitations in current smoking cessation interventions for youth can be maximally addressed by using video games as interventions. In the current project a video game will be developed and tested on its effectiveness and mechanisms of change to help youth and young adults quit smoking.

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  • Project Lead Category Project Status
    Joanneke Weerdmeester Anxiety Data Collection

    Biofeedback Videogames for Anxiety Regulation

    About the project

    This project aims to develop and assess the use of biofeedback videogames to help youth cope with stress and anxiety. In addition it aims to identify physiological markers and patterns of emotion regulation. The current studies within this project focus on exploring the potential of the virtual reality biofeedback game DEEP where players use deep diaphragmatic breathing to move through a beautiful underwater world.

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  • Project Lead Category Project Status
    Elke Schoneveld Anxiety Writing Dissertation

    MindLight - Childhood Anxiety Prevention

    About the project

    Many children have difficulties with fearful situations and are anxious. Interventions can help to teach children to cope effectively with anxiety-inducing situations. In our project, we rigorously tested whether an intervention in the form of a video game (MindLight) is effective in significantly reducing anxiety symptoms in children 8-12 years old. We did this by comparing MindLight to 1) a commercial game and 2) the gold-standard, cognitive-behavioural therapy for anxiety (Coping Cat). Furthermore, we aim to evaluate the reasons for why MindLight is effective (e.g., what kinds of mechanics work) and for whom (e.g., age and gender differences).

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Testing for Real-World Outcomes

Testing for Mechanisms of Change


Youth that play video games regularly


Youth who need mental health care but receive no services


Children diagnosed with an anxiety disorder



Do you want to play a virtual reality game that you can control with your own breath?

Then click below to learn more about "Take a DEEP Breath"!