Many youth are having problems with regulating their emotions, which could - over time - result in anxiety and/or externalizing problems. Two projects tested the videogame intervention Dojo that teaches youth relaxation techniques in order to improve their emotion regulation. One project focused on preventing the exacerbation of anxiety among adolescents in high-schools. The other projects focused on youth with externalizing problems - often with co-morbid anxiety - in residential care.

Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations. Dojo trains emotion regulation strategies (i.e., deep-breathing techniques, progressive muscle relaxation, positive thinking, and guided imagery) with instructional videos and by then engaging players in immersive and emotion evoking puzzles that challenge players to use these newly acquired strategies. To encourage players to effectively regulate their emotions, each challenge becomes increasingly difficult if the player’s heart rate increases. Thus, based on clinical research that shows that the combination of HRV biofeedback with emotion regulation training is effective in reducing anxiety—more so than either strategy alone–these techniques are the foundations of the game design in Dojo.

In the prevention project, a randomized controlled trial (n = 138) was conducted to test the effectiveness of Dojo for adolescents with elevated levels of anxiety. Adolescents (11–15 years old) "at-risk" for developing an anxiety disorder were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Adolescents’ anxiety levels were assessed at pre-test, post-test, and at three month follow-up, The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants’ expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.

In the residential care project, 37 youth were randomly assigned to play Dojo (eight 30-minute gameplay sessions) or to treatment as usual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline, post-treatment, and four-month follow-up through youths’ self-report and mentor-report. Intention-to-treat analyses revealed decreases in self-reported anxiety at posttreatment (p=.056) and self-reported externalizing problems at follow-up (p=.031), and mentor-reported anxiety at both posttreatment (p=.017) and follow-up (p=.005) for participants in the Dojo condition compared to the control condition. These findings show that Dojo is a promising, innovative intervention that engages high-risk youths.