Gaming Against Anxiety: New Methodology for Personalized Game Interventions

Project Lead Category Project status
Marieke van Rooij Anxiety | Depression Completed

Anxiety disorders are among the most common psychopathologies in children. This project investigates the effects of a biofeedback virtual reality game (DEEP) on breathing and anxiety-related symptoms in anxious children and develops new algorithms to detect changes in the player’s behavior during the game. The aim is to enable game interventions that are personalized to each individual child.

Project team


In the Netherlands, up to 23% of adolescents are affected by anxiety disorders and for younger children estimates range from 5-20% (Verhulst, van der Ende, Ferdinand, & Kasius, 1997; Bögels, 2007). Childhood anxiety is associated with a host of future problems, such as substance abuse, academic failure, and even suicidal behaviour (Woodward & Fergusson, 2001). The impact is enormous, both on a personal level and in terms of the associated societal costs (Greenberg, et al., 1999;  RIVM, 2013). Clearly, effective prevention and treatment programs are urgently mandated but despite evidence-based interventions being readily available, their outcomes are often disappointing and variable (Reynolds, Wilson, Austin, & Hooper, 2012).  Existing one-size-fits-all interventions are at best moderately effective long-term, and most importantly, not tailored to differences in individual responsiveness (James, James, Cowdrey, Soler, & Choke, 2013; Cartwright, Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, 2004). This project’s aim is to contribute to a new approach to the prevention and treatment of anxiety in children by developing new methodology to uncover and tailor interventions to individual response patterns, using a unique biofeedback virtual reality game (DEEP). DEEP targets key developmental factors associated with anxiety and consists of an immersive virtual underwater world, which players can explore freely, controlling their movements through breathing. We aim to uncover individual profiles of behavioural change and tailor DEEP to these profiles in real-time, combining dynamical systems theory and machine learning for automated classification of individual in-game behaviour. 


Children with anxiety problems


feels 'great' after playing DEEP


VR-researchers getting nauseated in VR


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

    Weerdmeester, J., van Rooij, M. M. J.W., & Granic, I. (2022). Visualization, Self-Efficacy, and Locus of Control in a Virtual Reality Biofeedback Video Game for Anxiety Regulation. Cyberpsychology, Behavior, and Social Networking, 25 (6).doi: 10.1089/cyber.2022.0030

    Author: Joanneke Weerdmeester

    Upload date: 06-10-2022

  • Take a DEEP Breath: Exploring the Potential of Game-based Biofeedback Interventions for Anxiety Regulations [Doctoral Dissertation]

    J.W. Weerdmeester (2021). Take a DEEP Breath: Exploring the Potential of Game-based Biofeedback Interventions for Anxiety Regulations. Doctoral Thesis. Radboud University.

    Author: Joanneke Weerdmeester

    Upload date: 11-21-2021

  • A Randomized Controlled Trial Assessing the Efficacy of a Virtual Reality Biofeedback Video Game: Anxiety Outcomes and Appraisal Processes

    Weerdmeester, J., van Rooij, M. M.J.W., Maciejewski, D. F., Engels, R. C.M.E, & Granic, I. (2021). A Randomized Controlled Trial Assessing the Efficacy of a Virtual Reality Biofeedback Video Game: Anxiety Outcomes and Appraisal Processes. Technology, Mind, and Behavior. doi: 10.1037/tmb0000028

    Author: Joanneke Weerdmeester

    Upload date: 08-05-2021

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

    Bossenbroek, R., Wols, A., Weerdmeester, J., Lichtwarck-Aschoff, A., Granic, I., & van Rooij, M. (2020). JMIR Mental Health, 7(3), e16066.

    Author: Aniek Wols

    Upload date: 03-24-2020

  • Exploring the Role of Self-efficacy in Biofeedback Video Games

    Weerdmeester, J., van Rooij, M., Harris, O., Smit, N., Engels, R. C., & Granic, I. (2017, October). In Extended Abstracts Publication of the Annual Symposium on Computer-Human Interaction in Play (pp. 453-461). ACM.

    Author: Joanneke Weerdmeester

    Upload date: 10-15-2017

  • DEEP: A Biofeedback Virtual Reality Game for Children At-risk for Anxiety

    van Rooij, M., Lobel, A., Harris, O., Smit, N., & Granic, I. (2016). CHI'16 Extended Abstracts, May 07-12, 2016, San Jose, CA, USA

    Author: Marieke van Rooij

    Upload date: 05-07-2016

Project team

Marieke van Rooij title=
Marieke van Rooij

Assistant prof. and data geek at the GEMH lab, dynamical modelling, personalisation, wants to put the I back into AI, news junkie, cat lover.


Assistant Professor


E-mail Marieke

Isabela Granic title=
Isabela Granic
Director of GEMH Lab

Professor and Chair of the Developmental Psychopathology department in the Behavioural Science Institute; writer; voracious podcast consumer; mother of two upstanding little gamers


Professor at McMaster's University & Co-founder of PlayNice Interactive


E-mail Isabela

Adam Lobel title=
Adam Lobel

User Research Analyst at Ubisoft Montréal. My favorite games tell emotionally rich stories and challenge me to think differently


User Research Analyst


E-mail Adam

Owen Harris title=
Owen Harris


Game Designer, Teacher & Human


E-mail Owen

Niki Smit title=
Niki Smit


Game Designer & Artist


E-mail Niki

Joanneke Weerdmeester title=
Joanneke Weerdmeester
Researcher at GEMH Lab

Behavioural scientist, lecturer, consultant, gamer, dungeon master, language enthusiast, and lover of all things geeky.


Freelance Consultant


E-mail Joanneke


All sources
  1. Verhulst, F. C., van der Ende, J., Ferdinand, R. F., & Kasius, M. C. (1997). De prevalentie van psychiatrische stoornissen bij Nederlandse adolescenten. Nederlands Tijdschrift voor Geneeskunde, 141, 777-781.
  2. Bögels, S. M. (2007). Behandeling van angststoornissen bij kinderen en adolescenten: Met het cognitief- gedragstherapeutisch protocol Denken+ Doen= Durven. Bohn Stafleu van Loghum.
  3. Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1086-1093.
  4. Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R., ... & Fyer, A. J. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry 60, 427-435.
  5. RIVM (2013). Kosten van ziekten database 2013. Retrieved from 0c3i0t1j0o3y6a- 1g0d31s54f0z0w2
  6. James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev, 6.
  7. Cartwright‐Hatton, S., Roberts, C., Chitsabesan, P., Fothergill, C., & Harrington, R. (2004). Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. British journal of clinical psychology, 43, 421-436.