MindLight - Childhood Anxiety Prevention

Project Lead Category Project status
Elke Schoneveld Anxiety | Depression Completed

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 evaluated the motivational characteristics of MindLight and for whom (e.g., age and gender differences) it is effective.

Project team

Share
29-06-2022

Childhood anxiety is a global mental health concern (Merikangas et al., 2010). However, our most advanced programs often lead to disappointing outcomes (Fisak, Richard, & Mann, 2011; Mychailyszyn, Brodman, Read, & Kendall, 2012). Interventions are needed that are effective, cost less, are more accessible and engage children long enough to build emotional resilience skills through practice. Video games promise a new, playful training ground that may address limitations of past prevention programs (Granic, Lobel, & Engels, 2014). Yet validated games for mental health are virtually nonexistent. We evaluated the effectiveness of MindLight, a new applied game, through two randomized controlled trials (RCTs).

MindLight is a 3D neurofeedback game designed to translate evidence-based, but often dull, clinical techniques for anxiety reduction into game mechanics that provides children with an immersive game world. Techniques embedded in the game are neurofeedback training (Price & Budzynski, 2009), exposure training (e.g. Feske & Chambless, 1995) and attention bias modification (Bar-Haim, Morag, & Glickman, 2011). MindLight aims to prevent the escalation of anxiety in at-risk children. In addition to the evaluation, we addressed serious methodological limitations of past studies on applied games, such as the lack of RCTs, a focus on short term effects and the use of a non-active control group.

The two RCTs followed a similar method: over 750 elementary school children (7-13 years old) were screened for elevated anxiety. Selected children (RCT 1: n = 136; RCT 2: n = 174) were randomly assigned to play MindLight or to a control condition, which was the commercial video game Max and the Magic Marker (RCT 1) or the most effective cognitive behavioral prevention program: Kendall’s Coping Cat (RCT 2; Flannery-Schroeder & Kendall, 1996). Self- and parent-reported anxiety was assessed at pre-, post-intervention, 3- and 6-months (RCT 2 only) follow-up.

The primary hypothesis of the first RCT was that children who played MindLight, compared to Max, would report reduced symptoms of anxiety at post-intervention and 3-month follow-up. Intent-to-treat analyses revealed an overall significant reduction in child- and parent-reported anxiety, but the magnitude of improvements did not differ between conditions (Schoneveld, et al., 2016).

The second RCT was registered as a non-inferiority trial: it was hypothesized that children in both conditions (MindLight and Coping Cat) would show a decrease in anxiety levels at post-intervention, 3- and 6-months follow-up. As expected, similar results were found: children in both conditions showed an overall significant reduction in anxiety, but the magnitude of improvements did not differ between conditions.

40%

Estimation of sub-clinical levels of anxiety in children

83%

Completed interventions

54%

Recommends MindLight to other children

Results

Both randomized controlled trials have shown that MindLight reduces anxiety levels. The first trial showed that MindLight was equally effective as a commercial game, Max and the Magic Marker. The second trial showed that it was as effective as the gold-standard cognitive behavioral therapy for anxiety.

Publications

Project team

Elke Schoneveld title=
Elke Schoneveld

Graduate and psychologist interested in the effect of games on mental health. Likes why-questions, social impact and multidisciplinary collaboration. Bubbly, (not so crazy) cat lady and outdoor enthusiast.

Function

Graduate

Contact

E-mail Elke

Anna Lichtwarck-Aschoff title=
Anna Lichtwarck-Aschoff

Assistant Professor at the Developmental Psychopathology Department, mainly interested in general processes and principles of clinical change; mother of two wild boys.

Function

Assistant Professor

Contact

E-mail Anna

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

Function

Professor at McMaster's University

Contact

E-mail Isabela

Rutger Engels title=
Rutger Engels

Function

CEO at Trimbos Institute / Professor Developmental Psychopathology Utrecht University

Contact

E-mail Rutger

Geert Verheijen title=
Geert Verheijen

Researcher with a focus on the social development of teens, interested in the effects of average, day-to-day video game use. enthusiastic board gamer & self-proclaimed institutional champion of Super Smash Brothers.

Function

PhD-Candidate

Contact

E-mail Geert

Tom Hollenstein title=
Tom Hollenstein
Collaborator

Associate Professor in Developmental Psychology at Queen's University in Kingston, Ontario, Canada.

Function

Associate Professor at Queen's University

Contact

E-mail Tom

Sources

All sources
  1. Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., ... & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980-989.
  2. Fisak, B. J., Jr., Richard, D., & Mann, A. (2011). The prevention of child and adolescent anxiety: a meta-analytic review. Prevention Science, 12(3), 255e268. http://dx.doi.org/10.1007/s11121-011-0210-0.
  3. Mychailyszyn, M. P., Brodman, D. M., Read, K. L., & Kendall, P. C. (2012). Cognitive behavioral school-based interventions for anxious and depressed youth: a meta-analysis of outcomes. Clinical Psychology-Science and Practice, 19(2), 129e153. http://dx.doi.org/10.1111/j.1468-2850.2012.01279.x.
  4. Granic, I., Lobel, A., & Engels, R. C. M. E. (2014). The benefits of playing video games. American Psychologist, 69(1), 66e78. http://dx.doi.org/10.1037/a0034857.
  5. Price, J., & Budzynski, T. (2009). Anxiety, EEG patterns, and neurofeedback. Introduction to quantitative EEG and neurofeedback: Advanced theory and applications, 453-470.
  6. Feske, U., & Chambless, D. L. (1995). Cognitive-behavioral versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy, 26(4), 695e720.http://dx.doi.org/10.1016/s0005-7894(05)80040-1.
  7. Bar-Haim, Y., Morag, I., & Glickman, S. (2011). Training anxious children to disengage attention from threat: a randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(8), 861e869. http://dx.doi.org/10.1111/j.1469-7610.2011.02368.x.
  8. Flannery-Schroeder, E. C., & Kendall, P. C. (1996). Cognitive-behavioral therapy for anxious children: Therapist manual for group treatment. Ardmore, PA: Workbook.
  9.  Schoneveld, E. A., Malmberg, M., Lichtwarck-Aschoff, A., Verheijen, G. P., Engels, R. C., & Granic, I. (2016). A neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial. Computers in Human Behavior, 63, 321-333.

Want to keep up-to-date with our research?