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.