Gaming Against Anxiety: New Methodology for Personalized Game Interventions

Project Lead Category Project status
Marieke van Rooij Anxiety Preparation

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


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

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


Director of GEMH Lab


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


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.

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