MindLight - Childhood Anxiety Prevention

Project Lead Category Project status
Elke Schoneveld Anxiety Writing Dissertation

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 aim to evaluate the reasons for why MindLight is effective (e.g., what kinds of mechanics work) and for whom (e.g., age and gender differences).

Project team

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21-10-2017

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.

Now two RCT’s have shown the efficacy of MindLight as an anxiety prevention program, we will investigate the mechanisms through which effects might occur by looking at self-efficacy and coping skills.

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 (published) showed that MindLight was equally effective as a commercial game, Max and the Magic Marker. The second trial (under revision) showed that it was as effective as the gold-standard cognitive behavioral therapy for anxiety.

Publications

Project team

Elke Schoneveld title=
Elke Schoneveld

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

Function

PhD-Candidate

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

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

Function

Director of GEMH Lab

Contact

E-mail Isabela

Rutger Engels title=
Rutger Engels

Function

Chairman at Trimbos Instituut

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

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

Function

Associate Professor - Collaborator

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.

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