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.