Nonspecific Factors in Video Games for Mental Health

Project Lead Category Project status
Aniek Wols Gaming Writing Dissertation

More and more games are designed to promote mental health. If these games are found to be effective, it is important to investigate which factors are responsible for the improvements in mental health. Most often, this type of research focuses on the specific clinical techniques that were designed into the game. However, from the clinical literature it is known that, for instance, expectations, motivation, and one’s mindset about the malleability of symptoms play a major role in positive intervention outcomes. In my project I aim to investigate these nonspecific factors and examine how we can manipulate these factors in order to optimize video games for mental health.

Project team


In the past years, the development and use of e-health applications (e.g., video games; but also computerized therapies, smartphone apps etc.) have grown rapidly, with the aim to disrupt more traditional forms of therapy, to make therapy more effective and to increase accessibility of mental health services. In the development of e-mental health applications the focus is almost exclusively on specific factors or techniques; these factors are drawn from theories about the specific working mechanisms responsible for the development and maintenance of the specific mental health disorder. Because traditional evidence-based programs in the field of developmental psychopathology are based on Cognitive Behavioural Therapy (CBT), the majority of e-mental health applications are based on CBT principles. That is, therapeutic techniques from CBT are translated into an app or video game to reduce mental health problems (see for example MindLight).

     The underlying assumption in the aforementioned approach is that these specific CBT techniques are (mainly) responsible for the observed improvements in mental health outcomes. However, in the therapy literature there is a consistent and large body of evidence showing that nonspecific factors - factors not specific to any theory of psychotherapy - play an important role in positive intervention outcomes as well. These nonspecific factors include client variables (e.g., beliefs about the malleability of symptoms; motivation to change), extra-therapeutic events (e.g., trauma), therapeutic relationship factors (e.g., therapeutic alliance), and expectancy and placebo effects (e.g., expectations for improvement or side-effects). Given the central role of nonspecific factors in nearly all psychological interventions, I think it is not unlikely that also in well-designed e-mental health applications nonspecific factors (partly) drive mental health improvements. Instead of controlling for nonspecific factors, I think it is crucial to harness these effects in order to optimize the effectiveness of e-health applications.


Specific clinical techniques


Client variables, extra-therapeutic events, expectancy and placebo effects


Therapeutic relationship

Percentages of improvement in therapy clients as a function of..


  • Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

    Wols, A., Pingel, M., Lichtwarck-Aschoff, A., & Granic, I. (2024). Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clinical Psychology Review, 102396.

    Author: Aniek Wols

    Upload date: 01-30-2024

  • The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health

    Wols, A., Hollenstein, T., Lichtwarck-Aschoff, A., & Granic (2021). Games for Health, 10(4), 207-219.

    Author: Aniek Wols

    Upload date: 08-09-2021

  • The Role of Motivation to Change and Mindsets in a Game Promoted for Mental Health

    Wols, A., Poppelaars, M., Lichtwarck-Aschoff, A., & Granic, I. (2020). Entertainment Computing, 100371.

    Author: Aniek Wols

    Upload date: 07-07-2020

  • Explicit Mental Health Messaging Promotes Serious Video Game Selection in Youth with Elevated Mental Health Symptoms

    Poppelaars, M., Wols, A., Lichtwarck-Aschoff, A., & Granic, I. (2018). Frontiers in Psychology.

    Author: Marlou Poppelaars

    Upload date: 09-10-2018

  • The Impact of Explicit Mental Health Messages in Video Games on Players’ Motivation and Affect

    Poppelaars, M., Lichtwarck-Aschoff, A., Kleinjan, M., & Granic, I. (2018). The impact of explicit mental health messages in video games on players’ motivation and affect. Computers in Human Behavior, 83, 16-23. doi:

    Author: Marlou Poppelaars

    Upload date: 07-01-2018

Project team

Aniek Wols title=
Aniek Wols
Researcher at GEMH Lab

I am interested in how and why applied games for mental health work, with a specific focus on the influence of one's mindset, motivation and expectations.


PhD-Candidate at Radboud University


E-mail Aniek

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


Professor at McMaster's University & Co-founder of PlayNice Interactive


E-mail Isabela

Anna Lichtwarck-Aschoff title=
Anna Lichtwarck-Aschoff

I am not so interested in *whether* certain interventions work but *how* they work. That is, I am mainly focusing on underlying processes and mechanisms of change across diagnostic categories and different treatment modalities. Mother of two wild boys!


Professor of Orthopedagogics at University of Groningen


E-mail Anna

Tom Hollenstein title=
Tom Hollenstein

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


Associate Professor at Queen's University


E-mail Tom

Marlou Poppelaars title=
Marlou Poppelaars

I am a Postdoctoral researcher passionate about internalizing psychopathology prevention and the use of technology and innovation for this purpose while stimulating intrinsic motivation. I love to read, cook and bake everything delicious. Working on finishing my dissertation and Two Dots (Level 3682 and counting).


Post Doctorate at University of Groningen


E-mail Marlou


All sources

Poppelaars, M., Wols, A., Lichtwarck-Aschoff, A., & Granic, I. (2018). Explicit mental health messaging promotes serious video game selection in youth with elevated mental health symptoms. Frontiers in psychology, 9, 1837.

Wols, A., Poppelaars, M., Lichtwarck-Aschoff, A., & Granic, I. (2020). The role of motivation to change and mindsets in a game promoted for mental health. Entertainment Computing, 100371.

Wols, A., Hollenstein, T., Lichtwarck-Aschoff, A., & Granic, I. (2019). Preregistration: The effect of expectations on experienced fun, mood, state-anxiety and in-game play behaviours while playing MindLight. doi: 10.17605/OSF.IO/6GMWV