Games for Health - Rutger Engels - Developing games for emotional health of children and adolescents
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Transcript of Games for Health - Rutger Engels - Developing games for emotional health of children and adolescents
Improving Mental Health by Sharing Knowledge
Evidence-basedgames for mentalhealth in youth
Rutger Engels
Together with prof. Isabel Granic
Adam Lobel
Elke Schoneveld
Marlou Poppelaars
Lieke Wijnhoven
Angela Schuurmans
Geert Verheijen
And..
And..
Why mental health?
1. High prevalence. One out of 4 adults become depressed in their life (NEMESIS, 2013)
2. High individual costs. Mental health disorders are the leading causes of disability adjusted life years (DALYs) worldwide (WHO, 2011)
3. High costs for employers
Top 3 of causes of # sick days (NEMESIS, 2011):
1. Depression
2. Chronic back pain
3. COPD and asthma
4. High societal costs
Top 3:
1. Depression
2. Childhood disorders (including ADHD and autism) 3. Anxiety
(Veerbeek et al., 2014)
Two major issues:
The importance of games (and gaming) as intervention tools
• Traditional prevention and treatment do work, but:
- High costs
- Not accessible to majority of youth (waiting lists)
- Stigmatizing
- Drop-out as programs are not engaging
Dilemma
• Hardly any games out there for mental health (ADHD as an exception)
• Some games are not engaging and do not hold the quality that kids are used to
Problems
SPARX: 2 studies by original developers: promising results (Merry et al., 2012)
Our own study: decreased depressive symptoms
BUT! teens reported being bored, wouldn’t play on their own, wouldn’t recommend it to others
Our aim:
Set up a framework that will lead to development of theory-based clinically-appropriate, ENGAGING games for depression and anxiety
Clinical Guidelines for Care
• Basis for financing care is inclusion in clinical guidelines
• Based on empirical evidence, so series of randomized controlled trials (experiments)
• Support by clinicians and patient-groups
No empirical evidence
=no funding for implementation and upscaling of serious games in mental health care
3 points to make
1. Rigorous testing
2. Games as a placebo
3. Resistance by professionals
1. Rigorous testing
Experimental designs, in which participants are randomized to control condition or game
Depressive symptoms
50.00
55.00
60.00
65.00
70.00
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
OVK
Depressive symptoms
50.00
55.00
60.00
65.00
70.00
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
Control
OVK
No control group
No interpretation possible
Measure transference to real life
In-game experiences should translate to out-of-game real life settings
Rigorous Designs
GameDesk, LA
Dojo: game to regulate emotions
Effects of Dojo were tested in a sample of 42 adolescents in residential care, referred for behavioral problems (Schuurmans et al., 2014)
Transference: Beneficial impact on anxiety AND behavioral problems
Testing the working mechanisms of the game
Rigorous Designs
MindLight: approx 8-10h game play, oriented on 8-14 year olds
If MindLight leads to lower anxiety, does this happen BECAUSE kids are better in dealing with threat?
Figure 2. the light in the dark
In-game data. Fine-grained data on player patterns
Rigorous Testing
• Testing in subgroups
– As prevention tool for all kids
– For clinically disordered kids
– Age and gender
– Preference for gaming
Rigorous Testing
Subgroups
RCT 1: teens in residential care for behavioral problems
RCT 2: anxious teens in schools
Subgroups
RCT 1: teens in residential care for behavioral problems
RCT 2: anxious teens in schools
Video Game Development
professional game
developers
Research
Outcome analysisComponent analysis
Process analysis
Go back to game development
2. Game as a placebo
Expectancies:
When teens invest time in a game AND are assured it works for them, it might already have an impact!
RCT with two conditions: a game for anxiety (MindLight) and a control condition
N = 140 (8-12 year olds, screened on anxiety, played 5 sessions of 1h)
MindLight lowered anxiety levels in children, even after 3-months follow-up
Magnitude of decline is comparable to a study in which we tested cognitive behavior therapy in group sessions lead by a therapist (van Starrenburget al., 2013; 2014)
Kids who played Max also went down..
Results
? Because they believed in the game, they got something out of it
? Parents supported them
Why
Recommendation:
Be aware of potential placebo effect
Test why a game has effects using data on game processes and mechanics
3. Overcoming resistance by professionals
Message: it does not replace them, but helps them in making therapy more effective and efficient (and perhaps even fun!)
Two perspectives co-exist
Game as intervention tool that replaces part of treatment or is an additive component
Game as a communication tool
Communication tool
• Creating alliance
• Using examples of in-game behavior like success, frustration and anger
• Dynamic assessment of progress– do children improve over course of therapy
Evidence and acceptance by professionals will assure uptake and financial investments by health insurance companies and authorities
Take-home message