Therapeutic Games Research Articles

Exploring the possible mental health and wellbeing benefits of video games for adult players: A cross-sectional study.

There is mixed evidence on the psychological effects of video games. While excessive use can be harmful, moderate use can have emotional, psychological and social benefits, with games successfully used in treating anxiety and depression. More data are required to understand how and for whom these benefits occur. This paper aims to identify correlations between video game genre, player demographics, wellbeing, and the in-play psychological processes for adult players. Adult gamers (n = 2107) completed an anonymous cross-sectional survey canvassing play style, genre, perception of psychological impact and mechanisms (wellbeing, self-determination and flow). A multivariate multiple regression model explored correlations. 88.4% of participants experienced emotional benefits from gaming, with stronger benefits experienced by younger players in all categories. The genres most strongly correlated with psychological benefits were music games, role-playing games and survival horror games. Multiplayer online battle arena games had lower scores for psychological and emotional wellbeing. Certain genres have stronger correlations with beneficial mechanisms, while some may be detrimental to players. These results may guide experimental studies to measure the directionality and strength of these correlations and can also impact practical aspects in development of therapeutic games to treat mental distress.

Are gains in emotional symptoms and emotion-regulation competencies after the REThink therapeutic game maintained in the long run? A 6-month follow-up.

Emotional disorders are the most prevalent mental health conditions affecting children and adolescents. Thus, it becomes essential to develop and test early intervention strategies that are accessible, attractive, and can effectively improve their emotional functioning. A randomized control trial compared the prevention effects of the REThink therapeutic game to those of astandard face-to-face prevention program,and a waitlist which was transformed at follow-up into care as usual. Out of 142 healthy children and adolescents who completed the intervention stage, 137 (mean age: 12.84, SD: 1.97) completed a follow-up assessment measuring emotional symptoms, depressive mood and emotion regulation. We also tested potential moderators of its long-term effects, such as parental psychological control, parent attachment and childhood trauma. Our results highlighted the fact that the REThink intervention had a durable impact on the children's mental health and their ability to regulate their emotions. Moreover, we found that trauma, parent psychological control and parent attachment moderated the maintenance of the improvements. Future research needs to further document how to personalize the game and prevention program components to better address the characteristics of the youths at risk for mental health problems. ClinicalTrials.gov NCT03308981, from 13.10.2017.

Efficacy of the Therapeutic Game "Trisquel" in the Treatment of Patients With Substance-Related Disorders Randomized Clinical Study.

Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients’ quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of “Trisquel,” an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that “Trisquel” is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).

Do Improvements in Therapeutic Game-Based Skills Transfer to Real Life Improvements in Children's Emotion-Regulation Abilities and Mental Health? A Pilot Study That Offers Preliminary Validity of the REThink In-game Performance Scoring.

Therapeutic or serious games are considered innovative ways of delivering psychological interventions especially suited for children and adolescents, which can have a positive impact on mental health, while also being fun and easily accessible online. While most serious games for children and adolescents address specific issues, such as anxiety or depression, preventive measures received less attention. REThink is an online therapeutic game designed as a stand-alone prevention tool, aiming to increase resilience in healthy children and adolescents in a Rational Emotive Behavioral Therapy framework (David et al., 2019). The aim of this pilot study was to investigate the validity of in-game performance measurements or scores as indicators of the game effectiveness in building real life emotion-regulation abilities. We analyzed how scores of different game levels (addressing different skills) are associated with improvements in mental health and emotion regulation abilities. Our preliminary results suggest that in-game performance at some levels (scores) consistently reflect improvements in psychological functioning, while in-game performance at other levels are less associated with changes in real life self-reported psychological functioning. These results offer important information about which levels can be used as preliminary indicators of psychological improvements, and which levels need to be revised in terms of task or scoring. Overall, results of our study offer preliminary validation of REThink's game scoring system, while also suggesting the elements to be refined.

CBT4Depression: A Cognitive Behaviour Therapy (CBT) Therapeutic Game to Reduce Depression Level among Adolescents

Dropping out of depression treatment commonly occurs in the current psychotherapy treatment. Adolescents often find it difficult to express their thoughts and feelings clearly due to their developmental constraints. They also have trouble realising their behaviours as unhealthy or problematic. The use of therapeutic games in depression treatment among adolescents can enhance the engagement level. Indirectly, the issue of dropping out can be reduced among the adolescents. Therefore, this study aimed to improve engagement levels and reduce depression level among adolescents with depression by designing a therapeutic game. A prototype named CBT4Depression was developed in this study. A quasi experimental study was conducted to evaluate the developed therapeutic game and 115 adolescents were recruited to measure their depression level using CBT4Depression. Based on the findings from the evaluation process, it can be concluded that the CBT4Depression considered success to engage and reduce the depression level among adolescents.

From idea to social change. Opportunities and barriers to the development of social innovations in Poland on the example of solutions for people on the autism spectrum

GoalThe aim of this paper is to describe the procedures for introducing social innovations in psychology in Poland on the example of three implemented solutions for people on the autism spectrum: the “Mary and Max” Peer Volunteering Program, Autilius Therapeutic Game, and PEERS® Social Skills Training. These solutions have been developed under the cooperation of three sectors (NGO, public and private) and based on various financing mechanisms. They will serve as examples for identifying the opportunities and barriers to the development of social innovations in Poland. The article proposes a solution that may contribute to the growth of social innovations. ThesesSocial innovations can be defined as all products, services, processes and regulations that are novel in a given context and have an advantage over the existing solutions to social problems. Innovation is a complex process that consists of the following stages: 1) problem identification, 2) generation of ideas and potential solutions, 3) prototyping and testing (including effectiveness assessments), 4) implementation and sustaining, 5) scaling and dissemination, 6) systemic change. The process of creating and implementing social innovations requires a multidisciplinary team of experts, cross-sector cooperation and a long-term financial plan. These elements are discussed in the context of the three described solutions. ConclusionsPoland lacks well-established procedures for creating and implementing social innovations. Such solutions should include support for team creation, development of financing mechanisms, favourable conditions for cross-sector cooperation and sources of know-how. Academic Incubators of Social Innovation (AIIS) could facilitate the development of social innovations by providing a collaborative platform for stakeholders other than the private sector and the scientific community.

An individualized and adaptive game-based therapy for cerebral visual impairment: Design, development, and evaluation

Children with cerebral visual impairment (CVI) exhibit a very heterogeneous clinical visuoperceptual picture, which implies that a targeted individualized and adaptive therapy is necessary. Serious games for CVI are limited, especially those that train multiple visuoperceptual skills in an individualized and adaptive manner without the frequent manual input from clinicians. In this paper, we describe the design, development, and evaluation process of novel individualized and adaptive serious mini-games for visual perceptual skills. First, an informant-led design, including focus groups with relevant stakeholders implementing a participation-via-proxy and brainstorming sessions, was performed. This resulted in rapid prototypes of four mini-games (MatchMaker, Hurricane Chaos, Maze Explorer 2D, and Maze Explorer 3D), targeting six visuoperceptual skills commonly impaired in children with CVI: (1) visual discrimination and matching, (2) object or picture recognition, (3) visual spatial perception, (4) figure-ground perception, (5) motion perception, and (6) visual short-term memory. Therapeutic game content (selecting, manipulating, and rating images; defining entry-level difficulty and in-game adaptivity rules) was evaluated by clinical and research experts. Finally, formative testing and expert feedback, including usability and user experience by clinicians, researchers, and typically developing children, led to important modifications in the mini-games.

Framework of Mobile Game Design as an Assistive Technology for Children with Motor Disabilities

Computer games have emerged in the past decade as potential media beyond entertainment. Despite its popularity, game accessibility remains a major concern of various researchers. Children population with motor disabilities is a potential target for developing entertainment or therapeutic support games due to their interest to play. This paper presents: (1) a framework for mobile games for children with motor disability using simple hand postures and (2) Xgboost decision tree as a hand posture recognizer (98.48 percent training accuracy and 96.76 percent testing accuracy) as a prototype of hand posture-based commands as assistive technology to interact with games.

A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation.

BackgroundTalking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them.ObjectiveThis exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2).MethodsThe therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines.ResultsRegarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?!ConclusionsThe most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients.

Effectiveness of the REThink therapeutic online video game in promoting mental health in children and adolescents

Although evidence-based interventions exist, estimates suggest that about 60% percent of children and adolescents with mental health disorders do not receive the treatment they need. In this context, one expanding strategy for increasing access to mental health care for children and adolescents is the use therapeutic, or serious, games. REThink is one such therapeutic game, developed to offer a CBT-based prevention that was documented in a controlled trial to develop psychological resilience in children and adolescents, aged between 10 and 16, helping them learn healthy strategies for coping with dysfunctional negative emotions such as anxiety, anger and depression. This study aims to test the effectiveness of the REThink therapeutic online video game in promoting emotional health in children and adolescents in a pilot study.Participants (N = 31), aged between 10 and 16 years, were recruited on a volunteer basis from a school. Emotional problems, irrational beliefs, negative automatic thoughts, rational beliefs, and problem solving abilities were assessed pre- and post-using the therapeutic game. We also measured participants' satisfaction with the game. Results obtained show improvements in terms of emotional problems of the youths, their irrational beliefs, negative automatic thoughts and high levels of intervention satisfaction. of this study are in support of the previous findings suggesting that the REThink online game can be a valuable tool for large-scale mental health efforts aimed at the prevention of emotional disorders in children and adolescents, in accordance with evidence-based prevention protocols.

Transplantation From Older Donors: Can Senolytics Turn Back the Clock?

Transplantation From Older Donors: Can Senolytics Turn Back the Clock?

Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation.

PurposeDesign and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension.MethodsA robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant’s game play performance was sampled and analyzed, and system modifications made between sessions.ResultsParticipants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable.ConclusionsThe novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.

Multitasking a Perceptual Activity

Performing vision therapy with a preschooler, especially one with developmental delays, can be very exhausting - especially in the current times of COVID quarantine. Turning therapy into a fun and interactive (yet therapeutic) game is how I have best found to perform therapy with my own such little patient. If done with some imagination, a simple game can be turned into a whole therapy session all on its own.

The Role of the Avatar in Gaming for Trans and Gender Diverse Young People.

A significant proportion of trans and gender diverse (TGD) young people report membership of the gaming community and resultant benefits to wellbeing. To date their experiences and needs regarding a key feature of games, the avatar, are largely unexplored, despite increasing interest in the therapeutic role of avatars in the general population. The aim of this study was to better understand the role of the avatar in gaming, its impact on TGD young people’s mental health, and their unique needs regarding avatar design. N = 17 TGD young people aged 11–22 years (M = 16.3 years) participated in four focus groups. A general inductive approach was used to thematically analyze the transcribed data. TGD young people report considerable therapeutic benefits of using avatars with positive mental health implications. Importantly, TGD young people use avatars to explore, develop and rehearse their experienced gender identities, often as a precursor to coming out in the offline world. They also report negative experiences of feeling excluded due to the constraints of conventional notions of gender that are widely reflected in game design. Participants described simple design features to better reflect gender diversity, such as increased customization. Such changes would facilitate the positive gains reported by participants and better reflect the diversity of young people who use games. The findings have important implications for both recreational and serious or therapeutic game design.

REThink Online Video Game for Children and Adolescents: Effects on State Anxiety and Frontal Alpha Asymmetry

Emotional disorders affect numerous children and adolescents worldwide; thus, developing accessible prevention tools to reduce associated burden in youths is of crucial importance. We conducted a randomized controlled study to examine the effects of the newly developed REThink therapeutic game on reducing the subjective emotional reactivity to a stressor in children and adolescents and in modulating their frontal EEG asymmetry. A number of 165 children and adolescents were randomly assigned to one of three conditions: REThink game, a Rational Emotive Behavior Education (REBE) intervention, or a Waitlist. Participants were asked to complete an impromptu speech twice, before and after the interventions, while their anxiety and brain activity were recorded. Results suggest that relative to the Waitlist and REBE interventions, the REThink game was effective in reducing biological reactivity manifested by children and adolescents in response to speech, but not for modulating subjective anxiety. Present results provide further evidence for the potential benefits of therapeutic games in promoting mental health in children and adolescents.

HandMATE: Wearable Robotic Hand Exoskeleton and Integrated Android App for At Home Stroke Rehabilitation.

We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.

La psicomotricidad como una herramienta del juego terapéutico implementada en un centro de estimulación multisensorial

The present investigation shows the way to work the psychomotricity as a tool of the therapeutic game implemented in a Multisensory Stimulation Center (CEMS) which is located in the Universidad Politécnica de Amozoc, Puebla, Mexico. The objectives are: a) Determine the level of psychomotor development in preschoolers, b) Develop a plan of playful strategies that contribute to psychomotor development, c) Evaluate the psychomotor development of children once the activities have been implemented. For this, educational activities were designed with third year preschool children, where previously a group of children was assessed using a specific test to determine their level of psychomotricity according to their development, which were reported by their teachers. Subsequently, the population to work was selected and a series of activities supported by means of therapeutic play were established, in such a way that they potentiated their psychomotor development. Finally, the contribution of this research is to demonstrate the impact that is obtained in psychomotor development through therapeutic play in preschool children.

On-line anxiety level detection from biosignals: Machine learning based on a randomized controlled trial with spider-fearful individuals.

We present performance results concerning the validation for anxiety level detection based on trained mathematical models using supervised machine learning techniques. The model training is based on biosignals acquired in a randomized controlled trial. Wearable sensors were used to collect electrocardiogram, electrodermal activity, and respiration from spider-fearful individuals. We designed and applied ten approaches for data labeling considering individual biosignals as well as subjective ratings. Performance results revealed a selection of trained models adapted for two-level (low and high) and three-level (low, medium and high) classification of anxiety using a minimal set of six features. We obtained a remarkable accuracy of 89.8% for the two-level classification and of 74.4% for the three-level classification using a short time window length of ten seconds when applying the approach that uses subjective ratings for data labeling. Bagged Trees proved to be the most suitable classifier type among the classification models studied. The trained models will have a practical impact on the feasibility study of an augmented reality exposure therapy based on a therapeutic game for the treatment of arachnophobia.

Effect of Puppet Show on Children's anxiety and pain levels during the circumcision operation: A randomized controlled trial

Surgical procedures are the most common causes of anxiety and pain in hospitalized children. One of the most common surgical procedures for children is circumcision. Surgical procedures such as circumcision in hospitals are the most common causes of pain, fear, and anxiety in children. Therapeutic play methods as non-pharmacological applications are being developed recently for children who use analgesics in the treatment of pain and anxiety. Nurses can use the game in three areas such as a care strategy for hospitalized children during daily routine practices, surgery, and invasive or painful treatment procedures. An extensive literature review revealed that there were therapeutic game plays performed before and after the surgical procedure. Nonetheless, no therapeutic game play performed during the surgical procedure were reported. In addition, no reported study of puppet show which is one of the therapeutic game methods were found. The aim of this study was to investigate the effect of the puppet show demonstrated to 7-11 years old children during circumcision on the anxiety and pain level of children. The study was designed as a randomized controlled experiment. The population of the study was the children between 7 and 11 years of old and being circumcised in the urology clinic at Research and Training Hospital in Karabük Turkey between 1 May and 1 September 2017. A total of 81 (experimental group: 40, control group: 41) children were included in the study. "Participant Information Form", "Wong Baker Faces Pain Rating Scale" and "State-Trait Anxiety Inventory for Children" were used as implemented in the literature. The median pain score of the experimental group during and after the procedure was statistically lower than the control group. The level of anxiety during and after the procedure in the experimental group showed a statistically significant decrease compared to the pre-treatment level and the level of anxiety after the procedure showed a statistically significant decrease compared to the procedure. In the control group, while the level of anxiety during the procedure showed a statistically significant increase compared to the pre-treatment level, the level of anxiety after the procedure showed a statistically significant decrease compared to the one during the procedure. It was concluded that the puppet show performed during the circumcision procedure was effective in reducing the pain and anxiety that developed during the circumcision and continued after the procedure.

"Step by step": the development of a therapeutic game to assist in the treatment of drug use.

This research aimed to understand the potential of game design to improve the experience of drug users and their families with psychoeducation. In the design field, the term experience refers to the quality of the interaction between people and a product, which is, in this research, a therapeutic game called "Step by Step". Fifteen in-depth interviews were developed with patients and their family members after playing "Step by Step" in multifamily groups. Results indicate that the game improved the experience with psychoeducation. Participants' appraisals suggested that the game dynamics facilitated users' immersion. The playing situation was assessed as safe to address sensitive issues not normally expressed between patients and their relatives. The visual and tactile designed stimuli were evaluated as learning facilitators. The simplicity of the game was appraised as helpful, allowing the inclusion of distinct generations in collective learning. Results provided insights to foster game design in the health field.