Video games for the prevention of depression and anxiety: A 21st century approach to emotional and mental health in adolescents

Periodic Reporting for period 4 - GEMH (Video games for the prevention of depression and anxiety: A 21st century approach to emotional and mental health in adolescents)

Periodo di rendicontazione: 2021-02-01 al 2021-11-30

Depression and anxiety are the most frequently diagnosed mental health problems, leading to devastating long-term outcomes that affect a huge proportion of youth across the globe. However, even our most advanced programs often lead to disappointing results. Therefore, a new approach to the prevention of these emotional disorders and new scientific methodology to test how these interventions work is needed.
Video games promise a ground-breaking innovation providing learning environments that keep youth motivated and engaged to practice emotional resiliency skills that help prevent anxiety and depression. A zeitgeist has emerged in the medical and educational fields for applied games as learning tools. Applied games — prolific in the medical and educational fields — are video games used for non-leisure purposes and are expected to surpass the multibillion dollar entertainment games industry in the next decade. The mental health field is poised to benefit enormously from a similar transformation.
At this early stage it is critical to develop a rigorous theoretical framework and a new methodology that stipulates how to use games to develop and test theories of psychological change, and implement prevention strategies based on its outcomes. The GEMH project therefore aimed to develop such a theoretical framework, new methodology, alongside the development of games using evidence-based game mechanics that target anxiety and depression in youth.
The GEMH project has resulted in an initial framework for the development of games for emotional and mental health and has contributed to developing theory surrounding adolescent mental health in digital spaces using this project's concrete instantiations of how tech can be used as effective interventions for youth. This theoretical work has already resulted in innovation with the development of a prototype of Alt-Shift an application stimulating youth's reflection on social media use ultimately aiming at improved well-being. Two further games were examined with promising initial results (i.e. ScrollQuest 2.0 and #Self-Care). And finally, the GEMH project resulted in the development of the Stimulated Recall Paradigm — a new methodology to gain more reliable and qualitatively richer insights into how youth use social media.

Within the GEMH ERC project we aimed to test three video games for their impact on internalizing symptoms (e.g. depression and anxiety symptoms) with youth with already elevated internalizing symptoms.

Subproject 1 — Shift.
The first project used the GEMH Lab framework to develop a prototype of Shift, a cooperative game for youth at risk for internalizing psychopathology and pilot tested its ability to affect causal mediators through the proposed game mechanics. Pilot test results showed that feelings of social support and growth mindset were not enhanced, but the reappraisal mechanism was promising. Pivoting this project, a prototype of Alt-Shift was developed using an updated theoretical model (https://doi.org/10.1080/1047840X.2020.1820214; https://doi.org/10.1080/1047840X.2020.1820225; book chapter in press). Alt-Shift capitalizes on youth's digital activities and social connection youth already have online, allowing them to collect those experiences and reflect on them — with the goal of ultimately improving their well-being. Alt-Shift's prototype was co-created with youth, having been user tested and explored in focus groups. Results have been written up and have been submitted for publication.

Subproject 2 — ScrollQuest.
The second project tested whether ScrollQuest 2.0 can differentiate between youth with and without internalizing symptoms and through social support can lower stress. ScrollQuest 2.0 was developed to ensure players can bond, can play cooperatively and competitively, can experience implicit and explicit rejection, and can practice with reappraisal training through changing solutions to similar looking puzzles. Initial pilot data suggested that youth respond differently to the social rejection episodes depending on internalizing symptoms. In addition, social support in ScrollQuest appeared to improve mood and reduce stress (publication in preparation). Next, in light of the pandemic, time was invested into additional development to insure that researchers within and outside of our own lab will be able to reliably and remotely collect rich behavioural data using ScrollQuest 2.0 in the future. Indeed, remotely collected experimental data suggests that youth respond with differential gameplay behaviours depending on receiving virtual support within the social rejection context created in ScrollQuest 2.0.

Subproject 3 — #Self-Care.
The third project examined the way youth use social media and games to regulate stress, anxiety, and other negative emotions, followed by an examination of the impact of #SelfCare on young people’s anxiety and stress regulation and predictions to mental health outcomes. First, an experimental study was performed using the newly developed Stimulated Recall Paradigm (https://doi.org/10.2196/15529) to explore youth’s social media use following a stress manipulation (https://doi.org/10.1057/s41599-021-00863-1; https://doi.org/10.3389/fpsyg.2021.789302). Participants reported on social media use in its various forms as a way of stress regulation. Results showed no relationship between social media use after stress and changes in momentary wellbeing — leaving room for an intervention to boost momentary well-being. Next, a large-scale, micro randomized trial of #SelfCare was performed entirely through virtual, digital means. Qualitative data from participant's exit interviews suggest #SelfCare offered young women a soothing and calming experience. #SelfCare's effects on the mood of young women with elevated internalizing symptoms are being written up for publication. Furthermore, EMA data were collected on vulnerable youth's use of social media and games — guiding the further development of just-in time interventions. Results showed that negative relationships between social media use and affective wellbeing are rare in emerging adults (submitted for publication).

This project's results have been disseminated in 7 scientific articles in international peer-reviewed journals, a host of presentations to academic, industry, and general public audiences, as well as multiple media interviews and publications. Furthermore, 1 book chapter and 1 scientific article are currently in press and 4 scientific articles are currently/soon to be submitted to international peer-reviewed journals.

The development of the Stimulated Recall Method is a significant advancement of the research field as it moves the discussion around digital activities beyond the one-dimensional concept of screen time (time spend on digital media) to include the likely influential concepts of content, experience, and context. In addition, our Psychological Inquiry target article (https://doi.org/10.1080/1047840X.2020.1820214) has begun a much-needed discussion in the developmental psychology field, finally putting digital media use at the forefront of developmental research instead of being relegated to pathologizing models or leisure activity. Combining existing theories and introducing new concepts this discussion guides the research field forward.

GEMH Tree

Periodic Reporting for period 4 - GEMH (Video games for the prevention of depression and anxiety: A 21st century approach to emotional and mental health in adolescents)

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