games for health - rutger engels - developing games for emotional health of children and adolescents
TRANSCRIPT
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Improving Mental Health by Sharing Knowledge
Evidence-basedgames for mentalhealth in youth
Rutger Engels
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Together with prof. Isabel Granic
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Adam Lobel
Elke Schoneveld
Marlou Poppelaars
Lieke Wijnhoven
Angela Schuurmans
Geert Verheijen
And..
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And..
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Why mental health?
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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)
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3. High costs for employers
Top 3 of causes of # sick days (NEMESIS, 2011):
1. Depression
2. Chronic back pain
3. COPD and asthma
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4. High societal costs
Top 3:
1. Depression
2. Childhood disorders (including ADHD and autism) 3. Anxiety
(Veerbeek et al., 2014)
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Two major issues:
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The importance of games (and gaming) as intervention tools
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• 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
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• 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
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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
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Our aim:
Set up a framework that will lead to development of theory-based clinically-appropriate, ENGAGING games for depression and anxiety
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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
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No empirical evidence
=no funding for implementation and upscaling of serious games in mental health care
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3 points to make
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1. Rigorous testing
2. Games as a placebo
3. Resistance by professionals
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1. Rigorous testing
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Experimental designs, in which participants are randomized to control condition or game
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Depressive symptoms
50.00
55.00
60.00
65.00
70.00
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
OVK
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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
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No control group
No interpretation possible
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Measure transference to real life
In-game experiences should translate to out-of-game real life settings
Rigorous Designs
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GameDesk, LA
Dojo: game to regulate emotions
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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
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Testing the working mechanisms of the game
Rigorous Designs
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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?
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Figure 2. the light in the dark
In-game data. Fine-grained data on player patterns
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Rigorous Testing
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• Testing in subgroups
– As prevention tool for all kids
– For clinically disordered kids
– Age and gender
– Preference for gaming
Rigorous Testing
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Subgroups
RCT 1: teens in residential care for behavioral problems
RCT 2: anxious teens in schools
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Subgroups
RCT 1: teens in residential care for behavioral problems
RCT 2: anxious teens in schools
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Video Game Development
professional game
developers
Research
Outcome analysisComponent analysis
Process analysis
Go back to game development
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2. Game as a placebo
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Expectancies:
When teens invest time in a game AND are assured it works for them, it might already have an impact!
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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)
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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
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? Because they believed in the game, they got something out of it
? Parents supported them
Why
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Recommendation:
Be aware of potential placebo effect
Test why a game has effects using data on game processes and mechanics
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3. Overcoming resistance by professionals
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Message: it does not replace them, but helps them in making therapy more effective and efficient (and perhaps even fun!)
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Two perspectives co-exist
Game as intervention tool that replaces part of treatment or is an additive component
Game as a communication tool
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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
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Evidence and acceptance by professionals will assure uptake and financial investments by health insurance companies and authorities
Take-home message