Toward Game-Based Digital Mental Health Interventions: Player Habits and Preferences

Background Designers of digital interventions for mental health often leverage interactions from games because the intrinsic motivation that results from game-based interventions may increase participation and translate into improved treatment efficacy. However, there are outstanding questions about the suitability (eg, are desktop or mobile interventions more appropriate?) and intervention potential (eg, do people with depression activate enough to play?) of games for mental health. Objective In this paper, we aimed to describe the presently unknown relationship between gaming activity and indicators of well-being so that designers make informed choices when designing game-based interventions for mental health. Methods We gathered validated scales of well-being (Beck’s Depression Inventory [BDI-II], Patient Health Questionnaire [PHQ-9], trait anxiety [TA], and basic psychological needs satisfaction [BPNS]), play importance (control over game behavior: control; gamer identity: identity), and play behavior (play frequency, platform preferences, and genre preferences) in a Web-based survey (N=491). Results The majority of our participants played games a few times a week (45.3%, 222/490) or daily (34.3%, 168/490). In terms of depression, play frequency was associated with PHQ-9 (P=.003); PHQ-9 scores were higher for those who played daily than for those who played a few times a week or less. Similarly, for BDI-II (P=.01), scores were higher for those who played daily than for those who played once a week or less. Genre preferences were not associated with PHQ-9 (P=.32) or BDI-II (P=.68); however, platform preference (ie, mobile, desktop, or console) was associated with PHQ-9 (P=.04); desktop-only players had higher PHQ-9 scores than those who used all platforms. Platform preference was not associated with BDI-II (P=.18). In terms of anxiety, TA was not associated with frequency (P=.23), platform preference (P=.07), or genre preference (P=.99). In terms of needs satisfaction, BPNS was not associated with frequency (P=.25) or genre preference (P=.53), but it was associated with platform preference (P=.01); desktop-only players had lower needs satisfaction than those who used all platforms. As expected, play frequency was associated with identity (P<.001) and control (P<.001); those who played more had identified more as a gamer and had less control over their gameplay. Genre preference was associated with identity (P<.001) and control (P<.001); those who played most common genres had higher control over their play and identified most as gamers. Platform preference was not associated with control (P=.80), but was with identity (P=.001); those who played on all devices identified more as a gamer than those who played on mobiles or consoles only. Conclusions Our results suggest that games are a suitable approach for mental health interventions as they are played broadly by people across a range of indicators of mental health. We further unpack the platform preferences and genre preferences of players with varying levels of well-being.

[1]  Andy P. Field,et al.  Discovering Statistics Using Ibm Spss Statistics , 2017 .

[2]  Master Textbook,et al.  Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health , 2017 .

[3]  Regan L. Mandryk,et al.  The Motivational Push of Games: The Interplay of Intrinsic Motivation and External Rewards in Games for Training , 2016, CHI PLAY.

[4]  Isabela Granic,et al.  A neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial , 2016, Comput. Hum. Behav..

[5]  Daniel M. Johnson,et al.  Motivations for videogame play: Predictors of time spent playing , 2016, Comput. Hum. Behav..

[6]  Hannah Fletcher,et al.  International Game Developers Association , 2016 .

[7]  Jong-Hwan Lee,et al.  Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting , 2016, Front. Psychol..

[8]  N. Daw,et al.  Taking Psychiatry Research Online , 2016, Neuron.

[9]  Pattie Maes,et al.  Computing in Mental Health , 2016, CHI Extended Abstracts.

[10]  Sebastian Deterding,et al.  Contextual Autonomy Support in Video Game Play: A Grounded Theory , 2016, CHI.

[11]  Regan L. Mandryk,et al.  Fostering Intrinsic Motivation through Avatar Identification in Digital Games , 2016, CHI.

[12]  Colby Johanson,et al.  Scaffolding Player Location Awareness through Audio Cues in First-Person Shooters , 2016, CHI.

[13]  Mark Begale,et al.  Uptake and usage of IntelliCare: A publicly available suite of mental health and well-being apps , 2016, Internet interventions.

[14]  P. Cuijpers,et al.  Scaling-up treatment of depression and anxiety: a global return on investment analysis. , 2016, The lancet. Psychiatry.

[15]  H. Riper,et al.  Internet-based CBT for social phobia and panic disorder in a specialised anxiety clinic in routine care: Results of a pilot randomised controlled trial , 2016, Internet interventions.

[16]  Adam Lobel,et al.  A Randomized Controlled Trial to Test the Effectiveness of an Immersive 3D Video Game for Anxiety Prevention among Adolescents , 2016, PloS one.

[17]  Verolien Cauberghe,et al.  Development and Validation of an Instrument for Measuring Individual Motives for Playing Digital Games , 2016 .

[18]  Manfred Tscheligi,et al.  Persuasive Technology , 2016, Lecture Notes in Computer Science.

[19]  Matthew K. Miller,et al.  How Self-Esteem Shapes our Interactions with Play Technologies , 2015, CHI PLAY.

[20]  G. Andersson,et al.  Internet-based treatment of depression , 2015 .

[21]  Konrad Paul Kording,et al.  Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study , 2015, Journal of medical Internet research.

[22]  Cristina Conati,et al.  Modeling Motivation in a Social Network Game Using Player-Centric Traits and Personality Traits , 2015, UMAP.

[23]  Patrick McAndrew,et al.  Game-Play Breakdowns and Breakthroughs: Exploring the Relationship Between Action, Understanding, and Involvement , 2015, Hum. Comput. Interact..

[24]  Regan L. Mandryk,et al.  Long-Term Use of Motion-Based Video Games in Care Home Settings , 2015, CHI.

[25]  N. Titov,et al.  A feasibility open trial of guided Internet-delivered cognitive behavioural therapy for anxiety and depression amongst Arab Australians , 2015 .

[26]  C. Beevers,et al.  Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial , 2015 .

[27]  Ron Tamborini,et al.  “In the Mood to Game”: Selective exposure and mood management processes in computer game play , 2015, New Media Soc..

[28]  Rosalind W. Picard,et al.  Text Messaging for Exercise Promotion in Older Adults From an Upper-Middle-Income Country: Randomized Controlled Trial , 2015, Journal of medical Internet research.

[29]  Scott Nicholson,et al.  A RECIPE for Meaningful Gamification , 2015 .

[30]  Julita Vassileva,et al.  Modeling the efficacy of persuasive strategies for different gamer types in serious games for health , 2014, User Modeling and User-Adapted Interaction.

[31]  Tracy A. Dennis,et al.  Mental Health on the Go , 2014, Clinical psychological science : a journal of the Association for Psychological Science.

[32]  Schubert Foo,et al.  Game-Based Digital Interventions for Depression Therapy: A Systematic Review and Meta-Analysis , 2014, Cyberpsychology Behav. Soc. Netw..

[33]  G. Andersson,et al.  Experiences of internet-delivered cognitive behavior therapy for social anxiety disorder four years later: A qualitative study , 2014 .

[34]  G. Andersson,et al.  Guided internet-delivered cognitive behavior therapy for post-traumatic stress disorder: A randomized controlled trial , 2014 .

[35]  Carl Gutwin,et al.  How players value their characters in world of warcraft , 2014, CSCW.

[36]  Janet A. Schmidt,et al.  Preliminary evaluation of PTSD Coach, a smartphone app for post-traumatic stress symptoms. , 2014, Military medicine.

[37]  Per Carlbring,et al.  Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial , 2014, BMJ Open.

[38]  R. Engels,et al.  The benefits of playing video games. , 2014, The American psychologist.

[39]  H. Christensen,et al.  Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review , 2013, Journal of medical Internet research.

[40]  Regan L. Mandryk,et al.  The Effects of Graphical Fidelity on Player Experience , 2013, MindTrek.

[41]  Peta Wyeth,et al.  The People-Game-Play model for understanding videogames' impact on wellbeing , 2013, 2013 IEEE International Games Innovation Conference (IGIC).

[42]  Joseph Hilgard,et al.  Individual differences in motives, preferences, and pathology in video games: the gaming attitudes, motives, and experiences scales (GAMES) , 2013, Front. Psychol..

[43]  Regan L. Mandryk,et al.  Games as neurofeedback training for children with FASD , 2013, IDC.

[44]  Regan L. Mandryk,et al.  Control your game-self: effects of controller type on enjoyment, motivation, and personality in game , 2013, CHI.

[45]  C. Ferguson,et al.  Friends, fun, frustration and fantasy: Child motivations for video game play , 2013 .

[46]  Joseph Gonzalez-Heydrich,et al.  "RAGE-Control": A Game to Build Emotional Strength. , 2013, Games for health journal.

[47]  Jesse Chandler,et al.  Using Mechanical Turk to Study Clinical Populations , 2013 .

[48]  S. Kelders,et al.  Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions , 2012, Journal of medical Internet research.

[49]  Kate Cavanagh,et al.  Computerized cognitive behavioural therapy and the therapeutic alliance: a qualitative enquiry. , 2012, The British journal of clinical psychology.

[50]  Ron Tamborini,et al.  Task demand and mood repair: The intervention potential of computer games , 2012, New Media Soc..

[51]  Mathijs F. G. Lucassen,et al.  The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial , 2012, BMJ : British Medical Journal.

[52]  Lennart E. Nacke,et al.  From game design elements to gamefulness: defining "gamification" , 2011, MindTrek.

[53]  A. Grob,et al.  Habitual computer game playing at night is related to depressive symptoms , 2011 .

[54]  Nicole C. Krämer,et al.  Entertaining Media Use and the Satisfaction of Recovery Needs: Recovery Outcomes Associated With the Use of Interactive and Noninteractive Entertaining Media , 2011 .

[55]  Martin F. Lynch,et al.  Motivation and Autonomy in Counseling, Psychotherapy, and Behavior Change: A Look at Theory and Practice 1ψ7 , 2011 .

[56]  Michael D. Buhrmester,et al.  Amazon's Mechanical Turk , 2011, Perspectives on psychological science : a journal of the Association for Psychological Science.

[57]  A. V. van Rooij,et al.  Online video game addiction: identification of addicted adolescent gamers. , 2010, Addiction.

[58]  Monique Ernst,et al.  Attention Bias Modification Treatment: A Meta-Analysis Toward the Establishment of Novel Treatment for Anxiety , 2010, Biological Psychiatry.

[59]  Artur Lugmayr,et al.  Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments , 2010 .

[60]  Gavin Andrews,et al.  Internet Treatment for Generalized Anxiety Disorder: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance , 2010, PloS one.

[61]  H. Christensen,et al.  The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials , 2010, The Medical journal of Australia.

[62]  Pamela M. Kato,et al.  Video Games in Health Care: Closing the Gap , 2010 .

[63]  C. Anderson,et al.  Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. , 2010, Psychological bulletin.

[64]  C. Spielberger.  State‐Trait Anxiety Inventory , 2010 .

[65]  Leonard Reinecke,et al.  Games and Recovery , 2009, J. Media Psychol. Theor. Methods Appl..

[66]  Richard M. Ryan,et al.  Having to versus Wanting to Play: Background and Consequences of Harmonious versus Obsessive Engagement in Video Games , 2009, Cyberpsychology Behav. Soc. Netw..

[67]  P. Vorderer,et al.  Serious games : mechanisms and effects , 2009 .

[68]  David R. Williams,et al.  Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys , 2009, PLoS medicine.

[69]  Leonard Reinecke,et al.  Games at Work: The Recreational Use of Computer Games During Working Hours , 2009, Cyberpsychology Behav. Soc. Netw..

[70]  M. Vasey,et al.  Attentional retraining: a randomized clinical trial for pathological worry. , 2009, Journal of psychiatric research.

[71]  Jeroen S. Lemmens,et al.  Development and Validation of a Game Addiction Scale for Adolescents , 2008 .

[72]  P. M. Kato,et al.  A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial , 2008, Pediatrics.

[73]  Aniket Kittur,et al.  Crowdsourcing user studies with Mechanical Turk , 2008, CHI.

[74]  P. Cuijpers,et al.  Behavioral activation treatments of depression: a meta-analysis. , 2007, Clinical psychology review.

[75]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[76]  Andrew K. Przybylski,et al.  The Motivational Pull of Video Games: A Self-Determination Theory Approach , 2006 .

[77]  G. Andersson,et al.  Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. , 2006, Journal of consulting and clinical psychology.

[78]  Richard Robinson.  Polyglutamine Leads to Altered Chromatin Architecture and Neurodegeneration , 2006, PLoS biology.

[79]  S. Skevington,et al.  The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group , 2004, Quality of Life Research.

[80]  神田 信彦.  Beck Depression Inventory-IIについての一考察 , 2004 .

[81]  B. D. Emery,et al.  State Mental Health , 2004, Administration and Policy in Mental Health and Mental Health Services Research.

[82]  Marylène Gagné,et al.  Autonomy Support and Need Satisfaction in the Motivation and Well-Being of Gymnasts , 2003 .

[83]  Sarah A. Mustillo,et al.  Prevalence and development of psychiatric disorders in childhood and adolescence. , 2003, Archives of general psychiatry.

[84]  Jonathan E. Cook,et al.  Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results , 2002, Cyberpsychology Behav. Soc. Netw..

[85]  P. Potts.  Detection of depression and anxiety in primary care: follow up study , 2002 .

[86]  E. Mościcki.  Epidemiology of completed and attempted suicide: toward a framework for prevention , 2001, Clinical Neuroscience Research.

[87]  E. Weir,et al.  Suicide: the hidden epidemic. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[88]  E. Deci,et al.  Extrinsic Rewards and Intrinsic Motivation in Education: Reconsidered Once Again , 2001 .

[89]  E. Deci,et al.  The "What" and "Why" of Goal Pursuits: Human Needs and the Self-Determination of Behavior , 2000 .

[90]  E. Deci,et al.  Intrinsic and Extrinsic Motivations: Classic Definitions and New Directions. , 2000, Contemporary educational psychology.

[91]  Robert J. Vallerand,et al.  An integrative analysis of intrinsic and extrinsic motivation in sport. , 1999 .

[92]  A. Lalonde.  Canadian Institute for Health Information. , 1994, Canadian journal of medical technology.

[93]  W. Swann,et al.  From self-conceptions to self-worth: on the sources and structure of global self-esteem. , 1989, Journal of personality and social psychology.

[94]  P. Lewinsohn,et al.  Depression as a function of levels of desired and obtained pleasure. , 1974, Journal of abnormal psychology.

[95]  L Crainford.  The Canadian Mental Health Association. , 1970, Canadian journal of public health = Revue canadienne de sante publique.

[96]  C. Dolea,et al.  World Health Organization , 1949, International Organization.