Game-Based Digital Interventions for Depression Therapy: A Systematic Review and Meta-Analysis

The aim of this study was to review the existing literature on game-based digital interventions for depression systematically and examine their effectiveness through a meta-analysis of randomized controlled trials (RCTs). Database searching was conducted using specific search terms and inclusion criteria. A standard meta-analysis was also conducted of available RCT studies with a random effects model. The standard mean difference (Cohen's d) was used to calculate the effect size of each study. Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis. Four types of game interventions-psycho-education and training, virtual reality exposure therapy, exercising, and entertainment-were identified, with various types of support delivered and populations targeted. The meta-analysis revealed a moderate effect size of the game interventions for depression therapy at posttreatment (d=-0.47 [95% CI -0.69 to -0.24]). A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions. A higher effect was achieved when a waiting list was used as the control. The review and meta-analysis support the effectiveness of game-based digital interventions for depression. More large-scale, high-quality RCT studies with sufficient long-term data for treatment evaluation are needed.

[1]  Jeffrey L. Krichmar,et al.  Social contracts and human–computer interaction with simulated adapting agents , 2013, Adapt. Behav..

[2]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[3]  Jose J. Valadez,et al.  Just a game after all: Violent video game exposure and time spent playing effects on hostile feelings, depression, and visuospatial cognition , 2012, Comput. Hum. Behav..

[4]  Michael Kyrios,et al.  An evaluation of 'Reach Out Central': an online gaming program for supporting the mental health of young people. , 2010, Health education research.

[5]  R E Glasgow,et al.  Behavioral bibliotherapy: a review of self-help behavior therapy manuals. , 1978, Psychological bulletin.

[6]  B. Rothbaum,et al.  Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study , 1999, Journal of traumatic stress.

[7]  Alexandra Rankin Macgill,et al.  Teens, Video Games, and Civics: Teens' Gaming Experiences Are Diverse and Include Significant Social Interaction and Civic Engagement. , 2008 .

[8]  G. Eysenbach.  The Law of Attrition , 2005, Journal of medical Internet research.

[9]  Pedro Gamito,et al.  PTSD Elderly War Veterans: A Clinical Controlled Pilot Study , 2009, Cyberpsychology Behav. Soc. Netw..

[10]  J. Salamone.  Dopamine, effort, and decision making: theoretical comment on Bardgett et al. (2009). , 2009, Behavioral neuroscience.

[11]  Eugene V Beresin,et al.  Factors correlated with violent video game use by adolescent boys and girls. , 2007, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[12]  G. Andersson,et al.  Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis , 2009, Cognitive behaviour therapy.

[13]  Kevin O'Brien,et al.  EEG, HRV and Psychological Correlates while Playing Bejeweled II: A Randomized Controlled Study , 2009, Annual Review of Cybertherapy and Telemedicine.

[14]  J. McGonigal.  Reality Is Broken: Why Games Make Us Better and How They Can Change the World , 2011 .

[15]  Sun I. Kim,et al.  Exploring the Use of Computer Games and Virtual Reality in Exposure Therapy for Fear of Driving Following a Motor Vehicle Accident , 2003, Cyberpsychology Behav. Soc. Netw..

[16]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[17]  D. Brooks,et al.  Evidence for striatal dopamine release during a video game , 1998, Nature.

[18]  E. Ho,et al.  The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. , 2011, Journal of clinical nursing.

[19]  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.

[20]  Todor Ganchev,et al.  Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study , 2012, Journal of mental health.

[21]  M. Krijn,et al.  Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. , 2002, Behaviour research and therapy.

[22]  Lina Gega,et al.  Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. , 2004, Journal of clinical psychology.

[23]  J. Mann,et al.  A Current Perspective of Suicide and Attempted Suicide , 2002, Annals of Internal Medicine.

[24]  T. Richardson,et al.  Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review , 2010, Clinical child and family psychology review.

[25]  David Coyle,et al.  Personal Investigator: A therapeutic 3D game for adolecscent psychotherapy , 2005, Interact. Technol. Smart Educ..

[26]  P. Cuijpers,et al.  Bibliotherapy in unipolar depression: a meta-analysis. , 1997, Journal of behavior therapy and experimental psychiatry.

[27]  Eric G. Johnson,et al.  The effect of virtual reality gaming on dynamic balance in older adults. , 2012, Age and ageing.

[28]  Suzanne Austin Boren,et al.  Videogames and Health Improvement: A Literature Review of Randomized Controlled Trials. , 2012, Games for health journal.

[29]  M Knox,et al.  Game-based biofeedback for paediatric anxiety and depression. , 2011, Mental health in family medicine.

[30]  Cheryl K. Olson,et al.  Video Games in Psychotherapy , 2010 .

[31]  Jacqueline Kerr,et al.  Exergames for subsyndromal depression in older adults: a pilot study of a novel intervention. , 2010, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[32]  S. Amir,et al.  The role of endorphins in stress: Evidence and speculations , 1980, Neuroscience & Biobehavioral Reviews.

[33]  Jay M Bernhardt,et al.  Health Benefits of Digital Videogames for Older Adults: A Systematic Review of the Literature. , 2012, Games for health journal.

[34]  Anne Marie Albano,et al.  Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. , 2005, The American journal of psychiatry.

[35]  Mark W. Lipsey,et al.  Practical Meta-Analysis , 2000 .

[36]  C. Ferguson,et al.  The Hitman Study Violent Video Game Exposure Effects on Aggressive Behavior, Hostile Feelings, and Depression , 2010 .

[37]  Derek Richards,et al.  Prevalence and clinical course of depression: a review. , 2011, Clinical psychology review.

[38]  E. Mayo-Wilson.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. , 2007, Psychological medicine.

[39]  Theresa Fleming,et al.  A pragmatic randomized controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents excluded from mainstream education. , 2012, Behavioural and cognitive psychotherapy.

[40]  E. Skinner,et al.  The development of coping. , 2007, Annual review of psychology.

[41]  K. Ressler,et al.  Virtual reality exposure therapy using a virtual Iraq: case report. , 2008, Journal of traumatic stress.

[42]  Patricia Obst,et al.  The Effect of Social Support Derived from World of Warcraft on Negative Psychological Symptoms , 2009, Cyberpsychology Behav. Soc. Netw..

[43]  Derek Richards,et al.  Computer-based psychological treatments for depression: a systematic review and meta-analysis. , 2012, Clinical psychology review.

[44]  B. Everitt,et al.  Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice , 2003, Psychological Medicine.

[45]  Luz María Alvarez,et al.  Computer program in the treatment for major depression and cognitive impairment in university students , 2008, Comput. Hum. Behav..

[46]  S. Hollon,et al.  Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. , 2006, Annual review of psychology.

[47]  Deborah I Thompson,et al.  Playing for real: video games and stories for health-related behavior change. , 2008, American journal of preventive medicine.

[48]  Rebecca P Ang,et al.  Online Video Game Therapy for Mental Health Concerns: A Review , 2008, The International journal of social psychiatry.

[49]  Amanda Lenhart,et al.  Adults and video games , 2008 .