Aniek Wols

10 Chapter 1 Anxiety and depression are the most prevalent mental health problems in youth. Their associated significant negative outcomes and economic consequences for society, call for effective prevention programs. Video games for mental health have been proposed as an alternative delivery approach and potential solution to tackle social and practical access barriers as well as limitations regarding engagement related to conventional prevention programs. The field of games for mental health has been rapidly developing, and research on both applied and casual games has grown extensively; however, a comprehensive overview of the field is lacking. Therefore, Part 1 of the current thesis aims to provide an overview of the field. Furthermore, research on games for mental health has largely overlooked the influence of nonspecific factors such as expectations, motivation to change, and mindsets on game uptake, engagement and mental health outcomes. The studies described in Part 2 and 3 of this dissertation aim to address this significant gap in the literature. MENTAL HEALTH PROBLEMS IN YOUTH Anxiety and depression rank among the most common mental health issues experienced by youth (Costello et al., 2003; Global Burden of Disease Collaborative Network, 2020; D. Knopf et al., 2008; Merikangas et al., 2010; Polanczyk et al., 2015). Although strongly related to each other and showing high comorbidity rates (Axelson & Birmaher, 2001; J. R. Cohen et al., 2014; Cummings et al., 2014), symptoms of anxiety and depression pertain to different constructs and represent different disorders with distinct features (Hale III et al., 2009; Seligman & Ollendick, 1998). Anxiety is a natural, common feeling of nervousness in response to dangerous, stressful or unfamiliar situations (American Psychiatric Association, 2013). One’s reaction to these situations may be physiological (e.g., palpitations, sweating, tense muscles), behavioural (e.g., avoidance of feared objects, stressful situations or people), and cognitive (e.g., increased attention, worrying) (American Psychiatric Association, 2013). While anxiety is a useful and adaptive emotional response to stress, facilitating avoidance of danger or coping with challenging situations, it becomes maladaptive when intense levels of anxiety persist and interfere with social or occupational functioning (Beesdo et al., 2009; Davis III, 2009; National Library of Medicine). Subsequently, an anxiety disorder may develop, which is characterised by intense feelings of anxiety, excessive worry about future events or activities, apprehensive expectations, increased attentional bias towards threat-related information, selective memory processing, and

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