176 Chapter 3 The third technique incorporated in MindLight is attention bias modification (ABM). Attentional biases characterized by a hyper attention towards potential threats play an important role in the development and maintenance of anxiety disorders (Muris, 2016; Muris & Field, 2008). With ABM-training, the attentional bias towards threats is retrained such that individuals pay more attention to positive stimuli rather than to negative stimuli (Bar-Haim, 2010; Bar-Haim et al., 2011). Conventional ABM-procedures have used a modified version of the dotprobe task or a visual search task and have been shown to reduce anxiety (at least in the short term; Bar-Haim, 2010; Bar-Haim et al., 2011; Hakamata et al., 2010). In MindLight, gaming elements have been added to the main principles of the dot-probe training. In the ABM puzzles, the player learns to focus on and attend to portraits of happy faces rather than threatening faces. Upon completion of the puzzle, the lights will turn back on in that particular room. Thus, ABM-training is done through the ABM-puzzles in MindLight (see Table 1). In-game play behaviours Although the game was designed to provide children with repeated training opportunities to learn emotion-regulation strategies, there is also variability in how much children actually practice these skills. This variability is largely a function of the design of the game, which allows children to play at their own pace and explore and progress through the game in a variety of ways that foster a sense of autonomy and fun. For example, some children may be too afraid to move through the game at first, and will hide in chests to avoid the fearful stimuli, while others might prefer to explore a great deal more from the outset. These play-pattern differences may lead to differences in the amount of opportunities to practice the relaxation skills or to encounter fear events further in the game. There are several specific in-game play behaviours that are most relevant to the intervention goals of MindLight (see Table 1). These behaviours can be classified into two types: “engaged” and “avoidant/safety” in-game play behaviours. Clinical research has shown that avoidant and/or safety behaviours are important maintenance processes for anxiety symptoms (Clark, 1999; McManus et al., 2008; Salkovskis et al., 1999; Salkovskis et al., 1996), and that reducing avoidant and/or safety behaviours and increasing engagement with the treatment are predictive of better treatment outcomes (e.g., Glenn et al., 2013; Morgan & Raffle, 1999; Salkovskis et al., 1999). While playing MindLight, children can show in-game play behaviours that indicate engagement versus avoidant/safety behaviour. To be successful at MindLight, children need to show engaged in-game play behaviours, which
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