3 177 IN-GAME PLAY BEHAVIOURS PREDICT IMPROVEMENTS IN ANXIETY will lead to a higher “dosage”, or more practice, with the game mechanics. Avoidant/safety in-game play behaviours limit that “dosage”. Differences in the dosage may result in anxiety symptom-reduction for some children and no anxiety symptom-reduction for other children based on how they played the game. Table 1 presents an overview of the in-game play behaviours categorised as “engaged” versus “avoidant/safety” and how these behaviours relate to the game mechanics and cognitive-behavioural principles that are incorporated in MindLight. In the “engaged” category, all behaviours represent experiences that support players’ practice of relaxation, exposure, and modifying attention biases. For example, by exploring children are more exposed to fear events, which they can chase away or decloak and from which they can learn how to regulate their anxiety in the face of perceived threat. By solving puzzles they learn to focus more on the positive faces than on the negative ones. The “avoidant/safety” category represents behaviours that interfere with the intervention goals in MindLight. For example, hiding inside a chest or being inactive reduces exposure to fear events in the game. Turning on ceiling lights minimizes relaxation training, because under the ceiling light monsters are less likely to show up and the child needs to rely less on his or her own mindlight to brighten the environment. Design and Hypotheses In the current study, participants were children with elevated levels of anxiety that participated in a RCT to test the effect of 6 play-sessions of MindLight compared to CBT (Schoneveld et al., 2018). Only children from the MindLight group were included in the current study. Engaged and avoidant/safety in-game play behaviours were coded for the first and last play-sessions to examine 1) how pre-test anxiety scores were related to in-game play behaviours during the first play-session, and 2) whether changes in in-game play behaviours from the first to the last play-session predicted changes in anxiety symptoms at the three-month follow-up assessment. We hypothesised that a) higher pre-test anxiety scores would be related to less engaged, and more avoidant/safety, ingame play behaviours during the first play-session, and b) increases in engaged behaviours and decreases in avoidant/safety behaviours from the first to the last play-session would predict reductions in anxiety symptoms at the threemonth follow-up assessment.
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