3 187 IN-GAME PLAY BEHAVIOURS PREDICT IMPROVEMENTS IN ANXIETY one association) is promising, because this suggests that MindLight is able to change the way in which children continued playing the game after the first session, enhancing opportunities to change anxiety symptoms. Additional findings showed negative associations between several engaged and avoidant/safety in-game play behaviours during the first playsession, which provide support for the theory-based distinction between these two types of behaviours and at the same time supports the contention that the MindLight Coding System-II is able to distinguish these conceptually different in-game play behaviours. In-Game Play Behaviours Representing Exposure Predicted Improvements in Anxiety Results showed that changes in in-game play behaviours representing therapeutic exposure techniques predicted improvements in anxiety symptoms three months later. Regarding the engaged in-game behaviours, exploring the fearful game-environment for longer periods of time predicted decreases in anxiety symptoms. The time spent on actual attempts to chase away these fearful stimuli did not predict changes in anxiety symptoms nor did the frequency of getting defeated by these fear events. Regarding the avoidant/safety in-game behaviours, more attempts to seek safety under a ceiling light and increases in time spent hiding inside chests (and therefore avoiding fearful stimuli) predicted higher anxiety symptoms three months later. These findings are in line with previous research on avoidant/safety behaviours during traditional therapy (Glenn et al., 2013; Hammond, 2005; Morgan & Riffle, 1999; Salkovskis et al., 1999; Price & Budzynski, 2009). However, the present study also extends this research by investigating these predictors in a game-based intervention. The current findings suggest that avoidant/safety behaviours play a similar role in an applied video game as in traditional faceto-face therapy. Moreover, relaxation during game-play (indicated by no or total mindlight) did not predict changes in anxiety symptoms. It might be that relaxation during game-play is not as important for improvements in anxiety as the exposure game mechanic. Recent evidence (published after MindLight was developed) suggests that the contribution of relaxation training to anxiety improvements in youth appears to be limited, although it might be that a higher dose of relaxation is needed to improve anxiety symptoms (Peris et al., 2015). Most importantly, the present study provides a unique contribution to the field by demonstrating that changes in the interaction with the game mechanics in MindLight predicted real-world improvements in anxiety symptoms at the
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