19 1 GENERAL INTRODUCTION disorders (e.g., relaxation and exposure training for anxiety; Kendall, 2011). In the development of applied games for mental health, the primary focus is on translating these specific therapeutic techniques into game elements and mechanisms (Eichenberg & Schott, 2017; Fleming et al., 2017). In research on applied games, the main objective is to examine the game’s overall effectiveness, and to a lesser extent, how specific techniques incorporated contribute to changes in mental health (for exceptions, see De Vries et al., 2015; Dovis et al., 2015; Van Houdt et al., 2019). The assumption underlying this research is, however, that the observed improvements in mental health can be attributed to the specific CBT techniques incorporated in the game. A substantial body of evidence, however, consistently indicates that nonspecific factors – factors not specific to any particular psychotherapeutic approach – significantly contribute to positive intervention outcomes (Colloca, 2018a, 2018b; Grencavage & Norcross, 1990; Ilardi & Craighead, 1994; Thiruchselvam et al., 2019; Wampold, 2015) as well as process-related variables such as engagement, adherence, alliance quality, effort and invested time in the treatment (Boettcher et al., 2013; Boot et al., 2013; Constantino et al., 2011; Greenberg et al., 2006; Meyer et al., 2002; Westra et al., 2007). In fact, specific factors explain relatively little and account for only a small percentage of the variance in outcome measures, whereas nonspecific factors play a more important role in treatment efficacy and improving mental health outcomes (Ahn & Wampold, 2001; Lambert, 2005, 2011). Examples of the most important and most researched nonspecific factors include the client-therapist relationship (Krupnick et al., 2006; Norcross, 2002), expectations for improvement and placebo effects (Asay & Lambert, 1999; Constantino et al., 2018; Crum & Phillips, 2015; Greenberg et al., 2006; Kazdin, 1979; Thiruchselvam et al., 2019), and client-related variables such as hope (Ilardi & Craighead, 1994), mindset or implicit theories of beliefs about the malleability of personal attributes (Crum & Phillips, 2015; Tamir et al., 2007), and motivation or readiness to change (Dozois et al., 2004; Norcross et al., 2011; Prochaska & Norcross, 2001; Taylor et al., 2012). Given the central role of nonspecific factors in nearly all psychological interventions (Lambert, 2005), it is likely that nonspecific factors, at least in part, drive mental health improvements in well-designed applied games as well. After all, applied games are often part of a treatment context, are delivered in a specific way, and individuals may have different expectations and beliefs about the effectiveness of applied games and different motivations to install or follow an applied game program. Findings from two randomised controlled trials (RCTs) performed by our own Games for Emotional and Mental Health (GEMH) lab further highlight the need to examine nonspecific
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