Aniek Wols

198 Chapter 4 ABSTRACT Anxiety disorders are the most prevalent mental health problems in childhood. Engaging, adequate, and appropriate prevention programs are needed. Applied games form a potential alternative delivery model and recent evidence suggests that they could be effective. The present randomised controlled non-inferiority trial investigated the beneficial effects of the applied game MindLight compared to cognitive behavioural therapy (CBT) on mental health outcomes associated with anxiety symptoms: internalising problems, externalising problems, and self-efficacy. In addition, we examined who benefitted most from both programs and analysed baseline levels of anxiety, maternal mental health problems, and self-efficacy as predictors of changes in anxiety symptoms. After being screened for elevated anxiety, 174 selected children (8–12-year-old) were randomised to play MindLight or to receive a prevention program based on CBT. Study variables were assessed before and after the intervention, and at 3- and 6-months follow-up. Intention-to-treat analyses showed a significant reduction in mother-reported internalising and externalising problems and an increase in self-efficacy. Importantly, the magnitude of change did not differ between intervention groups. Non-inferiority analyses showed that MindLight was as effective as CBT in affecting internalising problems and self-efficacy. However, CBT was more effective in decreasing externalising symptoms than MindLight. Furthermore, baseline anxiety levels, maternal mental health problems, and self-efficacy did not influence the change of anxiety symptoms over time. Applied games, specifically theory-based games such as MindLight, hold potential as effective interventions for not only targeting anxiety symptoms, but also more general mental health outcomes.

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