4 199 MENTAL HEALTH OUTCOMES OF APPLIED GAME MINDLIGHT Approximately one in five children has an anxiety disorder (Beesdo et al., 2009) and even more children suffer from subclinical levels of anxiety, with prevalence rates up to 49% (Muris et al., 2000a). Compared to children with low levels of anxiety, these children perform worse at school (Owens et al., 2012), and have a lower general quality of life (Ramsawh & Chavira 2016). In addition, children with elevated levels of anxiety have more depressive feelings (Lavigne et al., 2015), more difficulties in relationships with their peers (Hoglund & Chisholm 2014), express more conduct problems (Priddis et al., 2014; Kidwell et al., 2016), and show lower levels of self-efficacy (Mathews et al., 2016; Niditch & Varela 2012; O’Neal & Cotten 2016) than children with low levels of anxiety. Left untreated, anxiety symptoms show a disabling and chronic course (Asselmann & Beesdo-Baum 2015). Therefore, effective, accessible and engaging prevention programs are needed that are implemented before fullblown anxiety disorders develop (World Health Organization 2012). Decades of research has led to the development of several anxiety prevention programs (e.g., Van Starrenburg’s adaptation of Kendall’s Coping Cat, Barrett’s FRIENDS for Life and Rapee’s Cool Little Kids programs). However, conventional programs face several obstacles that hamper their implementation. Specifically, stigma (Salloum et al., 2016; Mukolo & Heflinger 2011) and program costs (Salloum et al., 2016) impede parents and children from seeking help. Furthermore, conventional programs are moderately effective as shown in various meta-analyses (Stockings et al., 2016; Mychailyszyn et al., 2012; Fisak et al., 2011; Teubert & Pinquart 2011) and drop-out rates are high (i.e., 28 up to 75%; De Haan et al., 2013), possibly because programs are not engaging, adequate, nor appropriate (World Health Organization 2012). These obstacles call for a reconsideration of current group-based and clinical expert-led delivery models of prevention programs (Kazdin, 2015). To overcome those barriers, applied games have recently been put forward as an alternative delivery model of therapeutic techniques used in prevention programs (Kazdin, 2015). In contrast to current services, games might be cheaper than therapists, easily accessible, engaging and not stigmatizing (Granic et al., 2014). In the past, we have tested the effectiveness of the applied game MindLight in two randomised controlled indicated prevention trials (RCTs; Schoneveld et al., 2016, 2018). MindLight is an applied game designed for children with anxiety symptoms. The game uses several evidence-based techniques, informed by cognitive behavioural therapy (CBT): exposure (Kendall et al., 2005), attention bias modification (Bar-Haim et al., 2011) and neurofeedback (Price & Budzynski 2009). These techniques are embedded in a horror-themed survival game that trains children to cope with anxious feelings. First, anxiety
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