200 Chapter 4 symptoms reported by both children and parents (primary outcomes) were examined in one RCT (Schoneveld et al., 2016). It was found that MindLight was as effective as a commercial video game (i.e., Max and the Magic Marker, an award-winning exploratory puzzle game) in 8–12-year-olds with elevated levels of anxiety symptoms. Anxiety symptoms decreased after game play and up to 3 months later. The second RCT was designed to more rigorously examine the effectiveness of MindLight by comparing the applied game with the first-line treatment of choice for anxiety symptoms: CBT (A. C. James et al., 2015). Children who played MindLight showed the same decrease in anxiety symptoms as children who received CBT (Schoneveld et al., 2018). Importantly, the magnitude of improvement was equal across MindLight and both comparison groups (i.e., commercial game and CBT). In addition, children’s age and gender did not moderate effectiveness in both RCTs. In light of these initial positive effects of MindLight on anxiety symptoms, the next steps are to investigate whether MindLight also has beneficial effects on other outcomes associated with anxiety symptoms, and for whom MindLight might be most effective. Children who experience elevated levels of anxiety often also suffer from depressive feelings (Lavigne et al., 2015), have difficulties in relationships with their peers (Hoglund & Chisholm 2014), express more externalising symptoms such as conduct problems (Priddis et al., 2014; Kidwell et al., 2016), and are generally characterized by low levels of self-efficacy (Mathews et al., 2016; Niditch & Varela 2012; O’Neal and Cotten 2016). Given the debilitating effect of these problems on the lives and further development of these children, and the fact that they co-occur as well as contribute to further increases in anxiety, it seems important to investigate whether anxiety prevention programs also have a beneficial effect on those domains. Previous studies assessing changes in internalising problems after anxiety prevention programs found that pre-school aged children with an anxiety disorder decreased in internalising behaviour problems from pre- to post-test after receiving an internet-based, therapist assisted, parentfocused, CBT program (Donovan & March 2014). In addition, Morgan et al. (2016) found that highly inhibited children between the age of 3 and 6 years improved significantly in emotional symptoms during an online version of the parenting group program Cool Little Kids. Last, a meta-analytic review showed that interventions targeting anxiety in youth showed significant effects on depressive symptoms for treatment and universal prevention programs, but not in targeted prevention programs (Garber et al., 2016). Thus, it seems that
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