220 Chapter 4 intervention, delivered as a game or face-to-face CBT for 8 weeks, seems to have a significant and promising impact on more than the targeted anxiety. The effects on internalising problems are consistent with prior findings that interventions targeting anxiety also effectively reduce internalising problems (Donovan & March 2014) and emotional symptoms (Morgan et al., 2016). The decrease in externalising problems corresponds with research showing that anxiety and externalising problems are strongly associated (Priddis et al., 2014). Last, self-efficacy increased in children participating in our study. This finding is in line with improvements in self-efficacy found in school-refusing children (King et al., 1998) and youth with anxiety disorders (Suveg et al., 2009) following a CBT-program, and now extends these results to applied games. The non-inferiority of MindLight to CBT on internalising symptoms and self-efficacy suggests that MindLight is as effective as CBT in improving these mental health outcomes. However, CBT was more effective in decreasing externalising symptoms than MindLight. An explanation could be the (minimal) involvement of parents in CBT, which is recommended in treatment guidelines for externalising problem behaviour (Buitelaar et al., 2013). In sum, these results may suggest that MindLight, an applied game, is as effective as a conventional expert-led group-based CBT prevention program in enhancing self-efficacy and internalising symptoms beyond reductions in anxiety. For Whom are MindLight and CBT effective? The second set of hypotheses were not supported: none of the mental health variables predicted interventions’ effectiveness in preventing anxiety symptoms over time. First, we found no differences in the rate of change in anxiety symptoms for children with relatively lower or higher levels of baseline anxiety. This is in contrast to prior research that has demonstrated that anxiety symptoms at baseline could impact the response to CBT positively (Van Starrenburg et al., 2017) or adversely (Cunningham et al., 2016). Our results seem to suggest that the responsiveness to MindLight and CBT has little to do with the severity of presenting problems children began with. In addition, levels of children’s self-efficacy did not predict interventions’ effectiveness. A possible explanation is the rather low variance in self-efficacy scores in our sample. Most children rated themselves at the middle “not good, not bad” end of the scale, perhaps because we selected children from the general population. Other prevention studies (e.g., Tak et al., 2014) have also found rather low variance on self-efficacy. This restricted range precludes detecting effects.
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