224 Chapter 4 seems to imply that skills transferred from the program context to everyday life, where mothers were able to observe their children’s behaviour. Last, we addressed a limitation of applied games research – a focus on short-term outcomes – by assessing children and mothers directly, 3 and 6 months after the program. These follow-ups give insight into the immediate, short-term but also longer-term effects of anxiety prevention programs, which informs implementation research. Programs with only short-term benefits might be less favourable than programs that show sustained beneficial effects. Apart from these strengths, this study has several limitations that need to be addressed in the future. First, the internal consistency statistics for the social self-efficacy subscale were in a questionable range, which may have affected the results related to social self-efficacy. However, when the pattern of these results is compared with the results of the remaining types of selfefficacy, no differences appear. Second, the sample consisted of relatively wellfunctioning children. Whether the current results hold in a more distressed sample is a question for future research. Third, given the absence of a waitlist control group, passage of time could not be eliminated as an alternative explanation for the change in mental health outcomes. In addition, future studies might want to investigate program effects on other important (secondary) outcomes. For example, as anxiety problems are related to worse academic performance (Nail et al., 2015), academic functioning indicators such as grades and problem solving skills could be relevant. Furthermore, assessing the effect of anxiety prevention programs on children’s social skills might be another important avenue for future research. Social skills start to develop in childhood, are affected by anxiety issues, and at the same time are an important contributing factor in the maintenance and further aggravation of mental health problems (Clarke et al., 2015). Prior research has shown that increasing children’s social skills helps to reduce their behavioural and emotional difficulties (Humphrey et al., 2010). Next to investigating outcomes, future studies may want to extend the range of possible predictors of effectiveness. An important general predictor of program effectiveness is children’s motivation to change. Children entering the program more motivated might show a larger decrease in anxiety symptoms than children who are less motivated (Dean et al., 2016). In addition, choice could be a moderator of program effectiveness. Given the positive effect of choice and autonomy on intrinsic motivation (Ryan & Deci 2000), children who choose themselves which program to attend might respond more positively than children who are randomly assigned.
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