Aniek Wols

4 225 MENTAL HEALTH OUTCOMES OF APPLIED GAME MINDLIGHT Furthermore, the current study leaves open the question about mechanisms of change. Possible psychological mechanisms worth of investigation in future studies are increased active coping skills (Thorne et al., 2013) and decreased maladaptive cognitions (Hogendoorn et al., 2014). Ideally, these mediators should be assessed repeatedly over the course of the intervention, to investigate whether changes in these mediators contribute to decreases in anxiety (Selig & Preacher 2009). In addition, studying mediators of change in applied games versus conventional prevention programs (i.e., moderated mediation) could be an interesting future direction. MindLight focuses more on relaxation whereas CBT centers on changing cognitions. Thus, contrasting the relative contribution of changes in relaxation and cognitions in anxiety reduction will give insight into program specific mechanisms of change but will also contribute to a broader understanding of what is actually driving changes in anxiety. Notwithstanding the remaining questions for future research, the findings of the current study and our previous work (Schoneveld et al., 2016, 2018) suggest that MindLight could be implemented as an indicated prevention program in schools to reduce anxiety symptoms, internalising and externalising problems, and to improve self-efficacy in children with elevated levels of anxiety, regardless of the potential mental health problems or struggles that children or their parents may have. An applied game as MindLight might facilitate cost-effectiveness because no clinicians or teachers need to be involved and there is no specific training required to guide children through the game. Adding MindLight to the list of other prevention programs that already take place in the school context may provide children an alternatively delivered prevention program at school that is potentially less stigmatizing, more accessible, and thereby increasing adherence and their motivation to participate in such programs. Future research on the implementation and costeffectiveness of MindLight in the school context is recommended.

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