5 235 THE EFFECT OF EXPECTATIONS IN AN APPLIED GAME There has been an increasing interest in the use of applied games to treat and prevent mental health problems (e.g., Granic et al., 2014; Lau et al., 2017). Due to their intrinsically motivating features and their high accessibility and potential for scalability, applied games are considered a promising and costeffective approach to improve access to mental health care (Granic et al., 2014; Kazdin, 2015). The primary focus in the development of applied games has been on translating evidence-based specific therapeutic techniques into game mechanics (Eichenberg & Schott, 2017; Fleming et al., 2017). These specific therapeutic techniques are drawn from theories about the working mechanisms responsible for the onset and maintenance of mental health disorders (e.g., relaxation and exposure training in cognitive behavioural therapy; Kendall, 2011). The underlying assumption is that these specific techniques are responsible for the observed improvements in mental health. There is, however, a consistent and large body of evidence showing that nonspecific factors – factors not specific to any psychotherapeutic school, such as individuals’ expectations and motivation to change – actually outweigh the role of specific techniques in explaining positive intervention outcomes (e.g., Ahn & Wampold, 2001; Lambert, 2005, 2011; Messer & Wampold, 2002; Wampold, 2001). Additionally, nonspecific factors are associated with patients’ engagement in the therapeutic process such as invested time and effort (Boettcher et al., 2013; Dean et al., 2016; Greenberg et al., 2006; Meyer et al., 2002) and adherence to the treatment regimen (e.g., homework assignments; Constantino et al., 2011; Westra et al., 2007). So far, nonspecific factors have largely been neglected in the e-health literature (Enck et al., 2017; Torous & Firth, 2016) and their effects remain unknown. In order to optimize the effectiveness of applied games to its best potential, it is crucial to examine and harness the benefits of nonspecific factors (Enck et al., 2013). Presumably, the most relevant nonspecific factor to examine in applied games is individuals’ expectations for improvement (Schakel et al., 2018; Schwarz et al., 2016). Previous research has shown that expectations drive a large majority of intervention effects (Greenberg et al., 2006), in particular in experimental game design studies (Boot et al., 2013). Although commercial video games are usually promoted for their entertainment value, applied games are often introduced with an explicit (mental) health aim, which naturally induces expectations for improvement. It is unknown how expectations relate to players’ experiences of a game and their engagement with it. Therefore, the primary aims of the current study were to examine the effect of expectations for improvement on 1)experienced fun and affect, and 2) in-game play behaviours while playing an applied game for mental health.
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