Aniek Wols

26 Chapter 1 dissertation aims to contribute to our understanding of the effect of specific and nonspecific factors on engagement and mental health outcomes in an applied game. We start off with Chapter 3, in which we examined to what extent engagement with the therapeutic techniques in an applied game for anxiety prevention (i.e., MindLight) predicts mental health improvements. More specifically, we examined whether baseline anxiety symptoms were related to in-game play behaviours as well as whether changes in in-game play behaviours predicted changes in anxiety symptoms three months after playing the game. The study in Chapter 4 aimed to further unravel whether MindLight also has beneficial effects on other mental health outcomes associated with anxiety symptoms (i.e., internalising problems, externalising problems and selfefficacy), given their overlap in symptoms and transdiagnostic mechanisms. Additionally, we examined who benefitted most from the game by assessing several possible nonspecific variables as predictors of changes in anxiety symptoms, namely baseline anxiety symptoms, maternal mental health problems, and self-efficacy. In Chapter 5, we experimentally manipulated expectations for improvement and examined the effect on engagement while playing MindLight, as well as the moderating role of symptom severity and motivation to change. Additionally, changes in state anxiety and arousal were examined. Despite the notable implementation benefits of games, there is a lack of research examining the uptake of and engagement with mental health games among individuals with mental health symptoms (Fleming et al., 2018; Fleming et al., 2016). Understanding how motivational factors influence selection and engagement with mental health games is crucial as it will enable us to customise and tailor the promotion of mental health games, maximising their uptake and sustained use. Therefore, in Part 3 of my dissertation, we aimed to examine how messaging and several (nonspecific) motivational factors influence choice for a mental health game, and subsequent game experiences and engagement. In Chapter 6, we examined how messaging affects game choice, perceived attractiveness and fun of the game, as well as subsequent engagement and experiences of gameplay. We further explored how severity and type of mental health symptoms influence game choice, game experiences and engagement. To better understand the influence of personal motivational traits, we examined how motivation to change and one’s mindsets influence game choice and engagement in Chapter 7. We also examined whether mindsets change after playing a game promoted as mental health game. To conclude my dissertation, Chapter 8 presents a summary and general discussion of the

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