Aniek Wols

328 Chapter 8 and explored the moderating roles of symptom severity and motivation to change. To experimentally manipulate expectations, participants watched a teaser trailer promoting MindLight either as a mental health game or a regular entertainment game. Similar to the methodology of the study described in Chapter 3, on-screen output during MindLight play was recorded, and in-game play behaviours were coded. Results indicated that expectations did not predict participants’ game experiences (i.e., experienced fun) nor engagement with the therapeutic techniques in MindLight. Additionally, neither symptom severity nor motivation to change predicted or moderated these outcomes. These findings show that nonspecific factors neither hinder nor enhance engagement with the therapeutic techniques in MindLight. From pre- to post-test, we found similar decreases in positive affect and similar increases in state anxiety and arousal between the experimental groups, which were not influenced by participants’ symptom severity or motivation to change. These results provide further evidence that nonspecific factors do not influence engagement with MindLight. In summary, the results of the studies described in Chapters 3, 4, and 5 indicate that nonspecific factors, such as baseline anxiety (symptom severity), maternal mental health, and children’s self-efficacy did not serve as predictors for effectiveness. Examining engagement with therapeutic techniques in MindLight revealed that in-game behaviours supporting players’ practice of exposure were associated with reduced anxiety symptoms three months later. Symptom severity, expectations for improvement and motivation to change did not influence game experiences and engagement. Our results contradict existing literature on conventional therapy showing that nonspecific factors significantly contribute to both positive intervention outcomes and engagement (Boettcher et al., 2013; Boot et al., 2013; Colloca, 2018a, 2018b; Constantino et al., 2018; Derisley & Reynolds, 2000; Dozois et al., 2004; Greenberg et al., 2006; Ilardi & Craighead, 1994; Lewis et al., 2009; Meyer et al., 2002; Norcross et al., 2011; Thiruchselvam et al., 2019; Wampold, 2015; Westra et al., 2007). A possible explanation for this may be that games are already naturally appealing and considered intrinsically motivating and engaging (Fleming et al., 2017; Granic et al., 2014; Kazdin, 2015), and because of that, motivation to change and expectations for improvement do not (further) contribute to engagement and subsequent mental health improvements in applied games as it does for conventional therapy. Research investigating the effects of symptom severity on the response to conventional programs is inconclusive. Previous research has shown that higher symptom severity is related to greater symptom decreases after intervention (Lorenzo-Luaces et al., 2020; Van Starrenburg et

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