62 Chapter 2 (American Academy of Pediactrics, 2011; Graham et al., 2011; Health Council of the Netherlands, 2014). Additionally, games may increase engagement and motivation for therapy in youths with ADHD (Bioulac et al., 2014; Prins et al., 2011). For youth with anxiety, current gold standard therapy (i.e., cognitive behavioural therapy) often involves decontextualised exercises that may not fully represent the authentic emotional and physical experiences of anxious youth (Granic et al., 2014). On the other hand, for depression and psychosis, applied games may be found less suitable as they are unable to detect and deal with crisis situations such as suicide or self-harm (Jiménez-Murcia et al., 2009; Shah et al., 2018). Moreover, for mental health problems such as depression, the pivotal therapeutic ingredient may involve the interpersonal connection with a therapist, rather than playing an applied game by yourself (Sucala et al., 2012). Thus, specific benefits for specific clinical populations may have been differentially related to the effectiveness of applied games. Across all mental health domains, the majority of studies examined the effects of an applied game, especially in clinical populations (Zayeni et al., 2020). The exception was studies on psychosis, which all included a casual game condition rather than an applied game. Interestingly, only one study in a (sub)clinical population with depressive symptoms examined the effects of two casual games (Poppelaars et al., 2021). Regarding the type of control groups, results showed a wide variety of control and comparison groups that was used to establish the effectiveness of the digital games. These included active and passive conditions, as well as other game conditions (both casual and applied). Depending on the comparison group, however, effectiveness varied. Games may look stronger in comparison to passive conditions, but active conditions are more scientifically rigorous and will provide the most convincing evidence for the effectiveness of a game as intervention tool (Boot et al., 2013; Connolly et al., 2012). Comparing the effectiveness of applied games directly to that of casual games also has its value. Given that casual games do not incorporate any specific therapeutic techniques but still may have beneficial effects on mental health (e.g., Fang et al., 2019; Kowal et al., 2021; Pallavicini et al., 2021; Suenderhauf et al., 2016), a direct comparison between applied and casual games sheds light on the (additional) effect of the therapeutic techniques incorporated in the applied game. Alternatively, if a casual game is equally effective as an applied game or active (treatment as usual) condition, it would be highly valuable to further examine cost-effectiveness as casual games are already easily accessible and scalable through mainstream media channels and game platforms.
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