Aniek Wols

2 63 REVIEW OF APPLIED & CASUAL GAMES FOR MENTAL HEALTH The current review highlights the potential of applied games. Overall, our findings showed that applied games are more effective than passive conditions (shown by 5 studies), equally effective as active conditions (shown by 19 studies), and sometimes even more effective than active conditions (shown by 4 studies). Many comparisons between applied games and active conditions were nonsignificant, meaning that the games were equally effective as conventional, often face-to-face therapies. Most often these were therapies that were strongly rooted in theory, had decades of support for their effectiveness, and served as clinical gold standards. The fact that a video game could compete and show comparable impacts on mental health outcomes is remarkable given these comparison contexts, and suggests that cost-effectiveness may be a topic for further research. It should be noted, however, that a couple of studies indicated that the applied game was not more effective than a passive control condition (Coles et al., 2015; Faja et al., 2021; McCashin et al., 2022), especially when examining ADHD (Rodrigo-Yanguas et al., 2023; Steiner et al., 2011; Van der Oord et al., 2014; Van Houdt et al., 2019; Van Houdt et al., 2021) and depressive symptoms (Bohr et al., 2023; Fleming et al., 2012; Poppelaars et al., 2021; Poppelaars et al., 2016). Considering that both ADHD and depression are highly heterogeneous syndromes with numerous biological and neurological correlates (e.g., Cassano & Fava, 2002; Fried & Nesse, 2015; Olbert et al., 2014; Sonuga-Barke, 2003; Willcutt et al., 2005), it may be that the games were only effective for a small number of youth. Alternatively, it may also be the case that a higher dose of interaction with the game mechanics is needed for ADHD and depressive symptoms to improve (Bohr et al., 2023; Poppelaars et al., 2021; Van der Oord et al., 2014; Van Houdt et al., 2021). In sum, the current review indicates that applied games used in (sub)clinical populations seem most promising and effective for improving social skills, verbal memory in psychosis and anxiety symptoms. These findings are in line with reviews showing that (serious and entertainment) games are effective in improving social skills in autism spectrum disorder (Silva et al., 2021) and cognitive difficulties in psychosis (Cella et al., 2020; Rus-Calafell et al., 2018), and research on traditional therapy showing the largest effects for anxiety (e.g., Weisz et al., 2017). For casual games, a promising picture emerged showing that they were as effective as both applied games and active conditions in the majority of studies that included a casual game condition. These findings suggest that further research into cost-effectiveness and working mechanisms would be valuable. The current review showed that casual games seem most promising and effective for improving depressive symptoms, anxiety symptoms and ADHD

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