Mental Health Outcomes of an Applied Game for Children with Elevated Anxiety Symptoms: A Randomized Controlled Non-inferiority Trial

Anxiety disorders are the most prevalent mental health problems in childhood. Engaging, adequate, and appropriate prevention programs are needed. Applied games form a potential alternative delivery model and recent evidence suggests that they could be effective. The present randomized controlled non-inferiority trial investigated the beneficial effects of the applied game MindLight compared to cognitive behavioral therapy (CBT) on mental health outcomes associated with anxiety symptoms: internalizing problems, externalizing problems, and self-efficacy. In addition, we examined who benefitted most from both programs and analyzed baseline levels of anxiety, maternal mental health problems, and self-efficacy as predictors of changes in anxiety symptoms. After being screened for elevated anxiety, 174 selected children (8-12-year-old) were randomized to play MindLight or to receive a prevention program based on CBT. Study variables were assessed before and after the intervention, and at 3- and 6-months follow-up. Intention-to-treat analyses showed a significant reduction in mother-reported internalizing and externalizing problems and an increase in self-efficacy. Importantly, the magnitude of change did not differ between intervention groups. Non-inferiority analyses showed that MindLight was as effective as CBT in affecting internalizing problems and self-efficacy. However, CBT was more effective in decreasing externalizing symptoms than MindLight. Furthermore, baseline anxiety levels, maternal mental health problems, and self-efficacy did not influence the change of anxiety symptoms over time. Applied games, specifically theory-based games such as MindLight, hold potential as effective interventions for not only targeting anxiety symptoms, but also more general mental health outcomes.