Developing, Co-Designing and Testing a New Approach in Digital Mental Health for Young Adolescents: Match Emoji, a Casual Video Game Adapted for Mental Health and Well-Being

Although mental health and well-being treatments for adolescents exist, many who would benefit from these supports do not access them due to attitudinal and structural barriers, including stigma and cost. Digital mental health interventions address some of these barriers but have often had poor reach and retention in real-world settings. In this research, I explore a new mechanism that has received little attention to date. Specifically, I examined the potential of casual video games to enhance mental health and well-being among young adolescents. I undertook a stepwise series of studies exploring existing literature, establishing interest from young adolescents and adult stakeholders, and developing and testing Match Emoji, a casual video game adapted to enhance mental health and well-being. Methods 1. A systematic review of peer-reviewed literature published between 2009 to 2020 was carried out on the effects of casual video games on anxiety, depression, stress, and low mood. 2. An exploratory study using focus groups, workshops and brief presentations followed by open text forms was completed with young adolescents (13-to-15-years-olds) attending one of seven local primary or secondary schools. 3. Teachers and health professionals, including psychologists, social workers, and counsellors from across New Zealand, took part in an anonymous online survey to explore their opinions on adolescent mental health, digital mental health interventions and casual video games. 4. The development and design of Match Emoji, a casual video game adapted to enhance mental health and well-being, was documented. 5. A pilot study of Match Emoji was carried out with young adolescents (12-to-15-years-olds) from two New Zealand secondary schools and one intermediate school. Pre- and post-intervention mental health and well-being measures (Child and Adolescent Mindfulness Measure, General Help-Seeking Questionnaire, Flourishing Scale and Revised Children's Anxiety and Depression Scale) and semi-structured interviews were used to estimate the acceptability and therapeutic potential of Match Emoji. From the 13 studies identified in the systematic literature review, 12 reported promising effects of casual video games on anxiety, depression, stress, and low mood (Study One). Among the 207 young adolescents who participated in the focus groups, workshops, and presentations, 91% reported playing casual video games at least once a week. Many participants reported playing these games to relieve stress, feel relaxed and become less bored. Overall, most participants were interested in the idea of casual video games adapted for mental health and well-being purposes and provided key recommendations, such as including brief mental health content, appealing colours and engaging game mechanisms (Study Two). In total, 98 teachers and health professionals took part in the online survey. Many participants shared similar views about the advantages of using digital mental health tools, including improving young people's access to mental health supports. A small number of participants were cautious about digital approaches, including using CVGs to deliver mental health and well-being content. However, given the importance of adolescent mental health, participants were open to novel ideas to address this challenge (Study Three). Among the 45 young adolescents who participated in a pilot study of Match Emoji, 71% (32/45) of participants reported playing the game after an 8-week follow-up, and participants reported some therapeutic benefits across the assessments after the completion of the study, with a significant difference found on the RCADS (P=.049) (Study Four). A casual video game adapted to deliver mental health and well-being messaging represents a promising approach to support young adolescents' psychological well-being. It is important to explore the affordances of casual video games and exploit target-users current technology strategies.</p

HRV Biofeedback Training for Children with Behavioural Disorders in New Zealand: Three Case Studies

Although treatments exist for children with behavioural disorders, they often require significant time and are costly. The current pilot study aimed to conduct a preliminary investigation to examine the feasibility of a brief heart rate variability (HRV) biofeedback intervention for children with behavioural disorders in New Zealand (NZ). Participants included 10 children aged between 6 and 11 years who were referred to secondary mental healthcare services in NZ to treat non compliant and aggressive behaviours. Participants included in the study had at least one diagnosis of attention deficit disorder (ADHD), Oppositional Defiant Disorder (ODD) or Anxiety Disorder (AD). Participants took part in 2 baseline HRV biofeedback sessions to understand how the HRV biofeedback tool HeartMath worked. After these baseline sessions, participants completed between 1 and 10 sessions of the biofeedback tool. We describe in detail case reviews of 3 participants with varied responses. Data is comprised of HeartMath performance and coherence scores, SDQ scores pre-and post-intervention, and clinical observations. Participants' achievement and coherence scores displayed meaningful patterns that seemed to demonstrate that learning was taking place, but SDQ scores did not indicate improvement patterns in socio-emotional or life impact factors. Participants found the biofeedback tool easy to use, and the intervention was easy to implement across environments. Given the need for low cost and accessible interventions, HRV biofeedback training may be a feasible and promising approach to support children with behavioural disorders in developing key self-regulation skills within the NZ context. However, more research is required to explore the potential of biofeedback interventions

Young adolescents’ interest in a mental health casual video game

Background Mental distress and disorders among adolescents are well documented. Despite the array of treatments available, many mental health issues remain untreated and often undiagnosed. In an attempt to narrow the treatment gap, researchers have adapted existing mental health interventions into digital formats. Despite their efficacy in trial settings, however, real-world uptake of digital mental health interventions is typically low. Casual video games (CVGs) are popular among adolescents and may be a promising tool to reduce stress, anxiety and depression. Aim We set out to explore young adolescents’ views of CVGs and their opinions of mental health CVG prototypes, to help determine whether this idea warrants further investigation. Methods Pen and paper feedback forms following a brief presentation to 13–15-year-old adolescents in seven high schools (n = 207) followed by more detailed focus groups (n = 42) and workshops (n = 21) with interested students. Findings Across all three methods, participants reported playing CVGs several times a week or day to help relieve stress, feel more relaxed and relieve boredom. Most were also interested in the idea of a mental health CVG. Participants in focus groups and workshops confirmed that playing CVGs was common among themselves and their peers, and that the idea of a CVG with subtle and brief mental health content such as game-linked ‘micro messages’ was appealing. Participants recommended that the game should have an engaging interface and subtle mental health skills and information. Conclusions Findings from this exploratory study suggest that the concept of a mental health CVG appears to be appealing to adolescents. This novel approach should be tested

The effects of casual videogames on anxiety, depression, stress, and low mood: A systematic review

Background: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered. Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood. Method: A systematic search was conducted, using the terms (casual gam∗ or casual videogam∗ or mini gam∗ or minigam∗ or mini-gam∗ or gamif∗) and (mental health or anx∗ or depress∗ or stress or mood) and (study or trial or treatment or prescribed or prevention) as "Title,""Abstracts,""Keywords,"or "Topic"words across all years. A Google search was also completed to check for articles that may have been missed. Results: N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified. Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood

A casual video game with psychological well-being concepts for young adolescents: Protocol for an acceptability and feasibility study

Background: Many face-to-face and digital therapeutic supports are designed for adolescents experiencing high levels of psychological distress. However, promoting psychological well-being among adolescents is often neglected despite significant short-term and long-term benefits. Objective: This research has 3 main objectives: (1) to assess the acceptability of Match Emoji, a casual video game with psychological well-being concepts among 13-15-year-old students in a New Zealand secondary school; (2) to identify the feasibility of the research process; and (3) to explore the preliminary well-being and therapeutic potential of Match Emoji. Methods: Approximately 40 participants aged 13-15 years from a local secondary college in Wellington, New Zealand, will be invited to download and play Match Emoji 3-4 times a week for 5-15 minutes over a 2-week period. Participants will complete 4 assessments at baseline, postintervention, and 3 weeks later to assess psychological well-being and therapeutic changes. Statistical analysis will be used to synthesize data from interviews and triangulated with assessment changes and game analytics. This synthesis will help to assess the acceptability and feasibility of the Match Emoji. Results: The key outputs from the project will include the acceptability, feasibility, and therapeutic potential of Match Emoji. It is anticipated that participants will have finished playing the recommended game play regimen by August 2021 with analysis of results completed by October 2021. Conclusions: Data from the study are expected to inform future research on Match Emoji including a randomized controlled trial and further adjustments to the design and development of the game

Development of a casual video game (Match Emoji) with psychological well-being concepts for young adolescents

Digital interventions for mental health and well-being have been shown to be effective in trials, yet uptake and retention in real-world settings are often disappointing. A more significant impact may be achieved by building interventions that are closer to how target groups use technology to support their own psychological well-being. Casual video games may be poised to offer an opportunity in this area as they are a highly popular activity among young people. We propose that mental health content can be integrated into the explicit content and the implicit processes used in casual video games. In this paper, we describe the design and core processes of Match Emoji, a casual video game designed to support the development of psychological well-being via gameplay and micro-messages. The iterative development of Match Emoji involved various phases, including a systematic review of the literature, consultation with target users, clinicians, game developers, and close reading of the literature. Expert collaboration was sought throughout the process to ensure gameplay and messages matched behaviour change and learning theories. An acceptability and feasibility study of Match Emoji will inform a randomised controlled trial in the future

Creating Translingual Teaching Resources Based on Translanguaging Grammar Rules and Pedagogical Practices

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