A new randomized control trial has found that turning mobile mental health intervention into a smartphone game can potentially improve well-being. Published September 2, 2020 in the open-access journal PLOS ONE, the five-week study conducted by Silja Litvin at the Ludwig Maximilian University of Munich and her colleagues shows that gamifying the content of mobile interventions improved resilience, a key character trait that reduces the susceptibility to depression, stress, and anxiety.
Mobile mental health apps have the potential to act as interventions for depression and anxiety, but their effectiveness appears limited with studies showing that individuals do not stick with the routine for long periods of time. To improve their effectiveness, the authors proposed turning intervention content into a game that includes levels that need passing, feedback, points, and other gaming elements. A five-week randomized control trial was completed by 358 participants who were assigned to one of three groups: gamified intervention app, normal intervention app, and waitlisted with no app. Resilience and anxiety were measured by self-report surveys at three time points.
The authors found that after five weeks, both measures were significantly better in the game group than in either of the other groups. Additionally, the game group retained 21% more participants than the other groups. The promotion of mental health is known to be an effective way to prevent the development of depression and anxiety disorders. However, interventions are rare for a variety of reasons, even for those who need them the most. A gamified mental health intervention app that retains user interest and improves resilience could maximize the benefits of mobile intervention by helping to prevent depression and anxiety, while at the same time being convenient, inexpensive, and a way to avoid getting professional help and experiencing the associated stigma and negative feelings. Since five weeks is relatively brief, especially for mental health interventions, future studies should examine the effectiveness of the gamified app over the long-term.
The authors add: "eQuoo [the gamified intervention app] was able to show that it not only had a significant and beneficial impact on the participant's mental wellbeing but that gamifying therapies counterbalances sky-high attrition rates most mental health apps struggle with, especially in the demographic of 18-35-year-olds."
Citation: Litvin S, Saunders R, Maier MA, Lüttke S (2020) Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial. PLoS ONE 15(9): e0237220. https://doi.org/10.1371/journal.pone.0237220
Funding: There has been no financial funding or sources of financial support externally or internally for this work that could have influenced its outcome.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: I, Silja Litvin, am the majority shareholder of the company PsycApps Limited, which developed eQuoo, the game used in the test group for this trial. The corresponding authors have no other conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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