Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial

Gradi, Naïma; Chopin, Adrien; Bavelier, Daphné; Shechner, Tomer; Pichon, Swann · 2024 · Crossref

DOI: 10.1186/s12888-024-05515-7

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Summary

This paper presents the protocol for a multi-center, parallel-group, assessor-blind randomized controlled trial designed to evaluate the feasibility and efficacy of two online video game interventions for reducing anxiety in adolescents. The study is motivated by the high prevalence of anxiety disorders during adolescence and the potential of digital interventions to improve mental health. Specifically, it addresses two theoretical pathways: the anxiolytic effect of casual gaming through distraction and flow, and the improvement of anxiety via enhanced attentional control, which is often impaired in anxious individuals. The trial aims to recruit 150 adolescents aged 12 to 14 with elevated anxiety levels, identified via the parent-reported Screen for Child Anxiety Related Disorders (SCARED) questionnaire. Participants will be randomized into three groups: an "action-like" game group playing *Eco-Rescue*, a casual game group playing *Bejeweled 3*, and a no-training control group. *Eco-Rescue* is a custom-designed game based on the Multiple Object Tracking (MOT) paradigm combined with a visual detection task, intended to progressively train attentional control. *Bejeweled 3* serves as a positive control, offering distraction without specific cognitive training. The intervention lasts six weeks, with assessments conducted at baseline (T1), one week post-intervention (T2), and four months post-intervention (T3) to measure durability. The primary outcome is anxiety symptoms, measured using the child-reported SCARED questionnaire. Secondary outcomes include attentional control, assessed via the Useful Field of View (UFOV) and Test of Variables of Attention (TOVA), and affective control, measured by the Affective Backward Digit Span (ABDS) task. The researchers hypothesize that both gaming interventions will significantly reduce anxiety compared to the control group. Furthermore, they expect *Eco-Rescue* to specifically improve attentional and affective control metrics more than *Bejeweled* or no training. Exploratory endpoints examine the relationship between attentional control improvements and anxiety reduction, as well as the impact of motivation and expectations on outcomes. The significance of this study lies in its rigorous design to test whether video games can serve as effective, accessible digital mental health interventions for adolescents. By comparing a cognitive training game against a distraction game and a control group, the trial seeks to clarify the mechanisms through which gaming alleviates anxiety—whether through improved cognitive regulation or mere distraction. The findings will contribute to the growing field of digital mental health by providing evidence on the feasibility of fully online interventions and their potential to offer scalable solutions for adolescent anxiety, a critical period for the onset of mental health disorders.

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