Therapeutic gaming for adolescent anxiety: development and evaluation of a mobile intervention

Anxiety is a common mental health problem in adolescents with significant short-, medium- and long-term implications if left untreated. Existing therapeutic interventions have proven effective but are associated with a number of barriers to access, engagement and maintenance of gain. Therapeutic games represent an opportunity to address barriers to treatment in a challenging population. This thesis assessed user-perceptions of existing relaxing and informative games to aid the development of a new gamified intervention. This uniquely combines aspects of cognitive-behavioural therapy and attention-bias modification, delivered via mobile devices and utilising remote data-capturing to facilitate access and engagement. After initial usability and acceptability assessment, followed by game-improvement, a pre- vs post-intervention evaluation with follow-up investigated the anxiolytic capabilities of the new intervention over both a two-week structured intervention and at two-month follow-up. Further investigation during follow-up was conducted to assess the extent and impact of self-directed play. Results revealed that the game made significant improvements to self-reported state- and trait-anxiety as well as threat-detection bias post-intervention which were maintained at follow-up. Additionally, self-directed play was predictive of outcome at follow-up stage. Limitations of the findings are discussed in addition to suggestions for future researc