A randomized controlled trial to test the effectiveness of an Immersive 3d Video game for anxiety prevention among adolescents
Open accessAbstract
Adolescent anxiety is debilitating, the most frequently diagnosed adolescent mental health problem, and leads to substantial long-term problems. A randomized controlled trial (n = 138) was conducted to test the effectiveness of a biofeedback video game (Dojo) for adolescents with elevated levels of anxiety. Adolescents (11-15 years old) were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Initial screening for anxiety was done on 1,347 adolescents in five high schools; only adolescents who scored above the "at-risk" cut-off on the Spence Children Anxiety Survey were eligible. Adolescents' anxiety levels were assessed at pre-test, post-test, and at three month follow-up to examine the extent to which playing Dojo decreased adolescents' anxiety. The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms (not of total anxiety symptoms) in the Dojo condition compared to the control condition. Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants' expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.
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The researchers concluded that 'Dojo' had crucial design issues including a lack of clear theoretical and therapeutic frameworks, and that research assessing the real-world effectiveness of video games in treating mental health issues should require an appropriate methodology for understanding the underlying causes of improvement.
“The researchers concluded that ‘Dojo’ had crucial design issues that needed to be addressed including a lack of clear theoretical and therapeutic frameworks, and that research assessing the real-world effectiveness of video games in the treatment of mental health issues should require an appropriate methodology for understanding the underlying causes of improvement.”
From Mixed-methods feasibility outcomes for a novel ACT-based video game ‘ACTing Minds’ to support mental health (2024) · cites this paper as [15]
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Experimental — accuracy not yet measuredDojo develops emotional regulation in adolescents with anxiety.
“Another game, Dojo,26 develops emotional regulation in adolescents with anxiety.”
From A novel ACT-based video game to support mental health through embedded learning: A mixed-methods feasibility study protocol (2020) · cites this paper as [26]
The Introduction (‘Dojo: Targets of intervention’) says Dojo trains emotion-regulation strategies and was designed to reduce anxiety in adolescents. But ‘develops’ implies a demonstrated improvement in those skills; the Discussion (‘Limitations and implications’) says the trial did not measure the coping strategies taught in the game, so it could not establish that outcome. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA pre-post RCT with 1347 participants comparing Dojo with the commercial game Rayman 2 reported no difference between Dojo and the control condition at reducing anxiety.
“However, a pre-post RCT with 1347 participants, compared with a standard ‘off the shelf’ commercial game ‘Rayman 2’ (whereby Rayman 2 was the control), reported no difference between Dojo and the control condition at reducing anxiety.”
From A novel ACT-based video game to support mental health through embedded learning: A mixed-methods feasibility study protocol (2020) · cites this paper as [26]
The Methods (Design and procedure; Participants, page unavailable) say 1,347 adolescents were screened, but only 138 participated in the pre-test/post-test RCT. The Methods (Intervention) identify the control as the commercial game Rayman 2, and the Results (Main Effects of Dojo on Anxiety Symptoms) found no significant difference between conditions in anxiety outcomes at follow-up. (LLM, conf=0.94)
Experimental — accuracy not yet measuredA full pre-post randomised controlled trial (n=138) found that playing either 'Dojo' or 'Rayman 2' significantly reduced participant anxiety at a 3-month follow-up, and there were no significant differences between the two games at reducing anxiety for this time period.
“a full pre-post randomised controlled trial (RCT) (n=138) found that playing either game significantly reduced participant anxiety at a 3-month follow-up, and there were no significant differences between these two games at reducing anxiety for this time period.15”
From Mixed-methods feasibility outcomes for a novel ACT-based video game ‘ACTing Minds’ to support mental health (2024) · cites this paper as [15]
Dojo uses biofeedback (heart rate variability) and trains breathing techniques, muscle relaxation, positive thinking and guided imagery to attempt to reduce anxiety in adolescence.
“It uses biofeedback (heart rate variability) and trains breathing techniques, muscle relaxation, positive thinking and guided imagery to attempt to reduce anxiety in adolescence.”
From A novel ACT-based video game to support mental health through embedded learning: A mixed-methods feasibility study protocol (2020) · cites this paper as [26]
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“%) were randomized controlled trials (RCTs; Fleming et al., 2012; Merry et al., 2012; Scholten, Malmberg, Lobel, Engels, & Granic, 2016; Schoneveld, Lichtwarck-Aschoff, & Granic, 2018; Schoneveld et al., 2016; Stasiak, Hatcher, Frampton, & Merry, 2014; Wijn-hoven et al., 2020; Wols,…”
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- Authors
- Scholten, H., Malmberg, M., Lobel, A., Engels, R. C. M. E., & Granic, I.
- Affiliations
- Radboud University Nijmegen (NL)
- Corresponding author
- Scholten, Hanneke
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-01-27
- Volume
- 11
- Issue
- 1
- Pages
- e0147763
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4729475
- OpenAlex
- W2259829585
- Cited by
- 116
- References
- 93
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 13 · 2023: 11 · 2022: 17 · 2021: 16 · 2020: 15 · 2019: 3 · 2018: 11 · 2017: 13 · 2016: 2
- FWCI
- 14.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Twente Research Information (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- adolescent anxiety, anxiety prevention, biofeedback, game-based intervention, at-risk youth, school-based prevention, latent growth curve models
- MeSH terms
- Adolescent, Anxiety, Child, Female, Follow-Up Studies, Humans, Male, Treatment Outcome, Video Games
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