Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game–based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.

Background Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability—it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs’ digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them.

BACKGROUND Digital tools and therapies are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHP) have considerable influence on their adoption. Yet, how MHPs use digital tools has remained insufficiently understood, which poses challenges to their design, development, and implementation. OBJECTIVE The study aims to create contextual understanding of how MHPs use different digital tools in clinical practice, and what characterizes the usage across tools. METHODS 19 MHPs were thematically interviewed, and the data were transcribed, coded, and inductively analyzed. RESULTS We found that MHP digital tool usage was characterized by four distinct functions: communication, diagnosis and evaluation, facilitating therapeutic change, and managing client data. Our research focused on the first three categories and found that MHPs use solutions ranging from analogue, to digitized, and to digital. The MHP client communication has grown to include various digital mediums alongside face-to-face meetings; symptom questionnaires were digitizing; and MHPs actively used digital materials to facilitate therapeutic change. Across the digital tools, the usage was characterized by adaptability: the usage was negotiated in client interaction. There was, however, considerable variance in the breadth of MHPs’ digital toolbox. We describe how the existing treatment practices, that emphasize MHP-client interaction, are likely to invite incremental rather than radical developments which challenges achieving scalability benefits native to digital tools. CONCLUSIONS MHPs use digital tools increasingly in client interaction. By describing how MHPs use, and do not use, digital tools in their practice, our results contribute to the user-centered research, development, and implementation of digital solutions in mental health care. CLINICALTRIAL Mental health professionals’ views and needs regarding game-based digital therapeutics https://doi.org/10.17605/OSF.IO/B8EG6

Despite gaming disorder now being diagnosable by the International Classification of Diseases (ICD-11) as a new mental disorder due to addictive behaviors, little is known about the concrete reasons for which people seek treatment for their videogame play. As the current literature is mainly based on children and adolescents, there is a strong need for better understanding adult treatment-seekers in particular. This preregistered study responds to the gap in research by qualitatively investigating the reasons for treatment-seeking with 110 participants who had sought help for their videogame play from a Finnish treatment program. We applied template analysis to the open-ended data, which consist of the participants’ personal accounts regarding their problems. Additionally, we report the game titles that the participants had problems with, as well as Internet Gaming Disorder Test (IGDT-10) scores, which were measured from 89 participants. The template analysis suggested five themes, which cover the main reasons for treatment-seeking: social reasons, existential reasons, practical reasons, self-perceived addiction, and wish for support. Many of these themes overlap with the ICD-11 description of gaming disorder, but several issues, such as loss of meaning and financial harms, are not part of the current diagnosis. The average IGDT-10 score among participants was 3.86 (SD = 2.55) and 37 (42%) individuals met the disorder cutoff (5.00). Numerous videogames with different designs were mentioned as sources of problems, of which 26 were mentioned more than once. The study indicates that adults seek treatment for many kinds of games and gaming-related problems, including but not limited to those, which are described part of the ICD-11 gaming disorder diagnoses. We recommend both researchers and practitioners to implement an expanded perspective on gaming behaviors, acknowledging that adults may seek treatment for diverse gaming-related problems, some of which not necessarily relevant to gaming disorder or mental disorders in general.

BACKGROUND AND AIMS. Despite gaming disorder now being diagnosable by the ICD-11 as a new disorder due to addictive behaviors, little is known about the concrete reasons for which people seek treatment for their videogame play. As the current literature is mainly based on children and adolescents, there is a strong need for better understanding adult treatment-seekers’ in particular. METHODS. This preregistered study responds to the gap in research by qualitatively investigating the reasons for treatment-seeking with 110 participants who had sought help for their videogame play from a Finnish treatment program. We applied template analysis to the open-ended data, which consist of the participants’ personal accounts regarding their problems. Additionally, we report the game titles that the participants had problems with, as well as Internet Gaming Disorder Test 10 (IGDT-10) scores, which were measured from 89 participants. RESULTS. The template analysis suggested five themes, which cover the main reasons for treatment- seeking: social reasons, existential reasons, practical reasons, self-perceived addiction, and wish for support. Many of these themes overlap with the ICD-11 description of gaming disorder, but several issues, such as existential reasons, are not part of the current diagnosis. The average IGDT- 10 score among participants was 3.86 (SD=2.55) and 37 (42%) individuals met the disorder cutoff. Numerous videogames with different designs were mentioned as sources of problems, of which 26 were mentioned more than once.CONCLUSIONS. The study indicates that adults seek treatment for many kinds of games and gaming- related problems, including but not limited to those, which are described part of the ICD-11 gaming disorder diagnoses. We recommend both researchers and practitioners to implement an expanded perspective on gaming behaviors, acknowledging that adults may seek treatment for diverse gaming-related problems, some of which not necessarily relevant to gaming disorder.