BACKGROUND Depression is a debilitating mental health disorder, with a large treatment gap. Recent years have seen a surge in digital interventions to bridge this treatment gap. Most of these interventions are based on computerized cognitive behavioral therapy. Despite the efficacy of computerized cognitive behavioral therapy–based interventions, their uptake is low and dropout rates are high. Cognitive bias modification (CBM) paradigms provide a complementary approach to digital interventions for depression. However, interventions based on CBM paradigms have been reported to be repetitive and boring. OBJECTIVE In this paper, we described the conceptualization, design, and acceptability of serious games based on CBM paradigms and the learned helplessness paradigm. METHODS We searched the literature for CBM paradigms that were shown to be effective in reducing depressive symptoms. For each of the CBM paradigms, we ideated how to create a game so that the gameplay was engaging while the active therapeutic component remained unchanged. RESULTS We developed 5 serious games based on the CBM paradigms and the learned helplessness paradigm. The games include various core elements of gamification, such as goals, challenges, feedback, rewards, progress, and fun. Overall, the games received positive acceptability ratings from 15 users. CONCLUSIONS These games may help improve the effectiveness and engagement levels of computerized interventions for depression.

Background Depression is a debilitating mental health disorder, with a large treatment gap. Recent years have seen a surge in digital interventions to bridge this treatment gap. Most of these interventions are based on computerized cognitive behavioral therapy. Despite the efficacy of computerized cognitive behavioral therapy–based interventions, their uptake is low and dropout rates are high. Cognitive bias modification (CBM) paradigms provide a complementary approach to digital interventions for depression. However, interventions based on CBM paradigms have been reported to be repetitive and boring. Objective In this paper, we described the conceptualization, design, and acceptability of serious games based on CBM paradigms and the learned helplessness paradigm. Methods We searched the literature for CBM paradigms that were shown to be effective in reducing depressive symptoms. For each of the CBM paradigms, we ideated how to create a game so that the gameplay was engaging while the active therapeutic component remained unchanged. Results We developed 5 serious games based on the CBM paradigms and the learned helplessness paradigm. The games include various core elements of gamification, such as goals, challenges, feedback, rewards, progress, and fun. Overall, the games received positive acceptability ratings from 15 users. Conclusions These games may help improve the effectiveness and engagement levels of computerized interventions for depression.

Depression is a debilitating mental health disorder with a huge treatment gap. Recent years have seen a surge of digital interventions to bridge this treatment gap. Most of these interventions are based on computerized Cognitive Behavioral Therapy (cCBT). Despite the efficacy of cCBT-based interventions, their uptake is low, and dropout rates are high. Cognitive bias modification (CBM) paradigms provide a complementary approach for digital interventions for depression. However, interventions based on CBM paradigms have been reported to be repetitive and boring. In this paper, we describe the conceptualization and design of serious games based on CBM paradigms and the learned helplessness paradigm. We describe how the games include various core elements of gamification, including goals, challenges, feedback, rewards, progress, and fun. These games may help in improving the effectiveness and engagement levels of computerized interventions for depression.