Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review

Abstract

BackgroundAutomatic biases, such as attentional biases and avoidance and interpretative biases, have been purported to be responsible for several psychiatric disorders. Gamification has been considered for cognitive bias modification, mainly to address the core issues of diminishing motivation to train over time, as bias modification intervention tasks tend to be highly repetitive. While a prior review has suggested how gamification strategies could be applied to such tasks, there remains a lack of systematic evaluation of gamified cognitive bias modification interventions in the literature.ObjectiveThe objective of this review is to understand the overall effectiveness of a gamified approach for cognitive bias modification and inform future research that seeks to integrate gamification technologies into existing conventional bias modification interventions.MethodsTo identify the relevant articles for our review, the following search terminologies were used: (“cognitive bias” OR “attention bias” OR “interpret* bias” OR “approach bias” OR “avoidance bias”) AND (“training” OR “modification” OR “practice” OR “therapy”) AND (“gamification” OR “game elements” OR “game” OR “gaming” OR “game mechanics”). PubMed, MEDLINE, PsycINFO, and Scopus databases were searched systematically for articles published after 2000. Articles were included if they described a gamified cognitive bias modification task and included participants with underlying psychopathological symptoms. Data were systematically extracted from the identified articles, and a qualitative synthesis was performed.ResultsFour studies evaluated gamified cognitive bias modification interventions. Two studies included participants with anxiety symptoms, one with affective symptoms, and one with alcohol problems. The conventional visual probe task paradigm was used in 3 studies, and the attentional visual search task paradigm was used in the last study. We found gaming elements incorporated to include that of animations, sounds, feedback, and a point-scoring system for response time and difficulty. Of the 4 identified studies, only 2 reported their gamified interventions to be effective.ConclusionsOur review is the first to systematically synthesize the evidence for gamified cognitive bias modification interventions. The results arising from our review should be considered in the future design and conceptualization of gamified cognitive bias modification interventions.International Registered Report Identifier (IRRID)RR2-10.2196/10154

A Critical Review of Studies Assessing Interpretation Bias Towards Social Stimuli in People With Eating Disorders and the Development and Pilot Testing of Novel Stimuli for a Cognitive Bias Modification Training

“…Multi-session studies combined with follow-up assessments allow for an investigation of the acceptability and effectiveness of the training in the long term. In doing so researchers should consider strategies for facilitating participant engagement with the training over time (Zhang et al, 2018) and to assess whether changes observed in interpretation biases are associated with changes in social perceptions and behaviors, as well as key clinical variables. It will also be important to explore potential pathways through which this training can be related to improvements in symptoms, such as through strengthening responsiveness to social acceptance or support.…”

Challenges When Evaluating Cognitive Bias Modification Interventions for Substance Use Disorder

“…Recently there has been investigations using serious games (games designed specifically for specific intervention) and gamification technologies to reduce the boredom associated with these interventions in the hope of reducing attrition. [14] in their review of gamified cognitive bias modification interventions, reported only two out of four interventions to be effective, and these two were for individuals with anxiety disorders. One of the studies, (Boendmarker et al (2016)) [33] reported there being no added effectiveness with the integration of gamification elements; despite their previous article suggesting various methods that gamification could be added onto a conventional task.…”

“…While, [14] have in their review of mobile cognitive bias modification interventions highlighted the presence of a disconnect between academic and developers, it must be noted that most of the existing cognitive bias modification interventions have been conceptualized based on inputs from academics. There remains a lack of patient participation in the conceptualization process, so the intervention might not meet their needs or preferences.…”

“…To overcome this gamification technologies have been considered, to help maintain participants motivation to train. Zhang et al (2018) [14] in their review of gamified cognitive bias modification intervention reported mixed findings for the use of gamification. One remaining challenge relates to the development of cognitive bias modification interventions.…”

Assessing Ethoshunt as a Gamification-Based Mobile App in Ethics Education: Pilot Mixed-Methods Study

“…Interestingly, many researchers have designed gamification-based applications to capture consumers’ fun and “gameful” experiences [ 9 ] and to observe weight loss in overweight and obese adolescents, which eventually improves their health conditions [ 12 ]. On the other hand, Zhang et al [ 17 ] used gamification for cognitive bias modification. Besides usage, usability of gamification is equally important as it enables users to perform tasks effectively and efficiently.…”