Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study

Abstract

BackgroundRecent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings.ObjectiveThis paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings.MethodsPesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data.ResultsA total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists’ reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model.ConclusionsThis study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use.

Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression: User-Centered Design Study

“…Research into blended therapy and the evaluations of existing systems that include therapist involvement show that this may indeed be the case [ 22 - 25 ]. This finding is also consistent with other recent research on digital mental health outside of the CBT space, which again found that therapist-led [ 48 ] and patient-led tailoring [ 49 ] can help to increase patient engagement. Therefore, this leads to the following design considerations:…”

A qualitative evaluation of Pesky gNATs in primary care – The experiences of assistant psychologists providing computer-assisted CBT to children experiencing low mood and anxiety

“…To address the above challenges, a variety of both interdisciplinary and adaptive methods have been proposed to ensure interventions are implementable ( Mohr et al, 2017 ). This includes understanding the journey of clinical stakeholders ( Mohr et al, 2015 ); and a recognition of the role of the deployment environment of interventions ( Ben-Zeev et al, 2015 ; van der Meulen et al, 2019 ). Additionally, alongside quantitative outcomes, the use of qualitative research is recognized as an integral part of understanding how an intervention works and why ( Noyes et al, 2018 ).…”

Digital tools for youth mental health

“…16 There is a rich legacy of web-based programs for youth mental health 17 and a stream of new tools using today’s social networking features. 18 Computer and video games are also receiving recognition as tools to improve mental health 19 and hold unique potential given their high rates of engagement. One game is even likely to receive FDA approval for ADHD, 20 suggesting therapeutic video games for youth mental health are likely to rapidly expand.…”