JMIR Publications

ABSTRACT

Background:

Anxiety is one of the mental disorders characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the non-pharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety was investigated by several systematic reviews, however, they are limited by design and methodological weaknesses.

Objective:

This study aims to assess the effectiveness of serious games in alleviating anxiety through summarizing the results of previous studies and providing an up-to-date review.

Methods:

We carried out a systematic review of randomized controlled trials (RCTs). We searched 7 databases: MEDLINE, CINAHL, PsycINFO, ACM Digital Library IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.

Results:

Out of 935 citations retrieved, 33 studies were included in this review. Of those, 22 RCTs were eventually included in meta-analyses. Very low quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on the anxiety level as compared to conventional exercises (P=0.70) and no intervention (P=0.27), respectively. While 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy (CBT) games on the anxiety level when compared with no intervention (P=0.01), the quality of the evidence reported was low. Likewise, low quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on the anxiety level when compared with conventional video games (P=0.03).

Conclusions:

This review shows that serious games have the potential in alleviating anxiety levels. However, our findings remain inconclusive mainly due to the high risk of bias in the individual studies included, the low quality of meta-analyzed evidence, few studies included in some meta-analyses, patients without anxiety recruited in most studies, and using purpose-shifted serious games in most studies. Therefore, serious games should be deemed as complementary to existing interventions. To have adequate and robust evidence, researchers should use serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit a diverse population of patients with anxiety, and minimize the risk of bias by following the recommended guidelines for conducting and reporting RCTs.