Accepted for/Published in: JMIR Serious Games
Date Submitted: Jul 9, 2023
Date Accepted: Sep 18, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Gamified Web-Delivered Attentional Bias Modification Training for Adults with Chronic Pain: A Randomised, Double-Blind, Placebo-Controlled Trial
ABSTRACT
Background:
Attentional bias to pain-related information has been implicated in pain chronicity. To date, research investigating attentional bias modification training (ABMT) procedures in pain samples has found variable success, perhaps because training paradigms are typically repetitive and monotonous, which could negatively affect engagement and adherence. Increasing engagement through the gamification (i.e., the use of game elements) of ABMT may provide the opportunity to overcome some of these barriers. However, ABMT studies applied to the chronic pain field have not yet incorporated gamification elements.
Objective:
The aim of this study was to investigate the effects of a gamified web-delivered ABMT intervention in a sample of adults with chronic pain via a randomised, double-blind, placebo-controlled trial.
Methods:
A final sample of 129 adults with chronic musculoskeletal pain, recruited from clinical (hospital outpatient waiting list) and non-clinical (wider community) settings, were included in this randomised, double-blind, placebo-controlled, 3-arm trial. Participants were randomly assigned to complete six web-based sessions of non-gamified standard ABMT (n=43), gamified ABMT (n=41), or a control condition (non-gamified sham ABMT; n=45), over a period of 3 weeks. Active ABMT conditions trained attention away from pain-related words. Participant outcomes were assessed at pre-training, during training, immediately after training, and at 1-month follow-up.
Results:
Across all conditions, there was an overall small to medium decline in self-reported task-related engagement between session 1 and 2 (P=<.001; Cohen’s d=0.257, 95% CI 0.13 to 0.39), session 1 and 3 (P=<.001; Cohen’s d=0.368, 95% CI 0.23 to 0.50), session 1 and 4 (P=<.001; Cohen’s d=0.473, 95% CI 0.34 to 0.61), session 1 and 5 (P=<.001; Cohen’s d=0.488, 95% CI 0.35 to 0.63), and session 1 and 6 (P=<.001; Cohen’s d=0.596, 95% CI 0.46 to 0.73). There was also an overall small decrease in depressive symptoms from baseline to post-training (P=.007; Cohen’s d=0.180, 95% CI 0.05 to 0.31), and in pain intensity (P=.008; Cohen’s d=0.180, 95% CI 0.05 to 0.31) and pain interference (P=<.001; Cohen’s d= 0.237, 95% CI 0.10 to 0.37) from baseline to follow-up. However, no differential effects were observed over time between the three conditions on measures of engagement, pain intensity, pain interference, attentional bias, anxiety, depression, interpretation bias, or perceived improvement (all Ps>.05).
Conclusions:
These findings suggest that gamification, in this context, was not effective at enhancing engagement and question the utility of web-delivered ABMT in treating individuals with chronic musculoskeletal pain. The implications of these findings are discussed and future directions for research are suggested. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12620000803998; https://anzctr.org.au/ACTRN12620000803998.aspx
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