Adequate control over evolutionary engrained bodily stress reactions is essential to avoid23 disproportionate responses during highly arousing situations in police. This regulation can be trained24 via heart rate variability (HRV)-biofeedback, a widely used intervention aiming to improve stress25 regulation, but typically conducted under passive, low arousing conditions. We integrated closed26 loop HRV-biofeedback in a newly designed engaging Virtual Reality (VR) action game containing the27 behavioral elements typically compromised under stress. Specifically, we aimed to train in-action28 physiological self-control under high arousal to allow improved transfer to real-life. A pre-registered29 (https://osf.io/cdsbx) quasi-randomized controlled trial in 109 Dutch police trainers demonstrated30 highly significant increases in HRV (32% average), through the engaging and gamified closed loop31 biofeedback. This ability to voluntarily upregulate in-action HRV transferred to game sessions32 without biofeedback (near transfer). Critically, we could additionally demonstrate transfer to a33 professional shooting performance assessment outside VR (far transfer). These results suggest that34 real time-biofeedback in stressful and active action contexts can help train professionals such as35 police in real-life stress regulation

Introduction: The 15-20% of adolescents worldwide who engage in non-suicidal self-injury (NSSI) face an increased risk of transitioning from suicidal ideation to suicide attempt. To resist NSSI urges, young people often seek peer support online. We examined adolescent help-seeking on a purpose-built online mental health peer support platform, which is a critically understudied help-seeking venue.Methods: Adolescents’ help-seeking posts in the “Self Harm” category on a large online peer support platform (575,261 posts from 114,937 users) were analyzed using topic modeling. We assessed the prevalence of NSSI-related topics versus morbid/suicidal topics.Results: Our 12-topic model produced interpretable themes. Three main findings emerged: posts included little information about the context of self-harm behavior; there was minimal evidence of pro-self-harm content in posts; and the primary topics of the posts were evenly split between NSSI-related topics and morbid/suicidal topics.Conclusion: Our findings have important implications for online mental health communities: requiring users to select a narrow category for their post may limit contextual information; moderation of pro-self-harm content may reduce its prevalence; and the absence of dedicated spaces for suicidal users may funnel those users into NSSI-focused spaces, potentially increasing risk for all users.

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

The current study aimed to identify specific feedback mechanics and psychological processes that may contribute to positive outcomes in biofeedback applications for anxiety regulation. Specifically, using a dismantling study design, the unique impact of visualizations that directly mirror users' breathing was examined in relation to anxiety regulation as well as locus of control and self-efficacy. Following an anxiety induction, participants (N = 67) were randomly assigned to play one of two variations of a biofeedback video game. In both versions, players' in-game movement was contingent on their breathing; however, the experimental condition additionally included visualizations that directly mirrored players' breathing. Changes in self-reported state anxiety and physiological arousal were measured as well as the level of internal control and self-efficacy participants experienced while playing the game. Results showed that all participants were able to effectively reduce their anxiety and arousal, but no condition differences were found. Implementing mirroring visualizations did not contribute to individuals' ability to self-regulate nor their self-efficacy or locus of control above and beyond receiving feedback based on their in-game movement. Overall, individuals who experienced higher self-efficacy and a stronger internal locus of control were better able to regulate their anxiety, but no clear links were found with changes in self-reported physiological arousal. In light of these results, we recommend the continued exploration of the role of specific design choices and intervention components as well as underlying mechanisms of change in biofeedback interventions, especially pertaining to how individuals perceive themselves and their ability to change.

Group-level studies of the association between social media use and wellbeing in emerging adults have so far yielded mixed and inconsistent results. As a result, recent research has shifted focus towards assessing potential heterogeneity in social media use relationships in youth. In this preregistered study, we aimed to take previous efforts further by incorporating both subjective and objective data, and by including more specific measures of social media use such as how active emerging adults were on social media, and with whom they interacted. While data resolution issues interfered with some of our analyses, our findings suggest that there is heterogeneity in some but not all of the relationships between social media use and emerging adults’ affective wellbeing.

Concerns regarding smartphones' and social media's impact on youth remain high amidst a growing realization that current research is not designed to confirm (or refute) such concerns. This study aims to answer fundamental questions regarding youths' use of smartphones, by implementing a novel user-centric research method. The smartphone use of 114 emerging adults was recorded, followed by in-depth interviews that incorporated the recording and in-app information to help participants recall their behaviours, motivations, and feelings. Results indicate that smartphone use is indeed ubiquitous; 88 out of 114 participants started using their smartphone as soon as they were left alone. However, the findings of this study also demonstrate great diversity in smartphone use, in e.g. social media platforms used and motivations for using different apps. These results illustrate that it no longer seems sensible to refer to "screen time" as if it represents a homogeneous phenomenon across youth. Additionally, preliminary indications have been found of relationships between individual differences in mental health indices and variations in smartphone use. The current study provides new insights into youths' smartphone use and its relationship with wellbeing.

Cementing irregularities have been associated with femoral failures of resurfacing arthroplasties in retrieval studies. We used an in vitro model to measure pressure, temperatures, and cement penetration as a function of 6 different cementing techniques. Filling the component with cement can lead to overpenetration or increase the resistance to component seating with resultant polar cement mass. Both conditions result in high and long-lasting cement pressures, cement defects, as well as peak temperatures higher than 50°C. Manual application of cement provides complete penetration of the available fixation area with the lowest cement pressures, the smallest total cement mass, and a peak temperature of 36.0°C ± 4.1°C. Application of the principles elucidated by this study may reduce the risk of cement overpenetration and incomplete seating.

Digital screens have become an integral part of everyday life. In the wake of the digital swell, pre-adolescents and their parents are learning to navigate seemingly new terrain regarding digital media use. The present study aimed to investigate parent and pre-adolescent perceptions of screen use and the source of conflict surrounding digital media. We employed a qualitative thematic analysis of 200 parent and pre-adolescent dyads discussing screen use. Our analysis showed five overarching themes for screen use perceptions and conflict: screen time, effects of screen use, balance, rules, and reasons for screen use. In contrast to previous studies that mainly focused on parental perceptions, we were also able to shed light on pre-adolescent perceptions of screen use and the difference in opinions with their parents. Furthermore, we found that patterns of the source of screen use conflict were oftentimes rooted in the age-old developmental tug of war between autonomy-seeking pre-adolescents and authority-seeking parents. Though navigating autonomy-granting and seeking behavior is familiar to developmental scientists, negotiating these challenges in a new digital world is unfamiliar. Autonomy support, open dialogue, and playful interaction between parents and children are needed to understand and resolve conflict of digital media use in family contexts.

Literature concerning the relationship between social media use and wellbeing is inconsistent in its findings, and most research has focused on time spent on social media rather than on what emerging adults do there, with whom and why. Here, we investigated whether momentary social stress affects emerging adults’ social media use, and whether this social media use relates to subsequent changes in wellbeing. We implemented a multi-method paradigm utilising objective and self-report data to investigate how social stress relates to how (much) and why emerging adults use social media. We report on findings based on 114 17–25-year-old emerging adults recruited on university campus. Our findings suggest that social stress does not affect adolescents’ subsequent social media use and that there is no relationship between social media use after stress and changes in momentary wellbeing. Our work illustrates the need for detailed approaches in social media and psychological wellbeing research.

Rejection consists of a range of behaviors from ignoring another to explicitly excluding someone from an encounter. Currently available experimental tasks have shown that rejection has strong emotional, behavioral, and physical effects, but the tasks have some limitations. We argue that video games can address these limitations and have developed a new experimental task (ScrollQuest) to show the potential of video games as rejection research tools. The primary goal of the present study was to explore the effects of ScrollQuest. We analyzed data from 116 young adults who played both ScrollQuest and the rejection experimental task Cyberball. Playing ScrollQuest had more negative effects on mood, more negative interpretation effects were observed after playing ScrollQuest, and ScrollQuest was perceived as more enjoyable, compared to Cyberball. Our findings suggest that ScrollQuest might be an effective new experimental task to study rejection in a digital environment, but more work is needed to improve ScrollQuest.

Objective: Smoking is a major cause of worldwide morbidity and mortality. Evidence-based intervention programs to help young adults quit smoking are largely lacking; identifying targets for intervention is therefore critical. A candidate target is inhibitory control, with previous studies on Go/No-Go trainings showing behavior change in the food and alcohol domain. The current study examined the mechanisms of change of HitnRun, a Go/No-Go game, in a smoking population that was motivated to quit. Method: A 2-armed experimental study (n = 106) was conducted and young adults (Mage = 22.15; SDage = 2.59) were randomly assigned to either play HitnRun or to read a psychoeducational brochure. Prior to and directly following the intervention period, smoking-specific and general inhibitory control, perceived attractiveness of smoking pictures, and weekly smoking behavior were assessed. Results: Results indicated that Go/No-Go training seems to decrease evaluations of smoking stimuli rather than top-down smoking-specific and general control processes. Similar reductions for weekly smoking were found in both groups. Conclusions: Go/No-Go training did not differentially influence smoking-specific inhibitory control, general inhibitory control and weekly smoking behavior. Go/No-Go training might be able to decrease evaluations of smoking stimuli, yet based on the current study we cannot rule out the possibility of regression to the mean. More research and iterative design is needed to better understand the potential role of Go/No-Go training in smoking cessation interventions, as well as exploring other evidence-based mechanisms (e.g., peer processes, self-efficacy) that might be an important addition to smoking cessation interventions for young people. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible. MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT) to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up. Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n = 60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment. ClinicalTrials.gov Identifier: NCT02326545.

This study assessed the efficacy of a virtual reality biofeedback video game (DEEP) in reducing anxiety symptoms. In addition, changes in engagement and cognitive appraisals including self-efficacy, locus of control, and threat-challenge appraisals were measured and it was explored how these factors related to anxiety regulation. Undergraduates with elevated anxiety symptoms (N = 112) were randomly assigned to four training sessions with DEEP or a smartphone-guided breathing application. Trait anxiety was measured at screening, pretest, posttest, and 3 months later. State anxiety was assessed before and after each session. In addition, engagement and appraisals were assessed in each session. Participants in both conditions showed a significant decrease in trait anxiety symptoms from pre- to posttest and this decrease remained stable at follow-up. Furthermore, all participants decreased in state anxiety from pre- to postsession, except for DEEP sessions that included exposure. DEEP users increased in self-efficacy and observed resources to cope throughout the training. In addition, DEEP users felt more engaged in initial sessions than those who used the control application, but their engagement decreased toward the final session. In contrast, participants in the control group showed no change in appraisals nor engagement. Taken together, results demonstrate the potential of digital interventions such as biofeedback games and guided relaxation applications as anxiety regulation tools and show that self-efficacy and threat-challenge appraisals in particular are potential mechanisms of change in biofeedback interventions.

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy — on which depression prevention programs are based — may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, Mage = 17.11, SDage = 1.76, 66.4% female) were given 4 weeks to play Journey (Mduration = 3 h 20 min) or the control game, Flower (Mduration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth’s change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

This study assessed the efficacy of a virtual reality biofeedback video game (DEEP) in reducing anxiety symptoms. In addition, changes in engagement and cognitive appraisals including self-efficacy, locus of control, and threat-challenge appraisals were measured and it was explored how these factors related to anxiety regulation. Undergraduates with elevated anxiety symptoms (N = 112) were randomly assigned to four training sessions with DEEP or a smartphone-guided breathing application. Trait anxiety was measured at screening, pretest, posttest, and 3 months later. State anxiety was assessed before and after each session. In addition, engagement and appraisals were assessed in each session. Participants in both conditions showed a significant decrease in trait anxiety symptoms from pre- to posttest and this decrease remained stable at follow-up. Furthermore, all participants decreased in state anxiety from pre- to postsession, except for DEEP sessions that included exposure. DEEP users increased in self-efficacy and observed resources to cope throughout the training. In addition, DEEP users felt more engaged in initial sessions than those who used the control application, but their engagement decreased toward the final session. In contrast, participants in the control group showed no change in appraisals nor engagement. Taken together, results demonstrate the potential of digital interventions such as biofeedback games and guided relaxation applications as anxiety regulation tools and show that self-efficacy and threat-challenge appraisals in particular are potential mechanisms of change in biofeedback interventions.

As part of the Dutch national science program “Professional Games for Professional Skills” we developed a stress-exposure biofeedback training in virtual reality (VR) for the Dutch police. We aim to reduce the acute negative impact of stress on performance, as well as long-term consequences for mental health by facilitating physiological stress regulation during a demanding decision task. Conventional biofeedback applications mainly train physiological regulation at rest. This might limit the transfer of the regulation skills to stressful situations. In contrast, we provide the user with the opportunity to practice breathing regulation while they carry out a complex task in VR. This setting poses challenges from a technical – (real-time processing of noisy biosignals) as well as from a user-experience perspective (multi-tasking). We illustrate how we approach these challenges in our training and hope to contribute a useful reference for researchers and developers in academia or industry who are interested in using biosignals to control elements in a dynamic virtual environment.

Anxiety disorders are the most prevalent mental health problems in childhood. Engaging, adequate, and appropriate prevention programs are needed. Applied games form a potential alternative delivery model and recent evidence suggests that they could be effective. The present randomized controlled non-inferiority trial investigated the beneficial effects of the applied game MindLight compared to cognitive behavioral therapy (CBT) on mental health outcomes associated with anxiety symptoms: internalizing problems, externalizing problems, and self-efficacy. In addition, we examined who benefitted most from both programs and analyzed baseline levels of anxiety, maternal mental health problems, and self-efficacy as predictors of changes in anxiety symptoms. After being screened for elevated anxiety, 174 selected children (8–12-year-old) were randomized to play MindLight or to receive a prevention program based on CBT. Study variables were assessed before and after the intervention, and at 3- and 6-months follow-up. Intention-to-treat analyses showed a significant reduction in mother-reported internalizing and externalizing problems and an increase in self-efficacy. Importantly, the magnitude of change did not differ between intervention groups. Non-inferiority analyses showed that MindLight was as effective as CBT in affecting internalizing problems and self-efficacy. However, CBT was more effective in decreasing externalizing symptoms than MindLight. Furthermore, baseline anxiety levels, maternal mental health problems, and self-efficacy did not influence the change of anxiety symptoms over time. Applied games, specifically theory-based games such as MindLight, hold potential as effective interventions for not only targeting anxiety symptoms, but also more general mental health outcomes.