Mixed-methods feasibility outcomes for a novel ACT-based video game 'ACTing Minds' to support mental health

Objectives To determine the feasibility and acceptability of 'ACTing Minds', a novel single-player adventure video game based on acceptance and commitment therapy (ACT). Design A single-arm, mixed-methods repeated measures feasibility study. Setting Intervention and questionnaires were completed at home by participants. Semistructured interviews were also conducted at home via the Zoom platform. Participants Thirty-six participants were recruited into the study, 29 completed all phases of the feasibility design. Eligibility criteria required participants to be over the age of 18 and self-reporting experiencing ongoing depression, anxiety or stress. Intervention Participants completed a single session of the 'ACTing Minds' video game, lasting approximately 1 hour, designed to educate users on key principles from ACT. Primary outcome measures Participant recruitment and retention, questionnaire completion, long-term intervention adherence and acceptability of the intervention. Reflexive thematic analysis was conducted on semistructured interviews run immediately postintervention and 3 weeks later. Secondary outcome measures Measures of depression, anxiety, stress, psychological flexibility, social connectedness and well-being were assessed at baseline, immediately following intervention completion, and after a 3-week follow-up period. We used a standardised battery of questionnaires. Primary results Twenty-nine participants completed the study. A reflexive thematic analysis indicated that participants responded positively to the intervention and the study at all stages. Themes reflect participants' desire for an engaging therapeutic experience, use of game for exploring emotions, as well as their perspectives on how they had applied their learning to the real world. Secondary results Quantitative results indicated small to large effect sizes associated with decreases in depression (eta p2 = 0.011), anxiety (eta p2 = 0.096) and stress (eta p2 = 0.108), and increases in psychological flexibility (eta p2 = 0.060), social connectedness (eta p2 = 0.021), well-being (eta p2 = 0.011) and participation in usual activities (eta p2 = .307). Conclusions Implementation of the 'ACTing Minds' intervention is warranted, based on both qualitative and quantitative outcomes. Trial registration number NCT04566042 ClinicalTrials.gov