Using Gaming and Biosensors to Improve Child Anxiety Prevention Efforts in Effectiveness Settings

Introduction: There is empirical support for the effects of childhood anxiety preventive interventions; however, program effect sizes are relatively modest (.18 to .26; Fisak & Mann, 2011). Assuming implementation quality is high, effects could be remediated by increasing program dosage, especially if focusing on putative mediators of change (Kraemer et al., 2002), aspects of control systems engineering (Pina et al., 2014), and technology (Pramana et al., 2014). We thus argue that anxiety prevention efforts could be improved by augmenting and personalizing the dosage of: (a) cognitive self-control training for biases in information processing that designate situations as threatening and (b) self-evaluation training to improve emotion understanding and the capacity to manage anxiety provoking situations. To gain some sense about the viability of improving putative mediators (a) and (b), we are conducting a study that involves biosensors, gaming technology, and REACH for Personal and Academic Success, a indicated prevention program (6-session/30min each; NIMH 1K01 MH086687-01A1; A. A. Pina, PI) delivered by school staff (psychologists, social workers) during school hours.

Methods: For this “effectiveness” demonstration study, we are developing and piloting a gaming app that communicates with a biosensor device. The purpose of this technology is to engage the user in opportunities to improve emotion understanding via psychoeducation, monitoring, and biofeedback (based on heart rate and body temperature coupled with momentary subjective ratings of distress) as well as cognitive self-control training to reduce interpretation biases. At this early stage, we are focusing on estimating user acceptability and effect sizes from data corresponding to 24 at-risk children (11 to 12 years old), identified via the Spence Child Anxiety Scale cut off scores and using a matched control design (data will be matched on pretest anxiety levels, gender, age, ethnicity [Hispanic/White], and implementation quality).

Results: Data presented will focus primarily on: (1) engagement with the gaming technology, (2) acceptability and stigma of wearable biosensors (wristband), (3) deriving within group pretest-posttest effect sizes on the two targeted putative mediator variables (a-b), and (4) between group pretest-posttest effect sizes on (a-b) for REACH versus REACH+ gaming and biosensors. We will report on (1)-(4) based on well-established measures that involve objective indices and rating scales.

Discussion: Findings will be discussed in terms of technology usage for real world settings, anxiety prevention theory relevant to targeting putative mediators for improvement of program effects, and directions relevant to dissemination and diffusion.