Abd-Alrazaq Alaa, Alajlani Mohannad, Alhuwail Dari, Schneider Jens, Akhu-Zaheya Laila, Ahmed Arfan, Househ Mowafa
Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
Artificial Intelligence Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.
JMIR Serious Games. 2022 Feb 14;10(1):e29137. doi: 10.2196/29137.
Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological 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 has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.
This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.
We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for 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 the results of the included studies.
Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low-quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03).
This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.
焦虑是一种以忧虑、紧张、不安及其他相关行为障碍为特征的精神障碍。用于减轻焦虑的非药物治疗方法之一是严肃游戏，即具有娱乐之外目的的游戏。多项系统评价对严肃游戏缓解焦虑的有效性进行了研究；然而，这些研究受到设计和方法学缺陷的限制。
本研究旨在通过总结既往研究结果并提供最新综述，评估严肃游戏缓解焦虑的有效性。
我们对随机对照试验（RCT）进行了系统评价。检索了以下七个数据库：MEDLINE、CINAHL、PsycINFO、ACM数字图书馆、IEEE Xplore、Scopus和谷歌学术。我们还对纳入研究及相关综述进行了前后向参考文献检查。两名评价者独立进行研究选择、数据提取、偏倚风险评估和证据质量评价。我们酌情采用叙述性和统计性方法综合纳入研究的结果。
在检索到的935篇文献中，本综述纳入了33项研究。其中，最终有22项RCT纳入了荟萃分析。9项RCT和5项RCT的证据质量极低，结果显示，与传统运动（P = 0.70）和无干预（P = 0.27）相比，健身游戏（需要进行体育锻炼的游戏）对焦虑水平无统计学显著影响。尽管6项RCT表明，与无干预相比，计算机化认知行为治疗游戏对焦虑水平有统计学和临床显著影响（P = 0.01），但所报告证据的质量较低。同样，3项RCT的低质量证据显示，与传统电子游戏相比，生物反馈游戏对焦虑水平有统计学和临床显著影响（P = 0.03）。
本综述表明，健身游戏在缓解焦虑方面与传统运动效果相当；计算机化认知行为治疗游戏和健身游戏比无干预更有效，生物反馈游戏比传统电子游戏更有效。然而，我们的研究结果仍无定论，主要原因是纳入的个别研究存在较高偏倚风险，荟萃分析证据质量较低，一些荟萃分析纳入的研究较少，大多数研究招募的是无焦虑的患者，且大多数研究使用的是目的转变的严肃游戏。因此，应将严肃游戏视为现有干预措施的补充。研究人员应使用专门设计用于缓解抑郁的严肃游戏，提供其他治疗方式，并招募不同类型的焦虑症患者。
