The Efficacy of Guided and Unguided Game-Based Cognitive-Behavioral Therapy in Reducing Distress in College Students.

College students` mental health is an international prioritized research subject. Dedicated interventions are constantly developed to be more suited, attractive, and effective and to reach as many students as possible. Our study aims to investigate the efficacy of an online game-based cognitive-behavioral therapy transdiagnostic intervention (REThink game) in reducing psychology students' distress. Our sample consisted of 139 students (mean age 26.27; 17 male students and 122 female students) who voluntarily enrolled in our study, and they were randomly assigned to 1 of our 3 groups (REThink game without guidance  = 44; REThink game with guidance  = 46; or care-as-usual control group  = 49). They completed the pretest questionnaires (distress [negative functional and dysfunctional emotions], rational, and irrational cognitions), then they were offered to play the trial version of the REThink game, and after that, two specific levels focused on relaxation with mindfulness abilities, and on cognitive change emotion-regulation abilities. After completing the game, students in the REThink game with guidance received email support aimed to help them implement the skills learned in the game. Results showed medium effect size improvements for the REThink game without guidance group compared to the control group in terms of dysfunctional negative emotions and improvements in irrational cognitions for both experimental groups compared to the control group. So far, the REThink therapeutic game proved to be a promising innovative, efficient, and highly accessible intervention for helping students manage distress. Trial Registration: ClinicalTrials.gov NCT04763954.