Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game

Abstract

BackgroundYoung adults often experiment with heavy use of alcohol, which poses severe health risks and increases the chance of developing addiction problems. In clinical patients, cognitive retraining of automatic appetitive processes, such as selective attention toward alcohol (known as “cognitive bias modification of attention,” or CBM-A), has been shown to be a promising add-on to treatment, helping to prevent relapse.ObjectiveTo prevent escalation of regular use into problematic use in youth, motivation appears to play a pivotal role. As CBM-A is often viewed as long and boring, this paper presents this training with the addition of serious game elements as a novel approach aimed at enhancing motivation to train.MethodsA total of 96 heavy drinking undergraduate students carried out a regular CBM-A training, a gamified version (called “Shots”), or a placebo training version over 4 training sessions. Measures of motivation to change their behavior, motivation to train, drinking behavior, and attentional bias for alcohol were included before and after training.ResultsAlcohol attentional bias was reduced after training only in the regular training condition. Self-reported drinking behavior was not affected, but motivation to train decreased in all conditions, suggesting that the motivational features of the Shots game were not enough to fully counteract the tiresome nature of the training. Moreover, some of the motivational aspects decreased slightly more in the game condition, which may indicate potential detrimental effects of disappointing gamification.ConclusionsGamification is not without its risks. When the motivational value of a training task with serious game elements is less than expected by the adolescent, effects detrimental to their motivation may occur. We therefore advise caution when using gamification, as well as underscore the importance of careful scientific evaluation.

Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review (Preprint)

“…However, the authors reported that there were differences in the gender, and the significant results were observed amongst females only. Contrary to the findings of Dennis TA et al For the study involving participants with alcohol-related problems (Boendermaker et al (2016)) (4), the gamified variant of the cognitive bias modification task did not reduce attention bias and failed to achieve a decline in overall alcohol consumption. Of importance, Boendermaker et al (2016)'s (4)study was also the only study that investigated the effects of gamification and motivation of participants in using the training task.…”

“…By adopting intrinsic integration, this helps to make the task more engaging, which might increase the inherent levels of motivation to continue training. Unfortunately, we found no evidence that the adoption of "intrinsic integration" did lead to increased motivation to train, as only one study included motivation to train as an outcome measure, and in that study (Boendermaker et al, 2016) (4), there was no improvements.…”

“…Table 1 provides an overview of the characteristics of the selected studies. (4). Three studies have based their gamified intervention on the visual probe task, and one on the attentional visual search task.…”

“…Automatic biases have been posited to be involved in the psychopathologies of several psychiatric disorders, including anxiety and alcohol and tobacco disorders (1)(2)(3)(4)(5). Cognitive biases include attention, approach/avoidance and interpretative biases, and these biases can be retrained.…”

No effect of gamification on attrition from a longitudinal cognitive testing study

“…Secondly, the map screen and changing graphical backgrounds may have hinted at player autonomy and exploration as is typical in other games, but ultimately the player experience was railroaded. These two factors may have undermined autonomy and violated participant expectations, resulting in a dissatisfying experience (Boendermaker, Maceiras, Boffo, & Wiers, 2016;Ryan, Rigby, & Przybylski, 2006). Despite this, it is possible that the clear end goal on the map and novelty of changing backgrounds could explain the maintenance of participants in the Theme variant, while still not being a very satisfying or enjoyable experience.…”