Feasibility and Efficacy of an mHealth Game for Managing Anxiety: "Flowy" Randomized Controlled Pilot Trial and Design Evaluation

Games for Health Journal

Volumn 5, Issue 1, 2016, Pages 50-67

  Pham, Quynh ^a,b   Khatib, Yasmin ^a   Stansfeld, Stephen ^a   Fox, Simon ^b   Green, Tobias ^b  

^a QUEEN MARY UNIVERSITY OF LONDON   (United Kingdom)

^b Playlab London   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ANXIETY; ANXIETY DISORDERS; BREATHING EXERCISE; FEMALE; HUMAN; HYPERVENTILATION; MALE; MOBILE APPLICATION; PANIC DISORDER; PROCEDURES; PSYCHOLOGY; SELF CARE; TELEMEDICINE; VIDEO GAME;

ADULT; ANXIETY; ANXIETY DISORDERS; BREATHING EXERCISES; FEMALE; HUMANS; HYPERVENTILATION; MALE; MOBILE APPLICATIONS; PANIC DISORDER; SELF CARE; TELEMEDICINE; VIDEO GAMES;

EID: 84993661817     PISSN: 2161783X     EISSN: 21617856     Source Type: Journal    
DOI: 10.1089/g4h.2015.0033     Document Type: Article

References (95)

1. Mathers C, Fat DM, Boerma JT; World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
2. Pilling S, Whittington C, Taylor C, Kendrick T. Identification and care pathways for common mental health disorders: Summary of NICE guidance. BMJ 2011; 342:d2868.
3. World Health Organization. Integrating the Response to Mental Health Disorders and Other Chronic Diseases in Health Care Systems. Geneva: World Health Organization; 2014.
4. Skapinakis P, Lewis G, Davies S, et al. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2011; 26:354-362.
5. Institute for Health Metrics and Evaluation. Financing Global Health 2010: Development Assistance and Country Spending in Economic Uncertainty. Seattle, WA: Institute for Health Metrics and Evaluation; 2010.
6. Department of Health. No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. Supporting Document-The Economic Case for Improving Efficiency and Quality in Mental Health. London: Department of Health; 2011.
7. Beamish PM, Granello PF, Granello DH, et al. Outcome studies in the treatment of panic disorder: A review. J Counsel Dev 1996; 74:460-467.
8. Clark DM. A cognitive approach to panic. Behav Res Ther 1986; 24:461-470.
9. Ley R. The efficacy of breathing retraining and the centrality of hyperventilation in panic disorder: A reinterpretation of experimental findings. Behav Res Ther 1991; 29:301-304.
10. Ley R. Pulmonary function and dyspnea/suffocation theory of panic. J Behav Ther Exp Psychiatry 1998; 29:1-11.
11. Lum LC. Hyperventilation and anxiety state. J R Soc Med 1981; 74:1-4.
12. Meuret AE, Wilhelm FH, Roth WT. Respiratory feedback for treating panic disorder. J Clin Psychol 2004; 60:197-207.
13. Mueser KT, Lu W, Rosenberg SD, Wolfe R. The trauma of psychosis: Posttraumatic stress disorder and recent onset psychosis. Schizophr Res 2010; 116:217-227.
14. Rapee RM, Ancis JR, Barlow DH. Emotional reactions to physiological sensations: Panic disorder patients and nonclinical Ss. Behav Res Ther 1988; 26:265-269.
15. Rapee RM, Brown TA, Antony MM, Barlow DH. Response to hyperventilation and inhalation of 5.5% carbon dioxideenriched air across the DSM-III-R anxiety disorders. J Abnorm Psychol 1992; 101:538-552.
16. CO2. J Clin Psychiatry 2012; 73:931-939.
17. Sanchez-Meca J, Rosa-Alcazar AI, Marin-Martinez F, Gomez-Conesa A. Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clin Psychol Rev 2010; 30:37-50.
18. Young C, Hunte A, Newell J, Valian P. Coping with panic. In: Cambridgeshire and Peterborough NHS Foundation Trust, ed. Improving Access to Psychological Therapies 2011, Vol. 4. Cambridge, United Kingdom: Cambridgeshire and Peterborough NHS Foundation Trust; 2011: 27-28.
19. Saxena S, Setoya Y. World Health Organization's comprehensive mental health action plan 2013-2020. Psychiatry Clin Neurosci 2014; 68:585-586.
20. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc 2008; 100:1275-1285.
21. Fox S, Duggan M. Mobile Health 2012. Pew Internet & American Life Project. 2012. www.pewinternet.org/2012/11/08/mobile-health-2012/ (accessed July 29, 2015).
22. U.S. Food and Drug Administration. Mobile Medical Applications. 2014. www.fda.gov/downloads/MedicalDevices/./UCM263366.pdf (accessed July 29, 2015).
23. Cotton R, Irwin J, Wilkins A, Young C. The Future's Digital: Mental Health and Technology. London: NHS Confederation Mental Health Network; 2014.
24. World Health Organization. mHealth: New Horizons for Health Through Mobile Technologies. Geneva: World Health Organization; 2011.
25. McCurdie T, Taneva S, Casselman M, et al. mHealth consumer apps: The case for user-centered design. Biomed Instrum Technol 2012;(Suppl):49-56.
26. Cafazzo JA, Casselman M, Hamming N, et al. Design of an mHealth app for the self-management of adolescent type 1 diabetes: A pilot study. J Med Internet Res 2012; 14:e70.
27. Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: defining "gamification." In: Proceedings of the 15th International Academic Mind-Trek Conference: Envisioning Future Media Environments. Tampere, Finland: ACM Press; 2011.
28. Zichermann G, Cunningham C. Gamification by Design: Implementing Game Mechanics in Web and Mobile Apps. Sebastopol, CA: O'Reilly Media, Inc.; 2011.
29. Heron KE, Smyth JM. Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol 2010; 15:1-39.
30. Brown SJ, Lieberman DA, Germeny BA, et al. Educational video game for juvenile diabetes: Results of a controlled trial. Med Inform (Lond) 1997; 22:77-89.
31. Kato PM, Cole SW, Bradlyn AS, Pollock BH. A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics 2008; 122:e305-e317.
32. Kato PM, Beale IL. Factors affecting acceptability to young cancer patients of a psychoeducational video game about cancer. J Pediatr Oncol Nurs 2006; 23:269-275.
33. Stinson JN, Jibb LA, Nguyen C, et al. Development and testing of a multidimensional iPhone pain assessment application for adolescents with cancer. J Med Internet Res 2013; 15:e51.
34. Bingham PM, Bates JH, Thompson-Figueroa J, Lahiri T. A breath biofeedback computer game for children with cystic fibrosis. Clin Pediatr (Phila) 2010; 49:337-342.
35. Bingham PM, Lahiri T, Ashikaga T. Pilot trial of spirometer games for airway clearance practice in cystic fibrosis. Respir Care 2012; 57:1278-1284.
36. Davis MA, Quittner AL, Stack CM, Yang MC. Controlled evaluation of the STARBRIGHT CD-ROM program for children and adolescents with cystic fibrosis. J Pediatr Psychol 2004; 29:259-267.
37. Asthma Advisory Committee Meeting. Asthma Self-Management Application Project. In: University of Western Ontario Centre for Global e-Health Innovation, Queen's University. The Lung Association. 2014. www.on.lung.ca/document.doc?id=2109 (accessed July 29, 2015).
38. Krishna S, Francisco BD, Balas EA, et al. Internet-enabled interactive multimedia asthma education program: A randomized trial. Pediatrics 2003; 111:503-510.
39. Developing Breathe: A Self-Management Web App for Asthma. Ottawa: Centre for Global eHealth Innovation, University Health Network; 2013.
40. Garde A, Umedaly A, Abulnaga SM, et al. Assessment of a mobile game ("MobileKids Monster Manor") to promote physical activity among children. Games Health J 2015; 4:149-158.
41. Lin J-H. "Just Dance": The effects of exergame feedback and controller use on physical activity and psychological outcomes. Games Health J 2015; 4:183-189.
42. Moller CA, Majewski S, Standish M, et al. Active fantasy sports: Rationale and feasibility of leveraging online fantasy sports to promote physical activity. JMIR Serious Games 2014; 2:e13.
43. Sato K, Kuroki K, Saiki S, Nagatomi R. Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: A randomized controlled trial. Games Health J 2015; 4:161-167.
44. Fish MT, Russoniello CV, O'Brien K. The efficacy of prescribed casual videogame play in reducing symptoms of anxiety: A randomized controlled study. Games Health J 2014; 3:291-295.
45. Leutwyler H, Hubbard EM, Dowling GA. Adherence to a videogame-based physical activity program for older adults with schizophrenia. Games Health J 2014; 3:227-233.
46. Roepke AM, Jaffee SR, Riffle OM, et al. Randomized controlled trial of SuperBetter, a smartphone-based/Internet-based self-help tool to reduce depressive symptoms. Games Health J 2015; 4:235-246.
47. Shepherd M, Fleming T, Lucassen M, et al. The design and relevance of a computerized gamified depression therapy program for indigenous Māori adolescents. JMIR Serious Games 2015; 3:e1.
48. Gutierrez B, Kaatz A, Chu S, et al. "Fair Play": A videogame designed to address implicit race bias through active perspective taking. Games Health J 2014; 3:371-378.
49. Chu SKW, Kwan ACM, Reynolds R, et al. Promoting sex education among teenagers through an interactive game: Reasons for success and implications. Games Health J 2015; 4:168-174.
50. D'Cruz J, Santa Maria D, Dube S, et al. Promoting parent-child sexual health dialogue with an intergenerational game: Parent and youth perspectives. Games Health J 2015; 4:113-122.
51. Driesmans K, Vandenbosch L, Eggermont S. Playing a videogame with a sexualized female character increases adolescents' rape myth acceptance and tolerance toward sexual harassment. Games Health J 2014; 4:91-94.
52. Jozkowski KN, Ekbia HR. "Campus Craft": A game for sexual assault prevention in universities. Games Health J 2014; 4:95-106.
53. Gorini A, Marzorati C, Casiraghi M, et al. A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: Study protocol for a randomized controlled trial. JMIR Res Protoc 2015; 4:e52.
54. Kottink AIR, Prange GB, Krabben T, et al. Gaming and conventional exercises for improvement of arm function after stroke: A randomized controlled pilot study. Games Health J 2014; 3:184-191.
55. Lozano-Quilis J-A, Gil-Gómez H, Gil-Gómez J-A, et al. Virtual rehabilitation for multiple sclerosis using a Kinectbased system: Randomized controlled trial. JMIR Serious Games 2014; 2:e12.
56. Proffitt R, Sevick M, Chang C-Y, Lange B. User-centered design of a controller-free game for hand rehabilitation. Games Health J 2015; 4:259-264.
57. Szturm T, Reimer KM, Hochman J. Home-based computer gaming in vestibular rehabilitation of gaze and balance impairment. Games Health J 2015; 4:211-220.
58. Granic I, Lobel A, Engels RCME. The Benefits of Playing Video Games. Nijmegen, The Netherlands: Radboud University Nijmegen; 2013.
59. Buijink AW, Visser BJ, Marshall L. Medical apps for smartphones: Lack of evidence undermines quality and safety. Evid Based Med 2013; 18:90-92.
60. Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf 2013; 36:111-117.
61. Misra S, Lewis TL, Aungst TD. Medical application use and the need for further research and assessment for clinical practice: Creation and integration of standards for best practice to alleviate poor application design. JAMA Dermatol 2013; 149:661-662.
62. Wolf JA, Moreau JF, Akilov O, et al. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013; 149:422-426.
63. McCartney M. How do we know whether medical apps work? BMJ 2013; 346:f1811.
64. Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare 2011; 17:308-312.
65. Ferrero NA, Morrell DS, Burkhart CN. Skin scan: A demonstration of the need for FDA regulation of medical apps on iPhone. J Am Acad Dermatol 2013; 68:515-516.
66. Lewis LT, Wyatt CJ. mHealth and mobile medical apps: A framework to assess risk and promote safer use. J Med Internet Res 2014; 16:e210.
67. Donker T, Petrie K, Proudfoot J, et al. Smartphones for smarter delivery of mental health programs: A systematic review. J Med Internet Res 2013; 15:e247.
68. Piantadosi S. Clinical Trials: A Methodologic Perspective. New York: Wiley; 2005.
69. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol 1998; 66:7-18.
70. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: getting started and moving on from stage I. Clin Psychol Sci Pract 2001; 8:133-142.
71. Balas EA, Boren SA. Managing clinical knowledge for healthcare improvements. In: van Bemmel JH, McCray AT, eds. Yearbook of Medical Informatics 2000. Stuttgart: Schattauer; 2000: 65-70.
72. Brown CH, Kellam SG, Kaupert S, et al. Partnerships for the design, conduct, and analysis of effectiveness, and implementation research: Experiences of the Prevention Science and Methodology Group. Adm Policy Ment Health 2012; 39:301-316.
73. Glasgow RE, Lichtenstein E, Marcus AC. Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health 2003; 93:1261-1267.
74. Collins LM, Murphy SA, Strecher V. The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART): New methods for more potent eHealth interventions. Am J Prev Med 2007; 32(5 Suppl):S112-S118.
75. Mohr CD, Schueller MS, Riley TW, et al. Trials of intervention principles: Evaluation methods for evolving behavioral intervention technologies. J Med Internet Res 2015; 17:e166.
76. Mohr DC, Cheung K, Schueller SM, et al. Continuous evaluation of evolving behavioral intervention technologies. Am J Prev Med 2013; 45:517-523.
77. Wyatt J. Assessing and improving evidence based health informatics research. Stud Health Technol Inform 2010; 151:435-445.
78. Eysenbach G; CONSORT-EHEALTH Group. CONSORTEHEALTH: Improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res 2011; 13:e126.
79. Eysenbach G. CONSORT-EHEALTH: Implementation of a checklist for authors and editors to improve reporting of web-based and mobile randomized controlled trials. Stud Health Technol Inform 2013; 192:657-661.
80. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006; 166:1092-1097.
81. Norman SB, Cissell SH, Means-Christensen AJ, Stein MB. Development and validation of an Overall Anxiety Severity and Impairment Scale (OASIS). Depress Anxiety 2006; 23:245-249.
82. Taylor S, Zvolensky MJ, Cox BJ, et al. Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess 2007; 19:176-188.
83. Shear MK, Rucci P, Williams J, et al. Reliability and validity of the Panic Disorder Severity Scale: Replication and extension. J Psychiatr Res 2001; 35:293-296.
84. van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res 1985; 29:199-206.
85. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of Life Enjoyment and Satisfaction Questionnaire: A new measure. Psychopharmacol Bull 1993; 29:321-326.
86. Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. J Med Internet Res 2006; 8:e27.
87. Everly GS, Lating JM. A Clinical Guide to the Treatment of the Human Stress Response, 3rd ed. New York: Springer; 2013.
88. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
89. Kumar S, Nilsen WJ, Abernethy A, et al. Mobile health technology evaluation: The mHealth Evidence Workshop. Am J Prev Med 2013; 45:228-236.
90. Deci EL, Ryan RM. Intrinsic Motivation and Self-Determination in Human Behavior. New York: Plenum; 1985.
91. Przybylski AK, Deci EL, Rigby CS, Ryan RM. Competence-impeding electronic games and players' aggressive feelings, thoughts, and behaviors. J Pers Soc Psychol 2014; 106:441-457.
92. Chao YY, Scherer YK, Wu YW, et al. The feasibility of an intervention combining self-efficacy theory and Wii Fit exergames in assisted living residents: A pilot study. Geriatr Nurs 2013; 34:377-382.
93. Kato PM, Cole SW, Bradlyn AS, Pollock BH. A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics 2008; 122:e305-317.
94. Lyons EJ, Hatkevich C. Prevalence of behavior changing strategies in fitness video games: Theory-based content analysis. J Med Internet Res 2013; 15:e81.
95. Schneider KL, Ferrara J, Lance B, et al. Acceptability of an online health videogame to improve diet and physical activity in elementary school students: "Fitter Critters." Games Health J 2012; 1:262-268.