Computer-aided learning for managing stress: A feasibility trial with clinical high risk adolescents and young adults

Kristen A Woodberry, Cole Chokran, Kelsey A Johnson, Keith H Nuechterlein, David J Miklowitz, Stephen V Faraone, Larry J Seidman, Kristen A Woodberry, Cole Chokran, Kelsey A Johnson, Keith H Nuechterlein, David J Miklowitz, Stephen V Faraone, Larry J Seidman

Abstract

Aim: The peak onset of psychotic disorders occurs during adolescence and early adulthood, yet treatments for youth at clinical high risk (CHR) for psychosis are generally designed for adults. CHR youth, despite poor academic and social engagement, spend hours each day playing complicated videogames. The aim of this study was to test the feasibility of integrating biofeedback and cooperative videogame play within family therapy as a means of engaging and enhancing this population's resilience.

Methods: We conducted a feasibility trial of an innovative 12-week family therapy for CHR ages 12-30 (clinicaltrials.gov NCT02531243). We report feasibility outcomes and preliminary effect sizes for pre-post changes and youth-parent differences.

Results: Of 88 individuals referred to the centre who met age and CHR criteria, 11 (13%) youth-parent pairs met full criteria and engaged in treatment. Ten (91%) completed at least six sessions. Youth found CALMS initially credible, but parents tended to find it more credible and to be more satisfied over time. Surprisingly, parents reported a better game experience than youth. As a group, youth and parent participants reported experiencing reduced stress and perceiving each other as less critical by the end of treatment. Youth were rated as having significantly improved social, but not role or global functioning by the end of treatment.

Conclusions: Multiuser videogames may have a role to play in engaging youth at risk for psychosis in therapy and reducing stress and familial risk factors. A number of key developments are needed to enhance the appeal, effectiveness and practicality of this approach.

Keywords: biofeedback; family therapy; multiuser; psychosis; stress; videogame.

Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare. The game technology is owned by Boston Children’s Hospital.

© 2020 John Wiley & Sons Australia, Ltd.

Figures

FIGURE 1
FIGURE 1
Consort diagram
FIGURE 2
FIGURE 2
Comparison of youth and parent reports of their experiences playing the CALMS game. Note: Mean scores by rater on the User Experience Questionnaire (UEQ) subscales. Overall group differences in “In-Game” experiences (1st 6 subscales) was significant at P = .008; Variance estimates, and thus error bars, are unavailable due to nonindependence within dyads. *P < .05, **P < .01, **P < .001 for differences between parent and youth scores
FIGURE 3
FIGURE 3
Mean Perceived Stress Scale score (PSS) before and after CALMS. *P < .05 for pre-post differences Variance estimates, and thus error bars, are unavailable for analysis of combined youth and parent ratings due to nonindependence within dyads
FIGURE 4
FIGURE 4
Perception of own and partner’s criticism before and after CALMS. Note: Variance estimates, and thus error bars, are unavailable for analysis of combined youth and parent ratings due to nonindependence within dyads. *P < .05 for pre-post differences
FIGURE 5
FIGURE 5
Conflict behaviour before and after CALMS. Note: Variance estimates, and thus error bars, are unavailable for analysis of combined youth and parent ratings due to nonindependence within dyads

Source: PubMed

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