Skip to main content
Full access
Reviews & Overviews
Published Online: 23 October 2019

Serious Games, Gamification, and Serious Mental Illness: A Scoping Review

Abstract

Objective:

The use of serious games and gamification to promote learning has a long history. More recently, serious games and gamification have been used in clinical settings to promote treatment and recovery. Yet there is little evidence to support their use with populations that experience serious mental illness.

Methods:

A scoping review was used to answer the following research question, What is the current state of knowledge about how games and gamification are used to promote treatment of serious mental illness? Scoping reviews clarify, define, and develop conceptual boundaries within a topic area. Twenty studies were identified and reviewed by using thematic content analysis.

Results:

A range of game types, formats, and technology were assessed. Six themes emerged from analysis. Serious games and the use of gamification to promote treatment have potential to engage persons with serious mental illness in game content and promote treatment outcomes. Game design that supported clear instruction, a coherent narrative, a smooth interface between mechanics and play, and service user involvement early in the process of game design were important for the successful promotion of engagement and learning. Games reviewed offered the opportunity for problem solving, collaboration, and goal-oriented activity that supported the delivery of therapeutic outcomes.

Conclusions:

The use of serious games and gamification to promote treatment of serious mental illness had high levels of feasibility and acceptability among both users and providers. The potential treatment value of games, however, is dependent on key features related to the games’ design, operation, and rationale.

HIGHLIGHTS

Serious games and gamification involve the utilization of game structure and format to promote service user engagement in treatment.
Increasingly, games are being used to engage hard-to-reach service users.
This article describes a scoping review that maps key concepts in the use of serious games and gamification to promote treatment for serious mental illness.
The role of gaming and the use of gamification in promoting treatment in health care settings is an emerging area of practice (1, 2). However, there is currently little evidence to support the use of gaming in mental health settings.
The purpose of this research was to map key concepts in the use of serious games and gamification to promote treatment of serious mental illness (schizophrenia, bipolar disorder, and schizophreniform disorder). Specifically, this study identified the common characteristics of gamified interventions, the effectiveness of the interventions in promoting treatment outcomes, and the acceptability and feasibility of their use in clinical settings. Findings are discussed in relation to the research question and its objectives. The article also includes recommendations to support future design and development of serious games.

Basic Concepts and Theories

Scoping reviews clarify, define, and develop conceptual boundaries within a topic area (3). They have particular relevance when emerging evidence is being reviewed, when there is a paucity of high-quality literature, and when a range of study designs need to be considered (48). Scoping reviews can have a number of aims, including to identify and map key concepts underpinning research within a topic area, to identify research gaps, and to inform future research and practice (4, 6, 9).
Persons who experience serious mental illness can present with an increased risk of re-emergence of elevated symptoms and disengagement from treatment (1012). Disengagement presents with substantial cost—treatment may cost up to four times more for patients who disengage than for those who do not relapse (13, 14). Disengagement can reflect a lack of perceived fit between service users and the treatment they receive. More often than not, traditional treatment has been restricted to symptom reduction, lifelong adherence to antipsychotic medication, and guarded expectations of a return to premorbid functioning (1517). For service users, these approaches have fostered a clinical environment that has nurtured learned helplessness; institutionalization (18, 19); and a deep sense of hopelessness, loss, and despair that continues to impede recovery today (12, 20, 21). Service users often reject treatment because they do not value it or do not believe that they can benefit from it, and new approaches are needed to engage this population (22, 23).
Serious games are constructed to engage the player and use pedagogy to impart instruction into the game experience (2, 24). As such, they pose a novel opportunity to introduce and engage service users in treatment, often when engagement has otherwise been unsuccessful (2426).
Serious games are a subcategory of games in which the goal of the game is positioned outside the game itself (2730). Serious games convey ideas and values that persuade players, influence their real-life thoughts and actions, and have an explicit, thought-out educational purpose (31, 32). Serious games have been collectively described in the literature as applied games, pervasive games, games for health, and alternate-reality games (3335). For the purpose of clarity and simplification of terminology, the terms serious games and gamification will henceforth be used. Often serious games are digital, but they are not limited to that format (30). Serious games are an effective medium for sustaining idea generation, improving communication, the resetting of power relations within a group, and creating a nonthreatening and engaging learning environment (36). The gamification of treatment involves the utilization of these characteristics to engage the service user in an activity that promotes treatment.
The term gamification was coined at the beginning of the 21st century (3740) and involves the redesign of one’s life activities through the structure, design, and methodology of games (34, 4042). Gamification provides a safe and controlled environment in which to practice and learn new behaviors in response to real-life challenges. Once learned, these lessons can then be applied in uncontrolled, real-life situations (39, 43). Most games rely on “pointsification”—the use of points, timed performance, badges, or leader-board systems—to reward players for completing an activity (37, 40, 43). The success of gamification, however, does not depend exclusively on pointsification, nor does it lie in the use of technology to motivate and engage players (42). Rather, attainment of the game’s goals is supported by the application of three separate but overlapping elements—game mechanics (rules and procedures), dynamics (interactions, behaviors, and player experience), and instructional design (pedagogy) (37). The goals are not achieved within the game, such as winning a race; instead, players are rewarded for meeting goals positioned outside the game, such as the acquisition of skills, knowledge, and experiences (37, 39, 43).
The use of gamification to structure learning environments that have treatment utility offers a new approach to engaging mental health service users (2). However, current knowledge and understanding of the use of gamification with those who experience serious mental illness remain nascent.
Practitioners who wish to explore the use of serious games and gamification in their clinical settings as a way to improve service delivery, user experience, and engagement could benefit from the findings and recommendations of this review. The findings could also benefit researchers developing serious games or gamified interventions for the treatment of serious mental illness.

Methods

To answer the research question, this review follows the five stages of a scoping review: identifying the initial review question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results (4, 44).

Stage 1: Identifying the Initial Review Questions

The review question was, What is the current state of knowledge about how games and gamification are used to promote treatment of service users who experience serious mental illness? The process of identifying the review questions followed an iterative, back-and-forth analysis of earlier findings and new insights, new search terms, and changing review questions (4, 45).

Stage 2: Identifying Relevant Studies

AMED, ASSIA, CINAHL, Cochrane, EMBASE, Medline, and PsychINFO databases from January 2000 to January 2019 were searched. Because the use of gamification in treatment is a new phenomenon, it was considered unlikely that relevant articles from before 2000 would be found. Prieto de Lope and Medina-Medina’s (46) search from 1990 to 2012, for example, found that 54% of articles on the subject of serious games were published after 2007. Included articles focused on the use of off-the-shelf or bespoke games (unique games designed to meet the needs of a specific population or condition) and gamification to promote treatment or treatment outcomes for people who experience serious mental illness.
Key words were established by following an initial broad search of the literature and consultation with a university librarian who is a specialist on literature reviews. The librarian’s input was valuable for the refinement of search terms and identification of relevant data bases. The search terms included mental illness, serious mental illness, psychosis schizophrenia, schizophreniform and bipolar disorder and key words such as games, gaming, serious games, and games for health, engagement and treatment.
The purpose of a scoping review is to comprehensively address a broad review question, but parameters are required to guide the search strategy and the formation of the research question (7, 44). Person, concept, and context (PCC), as recommended by Peters et al. (9), was used to structure the inclusion criteria as follows: person—mental illness, serious mental illness, psychosis (schizophrenia, schizophreniform disorder, and bipolar disorder); concept—games, gaming, serious games, pervasive games, alternate-reality games, applied games and games for health and promotion of treatment, interventions, engagement and reduction in illness and symptomology and behavior change and health behaviors and acceptability and feasibility of game and technology; and context—adult (age >18), English language and service users receiving treatment for serious mental illness and community, inpatients, secure setting and rehabilitation services.
The inclusion criteria and exclusion criteria were used to refine the search strategies and provided a framework for searching the literature (Table 1). Continual refinement of search strategy in response to the iterative process of investigation was ongoing and helped create greater methodological clarity and rigor (5).
TABLE 1. Inclusion and exclusion criteria for a scoping review of articles about studies of the use of gaming and gamification in treatment of serious mental illness
CriterionInclusionExclusion
LanguagePublished in the English languageNon-English articles
Time periodJanuary 2000–January 2019Articles published outside this time frame
Population focusAdults experiencing serious mental illness (schizophrenia, schizophreniform disorder, and bipolar disorder)Participants experiencing other conditions (e.g., depression, stroke, heart rehabilitation, and autism); adolescents.
Study focusUse of serious games and gamification within a gaming context that supports engagement and the delivery of therapeutic interventionsStudies not primarily focused on serious games and gamification, (e.g., virtual reality, fitness, and education) or studies that utilized TV or radio technology
Literature focusReview articles including systematic reviews, meta-analyses, meta-syntheses, narrative reviews, rapid reviews, critical reviews, integrative reviews, and the gray literature—such as blogs, commercial Web sites, opinion articles, commentaries, and information sitesArticles with only a passing focus or reference to serious games and gamification or articles about studies that used games as a control condition or for diagnostic purposes.

Stage 3: Study Selection

Through use of the search terms, 386 articles were identified. Twenty-two additional articles were identified through skimming of reference lists and review of Web sites of various organizations, such as the Serious Games Institute and the Serious Games Association. Forty-seven duplicates were removed, leaving a final total of 339 identified articles. We applied the inclusion and exclusion criteria to the abstracts of these articles. Abstracts that met the inclusion and exclusion criteria progressed to the next stage, and full articles were obtained. If uncertainty existed as to the appropriateness of an article, the full article was obtained. At the end of this process, 264 articles were rejected and 75 articles were identified for full-article review. We then reviewed these articles. Twenty articles were confirmed to be appropriate for inclusion. Articles were excluded because they did not have game structure or gamification as their primary focus; were not focused on treatment and treatment outcomes; had an emphasis on education; were concerned with an excluded population, such as adolescence and stroke patients; or used games as a control condition. This process followed the Preferred Reporting of Items for Systematic Review and Meta-Analysis (47) (see diagram in the online supplement).

Stage 4: Charting the Data

Articles were summarized and recorded according to study/author/year, location, intervention, study design/sample, and outcome.

Stage 5: Collating, Summarizing, and Reporting Results

Through use of thematic content analysis, six themes were identified. Thematic content aims to provide a map of content and topics across a wide data set (5, 48, 49). Following recognized stages of thematic analysis (49, 50), two researchers coded each article individually and then collaborated to review their findings until a consensus was achieved. Where differences occurred, both researchers returned to the codes and worked together to find agreement. During this process, proposed themes were often discarded, and new themes were created from the codes. This was done until a consensus on theme content and title was achieved.

Results

This scoping review generated 20 articles from 12 countries (5170) (Table 2). Some studies involved participants from more than one country. Six articles were from the United States, five from France, three each from Switzerland and the United Kingdom, two each from Belgium and the Netherlands, and one each from Australia, Italy, Japan, Korea, and Portugal. Thirteen studies were of quantitative design, five of qualitative design, and two of mixed design. All games involved service users who experienced schizophrenia, schizoaffective disorder, and delusional disorders. The number of study participants ranged from four to 172, but most studies had fewer than 55 participants, although two had 135 and 172 participants, respectively.
TABLE 2. Summary of studies included in a scoping review on the use of gaming and gamification in treatment of serious mental illness, by type of game
AuthorLocationInterventionStudy design and sampleOutcome
Physical activity game    
 Leutwyler et al., 2018 (57)USADescribed the effectiveness of Kinect video game for Xbox 360 game system on walking speed of adults with schizophrenia. Participants allocated to active game (intervention) or sedentary video game (control) for 30 minutes once a week for 6 weeks.Randomized controlled trial (RCT). N=28. Outpatients, patients in transitional residential and locked inpatient wards. Assessed pre- and postintervention. Schizophrenia or schizoaffective disorderWalking speed on the Short Physical Performance Battery. Intervention group, increase in walking speed of .08 meters per second. Control group, increase in walking speed of .03 meters per second. Difference not statistically significant but clinically significant. Video game–based physical activity program provided clinically meaningful improvement in walking speed.
 Shimizu et al., 2017 (64)JapanInvestigated effects of an interactive sports video game (IVG) (Nintendo Wii) on frontal lobe function of patients. IVG played once a week for 60 minutes for 3 monthsSingle blind crossover study. Schizophrenia. N=6. Pre- and postintervention assessment. Diagnosis of schizophrenia, score of ≥40 on the Global Assessment of Functioning (GAF)Frontal lobe blood flow volume assessed with functional near-infrared spectroscopy (fNIRS). Functional changes assessed by Frontal Assessment Battery and Health-Related Quality of Life scales. Physical functioning, behaviorally assessed with physical functioning tests. fNIRS performance significantly increased in the IVG period compared with control group. Intervention-related improvement in health-related quality of life. No significant difference in behaviorally assessed physical functioning. Conclusion: IVG may provide high-quality, low-cost rehabilitation for those experiencing schizophrenia
 Campos et al., 2015 (67)PortugalEvaluated the feasibility and acceptability of an exergame intervention as a tool to promote physical activity. Playing Microsoft Kinect for 20 minutes twice a week for 8 weeks. Difficulty levels were adjusted to match participant’s individual skills.Quasi-experimental trial, N=32. Schizophrenia, outpatients. Pretest/posttest feasibility study. Treatment group, N=16; completed treatment, N=13. Treatment as usual, N=16Positive and Negative Syndrome Scale (PANSS)total score was not significantly correlated with number of completed game levels. Sustained use was related to good game functioning, and poor game functioning was related to frustration and reduced use. Assessments: feasibility, attendance; acceptability, adapted 28-item self-report questionnaire; functional mobility, Timed Up and Go test; habitual physical activity, Baecke Modified Physical Activity Questionnaire; functional fitness performance, Senior Fitness Test; motor neurological soft signs, brief motor scale; hand grip strength, digital dynamometer; static balance, force plate; speed of processing, Trail making test; and schizophrenia-related symptoms, PANSS. High acceptability. No significant difference between groups at baseline. No significant difference between groups postintervention
 Kimhy et al., 2015 (68)USACharacterized the feasibility, acceptability, safety, and adherence associated with using active play video games as part of an aerobic exercise (AE) training program. Xbox 360 with Kinect motion sensing with motion-sensing devices and traditional exercise equipment. Treatment group received three 1-hour sessions of AE training per week for 12 weeks. Control group received standard psychiatric care.Single-blind RCT. Individuals with schizophrenia living in the community (N=25). Training targets were set on the basis of individual max heart rate (HR) as set at baseline (VO2 peak test). Minimal AE intensity was set at 60% of max HR week 1; 65%, week 2; 70%, week 3; and 75%, weeks 4–12X box most popular over traditional exercise, and users reported high acceptability. Participants in the AE group significantly increased their aerobic fitness, while the control group showed virtually no change. Provided preliminary support for the use of active play video games as part of an AE program for individuals with schizophrenia
 Leutwyler et al., 2015 (60)USADescribed the impact of a video game–based physical activity program using the Kinect for Xbox 360 game system on physical activity in older adults. Participants played an active video game for 30 minutes once a week for 6 weeks.One-group, pretest-posttest pilot study. N=20. Age >55, schizophrenia and schizoaffective disorderSubjective assessment of physical activity, Yale Physical Activity Scale. Objective assessment of physical activity, SenseWear Pro armband worn by participants for 7 days between weeks 1 and 2 and weeks 5 and 6. Adherence measured by comparing actual attendance with possible number of attendances. Actual activity overreported by participants. No statistically significant difference in objectively measured physical activity
 Leutwyler et al., 2014 (62)USADescribed adherence to and acceptability of a video game–based physical activity program using Kinect for Xbox 360 game system in older adults. Participants played an active video game using Kinect for Xbox 360 game system for 30 minutes once a week for 6 weeks.Descriptive longitudinal study, inpatient facilities. Older adults with schizophrenia (N=34).Acceptability assessed by open-ended questionnaire. Adherence assessed by number of sessions attended. Mobility assessed objectively by timed Get Up and Go and subjectively by the physical function items from the 12-item Short-Form Health Survey. High adherence to and acceptability of game; 50% of participants attended all 6 sessions
 Leutwyler et al., 2012 (61)USADescribed the preliminary acceptability of a video game–based physical activity program using the Kinect for Xbox 360 game system in older adults. Participants engaged in a 30-minute session once a week for 6 weeks.Pilot study of acceptability. Mixed methodology. Inpatient and locked mental health wards. Schizophrenia and schizoaffective disorder. N=15Posttest quantitative and qualitative rating of acceptability using Borg Scale. It was feasible and acceptable to incorporate Kinect for Xbox 360 game system into treatment programs. Participants rated games as fun and as an enjoyable way to be active. Secondary finding: in order for users to continue playing game, they need to feel they have the skills to play the game
Bespoke game    
 Olivet et al., 2018 (51)USADeveloped a prototype, computer-based, role-playing game (OnTrack). Determined feasibility and whether game improved consumers’ attitude toward treatment and recovery.20 participants; played game for 45–60 minutesPilot study. Mixed methods. First-episode psychosis (FEP)Preassessment at baseline and postassessment at 2 weeks. Assessments: hope (Herth Hope Index), recovery (Recovery Attitudes Questionnaire), stigma, empowerment (Rodgers Empowerment Scale), and engagement in treatment (Singh O’Brian Level of Engagement Scale). Postassessment: 20-minute semistructured interview about game play experience, FEP-related content, and how game could be improved. Recovery only measure that showed a statistically significant improvement
 Reynolds et al., 2017 (55)UKPrototype serious game developed by service users and researchers and studied in a clinical setting. Study aims: game development and exploration of usability and acceptability of serious gaming in forensic mental health servicesDevelopment and trial of game. User-centered design approach developed formative game versions for evaluation in focus groups. Male, low secure patients planning for discharge in the next 12 months. Participants were given the option of being a game producer (N=8) or tester (N=6).Game evaluated in situ by testers and focus groups. Views of service-user focus group on usability and acceptability of serious gaming in forensic mental health services were audio-recorded and transcribed. Findings supported the utility of serious gaming in forensic services to support service-user recovery. Codesign approach allowed for a realistic and enjoyable game. The development of environments and dialogue that reflect real-life experiences helped promote service-user engagement.
 Amado et al., 2016 (52)FranceVirtual game in an imaginary town. Hypothesis: a virtual reality (VR) environment improves cognitive abilities of prospective memory and planning and social functioning. Participants attended a weekly 1.5-hour session for 3 months. In first session patients listed their difficulties in everyday organization and planning. Further sessions focused on these difficulties in the game.Pilot study (N=10). Schizophrenia or schizoaffective disorder. Assessment at week 0 and week 12Quantitative assessment: clinical assessment, Brief Psychiatric Rating Scale (BPRS) and GAF). Psychosocial, Social Autonomy Scale (EAS);Schizophrenia Questionnaire for Quality of Life; Self-Esteem Rating Scale; Birchwood Insight Scale Questionnaire . Neurological, attention, visual scanning abilities; speed processing (D2 cancellation test); motor speed processing; verbal and visual working memory (Wechsler Adult Intelligence Scale; verbal learning (Grober and Buschke verbal learning test); executive functioning (zoo map test and Battery for Assessment of Dysexecutive Syndrome; and visuospatial abilities (Rey–Osterrieth Complex Figure Test). Qualitative assessment: opinions of participants gathered by clinicians. Quantitative results: Significant improvement in BPRS, GAF, and EAS scores. Benefits shown in attention and in working, prospective, and retrospective memory but no improvement in planning. Qualitative results: benefit in sparing time, planning, and management of housework. The VR game shows promise in improving neurocognitive deficits. Further evolution of game is required.
 Van der Krieke et al., 2014 (54)HollandIdentified ways of making cognitive-bias modification (CBM) more attractive. Explore service-user experience of engaging CBM in game format and making changes in response to findings. Bias Buster is an electronic serious game to train participants to appraise social situations positively and to manage social anxiety and self-deprecating thoughts.Pilot study. Mixed methods. N=7. Psychotic disorders, FEPGaming experience assessed with the Gaming Experience Questionnaire. Participants liked game design and found it pleasant to play. But scenarios were too easy, the game structure was unclear, and participants stopped playing.
 Fitzgerald et al., 2011 (56)UKUse of a serious game to consult service users in service development. Game played 4 times over 4 months. Aim 1, to involve service users in the design, layout, and furnishing of new low secure unit; aim 2, to answer specific design questions from builders and architects; and aim 3, to explore feasibility and acceptability of new medication-dispensing system proposed for unitQualitative study; schizophrenia, schizoaffective disorder, bipolar disorder; 25 out of a possible 30 service users who experienced serious mental illness and who resided on the low secure service participatedOutcome measure: Six Stages of Service User Involvement in Mental Health Services. All design questions answered. Service users rejected the new medication dispensing system proposed for unit. Participants stated that they enjoyed playing game and were satisfied with impact on the design and development process. Serious games offer a flexible, inclusive, and meaningful way of engaging service users in service development.
 Shrimpton and Hurworth,2005 (53)AustraliaDetermined feasibility and acceptability of Pogo’s Pledge in meeting the program objective—supporting young people to improve their mental health by learning about their psychosis and the strategies they can use to maximize their mental health
Expert review. N=19. Sampling of participants with reputational standing using snowballing techniquesFace-to-face interviews with 2 focus groups of 15 professionals working in game design, multimedia graphic/interface design, multimedia educational design and FEP and 1 focus group of 4 young people with lived experience of FEP. Substantial redevelopment of game needed. Educational games designed to engage young people are unlikely to succeed if they do not mimic the levels of design sophistication and iterative testing of the computer and console games already played by this population.
Card game    
 Khazaal et al., 2015 (59)Switzerland, France, Monaco, and ItalyEvaluated the effect of Michael’s Game (MG) on delusional conviction. Collaborative group, 80-card game targeting the ability to generate alternative hypotheses to explain a given experience. Training group leaders (2 per session) direct the game during weekly sessions lasting for about 1 hour. Game is completed when all 80 cards are played. Game directors: urses (N=14), psychologists (N=12), and psychiatrists specifically trained to deliver MG (N=6)RCT. N=172. Adult outpatients with psychotic disorders. Compared treatment as usual plus participation in MG with treatment as usual plus being on a waiting list. Assessments at inclusion (T1, baseline), 3 months (T2, posttreatment), and 6 months after second assessment (T3, follow-up)Assessments: conviction, distress, and preoccupation (Peters Delusion Inventory [21 items] [PDI-21]); symptoms (BPRS); cognition (Beck’s Cognitive Insight Scale [BCIS]); functioning GAF and Social and Occupational Functioning Assessment Scale); and belief flexibility (Maudsley Assessment of Delusional Schedule). Long-term treatment effect on primary outcome for conviction (p=.002). Long-term treatment effect on secondary outcomes of distress (p=.002), preoccupation (p=.001), and belief flexibility (p=.001). At T2, a positive treatment effect was observed on the primary outcome of conviction (p=.005). At T3, a sustained effect was observed for conviction (p=.002). At T3, further effects observed for distress (p=.002), preoccupation (p=.001), and belief flexibility (p=.001). Significant beneficial effect of playing MG was found.
 Oker et al., 2015 (70)FranceFour parts to this investigation: overview of impaired functioning in schizophrenia; description of how VR settings may prove useful for investigating social interaction, especially through the use of virtual agents; illustration of these ideas with the proposal of a new paradigm based on a virtual affective agent and how it may be used with patients; and examination of the use of a VR card game to identify emotions from facial expressions. Hypothesis: virtual agents and the use of naturalistic settings could prove useful for assessing the intermediate link between cognition and real-life functioningMixed-methods study. Persons with schizophrenia and healthy subjects. Generation of subjective reports of users’ experience of engagement with VR agentSubjective experience: 11-item questionnaire. Participants welcomed the use of VR affective agent and were motivated to engage. VR paradigms are effective agents in the assessment of social interaction of people who experience schizophrenia.
 Khazaal et al., 2011 (58)Switzerland, Belgium, and FranceTested the feasibility and impact of intervention, MG, in a naturalistic setting; 3–7 patients took part in groups that participated in 10–18 sessions facilitated by trained game supervisorsPre-post test design. N=135/N=115 at end point. Outpatient day centers or rehabilitation units. Schizophrenia, schizoaffective disorder, and delusional disorderPDI-21; self-report questionnaire assessing presence of 21 beliefs; and BCIS. Significant improvement in BCIS and reduction in severity of convictions and preoccupation score on PDI–21. Findings support the feasibility and effectiveness of game in a naturalistic setting.
 Khazaal et al., 2006 (69)Belgium, France, and SwitzerlandTested the feasibility and impact of MG in naturalistic settingsPre-post test design. N=55/ N=45 at end point. Schizophrenia, schizoaffective disorder, and depression. Outpatient and inpatient units.Pre- and posttest assessment using PDI-21. Self-report questionnaire assessing presences of 21 beliefs. Significant reduction in conviction and preoccupation scores, suggesting potential therapeutic effect of playing game. Easy to use in a natural setting after a short training session. Findings support the feasibility and effectiveness of MG in a naturalistic setting.
Online game    
Nieman et al., 2015 (65)NetherlandsInvestigated cognitive-remediation game, Monster Valley, with psychiatric patients via an online cognitive game played 3 times per week for .5 hours for 12 weeks. Aim: test feasibility of using an online cognitive game and assessment tool by psychiatric patients at homeRCT. Pilot study. N=19. Allocated to treatment as usual or treatment as usual plus. Outcome measures taken at baseline and 12 weeksCognitive performance: online assessment tool assessed performance in memory, attention, working memory, psychomotor speed, and executive function Intervention group improved significantly in verbal memory performance compared with control group. Most participants were able to play the game and use the online assessment tool at home. Some participants did not adhere to minimum playtime because game was not challenging enough. A new and more challenging game has since been developed.
 Han et al., 2008 (63)KoreaVideo playing is reported to increase activity of the prefrontal cortex and leads to dopamine release. Hypothesized that video playing might improve positive symptoms and extrapyramidal symptoms (EPS) of service users who experience schizophrenia. Intervention: playing Internet video games; control: watching movies for an equivalent period of time for an 8-week periodPretest/posttest design. N=81. Schizophrenia. Assessment at baseline and 8 weeksAssessment: clinical symptoms, Schedule for the Assessment of Negative Symptoms and Schedule for the Assessment of Positive Symptoms (SAPS); EPS, Abnormal Voluntary Movement Scale (AIMS). Improvement in positive symptoms in both groups. Intervention group as measured by SAPS showed greater reduction in the subscale of delusion. Both groups showed a reduction in AIMS scores, intervention group showed greatest reduction.
Game to evaluate interventions    
 Slater and Painter, 2016 (66)UKUsed collaborative group game design as part of routine evaluation of patient and practitioner experience of C-Co CBTp (a variant of cognitive-behavioral therapy [CBT] for high secure settings) within high secure (HS) settings. What impact did C-Co CBTp have on patient and practitioner participants within a HS context? Is collaborative group game design an advantageous method of evaluating this impact?Qualitative participatory action study. N=15. Purposeful sample of practitioners and patients who completed C-Co CBTpAs well as helping participants to evaluate the therapy experience, this approach consolidated and reinforced gains; offered a strong sense of collaboration and hope; and empowered participants to share and reflect.
Seven articles involved games of physical activity; six were original, bespoke games designed for a specific purpose and population; four involved the use of card games; two were online games; and one involved the use of a game to evaluate an intervention. The seven physical activity games involved Xbox (N=6) and Nintendo Wii (N=1) games and investigated the effect of game play on physical performance such as balance, hand grip, peak VO2, walking speed, and clinical symptoms of schizophrenia. The six bespoke video games included a computer-based, role-playing game; a prototype discharge planning gaming; a virtual game in an imaginary town to improve cognitive abilities; a cognitive-bias game that requires players to appraise social situations; a game designed to consult service users in the redesign of their environment; and a medieval fantasy game that provides psychoeducation for psychosis.
As study outcomes, Olivet et al. (51) investigated hope, recovery, empowerment, and stigma; Amado et al. (52) investigated the clinical symptoms of schizophrenia and cognitive skills of visual scanning, verbal and visual working memory, and visuospatial abilities; and Shrimpton and Hurworth (53), van der Krieke et al. (54), Reynolds et al. (55), and Fitzgerald et al. (56) investigated adherence, feasibility, and acceptability. Three of the four card games investigated Michael’s Game, an 80-card game designed to familiarize professionals and service users with cognitive-behavioral therapy (CBT) for psychosis; the fourth game encompasses a virtual reality (VR) card game that helps service users identify emotions from facial expressions. Outcomes for these studies focused on clinical symptoms of schizophrenia (5759) and adherence, feasibility, and acceptability (60). Online games included two studies. One involved a cognitive-remediation game that assesses performance in memory, attention, working memory, psychomotor speed, and executive function as outcome measures. The second compared the playing of video games with watching films and assessed clinical symptoms of schizophrenia. Games used to evaluate interventions involved one game that utilized a collaborative group game designed to explore patient and practitioner experience of receiving C-Co CBTp (a variant of CBT for high-security settings) and assessed user experience of receiving therapy as the outcome measure.
Nearly all games were viewed as acceptable formats for engaging service users and in promoting treatment outcomes. Thirteen games were associated with improvement in all measured outcomes, four showed mixed results, and three yielded no differences. Active, off-the-shelf games such as Xbox games were successful in promoting physical exercise (6163). Other studies found that active games were associated with a significant increase in frontal lobe blood flow (64) and a clinically important difference in walking speed (57). Leutwyler et al. (61, 62) found that these games were associated with high adherence and acceptability, but Leutwyler et al. (60) and Campos et al. (67) found that active games produced no significant difference in objectively measured physical activity.
Games utilized to address the symptoms of schizophrenia were also successful, for example, in the reduction of positive symptoms (52, 52, 5759, 63) and improvement in quality of life (52, 64). Nieman et al. (65) and Amado et al. (52) investigated cognition and found significant improvement in verbal, working, prospective, and retrospective memory. Olivet et al. (51) measured changes in hope, recovery, stigma, and empowerment associated with use of their computer-based game and found significant improvement in service users’ attitude toward recovery. Service users enjoyed playing van der Krieke et al.’s game (54) but found it not challenging enough. and Shrimpton and Hurworth’s (53) game was rejected outright by players because it was seen as too challenging and complicated and because there was no clear and easily discernible purpose.

Themes in Use of Serious Games

This scoping review identified a number of advantages and opportunities in the use of gamification to promote treatment of people with serious mental illness. These findings are grouped in six themes: game design, ease of use, adjuncts and complements to treatment, problem solving and learning, collaboration, and goal orientation. Table 3 displays the frequency of these themes within the 20 articles.
TABLE 3. Themes identified during a scoping review of the use of gaming and gamification in treatment of serious mental illness, by article
 Theme
ArticleGame designEase of useAdjunct and complement to treatmentProblem solving and learningCollaborationGoal orientation
Shrimpton and Hurworth, 2005 (53)  
Khazaal et al., 2006 (69)  
Han et al., 2008 (63)     
Khazaal et al., 2011 (58)  
Leutwyler et al., 2012 (61) 
Leutwyler et al., 2014 (62)  
Van der Krieke et al., 2014 (54)  
Campos et al. 2015 (67)   
Oker et al., 2015 (70)   
Khazaal et al., 2015 (59)  
Kimhy et al., 2015 (68)   
Leutwyler et al., 2015 (60)    
Slater and Painter, 2016 (66)   
Nieman et al., 2015 (65)     
Fitzgerald et al., 2011 (56) 
Amado et al., 2016 (52)    
Reynolds et al., 2017 (55)  
Shimizu et al., 2017 (64)    
Olivet et al., 2018 (51)    
Leutwyler et al., 2018 (57)  

Game design.

This theme was divided into two interrelated parts—game mechanics (features such as character, plot, points, control stick, or graphics that a player utilizes to engage game content) and service user involvement in the design and development of game mechanics. Fifteen of the 20 articles reviewed referred to the importance of design to the game’s ability to engage players and achieve intervention outcomes.
Seven studies used commercially available video games to deliver exercise programs. Five used originally designed role-playing game or VR formats, and one used a VR agent. All demonstrated high user acceptability, and players considered these formats to be authentic and realistic. Not all studies, however, used modern technology; three investigations involved Michael’s Game, and one used the traditional format of a board game. These games also demonstrated good retention rates and were effective in delivering their intervention outcomes. Having a choice and variety of options, appropriate levels of challenge, easy-to-follow instructions, and familiar, intuitive control devices corresponded to player enjoyment, confidence that they can play the game, and successful delivery of intervention outcomes.
Shrimpton and Hurworth (53), however, found that the complexity of their game’s design had a negative impact on the integration of player engagement with game content. Players disliked the game’s graphics and how the technology mediated their interaction with the game’s character, and they struggled to see the purpose of playing the role of their character within game play. Players in van der Krieke’s (54) cognitive-bias game and Nieman et al.’s (65) cognitive-training game found the games’ content unchallenging, became demotivated, and eventually stopped playing.
Games that had service user involvement early in the design process produced better game mechanics and, therefore, were better able to engage service users in game play and the delivery of intervention outcomes. Slater and Painter’s (66) participatory action study and Reynolds et al.’s (55) user-centered design involved service users at the beginning of the design stage and, as such, successfully delivered their intervention outcomes. The games studied by Fitzgerald et al. (56), Nieman et al. (65), and Olivet et al. (51) all showed promise, but the authors acknowledged a lack of service user involvement in the design process and recommended further game development with service users. Shrimpton and Hurworth (51) and van der Krieke et al. (54) struggled to deliver their intervention outcomes because of irreparable design flaws; in both cases, users had little to no involvement in the design process.

Ease of use.

Ease of use was cited by 13 of the 20 studies. The majority of games required no additional training and could therefore be easily administered by any member of the clinical team (51, 54, 56, 58, 61, 62, 67, 68). Michael’s Game (58, 59, 69) was the only game that required some facilitator training. However, this training was relatively straightforward, involving 2 hours of staff time and required no previous skills or understanding in cognitive therapy. Games that were straightforward, easy to use, and fun and that required no special skills were acceptable to both service users and staff (51, 5457, 61, 64, 67, 68). For games where ease of use was a challenge, there was also not enough game narrative to contextualize the player’s activity and a lack of clear instructions to inform the player as to what to do (53, 54). Easy-to-use games were also enjoyable to play (52, 55, 57). Participants who enjoyed playing games also reported an improved quality of life and said that they would recommend the intervention to others (61, 62, 68).

Adjuncts and complements to treatment.

Eleven articles identified the opportunities for games and gamification to be an adjunct or complement to existing treatment programs. Seven studies used commercially available Xbox or Nintendo Wii games to increase physical activity among service users. The authors suggested that these games be considered part of an overall health program for this population, providing a gateway for a more active lifestyle and a more enjoyable and accessible alternative to traditional forms of exercise (57, 61, 62, 67, 68). Shimizu et al.’s (64) investigation of the association between active games and frontal lobe function also found improvement in health-related quality of life measures.

Problem solving and learning.

Eleven articles identified the inclusion of problem solving as important. Problem solving was enabled during game play by the use of characters (53, 70), the navigation of complex virtual environments (51, 52, 55), or scenarios (54, 59). The gaming format enabled the opportunity for meaningful discussion, provided a safe way to engage users in challenging situations and their solutions, and served as a way of identifying and practicing alternative attributions. Participants reported valuing the opportunity to practice real-life scenarios, to employ autonomy in decision making, and to reflect, with peers, on the outcomes of their actions (51, 52, 55). However, authors noted that learning can successfully occur within a game context only if players understand that learning is one of the objectives of the game (53, 54).

Collaboration.

Having an opportunity for collaboration was identified in eight articles as helpful for enhancing participation. Khazaal et al. (69), Khazaal et al. (58), Khazaal et al. (59), and Fitzgerald et al. (56) found that the collaborative nature of their games promoted discussions between patients and staff, encouraged active peer-to-peer interactions, and increased service-user participation. Leutwyler et al. (61) and Leutwyler et al. (62) found that the group play options in commercially available games enhanced enjoyment and increased participation. Participants liked being able to cheer on one another and coach one another to improve goal achievement (61, 62). Collaboration facilitated the sharing of experiences, which enhanced learning from others and created a strong sense of hope among participants (66). Collaboration in the design process created a more realistic and enjoyable game experience.

Goal orientation.

In the articles reviewed, it did not matter whether the game was delivered via the use of complex technology or as a simple card game. If players have a clear purpose and the goals that indicate progress and success are clearly defined, the game is better accepted and engagement is enhanced.

Informed Consent and Institutional Ethics Approval

Of the studies reviewed, informed consent and institutional ethics approval was obtained in studies by Khazaal et al. (69), Han et al. (63), Khazaal et al. (58), Leutwyler et al. (61), Leutwyler et al. (62), Campos et al. (67), Khazaal et al. (59), Kimhy et al. (68), Leutwyler et al. (60), Amado et al. (52), Reynolds et al. (55), Shimizu et al. (64), Leutwyler et al. (57), and Olivet et al. (51). Without giving details, Slater and Painter (66) made reference to an institutional review process, and the study by Fitzgerald et al. (56) was a service evaluation. Studies by Shrimpton and Hurworth (53), van der Krieke et al. (54), Nieman et al. (65), and Oker et al. (70) made no reference to informed consent and institutional ethics approval.

Discussion

Games that were well-designed and that integrated seamlessly with the game’s technology had higher levels of feasibility and acceptability and were more successful in engaging users in game content and in achieving treatment outcomes. The success of the game was not determined per se by the technology used. It did not matter whether the game used system-based technology (such as Xbox), bespoke technology, or a traditional game format. What mediated success was the seamless integration of the game’s structure, content, and purpose with the technology used for delivery. If the structure and purpose of the game made sense to the player and the technology easily facilitated game play and engagement with game content, the player was more likely to feel confident regarding their skills to play the game, be motivated to play, and continue playing or return to play at another time.
User involvement early in game design improved the design of a game and its capacity to successfully deliver intervention outcomes. Of the games reviewed, those that facilitated user involvement were better able to identify and eliminate design problems and barriers at an early stage, which had a positive impact on uptake and sustained use (51, 55, 60, 61, 62, 6670). Games that contained real-life scenarios requiring problem solving and collaboration between service users and staff provided a clear purpose for playing and an opportunity for collaboration. Third-person agents—such as an avatar (70) or the fictional character of “Michael” in Michael’s Game (65)—or the use of electronic environments (51, 54, 55) helped to make the learning activity more realistic and the game more interesting to play.
The literature suggests that disengagement may result from a poor fit between the treatment provided and how meaningful it is to the service user. For most of the service users who participated in the reviewed studies, there seemed to be an acceptable fit between the demands of the intervention and the value they placed upon it as something worth engaging in. The key to improving fit between user and game was user involvement in game design and the ease by which game mechanics facilitated game play. When this goal was achieved, service users were better able to engage in the game and the gamified intervention it was designed to deliver. Because the intervention was gamified, it remained familiar, easy to use, enjoyable, and nonthreatening to the user. In this way gamification has the potential to overcome the barriers to engagement that have so often confounded traditional treatment approaches for serious mental illness.
Gamification can take many different forms. Studies reviewed in this article utilized gaming platforms that ranged from off-the-shelf commercial games and Internet technology to bespoke electronic games and traditional card and board game formats. Success seemed to be related to user involvement early in design, seamless integration with technology so as to enable ease of use, clear game purpose, and realistic learning scenarios. Those wishing to design games and to gamify interventions to engage this population will therefore need to be mindful of these important determinants.
All reviewed studies involved service users who experience serious mental illness and receive treatment in real-world settings, such as inpatient, outpatient, and secure services and early intervention in psychosis. One study was an expert review, and another an action participation study; both studies viewed service users as experts by experience. As such, the transferability of findings from study settings to real-world clinical practice is possible.
The studies investigated ranged from randomized controlled trials (RCTs) (59, 68) and studies with a quasi-experimental design to qualitative expert reviews (51) and participation action research design (66). Of the qualitative investigations, six studies had no control condition or only a limited description of their use of a control group, others had low to modest sample sizes, and two used self-report questionnaires. A number of studies did not collect pretest data or conduct follow-up. Qualitative studies also varied in their data collection methods. As such, the findings of this review should be viewed within this disparate and limited context.
However, the themes identified were consistent across different study designs and methods. Four of the six themes (game design, ease of use, adjunct to treatment, and problem solving) were present in over half of the studies reviewed, and no theme was present in fewer than six studies. The use of serious games and gamification to promote treatment had high feasibility and acceptability with service users who experience serious mental illness and with staff who work with them. When service users rejected games, they did so because of poor design—particularly if the game’s mechanics failed to create a game play experience that was meaningful and therefore motivating to play. When players were motivated to play, engagement in game content was possible.
User involvement early in game design may be the biggest challenge for those wishing to utilize serious games and gamification in clinical settings. It can be tempting for the clinician to provide or design a game with content that they think the service user needs and will benefit from. But enabling a perceived fit between service user and treatment is important for engagement. Despite the diverse range of study designs and methods presented in this review, games that were able to facilitate a better fit were more successful in engagement than those that did not. The six themes described in this review provide the reader with insight into how this perceived fit can be supported across a range of game and study designs.

Conclusions

People who experience serious mental illness and the services that provide care and treatment for them face very real challenges, not least of which include relapse, disengagement, and cost of care. Disengagement can result from a poor fit between the treatment offered and the service user; therefore new approaches that successfully engage the patient in care are desired. Serious games and gamification have a long history of use in management and health education. More recently, they have been used as novel approaches to the treatment of hard-to-engage populations, such as persons with serious mental illness.
This scoping review set out to investigate the current state of knowledge about how games and gamification are used to promote treatment of serious mental illness. Our conclusion is that such approaches have high user and provider feasibility and acceptability in promoting user engagement in treatment. Success was mediated by user involvement in the game design process.
Many of the studies reviewed were of low design quality, although three RCTs were promising in their design and findings. That is not surprising considering that the use of gamification in treatment of serious mental illness is an emerging area of practice. Scoping reviews have particular relevance when emerging evidence is being considered or a range of study designs need to be considered (48). Better-quality investigations that include controlled designs and postintervention follow-up are needed to improve our understanding of game design the use of gamification, and how that knowledge can be transferred to practice.

Supplementary Material

File (appi.ps.201800567.ds001.pdf)

References

1.
Sawyer B: From cells to cell processors: the integration of health and video games. IEEE Comput Graph Appl 2008; 28:83–85
2.
Bellotti F, Berta R, De Gloria A, et al: Adaptive experience engine for serious games. IEEE Trans Comput Intell AI Games 2009; 1:264–280
3.
Davis K, Drey N, Gould D: What are scoping studies? A review of the nursing literature. Int J Nurs Stud 2009; 46:1386–1400
4.
Arksey H, O’Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8:19–32
5.
Levac D, Colquhoun H, O’Brien KK: Scoping studies: advancing the methodology. Implement Sci 2010; 5:69
6.
Booth A, Papaioannou D, Sutton A: Systematic Approaches to a Successful Literature Review. London, Sage, 2011
7.
Halas G, Schultz AS, Rothney J, et al: A scoping review protocol to map the research foci trends in tobacco control over the last decade. BMJ Open 2015; 5:e006643
8.
Hardison ME, Roll SC: Mindfulness interventions in physical rehabilitation: a scoping review. Am J Occup Ther 2016; 70: 1–9
9.
Peters MD, Godfrey CM, Khalil H, et al: Guidance for conducting systematic scoping reviews. Int J Evid-Based Healthc 2015; 13:141–146
10.
Lieberman JA, Stroup TS, McEvoy JP, et al: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353:1209–1223
11.
Wilding N, Startup S: Patient treatment adherence in cognitive behavioural therapy for acute psychosis: the role of recovery style and working alliance. Behav Cogn Psychother 2006; 34:191–199
12.
Kreyenbuhl J, Nossel IR, Dixon LB: Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 2009; 35:696–703
13.
Almond S, Knapp M, Francois C, et al: Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004; 184:346–351
14.
Fitzgerald MM: Comparison of recovery style and insight of patients with severe mental illness in secure services with those in community services. J Psychiatr Ment Health Nurs 2009; 17:229–235
15.
Bellack AS: Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 2006; 32:432–442
16.
Mueser KT, Meyer PS, Penn DL, et al: The illness management and recovery program: rationale, development, and preliminary findings. Schizophr Bull 2006; 32(suppl_1): S32–S43
17.
Burgess P, Pirkis J, Coombs T, et al: Assessing the value of existing recovery measures for routine use in Australian mental health services. Aust N Z J Psychiatry 2011; 45:267–280
18.
Deegan PE: The independent living movement and people with psychiatric disabilities: taking back control over our own lives. Psychosocial Rehabilitation Journal 1992; 15:3
19.
Bodine MN: Validation of the Mental Health Recovery Measure as a clinical assessment. Doctoral dissertation, Toledo, Ohio, University of Toledo, 2013
20.
Deegan PE: Recovery as a journey of the heart. Psychiatr Rehabil J 1996; 19:91–97
21.
Andresen R, Caputi P, Oades L: Stages of recovery instrument: development of a measure of recovery from serious mental illness. Aust N Z J Psychiatry 2006; 40:972–980
22.
Lecomte T, Spidel A, Leclerc C, et al: Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis. Schizophr Res 2008; 102:295–302
23.
Anderson KH, Ford S, Robson D, et al: An exploratory, randomized controlled trial of adherence therapy for people with schizophrenia. Int J Ment Health Nurs 2010; 19:340–349
24.
Fitzgerald M, Kirk G: The design, development and trial of a serious game intervention for low secure service users who experience serious mental illness. Ment Health Pract 2013; 17:14–19
25.
Shandley K, Austin D, Klein B, et al: An evaluation of Reach Out Central: an online gaming program for supporting the mental health of young people. Health Educ Res 2010; 25:563–574
26.
Burns JM, Webb M, Durkin LA, et al: Reach Out Central: a serious game designed to engage young men to improve mental health and wellbeing. Med J Aust 2010; 192(suppl):S27–S30
27.
Purdy JA: Serious games: getting serious about digital games in learning. Corporate University Journal 2010. www.corpu.com
28.
McCallum S, Boletsis C: Dementia games: a literature review of dementia-related serious games; in Serious Games Development and Applications. Edited by Ma M, Oliveira MF, Petersen S, et al. Berlin, Springer, 2013
29.
Wiklund E, Wakerius V: The gamification process: a framework on gamification. Master’s thesis, Jönköping University, Jönköping International Business School, 2016. http://hj.diva-portal.org/smash/record.jsf?pid=diva2%3A931932&dswid=1702
30.
Lau HM, Smit JH, Fleming TM, et al: Serious games for mental health: are they accessible, feasible, and effective? A systematic review and meta-analysis. Front Psychiatry 2017; 7:209
31.
Abt CC: Serious Games. New York, Viking Press, 1970
32.
Mitgutsch K, Alvarado N: Purposeful by design? A serious game design assessment framework; in Proceedings of the International Conference on the Foundations of Digital Games. New York, Association for Computing Machinery, 2012
33.
Orji R, Mandryk RL, Vassileva J, et al: Tailoring persuasive health games to gamer type; in Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. New York, Association for Computing Machinery, 2013
34.
Morford ZH, Witts BN, Killingsworth KJ, et al: Gamification: the intersection between behaviour analysis and game design technologies. Behav Anal 2014; 37:25–40
35.
Fleming TM, Bavin L, Stasiak K, et al: Serious games and gamification for mental health: current status and promising directions. Front Psychiatry 2017; 7:215
36.
Triantafyllakos G, Palaigeorgiou G, Tsoukalas I: Designing educational software with students through collaborative design games: the We! Design & Play framework. Comput Educ 2011; 56:227–242
37.
Wood L, Reiners T: Gamification; in Encyclopedia of Information Science and Technology, Third Ed. Hershey, PA, IGI Global, 2015
38.
Huotari K, Hamari J: A definition for gamification: anchoring gamification in the service marketing literature. Electron Mark 2017; 27:21–31
39.
Sailer M, Hense JU, Mayr SK, et al: How gamification motivates: an experimental study of the effects of specific game design elements on psychological need satisfaction. Comput Human Behav 2017; 69:371–380
40.
Buckley J, DeWille T, Exton C: A gamification–motivation design framework for educational software developers. J Educ Technol Syst 2018; 47:101–127
41.
Deterding S, Dixon D, Khaled R, et al: From game design elements to gamefulness: defining gamification; in Proceedings of the 15th International Academic MindTrek Conference. New York, Association for Computing Machinery, 2011
42.
Urh M, Vukovic G, Jereb E: The model for introduction of gamification into e-learning in higher education. Procedia Soc Behav Sci 2015; 197:388–397
43.
Ruhi U: Level up your strategy: towards a descriptive framework for meaningful enterprise gamification. Technology Innovation Management Review 5:5–16, 2015
44.
O’Flaherty J, Phillips C: The use of flipped classrooms in higher education: a scoping review. Internet High Educ 25:85–95, 2015
45.
Dijkers M: What is a scoping review? KT Update 2015; 4:1–5. ktdrr.org/products/update/v4n1
46.
De Lope RP, Medina-Medina N: A comprehensive taxonomy for serious games. J Educ Comput Res 2017; 55:629–672
47.
Moher D, Liberati A, Tetzlaff J, et al: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6:e1000097
48.
Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005; 15:1277–1288
49.
Green J, Thorogood N: Qualitative Methods for Health Research. London, Sage, 2018
50.
Braun V, Clarke V: Successful Qualitative Research: A Practical Guide for Beginners. London, Sage, 2013
51.
Olivet J, Haselden M, Piscitelli S, et al: Results from a pilot study of a computer‐based role‐playing game for young people with psychosis. Early Interv Psychiatry 2019; 13:767–772
52.
Amado I, Brénugat-Herné L, Orriols E, et al: A serious game to improve cognitive functions in schizophrenia: a pilot study. Front Psychiatry 2016; 7:64
53.
Shrimpton B, Hurworth R: Adventures in evaluation: reviewing a CD-ROM based adventure game designed for young people recovering from psychosis. J Educ Multimed Hypermedia 2005; 14:273–290
54.
van der Krieke L, Boonstra N, Malda A: Bias Blaster: a game to beat interpretation bias in psychosis. Psychiatr Serv 2014; 65:961–996
55.
Reynolds LM, Davies JP, Mann B, et al: StreetWise: developing a serious game to support forensic mental health service users’ preparation for discharge: a feasibility study. J Psychiatr Ment Health Nurs 2017; 24:185–193
56.
Fitzgerald MM, Kirk GD, Bristow CA: Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment. J Psychiatr Ment Health Nurs 2011; 18:316–322
57.
Leutwyler H, Hubbard E, Cooper BA, et al: Impact of a pilot video game–based physical activity program on walking speed in adults with schizophrenia. Community Ment Health J 2018; 54:735–739
58.
Khazaal Y, Favrod J, Azoulay S, et al: “Michael’s Game,” a card game for the treatment of psychotic symptoms. Patient Educ Couns 2011; 83:210–216
59.
Khazaal Y, Chatton A, Dieben K, et al: Reducing delusional conviction through a cognitive-based group training game: a multicentre randomized controlled trial. Front Psychiatry 2015; 6:66
60.
Leutwyler H, Hubbard E, Cooper B, et al: The impact of a video game–based pilot physical activity program in older adults with schizophrenia on subjectively and objectively measured physical activity. Front Psychiatry 2015; 6:180
61.
Leutwyler H, Hubbard E, Vinogradov S, et al: Video games to promote physical activity in older adults with schizophrenia. Games Health J1:381–383
62.
Leutwyler H, Hubbard EM, Dowling GA: Adherence to a video game–based physical activity program for older adults with schizophrenia. Games Health J 2014; 3:227–233
63.
Han DH, Renshaw PF, Sim ME, et al: The effect of Internet video game play on clinical and extrapyramidal symptoms in patients with schizophrenia. Schizophr Res 2008; 103:338–340
64.
Shimizu N, Umemura T, Matsunaga M, et al: An interactive sports video game as an intervention for rehabilitation of community-living patients with schizophrenia: a controlled, single-blind, crossover study. PLoS One 2017; 12:e0187480
65.
Nieman D, Domen A, Kumar R, et al: Cognitive remediation in psychiatric patients with an online cognitive game and assessment tool. Eur Neuropsychopharmacol 2015; 25(suppl 2)
66.
Slater JJ, Painter G: Taking steps: using collaborative group game design to consolidate and evaluate experiences of individual chief complaint-orientated cognitive behavioural therapy for psychosis (C-Co CBTp) in conditions of high security Cogn Behav Therap 2016; 9:e9
67.
Campos C, Mesquita F, Marques A, et al: Feasibility and acceptability of an exergame intervention for schizophrenia. Psychol Sport Exerc 2015; 19:50–58
68.
Kimhy D, Khan S, Ayanrouh L, et al: Use of active-play video games to enhance aerobic fitness in schizophrenia: feasibility, safety, and adherence. Psychiatr Serv 2016; 67:240–243
69.
Khazaal Y, Favrod J, Libbrecht J, et al: A card game for the treatment of delusional ideas: a naturalistic pilot trial. BMC Psychiatry 2006; 6:48
70.
Oker A, Prigent E, Courgeon M, et al: How and why affective and reactive virtual agents will bring new insights on social cognitive disorders in schizophrenia? An illustration with a virtual card game paradigm. Front Hum Neurosci 2015; 9:133

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 170 - 183
PubMed: 31640521

History

Received: 16 December 2018
Revision received: 18 August 2019
Accepted: 29 August 2019
Published online: 23 October 2019
Published in print: February 01, 2020

Keywords

  1. Schizophrenia
  2. Recovery
  3. Serious Games
  4. Gamification
  5. Treatment Outcomes
  6. Scoping Review

Authors

Details

Martin Fitzgerald, B.Sc., M.Sc. [email protected]
School of Allied Health Professions and Midwifery, University of Bradford, Bradford, United Kingdom (Fitzgerald); Pennine Care National Health Service Foundation Trust, Lancashire, United Kingdom (Fitzgerald, Ratcliffe).
Gemma Ratcliffe, B.Sc., M.Sc
School of Allied Health Professions and Midwifery, University of Bradford, Bradford, United Kingdom (Fitzgerald); Pennine Care National Health Service Foundation Trust, Lancashire, United Kingdom (Fitzgerald, Ratcliffe).

Notes

Send correspondence to Mr. Fitzgerald ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share