Stress – mission possible! The STRESSmission game as a psychoeducational tool in coping with stress

Stress – mission possible! The STRESSmission game as a psychoeducational tool in coping with stress | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Stress – mission possible! The STRESSmission game as a psychoeducational tool in coping with stress Katarzyna Archanowicz-Kudelska, Joanna Sliwowska, Edyta Bonk This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5269742/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Stress is an inherent and inextricable aspect of the live. When stress is excessive, it become chronic and has a negative impact on health. There is a need to disseminate knowledge about stress management techniques in order to reduce stress levels. In response to this demand, STRESmission, a psycho-educational tool was designed. It comprises task cards (grouped according to Aristel's triad of soma, psyche and polis), stress event cards (scored based on the Holmes and Rahe stress event scale), power and place cards, and a game board. We have tested if STRESmission (1) reduces perceived stress levels immediately and on a one-off basis, and whether it is an educational tool that helps in the acquisition of coping strategies, (2) can reduce stress levels in the long term, (3) is useful and attractive enough to encourage its use and therefore practical use of its benefits. A series of studies was conducted on groups of University students. We have found that STRESSmission decreased both subjective stress levels (psychological tests) and objective stress levels (lowering cortisol - CORT levels in the saliva). We concluded that the board game could be a stress-releasing and a learning tool to help cope with stressors. Biological sciences/Neuroscience Biological sciences/Psychology stress game cortisol stress coping resilience COVID-19 Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 INTRODUCTION The contemporary era is characterized by circumstances that can be described as VUCA – an acronym for volatility, uncertainty, complexity, and ambiguity 1 . Additionally, COVID-19 started on 11 March 2019, which the World Health Organization (WHO) announced later as a pandemic 2 added to this complexity. The announcement marked the beginning of a challenging period, which presented a variety of stresses, strains, and threats to public health, both physical and mental. Fear of contracting the virus was only one part of the equation; other unknown sources of anxiety also caused stress for many individuals ,3,4,5,6 . The pandemic's impact stemmed from genuine health concerns and the prospect of one's own or a loved one's passing and from abrupt, unforeseen social disruptions that required us to adapt rapidly - with varying degrees of success. There were encountered numerous challenges. Due to lockdowns, long-term isolation or quarantine, and border closures, many people had to work and learn remotely. Additionally, the pandemic resulted in a loss of income for many individuals, leading to economic destabilization 7,8 . Thus, COVID-19 and its associated restrictions could be viewed as factors causing chronic stress. Indeed, meta-analyses reveal that over 50% of the worldwide populace underwent amplified stress and general anxiety levels following the COVID-19 outbreak 8 . Nonetheless, this percentage fluctuated between countries, hinging on factors like their healthcare infrastructures, COVID-19 control measures, and the support services available to their nationals 9 . As our study was performed in Poland, we would like to emphasize the impact of both the pandemic and the economic situation in the country on the population. High-stress levels noted in its population, in addition to the COVID-19 challenge, could arise from the elevated incidence rate, multiple conflicting pieces of information on preventive behavior, and low public access to psychological and psychiatric care 10,11 . Furthermore, in February 2022, following two years of pandemic, Russia launched a military invasion of Ukraine, which started right next to the Polish border. As a result, Polish citizens became anxious about the safety of their nation's borders and were left horrified by the media coverage depicting the nearby hostilities 12,13,14 . The conflict in Ukraine disrupted the established daily routine once again as over 2 million Ukrainian citizens, mainly women and children, fled to Polish territory in just one month due to the war 15 . Poles frequently assisted these refugees without depending on sluggish governmental and institutional aid. Although the state of epidemics in Poland was lifted in May 2022, the ongoing invasion in Ukraine no longer elicits such severe anxiety reactions, and the refugee crisis has been temporarily averted, the enduring consequences of stress must be addressed 16 . According to the WHO stress is defined as a state of worry or mental tension caused by a difficult situation. A natural human response prompts us to address challenges and threats. Everyone experiences stress to some degree, but how we respond to stress, makes a big difference to our overall well-being’ 17 . When stress it is strong or prolonged, it could be associated with health problems, including mental illness, such as depression or post-traumatic stress disorder (PTSD) 18.19 . The stress response has two components: a fast (rapid) response and a slow one. A rapid response starts by activating the sympathetic and inhibiting the parasympathetic autonomic nervous system and releasing adrenaline from the adrenal medulla. Fear, fight, and flight hormones mobilize the body to join the action in a stressful situation. In the second phase of the stress response, the hypothalamic-pituitary-adrenal (HPA) axis is involved. The corticotropin-releasing hormone (CRH) is secreted from the part of the brain called the hypothalamus, which stimulates the pituitary gland to secrete adrenocorticotropin hormone (ACTH). This leads to the release of cortisol- CORT hormones from the adrenal cortex. If the stress is intense and long-lasting (chronic), the body cannot cope with the situation. As a result, the accumulation of too much CORT could damage the brain and other organs and lead to exhaustion of the system and illness. Thus, people used different coping strategies in light of the stress challenges. Endler and Parker ( 1990 ) identified three styles of coping with stress: 1) task-focused style, 2) emotions-focused style, 3) avoidance-focused style 20 . Notably, for our current paper, the emotions-focus style relies on seeking social contacts to get away from problems and receive support 21 . The board games, such as the one described in this paper, STRESSmission, comprise social contact with psychoeducational components, which teach people how to use e methods to cope with everyday stress. It should be emphasized that this is a new game, and the prototype was tested in the current study (for the details, see www.stresmisja.pl ). In spite that the use of modern board games has been growing in past years in education, research, and mental health attendance 22 , there is a lack of comprehensive studies on using it as a psychoeducational tool helping in learning stress coping strategies. The literature concerning health benefits of board games is still limited and mainly focuses on subjective parameters (e.g. 23,24 ). Moreover, in a study performed during the COVID-19 pandemic, it was found that playing any type of modern board and card game (excluding games with a high incidence of luck) could be beneficial for children at risk of social exclusion 25 . In healthy older adults over 65 years old, it was revealed that board and card games could be an effective cognitive intervention to maintain some cognitive functions 26 . Moreover, the study performed in elderly demonstrates a significant association between a higher level of participation in leisure activities, including playing a board game, and a decreased risk of dementia such as Alzheimer’s disease and vascular dementia 27 . In light of the above findings, we perform studies to test if using the game STRESSmission could be a tool not only to release stress but also as a learning tool, which allows players to acquire strategies to cope with stressful situations. This game uses several coping strategies and employs various tasks during the game from three different categories: polis, soma, and psyche. Thus, the study aimed to investigate: 1) via longitudinal study – a) stress coping techniques and styles (CISS - Coping Inventory for Stressful Situations, Mini-COPE), b) life satisfaction (SWLS - The Satisfaction With Life Scale), and emotion regulation (ERQ - Emotion Regulation Questionnaire), c) knowledge of various stress coping techniques used in STRESmission using a psychological test- to assess participant knowledge of coping strategies used in the game, d) questions in the survey concerned experience with the game; 2) via physiological studies – levels of stress hormone (CORT) in the saliva before and after playing game; 3) via a qualitative study - the attractiveness and playability of the game prototype (as well as to test graphical concepts, one of which was eventually chosen). RESULTS 1. A longitudinal study – psychological tests Psychological tests were run according to the experimental design presented in Methods. Playing the STRESSmission increases number of anti-stress techniques used by participants We have tested the hypothesis, which stated that regular gaming (experimental group - E) increases the number of anti-stress techniques used compared to the control (C) group. Indeed, there was a statistically significant increase in number of anti-stress techniques in E compared to C group F (1, 68) = 5.86; p = 0.018 (Fig. 1 ). Further, analyses were then performed for each technique, which showed the following statistically significant results. When we have compered pre-test to post-test we have found an increase in number for the following techniques for E compared to C group: shaking - F (1, 70) = 12.31; p = 0. 001; movement - F (1, 70) = 8.00; p = 0.006; mindfulness - F (1, 70) = 7.16; p = 0.009; art-therapy - F (1, 70) = 5.81; p = 0.019, (Figs. 2 A-D ). Additionally, in pre-test for movement techniques there was a decrease in E compared to C group F(1, 70) = 4.20; p = 0.004. In contrast, in pre-test for mindfulness technique there was an increase in E compared to C group F(1, 70) = 4.98; p = 0.029. Playing STRESSmission changes the use of coping strategies We have also confirmed the hypothesis that regular playing STRESSmission causes changes in the use of various coping strategies in E compared to C group. This hypothesis was true (the data was statistically significant) between E and C group for the using of following techniques: Instrumental support - In post-test there was an increase in using this strategy in E groups, F (1, 70) = 7.26; p = 0.009, but not in C group F(1, 70) = 2.99; p = 0.088 (Fig. 3 A). Humor – While in E group there was a decrease in using this strategy F(1, 70) = 9.13; p = 0 004 in E group, and opposite effect was observed C group F(1, 70) = 4.29; p = 0.042; (Fig. 3 B). Venting – In post-test there was an increase in use this technique in E compared to C group F(1, 70) = 4.01; p = 0.049 (Fig. 3 C). There were changes in use of emotion-oriented as well as task- and avoidance-oriented style of coping with stress in response to playing STRESSmission In particular we have found that: Emotion-oriented style of coping - There was a decrease in using this style in E group F(1, 70) = 9.30; p = 0.003but not in C group, F(1, 70) = 0.42; p = 0.521; (Fig. 4 A). Avoidance-oriented style of coping - In the post-test there was an increase in using this techniques in E group, F (1, 70) = 4.52; p = 0.037compered to C group, F (1, 70) = 1.88; p = 0.174. (Fig. 4 B). Additionally there was a trend in increase in a sub-type of avoidance-oriented style called distracting oneself with other tasks only in E group F(1, 70) = 3.55, p = 0.064. Playing STRESSmission decreases subjective stress level There was a decrease in a subjective stress level in E group between game 1 and game 8 of playing the STRESSmission t (36) = 6.27, p < 0.001. The game 1 was played in December 2022 and game 8 in February 2023 (Fig. 5 ). Assessment of game attractiveness People playing STRESmission rated the attractiveness of the game at level 4 (on a 5-point scale, where one meant "I don't like it very much" and 5 - "I like it very much"). Referring to the positive aspects, the participants of the study primarily appreciated the psychoeducational value of the game : "STRESSmission allows me to develop curiosity about anti-stress techniques; it promotes coping with stress and shows how to do it; it is something new; I think necessary and effective, presenting stress coping strategies attractively; it provides extremely necessary information in an entertaining form". The respondents considered the added value of participating in the game to be the opportunity to have a nice time " The game is fun, some tasks are really enjoyable; you can interestingly spend time; you can calm down and relax" . Among the arguments proving the game's high attractiveness, there was also the possibility of integration with other players " an interesting way to talk and get to know yourself; I like the aspect of conversation and integration that the game brings; you can open up and feel a friendly, non-judgmental atmosphere ", which was provided by the cooperative nature of the game, as well as some of the tasks proposed as part of STRESmission (mainly from the POLIS category, in which some of the tasks involve sharing one's experience). The justification for the lower ratings of the game's attractiveness included mainly comments indicating the feeling of monotony in the situation of regularly playing the game with a similar group of students. Despite some criticisms, all respondents declared that they would recommend this game to others as they see significant. 2. A physiological study – measuring CORT level in saliva Playing STRESSmission game decreases CORT levels in saliva We have confirmed the hypothesis that the playing STRESSmission have both short- and long-term effects. In particular we have shown that during game 1, 4 and 8 there was a decrease in CORT levels in the saliva after playing the game (p’s < 0,5; Fig. 6 ). We have also found a long-term effects, such as a reduction in the CORT levels during the 8 game (post-test) was lower compared to 1 game (pre-test; p < 0.05; Fig. 6 ). Additionally we have found that in post-test CORT level was lower at game 4 compared to game 1 (p < 0.05; Fig. 6 ). 3. A qualitive study Evaluation of the game as a psychoeducational tool The idea of the game was very well received. Based on the obtained results, the following features of the STRESSmission game were emphasized by participants: uniqueness, cooperative nature, psyche-educational value, psycho-educational aid in therapy, and building mutual trust between group members; the responses given by the respondents for each characteristic are presented in their own words, in Table 1 . Table 1 Table 1 Verbatims of the respondents from Focus Group Interventions (FGI) received during the qualitive studies Characteristic of STRESSmission Verbatims of the respondents from Focus Group Interventions (FGI) Uniqueness : ‘Well, I haven't seen anything like this on the market. (…) It teaches you how to manage stress". Its cooperative nature : ‘Most games are for this kind of competition. And here we play as a team. I like that’, ‘We're all playing for the same basket’. Psycho-educational value : ‘This game shows what you can do to cope better with stress. It plays like that - it teaches’, ‘It smuggles in the fact that we are supposedly playing, but in reality we are learning how to deal with stress’, ‘You can learn some techniques so that you can remember them and deal with them yourself in a certain way’. ‘The game wants to sell some kind of tricks or methods to deal with stress, to chill out, to relax, to breathe - that's cool’. Psycho-educational aid in therapy : "It could be like that at school, in the pedagogue's office, or something to play so that you can mentally clear yourself." Building mutual trust between group members - within the within teams and groups : ‘This allows the players to get to know each other better, but also to get closer to each other, to integrate with friends, work and family. This, in turn, builds a relationship.’, ‘Yes, this game brings you closer, it brings you together’, ‘I see these games at some of these meetings, integration training or something’, ‘It's not about making time go by quickly, it's about staying together’. Building mutual trust between group members - within the family and people who, by definition, should be close to each other but don't always succeed : ‘I can see that you can sit down with your family. These are the times when we don't know much. What does my son like? What does my partner like? What are his favorite perfumes? Well, I don't know, and this way I might find out. It would be good for my family.’, ‘I would play with my family. Because I can see that everybody has to say something about themselves and then you can get to know these children, your children…’ As we see in Table 1 , the STRESSmission game was seen as suitable for playing with good friends we already trust or with family because of the subject matter. It was also found to have the potential to bring up personal issues that we do not often share, even with loved ones. It was noted that players should have a certain reflexivity, be interested in personal development, self-development, psychology (including pop psychology), and stress reduction techniques, or at least not dismiss them as 'not turning everything into a joke', 'It's a game for people who have at least a slightly higher level of awareness that stress exists, that it needs to be dealt with.' Because it requires concentration, it should be played in a quiet, calm place, in a trusted, responsible group of people with whom you can be yourself, and even in a therapist's office; you need to find the right time and place for it. 'It is not the kind of game you can just put on the table and play all the time’. DISSCUSSION Stress – mission possible! Summary of the findings Although the subject concentrating on using different games, including board games, to cope with different diseases and broaden their knowledge is presented in the literature, this study is the first one to examine changes in physiological outcomes such as cortisol (stress hormone levels) in response to playing the game. Importantly, we have provided a novel data, which have shown that the game decreased both subjective stress levels (psychological tests) and objective (lowering CORT levels in the saliva). Importantly, the effects are long-lasting. Moreover, we have found that playing this game increased number of anti-stress techniques used by participants. In particular, we have found that STRESSmission influenced coping with stress strategies used by players: 1) increases the use of mindfulness, movement, shaking, and art-therapy techniques; 2) decreases the coping strategies based on the sense of humor in comparison to control group. A sense of humor can escape a stressful situation 28 or cover real emotions (e.g., fear) with a smile, 29 . If we treat this strategy as distancing oneself from the problem or even as a defense mechanism, acquiring new skills may reduce the frequency of using such a method. Thus, we assumed that those playing participants may have begun to use a different repertoire of techniques instead of humor as a result of psychoeducation. Additionally, we have revealed that in post-test experimental group used more often instrumental support and venting strategy compared to controls. Instrumental support refers to helps with everyday needs such as shopping, cooking, dog walking etc. In order to cope with stressors, people use different styles of coping with stress: 1) task-oriented, 2) emotions-oriented, 3) avoidance-oriented 20 . Here we shown that playing STRESSmission changes use of different style of coping with stress, with decrease of emotion-oriented, and higher number of avoidance-oriented style in post-test in experimental compared to control group. Finally, we have shown the attractiveness and usefulness of as a psychoeducational tool for learning anti-stress techniques. To summarize the above results, it can be concluded that the game fulfills its psycho-educational goal of acquiring new skills for dealing with stressors. In addition to summarizing above the most important finding, numerous others were made. Notably, there was a decrease in CORT levels, which we have seen during the first, four and eight playing game. Moreover, the effect of playing the game was long-lasting as the post-test level of CORT was lower during game 8, compared to pre-test game 1. This finding was also confirmed by psychological tests in which participants reported lower level of stress during game 8 compared to game 1. Board games vs. computer games Different types of games have been proven as useful coping strategies in cases of traumatic events. Among these are computer games, which are much better studied than board games. Even a brief intervention involving a computer game was found to be a promising strategy to reduce intrusive memories of trauma, which is considered one of the core clinical symptoms of PTSD 30 . In another study, a virtual game board and fMRI were employed to assess individual differences in the ability to cope with danger and examine changes in the synchronization of different brain parts 31 . These exciting experiments concluded that successfully performing adaptive actions in the face of threat requires functional synchronization of a neural circuit consisting of the medial prefrontal cortex (mPFC), striatum, and amygdala. On the other hand, alterations in the crosstalk between these brain regions might underlie anxiety symptoms and impair ability to cope under stress actively 31 . However, it is essential to note that many studies in this subject are still at an early stage. Nevertheless, their potential for large-scale use and relatively low unit cost is promising in providing beneficial effects for the population 32 . However, besides the examples mentioned above of beneficial effects of computer games, numerous studies indicate that these games may lead to long-term changes in the reward circuitry that resemble the effects of substance dependence 33 . Thus, the alternative could be board games, which have a long history, with the earliest known board games being 5,000 years old and were played in Egypt. A majority of the board game interventions focused on education to increase health-related knowledge and behaviors 34 . A board game called ShopTalk was found to be a therapeutic tool developed to help children ages 7–16 years living with cancer 35 . This pilot study showed that the game helped young patients talk about their illness in a non-threatening, fun, and creative way. Another example of the beneficial effect of board games came from Japan, where Shogi, a popular board game, and shogi-assisted cognitive–behavioral therapy (S-CBT) has been examined. In a group of 61 elderly participants, it was found that the S-CBT may be beneficial for stress management 36 . It was found that playing the game increased problem-solving skills for alleviating stress. Thus, the above-mentioned data indicate the beneficial effects of board games on improving health outcomes. STRESSmission as a psychoeducational tool Our results indicate that the STRESSmission is indeed a psychoeducational tool as it caused changes in coping style and decreased use of emotions-oriented style. As this style relies on seeking social contacts to get away from problems and receive support 21 , thus by playing the game the above goals could be achieved. Moreover, a decrease in coping strategies focused on emotions by playing the STRESSmission is of particular interest as this strategy can deepen tension and depression 37 . As research indicates, this style is characteristic of people experiencing anxiety and experiencing depression 38 and with lower self-efficacy 39 . Thus, playing through the educational experience of stress management techniques can indirectly influence the control of affective states. An increase in avoidance techniques in players (which includes engaging in substitute activities and seeking social contacts) may be related to practicing redirecting attention and conversations between participants in the game. Furthermore, our results indicate higher levels of social support-seeking and discharge strategies in the experimental group in the post-test than in the control group. So, we concluded that the game creates a space to talk about situations related to stress and coping. Perhaps it was a supportive experience for those who played and provided an opportunity to discharge emotions. It can be concluded that the cooperative nature of the game and conversation-oriented tasks (polis category) is combined with one of the forms of this strategy, which is the search for support and social contact. It is well known that mutual interaction and aid are of key importance for living both for humans. Numerous studies indicate that prosocial behavior has protective effects on health and adaptation to stress 40,41,42 . Significant outcomes of our study were an assessment of subjective and objective stress levels. The declared level of perceived stress after 3 months of playing STRESSmission has diminished. This result indicates realizing the primary goal of learning techniques for coping with stress. The game fulfills its functions at the level of subjective feelings of stress. Finally, the above results were confirmed by physiological data (cortisol – CORT measurement in the saliva of participants). Besides the psychological tests outcomes described above, other benefits of games are presented in the literature. In general, games can support engagement in play and fantasy. These, in turn, are indicated as important mechanisms facilitating greater attentional control, enhanced learning, and providing patient insight toward impacting long-term behaviors 43 . However compared to video games, board games have a significant advantage via their ability to facilitate face-to-face interactions with other friends, family members, or even a therapist. Moreover, these social interactions should enhance learning opportunities 44 . Additionally, it was shown that board games are good tools for building knowledge, and examples of using it to broaden information on HIV and sexually transmitted diseases 45 , learning of healthy eating habits 46 and health outcomes in diabetic patients 47 . Our studies were performed on cohorts of healthy students; however, in the light of other results discussed above, it is possible that this board game could also be successfully used in patients dealing with trauma, anxiety, depression, and other disorders. During our work on this product, we have carefully considered this further application of the game for people with mental health problems, designing with care the tasks using psychological knowledge. Thus, together, the above-mentioned studies open an array of possibilities for applying games such as STRESSmission, not only as a psychoeducational tool to teach anti-stress techniques, but also likely in the future as promising therapeutic targets for fear and anxiety disorders and illnesses related to trauma and stress. It is also important to note that our current study has limitations, e.g., the women were overrepresented in study groups, as 47 woman, 29 man participated in this experiment. Further studies should be performed on participants with traumas, PTSD and other stress-related health problems and compared with healthy participants. Another limitation of the study is the size and age of the group. Experiments could be continued on bigger-sized groups and participants of different age groups, as well as study sex differences. Moreover, it would be of interest to compare the above-discussed outcomes to those of other board games or video games. Due to the luck of adequate founding, we could not perform such comparison in the current study. It would be also of interest to use fMRI in the further experiments during performing certain tasks. Future directions: From bench to market Besides, the benefits described above coming from quantitative studies – psychological and physiological tests, in the qualitative studies and psychological tests we also proved the game's attractiveness. Based on our results we concluded that the game was well-received. It is also worth mentioning that STRESSmission received the silver award at the 16th International Invention and Innovation Show INTARG 2023, Katowice, Poland. The idea of creating a social innovation - a psychoeducational game, STRESSmission was also presented in detail in our previous paper 48 . The webpage describing the major benefits from playing the game was created (for the details see www.stesmisja.pl ), and the booklet outlining stress management techniques is available to the public. Thus, the data obtained so far encourages our research team to continue developing strategies to bring the product into the market. We believe that our interdisciplinary effort will succeed in bringing the product from the bench to the marker. Conclusion To summarize our findings, performing qualitative, longitudinal, and physiological studies on a group of university students, we concluded that the STRESSmission board game could be a stress-releasing and a learning tool to help cope with stressors. In light of the obtained data, we recommend including this game as a psychoeducational tool, which may improve the quality of life of people in modern society who deal with stress-related problems in the post-COVID-19 era. METHODS The study has been approved by the Ethical committee at Poznań University of Medical Sciences in Poznań, Poland (license number 395/22). All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants. All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants and/or their legal guardians. 1. A longitudinal study – Psychological tests The following 6 hypotheses (H) were tested: H1: Regular playing the STRESSmission increases the number of anti-stress techniques used in experimental (E) compared to control (C) group. H2: Regular playing STRESSmission causes changes in the use of various coping strategies and /or styles in E compared to C group. Additionally, in E group we have tested the following hypothesis H3: The subjective stress level will decrease due to the regular playing the STRESSmission. H4: The STRESSmission game is useful and attractive enough to encourage to be a practical tool to cope with stress. Participants The study involved 76 participants /39 in the experimental group (E) and 37 in the control (C) group; 47 woman, 29 man, average age 23 years old/, who were psychology students at SWPS University and signed up for the study through the SONA research panel. The first 40 people were qualified to the experimental group and the following 36 to the control. Students participating in the study were healthy, which means they did not report chronic diseases in the last three months. They also were not addicted to drugs, including nicotine, and did not suffer from trauma in the last three months before the experiment started. Measures The study measured the dependent variable - stress coping techniques and styles (CISS - Coping Inventory for Stressful Situations, Mini-COPE), and emotion regulation (ERQ - Emotion Regulation Questionnaire) - at two-time points over three months: the pretest (before playing a board game) and the posttest (immediately after playing a board game). The Polish version of the CISS measured task-, emotion-, and avoidance-oriented coping strategies 20,49 . The measure consists of 48 items to which subjects respond on a five-point Likert-type scale ranging from ‘1 – not at all’, to ‘5 – very much’. Mini-COPE Questionnaire 50 in Polish adaptation consisted of 28 statements that were part of 14 strategies (two statements in each strategy): ‘active coping,’ ‘planning,’ ‘positive reframing,’ ‘acceptance,’ ‘humor,’ ‘religion,’ ‘use of emotional support,’ ‘use of instrumental support,’ ‘self-distraction,’ ‘denial,’ ‘venting,’ ‘substance use,’ ‘behavioral disengagement,’ and ‘self-blame,.’ The respondent reacted to a given statement by selecting the answer from a four-point scale (0 - ‘I hardly ever do it’; 1 - ‘I rarely do it’; 2 - ‘I frequently do it’; 3 - ‘I do it most of the time’). The Polish version ERQ - Emotion Regulation Questionnaire 51 of the 10-item scale was designed to measure respondents’ tendency to regulate their emotions in two ways: (1) Cognitive Reappraisal and (2) Expressive Suppression. Respondents answer each item on a 7-point Likert-type scale ranging from 1 ‘strongly disagree’ to 7 ‘strongly agree’. In addition to psychological tests, respondents answered questions about their knowledge of various stress-coping techniques used in STRESSmission (both in pre-and post-test). The additional last block of questions in the survey (during the last meeting) concerned experience with the game and, in addition to closed questions, also included open questions where respondents shared their opinions about the STRESSmission game (e.g, to assess game attractiveness). The experimental group met weekly for eight weeks to play the STRESSmission game, and the pre-test (before playing a game) and post-test (after playing a game) measurements were conducted during the first and last meetings (13.12.2022 and 21.02.2023). At the same time, no interventions were introduced in the control group. The control group at the time, during which the experimental group was playing a game, participated in lectures not connected to the stress subject (Fig. 7 ). Statistical analysis Statistical analyses were performed using the IBM SPSS Statistics 25 package. The classic threshold of α = 0.05 was considered the level of significance. To test hypotheses 1–2 (H1-H2), a series of two-factor analyses of variance were performed in a mixed design. To verify hypothesis 3 a Student's t-test for dependent samples was therefore performed. Data are presented as a mean ± SEM. 2. Measurement of cortisol (CORT) levels in the saliva Participants The study involved 39 participants (average age 23 years old) who were psychology students at SWPS University and signed up for the study through the SONA research panel. Students participating in the study were healthy, which means they did not report chronic diseases in the last three months. They also were not addicted to drugs, including nicotine, and did not suffer from trauma in the last three months before the experiment started. Procedure and measurements The samples of saliva was taken during the described above a longitudinal study, which was performed for 3 months (December 2022 February 2023). The participants met weekly playing a game for eight weeks. CORT levels in the saliva were measured at three-time points in: December 13.12. 2022 – game 1st; January − 4 17.01.2023 – game 4th, and February − 21.02.2023 – game 8th. At each time point, the saliva samples were taken twice: the pre-test (before playing the game) and the post-test (after playing the game) – see Fig. 7 . Shortly, the procedure of collecting saliva looks as follows. Firstly, the participants were instructed how to perform spitting into tubes. Next, the participants were asked to rinse their mouths with water and spit a saliva sample into a sterile tube obtained from the Salimetrics company. Immediately after obtaining saliva samples, they were put into the fridge (4 O C) for 30 min., and after that, stored in the freezer. The samples were taken at the SWPS University in Sopot, transported on the dry ice to Poznan University of Life Sciences, and stored at -20 O C until the CORT measurements were performed. Every sample was given a unique code. Due to the low amount of saliva we obtained from 2 participants, we could not assess CORT levels. Thus, the final measurement of the hormone level was performed on samples from 36 participants. The following hypotheses (H) were tested: H5: Regular playing STRESSmission reduces stress in a single game by lowering the cortisol (CORT) level in the participants' saliva. H6: CORT levels in the saliva would depend on the number of times the participants played the game. To test the above hypotheses, the samples of saliva before and after playing the board game were taken, and CORT levels were measured and compared. Moreover, we compared the samples at three time points (game 1st, 4th, and 8th) to assess how the duration of playing the board game influenced the CORT levels in participants' saliva. The CORT measurements were performed using an ELISA kit provided by the Salivary cortisol enzyme immunoassay kit (cat No 1-3002) Salimetrics, represented in Europe by BIOZOL Diagnostica Vertrieb GmbH. The assay was performed according to the manufacturer's procedure, and every sample was run in duplicate. Statistical analysis The measurements from duplicate samples were averaged and mean ± SEM were presented. The statistical analysis was performed in Statistica using the repeated measured ANOVA test and Fischer’s LSD post hoc tests. The classic threshold of α = 0.05 was considered the level of significance. 3. Qualitive study Participants The study was conducted on January 2023 using four focus groups, which are also known as focus group interviews (FGI), focus group discussions (FGD), or group depth interviews (GDI) 52, 53,54 . The exact division into groups is shown in Table 1 : Focus group intervention nr 1 − 6 women - board game players - enjoy playing board games and do so at least once a month - aged 25–45 - secondary education + - do not have a psychological, sociological or therapeutic education and do not have such professions - place of survey - Warsaw Focus group intervention nr 2 − 5 men - board game players - enjoy playing board games and do so at least once a month - aged 25–45 - secondary education + - do not have a psychological, sociological or therapeutic education and do not have such professions - place of survey – Warsaw Focus group intervention nr 3 − 5 women - board game players - enjoy playing board games and do so at least once a month - aged 25–45 - secondary education + - do not have a psychological, sociological or therapeutic education and do not have such professions - place of survey - Sopot Focus group intervention nr 4 − 5 men - board game players - enjoy playing board games and do so at least once a month - aged 25–45 - secondary education + - do not have a psychological, sociological or therapeutic education and do not have such professions - place of survey – Sopot Total: 21 respondents Tabele 2 Procedure and measurements The study included two parts. In the first part, the respondents were introduced to the game and its rules by the leader (co-creator of the game). The respondents then played the game in the presence of the leader for 45 minutes, after which the leader left the session so as not to influence the group discussion with her presence. In the second part of the study, which lasted for a half hour, a meeting with an FGI facilitator (not present during the game but observing) took place. The participants discussed their experience, rating the playability and attractiveness of the game, their impressions and feelings about the game itself, and their feelings of stress levels during and after the game. Their statements were recorded and transcribed and then analyzed using qualitative methods. Qualitative research aims to understand reality in its natural environment and pay close attention to the context and specific cases studied 55 . In induction, data is used to build a 'middle-range theory' 56 , describing and naming social phenomena and formulating hypotheses that link them. As one of the study's aims was to explore the graphic concepts of the game, a 'raw' black and white prototype was used, with no signs, symbols, or graphic references. Declarations Additional Information (including a Competing Interests Statement) There is no conflict of interest. Funding Study was supported by the grant "Innovation Incubator 4.0" („Inkubator Innowacyjności 4.0”), project implemented under the Smart Growth Operational Program, 2014–2020, measure 4.4: (Program Operacyjnego Inteligentny Rozwój, 2014–2020, działanie 4.4): "Support for scientific research management and commercialization of B + R results in scientific units and enterprises" implemented by SWPS University and Military University of Technology. Author Contribution E.B - design and performed psychological tests, prepared graphs and statistical analysis of date, participated in writing the manuscript; K.A.K – designed and performed qualitive studies and analyzed results, helped in writing the manuscript; J.H.S – Design of the work concerning CORT levels in the saliva, overseas the collection and analysis of data and performed statistical analysis. Prepared the draft of the manuscript and coordinated the writing process. All authors reviewed the manuscript. Acknowledgement We would like to thank you Dr Emilia Grzęda for performing ELISA analysis. We also would like to thank you to STRESSmission team members Katarzyna Barcińska, MSc, Patrycja Sikora-Sawicka, MSc, Jakub Felczak, MSc, Dominika Winogrodzka, MSc for help and motivation to conduct this project. This project will not be successful without your support. Data Availability Data for this study have been deposited in SWPS University. Please contact dr Edyta Bonk for data request – email: [email protected] References Baran, B. E., & Woznyj, H. M. Managing VUCA: The human dynamics of agility. Organizational dynamics , 100787. Advance online publication. https://doi.org/10.1016/j.orgdyn.2020.100787 (2020). Di Gennaro et al.Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health, 17(8), doi: 10.3390/ijerph17082690 (2020). Fardin, M.A. COVID-19 and anxiety: a review of psychological impacts of infectious disease outbreaks. Arch Clin Infect Dis, 4(15), doi : https://doi.org/10.5812/archcid.102779 (2020). Ornell, F., Schuch, J.B., Sordi, A.O. & Kessler, F.H.P. "Pandemic fear" and COVID-19: mental health burden and strategies. Braz J Psychiatry, 42(3), 232-235, doi: 10.1590/1516-4446-2020-0008 (2020). Dragan, M., Grajewski, P., & Shevlin, M. Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. European journal of psychotraumatology , 12(1), 1860356. https://doi.org/10.1080/20008198.2020.1860356 (2021). Sokol-Szawlowska, M. Wpływ kwarantanny na zdrowie psychiczne podczas pandemii COVID-19. Psychiatry, 18(1), 57–62, doi: 10.5603/PSYCH.a2020.0046 (2021). Dymecka, J. Psychosocial effects of the COVID-19 pandemic. Neuropsychiatry and Neuropsychology , 16(1), 1-10. https://doi.org/10.5114/nan.2021.108030 (2021). Fountoulakis, K. N. et al.Results of the COVID-19 mental health international for the general population (COMET-G) study. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology , 54, 21–40. https://doi.org/10.1016/j.euroneuro.2021.10.004 (2022). Nochaiwong, S., et al. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Sci Rep, 11 , 10173 https://doi.org/10.1038/s41598-021-89700-8 (2021). Wang, C., et al. The Association Between Physical and Mental Health and Face Mask Use During the COVID-19 Pandemic: A Comparison of Two Countries With Different Views and Practices. Frontiers in psychiatry , 11, 569981. https://doi.org/10.3389/fpsyt.2020.569981 (2020). Wang, C., et al. A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans. Scientific reports, 11(1), 6481. (2021). Rozanov V., Frančišković T., Marinic I. Mental health consequences of war conflicts. In Javed A., Fountoulakis K. (Eds.) Advances in Psychiatry , 281–304. Springer. https://doi.org/10.1007/978-3-319-70554-5_17 (2019). Surzykiewicz, J., Skalski, S. B., Sołbut, A., Rutkowski, S., & Konaszewski, K. Resilience and Regulation of Emotions in Adolescents: Serial Mediation Analysis through Self-Esteem and the Perceived Social Support. International journal of environmental research and public health , 19(13), 8007. https://doi.org/10.3390/ijerph19138007 (2022). Brągiel, A., & Gambin, M. Depressive symptoms and psychological pain experienced by Polish adults in the context of both the war in Ukraine and the COVID-19 pandemic. Journal of affective disorders reports , 12, 100487. https://doi.org/10.1016/j.jadr.2023.100487 (2023). UNHCR - Refugee Statistics https://www.unhcr.org/refugee-statistics/ (2022). Shigemura, J., Ursano, R. J., Morganstein, J. C., Kurosawa, M., & Benedek, D. M. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry and clinical neurosciences , 74(4), 281–282. https://doi.org/10.1111/pcn.12988 (2020). Questions and answers: Stress, World Health Organization Newsroom https://www.who.int/news-room/questions-and-answers/item/stress (2023). Godoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N and Umeoka EHL. A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications. Front. Behav. Neurosci. 12, 127. doi: 10.3389/fnbeh.2018.00127 (2018). Gold PW. The organization of the stress system and its dysregulation in depressive illness. Molecular Psychiatry 20, 32–47. doi: 10.1038/mp.2014.163 (2015). Endler, N. S.; Parker, J. D. A. Coping Inventory of Stressful Situations (CISS): Manual. Multi-Health Systems: Toronto, (1990). Endler, N. S.; Parker, J. D. A. Assessment of multidimensional coping: Task, emotions and avoidance strategies. Psychological Assessment, 6(1), 50-60, https://doi.org/10.1037/1040-3590.6.1.50 (1994). Vita-Barrull, N., et al. The Cognitive Processes Behind Commercialized Board Games for Intervening in Mental Health and Education: A Committee of Experts. Games for health journal , https://doi.org/10.1089/g4h.2022.0109 (2022). Wanyama, J. N., et al. A randomized controlled trial to evaluate the effectiveness of a board game on patients' knowledge uptake of HIV and sexually transmitted diseases at the Infectious Diseases Institute, Kampala, Uganda. Journal of acquired immune deficiency syndromes (1999) , 59(3), 253–258. https://doi.org/10.1097/QAI.0b013e31824373d5 (2012). Crawford, P., & Wiltz, S. Participation in the Journey to Life Conversation Map Improves Control of Hypertension, Diabetes, and Hypercholesterolemia. Journal of the American Board of Family Medicine: JABFM , 28(6), 767–771. https://doi.org/10.3122/jabfm.2015.06.140142 (2015). Moya-Higueras, J., et al. Just Play Cognitive Modern Board and Card Games, It's Going to Be Good for Your Executive Functions: A Randomized Controlled Trial with Children at Risk of Social Exclusion. Children (Basel, Switzerland) , 10(9), 1492. https://doi.org/10.3390/children10091492 (2023). Estrada-Plana, V., et al. Cognitive training with modern board and card games in healthy older adults: two randomized controlled trials. International journal of geriatric psychiatry , 36(6), 839–850. https://doi.org/10.1002/gps.5484 (2021). Verghese, J., et al. Leisure activities and the risk of dementia in the elderly. The New England journal of medicine , 348(25), 2508–2516. https://doi.org/10.1056/NEJMoa022252 (2003). Abel, M. Humor, stress, and coping strategies. HUMOR , 15 (4), 365-381. https://doi.org/10.1515/humr.15.4.365 (2002). Weir, K. What's behind that smile? Psychological researchers are delving deeper into what our facial expressions and bodily movements reveal about our emotions, American Psychologiacal Association, 51(7), 46 , https://www.apa.org/monitor/2020/10/behind-smile 2020. Gamble, B., Depa, K., Holmes, E. A., & Kanstrup, M. Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma: Qualitative Interview Study. JMIR mental health , 8(2), e23712. https://doi.org/10.2196/23712 (2021). Collins, K. A., Mendelsohn, A., Cain, C. K., & Schiller, D. Taking action in the face of threat: neural synchronization predicts adaptive coping. The Journal of neuroscience: the official journal of the Society for Neuroscience , 34 (44), 14733–14738. https://doi.org/10.1523/JNEUROSCI.2152-14.2014 (2014). Andersson, E., Holmes, E. A., & Kavanagh, D. Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science. mHealth , 4, 47, https://doi.org/10.21037/mhealth.2018.09.11 (2018). Weinstein, A. M. Computer and Video Game Addiction—A Comparison between Game Users and Non-Game Users. The American Journal of Drug and Alcohol Abuse, 36, 268-276. http://dx.doi.org/10.3109/00952990.2010.491879 (2010). Gauthier, A., et al. Board Games for Health: A Systematic Literature Review and Meta-Analysis. Games for health journal , 8(2), 85–100. https://doi.org/10.1089/g4h.2018.0017 (2019). Wiener, L., Battles, H., Mamalian, C., & Zadeh, S. ShopTalk: a pilot study of the feasibility and utility of a therapeutic board game for youth living with cancer. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer , 19(7), 1049–1054. https://doi.org/10.1007/s00520-011-1130-z (2011). Nakao, M., Furukawa, H., Kitashima, C. & Noda, S. Subjective well-being and problem-solving skills for alleviating the stress of elderly men attending a randomized controlled trial of shogi-assisted cognitive behavioral therapy. BioPsychoSocial Med 13 , 11 https://doi.org/10.1186/s13030-019-0153-4 (2019). Endler, N. S., & Parker, J. D. State and trait anxiety, depression and coping styles. Australian Journal of Psychology , 42 (2), 207-220, https://doi.org/10.1080/00049539008260119 (1990). Lelek, A., Mostowik, J., Kwapniewska, A. & Adamczyk-Banach, M. How do adolescents cope with crisis situations? preliminary reports from a study of adolescents with depressive and anxiety disorders. Psychoterapia 4 (199), 49-63, doi: 10.12740/PT/146493 (2021). Endler, N. S., Macrodimitris, S. D., & Kocovski, N. L. Controllability in cognitive and interpersonal tasks: Is control good for you? Personality and Individual Differences, 29(5), 951–962. https://doi.org/10.1016/S0191-8869(99)00246-9 (2000). Kropotkin, P. Mutual aid: A factor of evolution. Paul AV, editor. New York University Press; (1972). Bullinger, A. F., Zimmermann, F., Kaminski, J., & Tomasello, M. Different social motives in the gestural communication of chimpanzees and human children. Developmental Science, 14(1), 58–68. https://doi.org/10.1111/j.1467-7687.2010.00952.x (2011). Tomasello, M. et al. Why We Cooperate. Cambridge, MA: MIT Press. https://doi.org/10.7551/mitpress/8470.001.0001 (2009). Cardoso-Leite, P., & Bavelier, D. Video game play, attention, and learning: how to shape the development of attention and influence learning? Current opinion in neurology , 27 (2), 185–191. https://doi.org/10.1097/WCO.0000000000000077 (2014). Bochennek, K., Wittekindt, B., Zimmermann, S. Y. & Klingebiel, T. More than mere games: a review of card and board games for medical education. Medical teacher , 29 (9), 941–948. https://doi.org/10.1080/01421590701749813 (2007). Wanyama, J. N., et al. A randomized controlled trial to evaluate the effectiveness of a board game on patients' knowledge uptake of HIV and sexually transmitted diseases at the Infectious Diseases Institute, Kampala, Uganda. Journal of acquired immune deficiency syndromes (1999) , 59 (3), 253–258. https://doi.org/10.1097/QAI.0b013e31824373d5 (2012). Viggiano, A., et al. Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion. European journal of pediatrics , 174 (2), 217–228. https://doi.org/10.1007/s00431-014-2381-8 (2015). Crawford, P., & Wiltz, S. Participation in the Journey to Life Conversation Map Improves Control of Hypertension, Diabetes, and Hypercholesterolemia. Journal of the American Board of Family Medicine: JABFM , 28 (6), 767–771. https://doi.org/10.3122/jabfm.2015.06.140142 (2015). Barcińska, K., Winogrodzka, D., Śliwowska, J.H., Archanowicz-Kudelska, K., Bonk, E. Jak grać ze stresem? O budowaniu innowacji społecznej na przykładzie psychoedukacyjnej gry STRESmisja. Innowacje społeczne in press (2024). Endler, N. S., & Parker, J. D. A. Coping Inventory for Stressful Situations--Short Form (CISS-SF) Manual, 2nd ed. Toronto, ON: Multi-Health Systems. https://doi.org/10.1037/t67919-000 (1999). Carver C. S. You want to measure coping but your protocol's too long: consider the brief COPE. International journal of behavioral medicine , 4 (1), 92–100. https://doi.org/10.1207/s15327558ijbm0401_6 (1997). Gross, J. J., & John, O. P. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology , 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348 (2003). Merton, R. K. The Focused Interview and Focus Groups. Continuities and Discontinuities, Public Opinion Quarterly, 51, 550-566, https://www.jstor.org/stable/2749327 (1987). Morgan, D. L. Focus groups as qualitative research , 16, Sage publications. (1996). Stewart, D. W., & Shamdasani, P. N. Focus groups: Theory and practice, 20, Sage publications (2014). Denzin, N. K., & Lincoln, Y. S. Handbook of qualitative research. Journal of Leisure Research , 28 (2), 132, (1996). Merton, R. K. Social theory and social structure . Free Press, (1968). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5269742","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":383866584,"identity":"38ffa5fc-00ab-460f-9be1-69183a41a56a","order_by":0,"name":"Katarzyna Archanowicz-Kudelska","email":"","orcid":"","institution":"Kozminski University","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Archanowicz-Kudelska","suffix":""},{"id":383866586,"identity":"3a7c1cf5-5ca9-4c56-8997-1dd96c617fda","order_by":1,"name":"Joanna Sliwowska","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYBACxgYog48ZTCUw8IOpAiK0sMG0SIJEEgyIsI6NAarF4ACIxqOFub352eOCGgZ7NnYew8c8f9Lkjc+vTvzwwIBBnl/sAHaH9RwzN55xjCGxjZnH2Ji3Lcdw2423myWADjOcOTsBu5YZCWbSPGwMCWzMvNukcxsqGLfdOLsBpCXB4DYuLenfpHn+AR0G0pLzp8J+84yzm3/g15JjJs3bxsDYBtbClpO4gb93G35bes6USfP2SQD9wv/Z+G9bWvKMG7zbLBIMJHD6xbC9fZs0zzcbe37+Y4kPZ/xJtu3vP7v55o8KG3l+aRxaGsCUBJKQRAK6CCqQxxTiP4BT9SgYBaNgFIxMAAD7+1dektBpPwAAAABJRU5ErkJggg==","orcid":"","institution":"Poznan University of Life Sciences","correspondingAuthor":true,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Sliwowska","suffix":""},{"id":383866590,"identity":"db78127a-0902-4cc7-ac89-87d193745d75","order_by":2,"name":"Edyta Bonk","email":"","orcid":"","institution":"SWPS University","correspondingAuthor":false,"prefix":"","firstName":"Edyta","middleName":"","lastName":"Bonk","suffix":""}],"badges":[],"createdAt":"2024-10-15 14:53:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5269742/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5269742/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70185585,"identity":"2757a361-7ca7-4456-99ce-c2a3ef4bc77f","added_by":"auto","created_at":"2024-11-29 09:23:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77680,"visible":true,"origin":"","legend":"\u003cp\u003eNumber used anti-stress techniques used during playing the board game STRESSmission. E - experimental group, C – control group, pre-test – before playing the game; post-test – after playing the game; *p\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/8b4e0bfc4f5c07250cfa0197.png"},{"id":70184834,"identity":"db0dab0d-d931-4dbf-876e-53020213320a","added_by":"auto","created_at":"2024-11-29 09:15:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":341071,"visible":true,"origin":"","legend":"\u003cp\u003eTypes of anti-stress techniques used during playing the board game STRESSmission, which were found to be statistically significant between E and C groups. E - experimental group, C – control group; pre-test – before playing the game, post-test – after playing the game; * p\u0026lt;0.05; ** p\u0026lt;0.01; *** p\u0026lt;0.005.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/0395b23070c4592b814104ef.png"},{"id":70184832,"identity":"e058c365-cd07-4210-8a74-75432db0110d","added_by":"auto","created_at":"2024-11-29 09:15:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":72140,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of coping strategies during playing the STRESSmission game. E - experimental group, C – control group; pre-test – before playing the game, post-test – after playing the game; p* p\u0026lt;0.05; ** p\u0026lt;0.01; *** p\u0026lt;0.005.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/f9b67de76e5985885b95cf0e.png"},{"id":70186948,"identity":"14149583-b9f4-4a06-abf4-e11cdece5fdd","added_by":"auto","created_at":"2024-11-29 09:31:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":93284,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of changes in use of emotion-oriented and avoidance-oriented style of coping with stress in response to playing STRESSmission. E - experimental group, C – control group; pre-test – before playing the game, post-test – after playing the game; p*\u0026lt;0.05; *** p\u0026lt;0.005.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/0727f186b322727b6a5592a0.png"},{"id":70184840,"identity":"a7c14cd7-b014-43da-a47a-40a709d32ec2","added_by":"auto","created_at":"2024-11-29 09:15:24","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":43181,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of subjective stress level in pre-test and post-test in experimental and control groups. E - experimental group, C – control group; pre-test – before playing the game, post-test – after playing the game **** p\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/494dcf442b104a793cab2182.png"},{"id":70184839,"identity":"550ef7ab-3504-4088-8d70-a4271e3641a0","added_by":"auto","created_at":"2024-11-29 09:15:24","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":23808,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of cortisol (CORT) level in saliva in participants playing the STRESSmission game. Pre-test - before playing a game; post-test – after playing a game; *p \u0026lt;0.05; ****p\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/78029d79bec440360bd59001.png"},{"id":70185593,"identity":"dd87b2ff-c7ff-4c89-89f5-0efea8a952a8","added_by":"auto","created_at":"2024-11-29 09:23:24","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":120459,"visible":true,"origin":"","legend":"\u003cp\u003eExperimental design of psychological and physiological studies.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/9f6ee093560e8d626023075c.png"},{"id":75548048,"identity":"578ecd1a-42e9-4952-be6e-60b185b69d89","added_by":"auto","created_at":"2025-02-05 17:46:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2459110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5269742/v1/1c69c78b-ab6a-43de-a213-d4b9b0444d2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stress – mission possible! The STRESSmission game as a psychoeducational tool in coping with stress","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe contemporary era is characterized by circumstances that can be described as VUCA \u0026ndash; an acronym for volatility, uncertainty, complexity, and ambiguity\u003csup\u003e1\u003c/sup\u003e. Additionally, COVID-19 started on 11 March 2019, which the World Health Organization (WHO) announced later as a pandemic\u003csup\u003e2\u003c/sup\u003e added to this complexity. The announcement marked the beginning of a challenging period, which presented a variety of stresses, strains, and threats to public health, both physical and mental. Fear of contracting the virus was only one part of the equation; other unknown sources of anxiety also caused stress for many individuals\u003csup\u003e,3,4,5,6\u003c/sup\u003e. The pandemic's impact stemmed from genuine health concerns and the prospect of one's own or a loved one's passing and from abrupt, unforeseen social disruptions that required us to adapt rapidly - with varying degrees of success. There were encountered numerous challenges. Due to lockdowns, long-term isolation or quarantine, and border closures, many people had to work and learn remotely. Additionally, the pandemic resulted in a loss of income for many individuals, leading to economic destabilization\u003csup\u003e7,8\u003c/sup\u003e. Thus, COVID-19 and its associated restrictions could be viewed as factors causing chronic stress. Indeed, meta-analyses reveal that over 50% of the worldwide populace underwent amplified stress and general anxiety levels following the COVID-19 outbreak\u003csup\u003e8\u003c/sup\u003e. Nonetheless, this percentage fluctuated between countries, hinging on factors like their healthcare infrastructures, COVID-19 control measures, and the support services available to their nationals\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAs our study was performed in Poland, we would like to emphasize the impact of both the pandemic and the economic situation in the country on the population. High-stress levels noted in its population, in addition to the COVID-19 challenge, could arise from the elevated incidence rate, multiple conflicting pieces of information on preventive behavior, and low public access to psychological and psychiatric care\u003csup\u003e10,11\u003c/sup\u003e. Furthermore, in February 2022, following two years of pandemic, Russia launched a military invasion of Ukraine, which started right next to the Polish border. As a result, Polish citizens became anxious about the safety of their nation's borders and were left horrified by the media coverage depicting the nearby hostilities\u003csup\u003e12,13,14\u003c/sup\u003e. The conflict in Ukraine disrupted the established daily routine once again as over 2\u0026nbsp;million Ukrainian citizens, mainly women and children, fled to Polish territory in just one month due to the war\u003csup\u003e15\u003c/sup\u003e. Poles frequently assisted these refugees without depending on sluggish governmental and institutional aid. Although the state of epidemics in Poland was lifted in May 2022, the ongoing invasion in Ukraine no longer elicits such severe anxiety reactions, and the refugee crisis has been temporarily averted, the enduring consequences of stress must be addressed\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to the WHO \u003cem\u003estress\u003c/em\u003e is defined as a state of worry or mental tension caused by a difficult situation. A natural human response prompts us to address challenges and threats. Everyone experiences stress to some degree, but how we respond to stress, makes a big difference to our overall well-being\u0026rsquo;\u003csup\u003e17\u003c/sup\u003e. When stress it is strong or prolonged, it could be associated with health problems, including mental illness, such as depression or post-traumatic stress disorder (PTSD)\u003csup\u003e18.19\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe stress response has two components: a fast (rapid) response and a slow one. A rapid response starts by activating the sympathetic and inhibiting the parasympathetic autonomic nervous system and releasing adrenaline from the adrenal medulla. Fear, fight, and flight hormones mobilize the body to join the action in a stressful situation. In the second phase of the stress response, the hypothalamic-pituitary-adrenal (HPA) axis is involved. The corticotropin-releasing hormone (CRH) is secreted from the part of the brain called the hypothalamus, which stimulates the pituitary gland to secrete adrenocorticotropin hormone (ACTH). This leads to the release of cortisol- CORT hormones from the adrenal cortex. If the stress is intense and long-lasting (chronic), the body cannot cope with the situation. As a result, the accumulation of too much CORT could damage the brain and other organs and lead to exhaustion of the system and illness. Thus, people used different coping strategies in light of the stress challenges. Endler and Parker (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1990\u003c/span\u003e) identified three styles of coping with stress: 1) task-focused style, 2) emotions-focused style, 3) avoidance-focused style\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNotably, for our current paper, the emotions-focus style relies on seeking social contacts to get away from problems and receive support\u003csup\u003e21\u003c/sup\u003e. The board games, such as the one described in this paper, STRESSmission, comprise social contact with psychoeducational components, which teach people how to use e methods to cope with everyday stress. It should be emphasized that this is a new game, and the prototype was tested in the current study (for the details, see \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.stresmisja.pl\u003c/span\u003e\u003cspan address=\"http://www.stresmisja.pl\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn spite that the use of modern board games has been growing in past years in education, research, and mental health attendance\u003csup\u003e22\u003c/sup\u003e, there is a lack of comprehensive studies on using it as a psychoeducational tool helping in learning stress coping strategies. The literature concerning health benefits of board games is still limited and mainly focuses on subjective parameters (e.g.\u003csup\u003e23,24\u003c/sup\u003e). Moreover, in a study performed during the COVID-19 pandemic, it was found that playing any type of modern board and card game (excluding games with a high incidence of luck) could be beneficial for children at risk of social exclusion\u003csup\u003e25\u003c/sup\u003e. In healthy older adults over 65 years old, it was revealed that board and card games could be an effective cognitive intervention to maintain some cognitive functions\u003csup\u003e26\u003c/sup\u003e. Moreover, the study performed in elderly demonstrates a significant association between a higher level of participation in leisure activities, including playing a board game, and a decreased risk of dementia such as Alzheimer\u0026rsquo;s disease and vascular dementia\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn light of the above findings, we perform studies to test if using the game STRESSmission could be a tool not only to release stress but also as a learning tool, which allows players to acquire strategies to cope with stressful situations. This game uses several coping strategies and employs various tasks during the game from three different categories: polis, soma, and psyche. Thus, the study aimed to investigate: 1) via longitudinal study \u0026ndash; a) stress coping techniques and styles (CISS - Coping Inventory for Stressful Situations, Mini-COPE), b) life satisfaction (SWLS - The Satisfaction With Life Scale), and emotion regulation (ERQ - Emotion Regulation Questionnaire), c) knowledge of various stress coping techniques used in STRESmission using a psychological test- to assess participant knowledge of coping strategies used in the game, d) questions in the survey concerned experience with the game; 2) via physiological studies \u0026ndash; levels of stress hormone (CORT) in the saliva before and after playing game; 3) via a qualitative study - the attractiveness and playability of the game prototype (as well as to test graphical concepts, one of which was eventually chosen).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1. A longitudinal study \u0026ndash; psychological tests\u003c/h2\u003e \u003cp\u003ePsychological tests were run according to the experimental design presented in Methods.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePlaying the STRESSmission increases number of anti-stress techniques used by participants\u003c/h3\u003e\n\u003cp\u003eWe have tested the hypothesis, which stated that regular gaming (experimental group - E) increases the number of anti-stress techniques used compared to the control (C) group.\u003c/p\u003e \u003cp\u003eIndeed, there was a statistically significant increase in number of anti-stress techniques in E compared to C group \u003cem\u003eF\u003c/em\u003e(1, 68)\u0026thinsp;=\u0026thinsp;5.86; p\u0026thinsp;=\u0026thinsp;0.018 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFurther, analyses were then performed for each technique, which showed the following statistically significant results. When we have compered pre-test to post-test we have found an increase in number for the following techniques for E compared to C group: shaking - \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;12.31; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0. 001; movement - \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;8.00; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006; mindfulness - \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;7.16; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009; art-therapy \u003cb\u003e-\u003c/b\u003e \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;5.81; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019, (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-D ).\u003c/p\u003e \u003cp\u003eAdditionally, in pre-test for movement techniques there was a decrease in E compared to C group F(1, 70)\u0026thinsp;=\u0026thinsp;4.20; p\u0026thinsp;=\u0026thinsp;0.004. In contrast, in pre-test for mindfulness technique there was an increase in E compared to C group F(1, 70)\u0026thinsp;=\u0026thinsp;4.98; p\u0026thinsp;=\u0026thinsp;0.029.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePlaying STRESSmission changes the use of coping strategies\u003c/h3\u003e\n\u003cp\u003eWe have also confirmed the hypothesis that regular playing STRESSmission causes changes in the use of various coping strategies in E compared to C group. This hypothesis was true (the data was statistically significant) between E and C group for the using of following techniques:\u003c/p\u003e \u003cp\u003e \u003cb\u003eInstrumental support\u003c/b\u003e - In post-test there was an increase in using this strategy in E groups, \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;7.26; p\u0026thinsp;=\u0026thinsp;0.009, but not in C group F(1, 70)\u0026thinsp;=\u0026thinsp;2.99; p\u0026thinsp;=\u0026thinsp;0.088 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHumor \u0026ndash;\u003c/b\u003e While in E group there was a decrease in using this strategy F(1, 70)\u0026thinsp;=\u0026thinsp;9.13; p\u0026thinsp;=\u0026thinsp;0 004 in E group, and opposite effect was observed C group F(1, 70)\u0026thinsp;=\u0026thinsp;4.29; p\u0026thinsp;=\u0026thinsp;0.042; (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003cb\u003eVenting\u003c/b\u003e \u0026ndash; In post-test there was an increase in use this technique in E compared to C group F(1, 70)\u0026thinsp;=\u0026thinsp;4.01; p\u0026thinsp;=\u0026thinsp;0.049 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThere were changes in use of emotion-oriented as well as task- and avoidance-oriented style of coping with stress in response to playing STRESSmission\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn particular we have found that:\u003c/p\u003e \u003cp\u003e \u003cb\u003eEmotion-oriented style of coping\u003c/b\u003e - There was a decrease in using this style in E group F(1, 70)\u0026thinsp;=\u0026thinsp;9.30; p\u0026thinsp;=\u0026thinsp;0.003but not in C group, F(1, 70)\u0026thinsp;=\u0026thinsp;0.42; p\u0026thinsp;=\u0026thinsp;0.521; (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003cb\u003eAvoidance-oriented style of coping\u003c/b\u003e - In the post-test there was an increase in using this techniques in E group, \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;4.52; p\u0026thinsp;=\u0026thinsp;0.037compered to C group, \u003cem\u003eF\u003c/em\u003e(1, 70)\u0026thinsp;=\u0026thinsp;1.88; p\u0026thinsp;=\u0026thinsp;0.174. (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Additionally there was a trend in increase in a sub-type of avoidance-oriented style called distracting oneself with other tasks only in E group F(1, 70)\u0026thinsp;=\u0026thinsp;3.55, p\u0026thinsp;=\u0026thinsp;0.064.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePlaying STRESSmission decreases subjective stress level\u003c/h3\u003e\n\u003cp\u003eThere was a decrease in a subjective stress level in E group between game 1 and game 8 of playing the STRESSmission t (36)\u0026thinsp;=\u0026thinsp;6.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The game 1 was played in December 2022 and game 8 in February 2023 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eAssessment of game attractiveness\u003c/h3\u003e\n\u003cp\u003ePeople playing STRESmission rated the attractiveness of the game at level 4 (on a 5-point scale, where one meant \"I don't like it very much\" and 5 - \"I like it very much\"). Referring to the positive aspects, the participants of the study primarily appreciated the \u003cb\u003epsychoeducational value of the game\u003c/b\u003e: \u003cem\u003e\"STRESSmission allows me to develop curiosity about anti-stress techniques; it promotes coping with stress and shows how to do it; it is something new; I think necessary and effective, presenting stress coping strategies attractively; it provides extremely necessary information in an entertaining form\".\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe respondents considered the added value of participating in the game to be the \u003cb\u003eopportunity to have a nice time\u003c/b\u003e \"\u003cem\u003eThe game is fun, some tasks are really enjoyable; you can interestingly spend time; you can calm down and relax\"\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eAmong the arguments proving the game's high attractiveness, there was also the \u003cb\u003epossibility of integration with other players\u003c/b\u003e \"\u003cem\u003ean interesting way to talk and get to know yourself; I like the aspect of conversation and integration that the game brings; you can open up and feel a friendly, non-judgmental atmosphere\u003c/em\u003e\", which was provided by the cooperative nature of the game, as well as some of the tasks proposed as part of STRESmission (mainly from the POLIS category, in which some of the tasks involve sharing one's experience).\u003c/p\u003e \u003cp\u003eThe justification for the lower ratings of the game's attractiveness included mainly comments indicating the feeling of monotony in the situation of regularly playing the game with a similar group of students. Despite some criticisms, \u003cb\u003eall respondents declared that they would recommend this game to others\u003c/b\u003e as they see significant.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2. A physiological study \u0026ndash; measuring CORT level in saliva\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003ePlaying STRESSmission game decreases CORT levels in saliva\u003c/h2\u003e \u003cp\u003eWe have confirmed the hypothesis that the playing STRESSmission have both short- and long-term effects. In particular we have shown that during game 1, 4 and 8 there was a decrease in CORT levels in the saliva after playing the game (p\u0026rsquo;s\u0026thinsp;\u0026lt;\u0026thinsp;0,5; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). We have also found a long-term effects, such as a reduction in the CORT levels during the 8 game (post-test) was lower compared to 1 game (pre-test; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Additionally we have found that in post-test CORT level was lower at game 4 compared to game 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003e3. A qualitive study\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of the game as a psychoeducational tool\u003c/h2\u003e \u003cp\u003eThe idea of the game was very well received. Based on the obtained results, the following features of the STRESSmission game were emphasized by participants: uniqueness, cooperative nature, psyche-educational value, psycho-educational aid in therapy, and building mutual trust between group members; the responses given by the respondents for each characteristic are presented in their own words, in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVerbatims of the respondents from Focus Group Interventions (FGI) received during the qualitive studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic of STRESSmission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbatims of the respondents from Focus Group Interventions (FGI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUniqueness\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;Well, I haven't seen anything like this on the market. (\u0026hellip;) It teaches you how to manage stress\".\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIts cooperative nature\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;Most games are for this kind of competition. And here we play as a team. I like that\u0026rsquo;, \u0026lsquo;We're all playing for the same basket\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsycho-educational value\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;This game shows what you can do to cope better with stress. It plays like that - it teaches\u0026rsquo;, \u0026lsquo;It smuggles in the fact that we are supposedly playing, but in reality we are learning how to deal with stress\u0026rsquo;, \u0026lsquo;You can learn some techniques so that you can remember them and deal with them yourself in a certain way\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;The game wants to sell some kind of tricks or methods to deal with stress, to chill out, to relax, to breathe - that's cool\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsycho-educational aid in therapy\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It could be like that at school, in the pedagogue's office, or something to play so that you can mentally clear yourself.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBuilding mutual trust between group members - within the within teams and groups\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;This allows the players to get to know each other better, but also to get closer to each other, to integrate with friends, work and family. This, in turn, builds a relationship.\u0026rsquo;, \u0026lsquo;Yes, this game brings you closer, it brings you together\u0026rsquo;, \u0026lsquo;I see these games at some of these meetings, integration training or something\u0026rsquo;, \u0026lsquo;It's not about making time go by quickly, it's about staying together\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBuilding mutual trust between group members - within the family and people who, by definition, should be close to each other but don't always succeed\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;I can see that you can sit down with your family. These are the times when we don't know much. What does my son like? What does my partner like? What are his favorite perfumes? Well, I don't know, and this way I might find out. It would be good for my family.\u0026rsquo;, \u0026lsquo;I would play with my family. Because I can see that everybody has to say something about themselves and then you can get to know these children, your children\u0026hellip;\u0026rsquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs we see in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the STRESSmission game was seen as suitable for playing with good friends we already trust or with family because of the subject matter. It was also found to have the potential to bring up personal issues that we do not often share, even with loved ones.\u003c/p\u003e \u003cp\u003eIt was noted that players should have a certain reflexivity, be interested in personal development, self-development, psychology (including pop psychology), and stress reduction techniques, or at least not dismiss them as 'not turning everything into a joke', 'It's a game for people who have at least a slightly higher level of awareness that stress exists, that it needs to be dealt with.' Because it requires concentration, it should be played in a quiet, calm place, in a trusted, responsible group of people with whom you can be yourself, and even in a therapist's office; you need to find the right time and place for it. \u003cem\u003e'It is not the kind of game you can just put on the table and play all the time\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"DISSCUSSION","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStress \u0026ndash; mission possible! Summary of the findings\u003c/h2\u003e \u003cp\u003eAlthough the subject concentrating on using different games, including board games, to cope with different diseases and broaden their knowledge is presented in the literature, this study is the first one to examine changes in physiological outcomes such as cortisol (stress hormone levels) in response to playing the game. Importantly, we have provided a novel data, which have shown that the game decreased both subjective stress levels (psychological tests) and objective (lowering CORT levels in the saliva). Importantly, the effects are long-lasting. Moreover, we have found that playing this game increased number of anti-stress techniques used by participants. In particular, we have found that STRESSmission influenced coping with stress strategies used by players: 1) increases the use of mindfulness, movement, shaking, and art-therapy techniques; 2) decreases the coping strategies based on the sense of humor in comparison to control group. A sense of humor can escape a stressful situation\u003csup\u003e28\u003c/sup\u003e or cover real emotions (e.g., fear) with a smile,\u003csup\u003e29\u003c/sup\u003e. If we treat this strategy as distancing oneself from the problem or even as a defense mechanism, acquiring new skills may reduce the frequency of using such a method. Thus, we assumed that those playing participants may have begun to use a different repertoire of techniques instead of humor as a result of psychoeducation. Additionally, we have revealed that in post-test experimental group used more often instrumental support and venting strategy compared to controls. Instrumental support refers to helps with everyday needs such as shopping, cooking, dog walking etc.\u003c/p\u003e \u003cp\u003eIn order to cope with stressors, people use different styles of coping with stress: 1) task-oriented, 2) emotions-oriented, 3) avoidance-oriented\u003csup\u003e20\u003c/sup\u003e. Here we shown that playing STRESSmission changes use of different style of coping with stress, with decrease of emotion-oriented, and higher number of avoidance-oriented style in post-test in experimental compared to control group. Finally, we have shown the attractiveness and usefulness of as a psychoeducational tool for learning anti-stress techniques. To summarize the above results, it can be concluded that the game fulfills its psycho-educational goal of acquiring new skills for dealing with stressors.\u003c/p\u003e \u003cp\u003eIn addition to summarizing above the most important finding, numerous others were made. Notably, there was a decrease in CORT levels, which we have seen during the first, four and eight playing game. Moreover, the effect of playing the game was long-lasting as the post-test level of CORT was lower during game 8, compared to pre-test game 1. This finding was also confirmed by psychological tests in which participants reported lower level of stress during game 8 compared to game 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBoard games vs. computer games\u003c/h2\u003e \u003cp\u003eDifferent types of games have been proven as useful coping strategies in cases of traumatic events. Among these are computer games, which are much better studied than board games. Even a brief intervention involving a computer game was found to be a promising strategy to reduce intrusive memories of trauma, which is considered one of the core clinical symptoms of PTSD\u003csup\u003e30\u003c/sup\u003e. In another study, a virtual game board and fMRI were employed to assess individual differences in the ability to cope with danger and examine changes in the synchronization of different brain parts\u003csup\u003e31\u003c/sup\u003e. These exciting experiments concluded that successfully performing adaptive actions in the face of threat requires functional synchronization of a neural circuit consisting of the medial prefrontal cortex (mPFC), striatum, and amygdala. On the other hand, alterations in the crosstalk between these brain regions might underlie anxiety symptoms and impair ability to cope under stress actively\u003csup\u003e31\u003c/sup\u003e. However, it is essential to note that many studies in this subject are still at an early stage. Nevertheless, their potential for large-scale use and relatively low unit cost is promising in providing beneficial effects for the population\u003csup\u003e32\u003c/sup\u003e. However, besides the examples mentioned above of beneficial effects of computer games, numerous studies indicate that these games may lead to long-term changes in the reward circuitry that resemble the effects of substance dependence\u003csup\u003e33\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThus, the alternative could be board games, which have a long history, with the earliest known board games being 5,000 years old and were played in Egypt. A majority of the board game interventions focused on education to increase health-related knowledge and behaviors\u003csup\u003e34\u003c/sup\u003e. A board game called ShopTalk was found to be a therapeutic tool developed to help children ages 7\u0026ndash;16 years living with cancer\u003csup\u003e35\u003c/sup\u003e. This pilot study showed that the game helped young patients talk about their illness in a non-threatening, fun, and creative way. Another example of the beneficial effect of board games came from Japan, where Shogi, a popular board game, and shogi-assisted cognitive\u0026ndash;behavioral therapy (S-CBT) has been examined. In a group of 61 elderly participants, it was found that the S-CBT may be beneficial for stress management\u003csup\u003e36\u003c/sup\u003e. It was found that playing the game increased problem-solving skills for alleviating stress. Thus, the above-mentioned data indicate the beneficial effects of board games on improving health outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSTRESSmission as a psychoeducational tool\u003c/h2\u003e \u003cp\u003eOur results indicate that the STRESSmission is indeed a psychoeducational tool as it caused changes in coping style and decreased use of emotions-oriented style. As this style relies on seeking social contacts to get away from problems and receive support\u003csup\u003e21\u003c/sup\u003e, thus by playing the game the above goals could be achieved. Moreover, a decrease in coping strategies focused on emotions by playing the STRESSmission is of particular interest as this strategy can deepen tension and depression\u003csup\u003e37\u003c/sup\u003e. As research indicates, this style is characteristic of people experiencing anxiety and experiencing depression\u003csup\u003e38\u003c/sup\u003e and with lower self-efficacy\u003csup\u003e39\u003c/sup\u003e. Thus, playing through the educational experience of stress management techniques can indirectly influence the control of affective states. An increase in avoidance techniques in players (which includes engaging in substitute activities and seeking social contacts) may be related to practicing redirecting attention and conversations between participants in the game. Furthermore, our results indicate higher levels of social support-seeking and discharge strategies in the experimental group in the post-test than in the control group. So, we concluded that the game creates a space to talk about situations related to stress and coping. Perhaps it was a supportive experience for those who played and provided an opportunity to discharge emotions. It can be concluded that the cooperative nature of the game and conversation-oriented tasks (polis category) is combined with one of the forms of this strategy, which is the search for support and social contact. It is well known that mutual interaction and aid are of key importance for living both for humans. Numerous studies indicate that prosocial behavior has protective effects on health and adaptation to stress\u003csup\u003e40,41,42\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSignificant outcomes of our study were an assessment of subjective and objective stress levels. The declared level of perceived stress after 3 months of playing STRESSmission has diminished. This result indicates realizing the primary goal of learning techniques for coping with stress. The game fulfills its functions at the level of subjective feelings of stress. Finally, the above results were confirmed by physiological data (cortisol \u0026ndash; CORT measurement in the saliva of participants).\u003c/p\u003e \u003cp\u003eBesides the psychological tests outcomes described above, other benefits of games are presented in the literature. In general, games can support engagement in play and fantasy. These, in turn, are indicated as important mechanisms facilitating greater attentional control, enhanced learning, and providing patient insight toward impacting long-term behaviors\u003csup\u003e43\u003c/sup\u003e. However compared to video games, board games have a significant advantage via their ability to facilitate face-to-face interactions with other friends, family members, or even a therapist. Moreover, these social interactions should enhance learning opportunities\u003csup\u003e44\u003c/sup\u003e. Additionally, it was shown that board games are good tools for building knowledge, and examples of using it to broaden information on HIV and sexually transmitted diseases\u003csup\u003e45\u003c/sup\u003e, learning of healthy eating habits\u003csup\u003e46\u003c/sup\u003e and health outcomes in diabetic patients\u003csup\u003e47\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur studies were performed on cohorts of healthy students; however, in the light of other results discussed above, it is possible that this board game could also be successfully used in patients dealing with trauma, anxiety, depression, and other disorders. During our work on this product, we have carefully considered this further application of the game for people with mental health problems, designing with care the tasks using psychological knowledge. Thus, together, the above-mentioned studies open an array of possibilities for applying games such as STRESSmission, not only as a psychoeducational tool to teach anti-stress techniques, but also likely in the future as promising therapeutic targets for fear and anxiety disorders and illnesses related to trauma and stress.\u003c/p\u003e \u003cp\u003eIt is also important to note that our current study has limitations, e.g., the women were overrepresented in study groups, as 47 woman, 29 man participated in this experiment. Further studies should be performed on participants with traumas, PTSD and other stress-related health problems and compared with healthy participants. Another limitation of the study is the size and age of the group. Experiments could be continued on bigger-sized groups and participants of different age groups, as well as study sex differences. Moreover, it would be of interest to compare the above-discussed outcomes to those of other board games or video games. Due to the luck of adequate founding, we could not perform such comparison in the current study. It would be also of interest to use fMRI in the further experiments during performing certain tasks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFuture directions: From bench to market\u003c/h2\u003e \u003cp\u003eBesides, the benefits described above coming from quantitative studies \u0026ndash; psychological and physiological tests, in the qualitative studies and psychological tests we also proved the game's attractiveness. Based on our results we concluded that the game was well-received. It is also worth mentioning that STRESSmission received the silver award at the 16th International Invention and Innovation Show INTARG 2023, Katowice, Poland. The idea of creating a social innovation - a psychoeducational game, STRESSmission was also presented in detail in our previous paper\u003csup\u003e48\u003c/sup\u003e. The webpage describing the major benefits from playing the game was created (for the details see \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.stesmisja.pl\u003c/span\u003e\u003cspan address=\"http://www.stesmisja.pl\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), and the booklet outlining stress management techniques is available to the public. Thus, the data obtained so far encourages our research team to continue developing strategies to bring the product into the market. We believe that our interdisciplinary effort will succeed in bringing the product from the bench to the marker.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo summarize our findings, performing qualitative, longitudinal, and physiological studies on a group of university students, we concluded that the STRESSmission board game could be a stress-releasing and a learning tool to help cope with stressors. In light of the obtained data, we recommend including this game as a psychoeducational tool, which may improve the quality of life of people in modern society who deal with stress-related problems in the post-COVID-19 era.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003cdiv id=\"Sec28\" class=\"Section4\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"METHODS","content":"\u003cp\u003e The study has been approved by the Ethical committee at Poznań University of Medical Sciences in Poznań, Poland (license number 395/22). All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants. All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants and/or their legal guardians.\u003c/p\u003e\u003ch2\u003e1. A longitudinal study – Psychological tests\u003c/h2\u003e\u003cp\u003eThe following 6 hypotheses (H) were tested:\u003c/p\u003e\u003cp\u003eH1: Regular playing the STRESSmission increases the number of anti-stress techniques used in experimental (E) compared to control (C) group.\u003c/p\u003e\u003cp\u003eH2: Regular playing STRESSmission causes changes in the use of various coping strategies and /or styles in E compared to C group.\u003c/p\u003e\u003cp\u003eAdditionally, in E group we have tested the following hypothesis\u003c/p\u003e\u003cp\u003eH3: The subjective stress level will decrease due to the regular playing the STRESSmission.\u003c/p\u003e\u003cp\u003eH4: The STRESSmission game is useful and attractive enough to encourage to be a practical tool to cope with stress.\u003c/p\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe study involved 76 participants /39 in the experimental group (E) and 37 in the control (C) group; 47 woman, 29 man, average age 23 years old/, who were psychology students at SWPS University and signed up for the study through the SONA research panel. The first 40 people were qualified to the experimental group and the following 36 to the control. Students participating in the study were healthy, which means they did not report chronic diseases in the last three months. They also were not addicted to drugs, including nicotine, and did not suffer from trauma in the last three months before the experiment started.\u003c/p\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003cp\u003eThe study measured the dependent variable - stress coping techniques and styles (CISS - Coping Inventory for Stressful Situations, Mini-COPE), and emotion regulation (ERQ - Emotion Regulation Questionnaire) - at two-time points over three months: the pretest (before playing a board game) and the posttest (immediately after playing a board game).\u003c/p\u003e\u003cp\u003eThe Polish version of the CISS measured task-, emotion-, and avoidance-oriented coping strategies\u003csup\u003e20,49\u003c/sup\u003e. The measure consists of 48 items to which subjects respond on a five-point Likert-type scale ranging from ‘1 – not at all’, to ‘5 – very much’.\u003c/p\u003e\u003cp\u003eMini-COPE Questionnaire\u003csup\u003e50\u003c/sup\u003e in Polish adaptation consisted of 28 statements that were part of 14 strategies (two statements in each strategy): ‘active coping,’ ‘planning,’ ‘positive reframing,’ ‘acceptance,’ ‘humor,’ ‘religion,’ ‘use of emotional support,’ ‘use of instrumental support,’ ‘self-distraction,’ ‘denial,’ ‘venting,’ ‘substance use,’ ‘behavioral disengagement,’ and ‘self-blame,.’ The respondent reacted to a given statement by selecting the answer from a four-point scale (0 - ‘I hardly ever do it’; 1 - ‘I rarely do it’; 2 - ‘I frequently do it’; 3 - ‘I do it most of the time’).\u003c/p\u003e\u003cp\u003eThe Polish version ERQ - Emotion Regulation Questionnaire\u003csup\u003e51\u003c/sup\u003e of the 10-item scale was designed to measure respondents’ tendency to regulate their emotions in two ways: (1) Cognitive Reappraisal and (2) Expressive Suppression. Respondents answer each item on a 7-point Likert-type scale ranging from 1 ‘strongly disagree’ to 7 ‘strongly agree’.\u003c/p\u003e\u003cp\u003eIn addition to psychological tests, respondents answered questions about their knowledge of various stress-coping techniques used in STRESSmission (both in pre-and post-test). The additional last block of questions in the survey (during the last meeting) concerned experience with the game and, in addition to closed questions, also included open questions where respondents shared their opinions about the STRESSmission game (e.g, to assess game attractiveness).\u003c/p\u003e\u003cp\u003eThe experimental group met weekly for eight weeks to play the STRESSmission game, and the pre-test (before playing a game) and post-test (after playing a game) measurements were conducted during the first and last meetings (13.12.2022 and 21.02.2023). At the same time, no interventions were introduced in the control group. The control group at the time, during which the experimental group was playing a game, participated in lectures not connected to the stress subject (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using the IBM SPSS Statistics 25 package. The classic threshold of α = 0.05 was considered the level of significance. To test hypotheses 1–2 (H1-H2), a series of two-factor analyses of variance were performed in a mixed design. To verify hypothesis 3 a Student's t-test for dependent samples was therefore performed. Data are presented as a mean ± SEM.\u003c/p\u003e\u003ch2\u003e2. Measurement of cortisol (CORT) levels in the saliva\u003c/h2\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe study involved 39 participants (average age 23 years old) who were psychology students at SWPS University and signed up for the study through the SONA research panel. Students participating in the study were healthy, which means they did not report chronic diseases in the last three months. They also were not addicted to drugs, including nicotine, and did not suffer from trauma in the last three months before the experiment started.\u003c/p\u003e\u003ch2\u003eProcedure and measurements\u003c/h2\u003e\u003cp\u003eThe samples of saliva was taken during the described above a longitudinal study, which was performed for 3 months (December 2022 February 2023). The participants met weekly playing a game for eight weeks. CORT levels in the saliva were measured at three-time points in: December 13.12. 2022 – game 1st; January − 4 17.01.2023 – game 4th, and February − 21.02.2023 – game 8th. At each time point, the saliva samples were taken twice: the pre-test (before playing the game) and the post-test (after playing the game) – see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. Shortly, the procedure of collecting saliva looks as follows. Firstly, the participants were instructed how to perform spitting into tubes. Next, the participants were asked to rinse their mouths with water and spit a saliva sample into a sterile tube obtained from the Salimetrics company. Immediately after obtaining saliva samples, they were put into the fridge (4\u003csup\u003eO\u003c/sup\u003eC) for 30 min., and after that, stored in the freezer. The samples were taken at the SWPS University in Sopot, transported on the dry ice to Poznan University of Life Sciences, and stored at -20\u003csup\u003eO\u003c/sup\u003eC until the CORT measurements were performed. Every sample was given a unique code. Due to the low amount of saliva we obtained from 2 participants, we could not assess CORT levels. Thus, the final measurement of the hormone level was performed on samples from 36 participants.\u003c/p\u003e\u003cp\u003eThe following hypotheses (H) were tested:\u003c/p\u003e\u003cp\u003e H5: Regular playing STRESSmission reduces stress in a single game by lowering the cortisol (CORT) level in the participants' saliva.\u003c/p\u003e\u003cp\u003e H6: CORT levels in the saliva would depend on the number of times the participants played the game.\u003c/p\u003e\u003cp\u003e To test the above hypotheses, the samples of saliva before and after playing the board game were taken, and CORT levels were measured and compared. Moreover, we compared the samples at three time points (game 1st, 4th, and 8th) to assess how the duration of playing the board game influenced the CORT levels in participants' saliva.\u003c/p\u003e\u003cp\u003eThe CORT measurements were performed using an ELISA kit provided by the Salivary cortisol enzyme immunoassay kit (cat No 1-3002) Salimetrics, represented in Europe by BIOZOL Diagnostica Vertrieb GmbH. The assay was performed according to the manufacturer's procedure, and every sample was run in duplicate.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe measurements from duplicate samples were averaged and mean ± SEM were presented. The statistical analysis was performed in Statistica using the repeated measured ANOVA test and Fischer’s LSD post hoc tests. The classic threshold of α = 0.05 was considered the level of significance.\u003c/p\u003e\u003ch2\u003e3. Qualitive study\u003c/h2\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe study was conducted on January 2023 using four focus groups, which are also known as focus group interviews (FGI), focus group discussions (FGD), or group depth interviews (GDI)\u003csup\u003e52, 53,54\u003c/sup\u003e. The exact division into groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e:\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFocus group intervention nr 1\u003c/p\u003e \u003cp\u003e− 6 women\u003c/p\u003e \u003cp\u003e- board game players - enjoy playing board games and do so at least once a month\u003c/p\u003e \u003cp\u003e- aged 25–45\u003c/p\u003e \u003cp\u003e- secondary education +\u003c/p\u003e \u003cp\u003e- do not have a psychological, sociological or therapeutic education and do not have such professions\u003c/p\u003e \u003cp\u003e- place of survey - Warsaw\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFocus group intervention nr 2\u003c/p\u003e \u003cp\u003e− 5 men\u003c/p\u003e \u003cp\u003e- board game players - enjoy playing board games and do so at least once a month\u003c/p\u003e \u003cp\u003e- aged 25–45\u003c/p\u003e \u003cp\u003e- secondary education +\u003c/p\u003e \u003cp\u003e- do not have a psychological, sociological or therapeutic education and do not have such professions\u003c/p\u003e \u003cp\u003e- place of survey – Warsaw\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFocus group intervention nr 3\u003c/b\u003e\u003c/p\u003e \u003cp\u003e− 5 women\u003c/p\u003e \u003cp\u003e- board game players - enjoy playing board games and do so at least once a month\u003c/p\u003e \u003cp\u003e- aged 25–45\u003c/p\u003e \u003cp\u003e- secondary education +\u003c/p\u003e \u003cp\u003e- do not have a psychological, sociological or therapeutic education and do not have such professions\u003c/p\u003e \u003cp\u003e- place of survey - \u003cb\u003eSopot\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFocus group intervention nr 4\u003c/b\u003e\u003c/p\u003e \u003cp\u003e− 5 men\u003c/p\u003e \u003cp\u003e- board game players - enjoy playing board games and do so at least once a month\u003c/p\u003e \u003cp\u003e- aged 25–45\u003c/p\u003e \u003cp\u003e- secondary education +\u003c/p\u003e \u003cp\u003e- do not have a psychological, sociological or therapeutic education and do not have such professions\u003c/p\u003e \u003cp\u003e- place of survey – \u003cb\u003eSopot\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal: 21 respondents\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eTabele 2\u003c/h2\u003e\u003ch2\u003eProcedure and measurements\u003c/h2\u003e\u003cp\u003eThe study included two parts. In the first part, the respondents were introduced to the game and its rules by the leader (co-creator of the game). The respondents then played the game in the presence of the leader for 45 minutes, after which the leader left the session so as not to influence the group discussion with her presence. In the second part of the study, which lasted for a half hour, a meeting with an FGI facilitator (not present during the game but observing) took place. The participants discussed their experience, rating the playability and attractiveness of the game, their impressions and feelings about the game itself, and their feelings of stress levels during and after the game. Their statements were recorded and transcribed and then analyzed using qualitative methods.\u003c/p\u003e\u003cp\u003eQualitative research aims to understand reality in its natural environment and pay close attention to the context and specific cases studied\u003csup\u003e55\u003c/sup\u003e. In induction, data is used to build a 'middle-range theory'\u003csup\u003e56\u003c/sup\u003e, describing and naming social phenomena and formulating hypotheses that link them. As one of the study's aims was to explore the graphic concepts of the game, a 'raw' black and white prototype was used, with no signs, symbols, or graphic references.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eAdditional Information (including a Competing Interests Statement)\u003c/h2\u003e \u003cp\u003eThere is no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eStudy was supported by the grant \"Innovation Incubator 4.0\" (\u0026bdquo;Inkubator Innowacyjności 4.0\u0026rdquo;), project implemented under the Smart Growth Operational Program, 2014\u0026ndash;2020, measure 4.4: (Program Operacyjnego Inteligentny Rozw\u0026oacute;j, 2014\u0026ndash;2020, działanie 4.4): \"Support for scientific research management and commercialization of B\u0026thinsp;+\u0026thinsp;R results in scientific units and enterprises\" implemented by SWPS University and Military University of Technology.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.B - design and performed psychological tests, prepared graphs and statistical analysis of date, participated in writing the manuscript; K.A.K \u0026ndash; designed and performed qualitive studies and analyzed results, helped in writing the manuscript; J.H.S \u0026ndash; Design of the work concerning CORT levels in the saliva, overseas the collection and analysis of data and performed statistical analysis. Prepared the draft of the manuscript and coordinated the writing process. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank you Dr Emilia Grzęda for performing ELISA analysis. We also would like to thank you to STRESSmission team members Katarzyna Barcińska, MSc, Patrycja Sikora-Sawicka, MSc, Jakub Felczak, MSc, Dominika Winogrodzka, MSc for help and motivation to conduct this project. This project will not be successful without your support.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData for this study have been deposited in SWPS University. Please contact dr Edyta Bonk for data request \u0026ndash; email:[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaran, B. E., \u0026amp; Woznyj, H. M. Managing VUCA: The human dynamics of agility. \u003cem\u003eOrganizational dynamics\u003c/em\u003e, 100787. Advance online publication. https://doi.org/10.1016/j.orgdyn.2020.100787 (2020).\u003c/li\u003e\n\u003cli\u003eDi Gennaro et al.Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. \u003cem\u003eInt J Environ Res Public Health,\u003c/em\u003e \u003cstrong\u003e17(8),\u003c/strong\u003e doi: 10.3390/ijerph17082690 (2020).\u003c/li\u003e\n\u003cli\u003eFardin, M.A. COVID-19 and anxiety: a review of psychological impacts of infectious disease outbreaks. \u003cem\u003eArch Clin Infect Dis, \u003c/em\u003e\u003cstrong\u003e4(15),\u003c/strong\u003e\u003cem\u003e \u003c/em\u003edoi\u003cem\u003e: \u003c/em\u003e\u003cem\u003ehttps://doi.org/10.5812/archcid.102779\u003c/em\u003e (2020).\u003c/li\u003e\n\u003cli\u003eOrnell, F., Schuch, J.B., Sordi, A.O. \u0026amp; Kessler, F.H.P. \u0026quot;Pandemic fear\u0026quot; and COVID-19: mental health burden and strategies. \u003cem\u003eBraz J Psychiatry,\u003c/em\u003e \u003cstrong\u003e42(3),\u003c/strong\u003e 232-235, doi: 10.1590/1516-4446-2020-0008 (2020).\u003c/li\u003e\n\u003cli\u003eDragan, M., Grajewski, P., \u0026amp; Shevlin, M. Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. \u003cem\u003eEuropean journal of psychotraumatology\u003c/em\u003e, \u003cstrong\u003e12(1),\u003c/strong\u003e 1860356. https://doi.org/10.1080/20008198.2020.1860356 (2021).\u003c/li\u003e\n\u003cli\u003eSokol-Szawlowska, M. Wpływ kwarantanny na zdrowie psychiczne podczas pandemii COVID-19. \u003cem\u003ePsychiatry,\u003c/em\u003e\u003cstrong\u003e 18(1),\u003c/strong\u003e 57\u0026ndash;62, doi: 10.5603/PSYCH.a2020.0046 (2021).\u003c/li\u003e\n\u003cli\u003eDymecka, J. Psychosocial effects of the COVID-19 pandemic. \u003cem\u003eNeuropsychiatry and Neuropsychology\u003c/em\u003e, \u003cstrong\u003e16(1), \u003c/strong\u003e1-10. https://doi.org/10.5114/nan.2021.108030 (2021).\u003c/li\u003e\n\u003cli\u003eFountoulakis, K. N. et al.Results of the COVID-19 mental health international for the general population (COMET-G) study. \u003cem\u003eEuropean neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology\u003c/em\u003e, \u003cstrong\u003e54,\u003c/strong\u003e 21\u0026ndash;40. https://doi.org/10.1016/j.euroneuro.2021.10.004 (2022).\u003c/li\u003e\n\u003cli\u003eNochaiwong, S., et al. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. \u003cem\u003eSci Rep,\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 10173 https://doi.org/10.1038/s41598-021-89700-8 (2021).\u003c/li\u003e\n\u003cli\u003eWang, C., et al. The Association Between Physical and Mental Health and Face Mask Use During the COVID-19 Pandemic: A Comparison of Two Countries With Different Views and Practices. \u003cem\u003eFrontiers in psychiatry\u003c/em\u003e, \u003cstrong\u003e11,\u003c/strong\u003e 569981. https://doi.org/10.3389/fpsyt.2020.569981 (2020).\u003c/li\u003e\n\u003cli\u003eWang, C., et al. A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans. \u003cem\u003eScientific reports,\u003c/em\u003e \u003cstrong\u003e11(1),\u003c/strong\u003e 6481. (2021).\u003c/li\u003e\n\u003cli\u003eRozanov V., Franči\u0026scaron;ković T., Marinic I. Mental health consequences of war conflicts. In Javed A., Fountoulakis K. (Eds.) \u003cem\u003eAdvances in Psychiatry\u003c/em\u003e, 281\u0026ndash;304. Springer. https://doi.org/10.1007/978-3-319-70554-5_17 (2019).\u003c/li\u003e\n\u003cli\u003eSurzykiewicz, J., Skalski, S. B., Sołbut, A., Rutkowski, S., \u0026amp; Konaszewski, K. Resilience and Regulation of Emotions in Adolescents: Serial Mediation Analysis through Self-Esteem and the Perceived Social Support. \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e, \u003cstrong\u003e19(13),\u003c/strong\u003e 8007. https://doi.org/10.3390/ijerph19138007 (2022).\u003c/li\u003e\n\u003cli\u003eBrągiel, A., \u0026amp; Gambin, M. Depressive symptoms and psychological pain experienced by Polish adults in the context of both the war in Ukraine and the COVID-19 pandemic. \u003cem\u003eJournal of affective disorders reports\u003c/em\u003e, \u003cstrong\u003e12,\u003c/strong\u003e 100487. https://doi.org/10.1016/j.jadr.2023.100487 (2023).\u003c/li\u003e\n\u003cli\u003eUNHCR - Refugee Statistics https://www.unhcr.org/refugee-statistics/ (2022). \u003c/li\u003e\n\u003cli\u003eShigemura, J., Ursano, R. J., Morganstein, J. C., Kurosawa, M., \u0026amp; Benedek, D. M. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. \u003cem\u003ePsychiatry and clinical neurosciences\u003c/em\u003e, \u003cstrong\u003e74(4),\u003c/strong\u003e 281\u0026ndash;282. https://doi.org/10.1111/pcn.12988 (2020).\u003c/li\u003e\n\u003cli\u003eQuestions and answers: Stress, \u003cem\u003eWorld Health Organization Newsroom \u003c/em\u003ehttps://www.who.int/news-room/questions-and-answers/item/stress (2023).\u003c/li\u003e\n\u003cli\u003eGodoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N and Umeoka EHL. A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications. \u003cem\u003eFront. Behav. Neurosci.\u003c/em\u003e \u003cstrong\u003e12,\u003c/strong\u003e 127. doi: 10.3389/fnbeh.2018.00127 (2018).\u003c/li\u003e\n\u003cli\u003eGold PW. The organization of the stress system and its dysregulation in depressive illness. \u003cem\u003eMolecular Psychiatry\u003c/em\u003e \u003cstrong\u003e20,\u003c/strong\u003e 32\u0026ndash;47. doi: 10.1038/mp.2014.163 (2015).\u003c/li\u003e\n\u003cli\u003eEndler, N. S.; Parker, J. D. A. Coping Inventory of Stressful Situations (CISS): Manual. Multi-Health Systems: Toronto, (1990).\u003c/li\u003e\n\u003cli\u003eEndler, N. S.; Parker, J. D. A. Assessment of multidimensional coping: Task, emotions and avoidance strategies. Psychological Assessment, \u003cstrong\u003e6(1),\u003c/strong\u003e 50-60, https://doi.org/10.1037/1040-3590.6.1.50 (1994).\u003c/li\u003e\n\u003cli\u003eVita-Barrull, N., et al. The Cognitive Processes Behind Commercialized Board Games for Intervening in Mental Health and Education: A Committee of Experts. \u003cem\u003eGames for health journal\u003c/em\u003e, https://doi.org/10.1089/g4h.2022.0109 (2022).\u003c/li\u003e\n\u003cli\u003eWanyama, J. N., et al. A randomized controlled trial to evaluate the effectiveness of a board game on patients\u0026apos; knowledge uptake of HIV and sexually transmitted diseases at the Infectious Diseases Institute, Kampala, Uganda. \u003cem\u003eJournal of acquired immune deficiency syndromes (1999)\u003c/em\u003e, \u003cstrong\u003e59(3),\u003c/strong\u003e 253\u0026ndash;258. https://doi.org/10.1097/QAI.0b013e31824373d5 (2012).\u003c/li\u003e\n\u003cli\u003eCrawford, P., \u0026amp; Wiltz, S. Participation in the Journey to Life Conversation Map Improves Control of Hypertension, Diabetes, and Hypercholesterolemia. \u003cem\u003eJournal of the American Board of Family Medicine: JABFM\u003c/em\u003e, \u003cstrong\u003e28(6),\u003c/strong\u003e 767\u0026ndash;771. https://doi.org/10.3122/jabfm.2015.06.140142 (2015).\u003c/li\u003e\n\u003cli\u003eMoya-Higueras, J., et al. Just Play Cognitive Modern Board and Card Games, It\u0026apos;s Going to Be Good for Your Executive Functions: A Randomized Controlled Trial with Children at Risk of Social Exclusion. \u003cem\u003eChildren (Basel, Switzerland)\u003c/em\u003e, \u003cstrong\u003e10(9),\u003c/strong\u003e 1492. https://doi.org/10.3390/children10091492 (2023).\u003c/li\u003e\n\u003cli\u003eEstrada-Plana, V., et al. Cognitive training with modern board and card games in healthy older adults: two randomized controlled trials. \u003cem\u003eInternational journal of geriatric psychiatry\u003c/em\u003e, \u003cstrong\u003e36(6),\u003c/strong\u003e 839\u0026ndash;850. https://doi.org/10.1002/gps.5484 (2021).\u003c/li\u003e\n\u003cli\u003eVerghese, J., et al. Leisure activities and the risk of dementia in the elderly. \u003cem\u003eThe New England journal of medicine\u003c/em\u003e, \u003cstrong\u003e348(25),\u003c/strong\u003e 2508\u0026ndash;2516. https://doi.org/10.1056/NEJMoa022252 (2003).\u003c/li\u003e\n\u003cli\u003eAbel, M. Humor, stress, and coping strategies. \u003cem\u003eHUMOR\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(4), 365-381. https://doi.org/10.1515/humr.15.4.365 (2002).\u003c/li\u003e\n\u003cli\u003eWeir, K. What\u0026apos;s behind that smile? Psychological researchers are delving deeper into what our facial expressions and bodily movements reveal about our emotions, American Psychologiacal Association, \u003cstrong\u003e51(7),\u003c/strong\u003e 46\u003cem\u003e, \u003c/em\u003ehttps://www.apa.org/monitor/2020/10/behind-smile\u003cem\u003e \u003c/em\u003e2020.\u003c/li\u003e\n\u003cli\u003eGamble, B., Depa, K., Holmes, E. A., \u0026amp; Kanstrup, M. Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma: Qualitative Interview Study. \u003cem\u003eJMIR mental health\u003c/em\u003e, \u003cstrong\u003e8(2),\u003c/strong\u003e e23712. https://doi.org/10.2196/23712 (2021).\u003c/li\u003e\n\u003cli\u003eCollins, K. A., Mendelsohn, A., Cain, C. K., \u0026amp; Schiller, D. Taking action in the face of threat: neural synchronization predicts adaptive coping. \u003cem\u003eThe Journal of neuroscience: the official journal of the Society for Neuroscience\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e34\u003c/em\u003e(44),\u003c/strong\u003e 14733\u0026ndash;14738. https://doi.org/10.1523/JNEUROSCI.2152-14.2014 (2014).\u003c/li\u003e\n\u003cli\u003eAndersson, E., Holmes, E. A., \u0026amp; Kavanagh, D. Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science. \u003cem\u003emHealth\u003c/em\u003e, \u003cstrong\u003e4, 47,\u003c/strong\u003e https://doi.org/10.21037/mhealth.2018.09.11 (2018).\u003c/li\u003e\n\u003cli\u003eWeinstein, A. M. Computer and Video Game Addiction\u0026mdash;A Comparison between Game Users and Non-Game Users. The American Journal of Drug and Alcohol Abuse, \u003cstrong\u003e36,\u003c/strong\u003e 268-276. http://dx.doi.org/10.3109/00952990.2010.491879 (2010).\u003c/li\u003e\n\u003cli\u003eGauthier, A., et al. Board Games for Health: A Systematic Literature Review and Meta-Analysis. \u003cem\u003eGames for health journal\u003c/em\u003e, \u003cstrong\u003e8(2),\u003c/strong\u003e 85\u0026ndash;100. https://doi.org/10.1089/g4h.2018.0017 (2019).\u003c/li\u003e\n\u003cli\u003eWiener, L., Battles, H., Mamalian, C., \u0026amp; Zadeh, S. ShopTalk: a pilot study of the feasibility and utility of a therapeutic board game for youth living with cancer. \u003cem\u003eSupportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer\u003c/em\u003e, \u003cstrong\u003e19(7),\u003c/strong\u003e 1049\u0026ndash;1054. https://doi.org/10.1007/s00520-011-1130-z (2011).\u003c/li\u003e\n\u003cli\u003eNakao, M., Furukawa, H., Kitashima, C. \u003cem\u003e\u0026amp; Noda, S. \u003c/em\u003eSubjective well-being and problem-solving skills for alleviating the stress of elderly men attending a randomized controlled trial of shogi-assisted cognitive behavioral therapy. \u003cem\u003eBioPsychoSocial Med\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 11 https://doi.org/10.1186/s13030-019-0153-4 (2019).\u003c/li\u003e\n\u003cli\u003eEndler, N. S., \u0026amp; Parker, J. D. State and trait anxiety, depression and coping styles. \u003cem\u003eAustralian Journal of Psychology\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e42\u003c/em\u003e(2),\u003c/strong\u003e 207-220, \u003cstrong\u003ehttps://doi.org/10.1080/00049539008260119\u003c/strong\u003e (1990).\u003c/li\u003e\n\u003cli\u003eLelek, A., Mostowik, J., Kwapniewska, A. \u0026amp; Adamczyk-Banach, M. How do adolescents cope with crisis situations? preliminary reports from a study of adolescents with depressive and anxiety disorders. \u003cem\u003ePsychoterapia\u003c/em\u003e \u003cstrong\u003e4 (199),\u003c/strong\u003e 49-63, doi: 10.12740/PT/146493 (2021).\u003c/li\u003e\n\u003cli\u003eEndler, N. S., Macrodimitris, S. D., \u0026amp; Kocovski, N. L. Controllability in cognitive and interpersonal tasks: Is control good for you? \u003cem\u003ePersonality and Individual Differences, \u003c/em\u003e\u003cstrong\u003e29(5),\u003c/strong\u003e 951\u0026ndash;962. https://doi.org/10.1016/S0191-8869(99)00246-9 (2000).\u003c/li\u003e\n\u003cli\u003eKropotkin, P. \u003cem\u003eMutual aid: A factor of evolution.\u003c/em\u003e Paul AV, editor. New York University Press; (1972).\u003c/li\u003e\n\u003cli\u003eBullinger, A. F., Zimmermann, F., Kaminski, J., \u0026amp; Tomasello, M. Different social motives in the gestural communication of chimpanzees and human children. \u003cem\u003eDevelopmental Science, \u003c/em\u003e\u003cstrong\u003e14(1),\u003c/strong\u003e 58\u0026ndash;68. https://doi.org/10.1111/j.1467-7687.2010.00952.x (2011).\u003c/li\u003e\n\u003cli\u003eTomasello, M. et al. \u003cem\u003eWhy We Cooperate.\u003c/em\u003e Cambridge, MA: MIT Press.\u003cbr\u003e https://doi.org/10.7551/mitpress/8470.001.0001 (2009).\u003c/li\u003e\n\u003cli\u003eCardoso-Leite, P., \u0026amp; Bavelier, D. Video game play, attention, and learning: how to shape the development of attention and influence learning? \u003cem\u003eCurrent opinion in neurology\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e27\u003c/em\u003e(2),\u003c/strong\u003e 185\u0026ndash;191. https://doi.org/10.1097/WCO.0000000000000077 (2014).\u003c/li\u003e\n\u003cli\u003eBochennek, K., Wittekindt, B., Zimmermann, S. Y. \u0026amp; Klingebiel, T. More than mere games: a review of card and board games for medical education. \u003cem\u003eMedical teacher\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e29\u003c/em\u003e(9),\u003c/strong\u003e 941\u0026ndash;948. https://doi.org/10.1080/01421590701749813 (2007).\u003c/li\u003e\n\u003cli\u003eWanyama, J. N., et al. A randomized controlled trial to evaluate the effectiveness of a board game on patients\u0026apos; knowledge uptake of HIV and sexually transmitted diseases at the Infectious Diseases Institute, Kampala, Uganda. \u003cem\u003eJournal of acquired immune deficiency syndromes (1999)\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e59\u003c/em\u003e(3),\u003c/strong\u003e 253\u0026ndash;258. https://doi.org/10.1097/QAI.0b013e31824373d5 (2012).\u003c/li\u003e\n\u003cli\u003eViggiano, A., et al. Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion. \u003cem\u003eEuropean journal of pediatrics\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e174\u003c/em\u003e(2),\u003c/strong\u003e 217\u0026ndash;228. https://doi.org/10.1007/s00431-014-2381-8 (2015).\u003c/li\u003e\n\u003cli\u003eCrawford, P., \u0026amp; Wiltz, S. Participation in the Journey to Life Conversation Map Improves Control of Hypertension, Diabetes, and Hypercholesterolemia. \u003cem\u003eJournal of the American Board of Family Medicine: JABFM\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e28\u003c/em\u003e(6),\u003c/strong\u003e 767\u0026ndash;771. https://doi.org/10.3122/jabfm.2015.06.140142 (2015). \u003c/li\u003e\n\u003cli\u003eBarcińska, K., Winogrodzka, D., Śliwowska, J.H., Archanowicz-Kudelska, K., Bonk, E. Jak grać ze stresem? O budowaniu innowacji społecznej na przykładzie psychoedukacyjnej gry STRESmisja. \u003cem\u003eInnowacje społeczne \u003c/em\u003ein press (2024).\u003c/li\u003e\n\u003cli\u003eEndler, N. S., \u0026amp; Parker, J. D. A. \u003cem\u003eCoping Inventory for Stressful Situations--Short Form (CISS-SF)\u003c/em\u003e\u003cem\u003e \u003c/em\u003e\u003cem\u003eManual, 2nd ed. Toronto, ON: Multi-Health Systems.\u003c/em\u003e https://doi.org/10.1037/t67919-000 (1999). \u003c/li\u003e\n\u003cli\u003eCarver C. S. You want to measure coping but your protocol\u0026apos;s too long: consider the brief COPE. \u003cem\u003eInternational journal of behavioral medicine\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e(1),\u003c/strong\u003e 92\u0026ndash;100. https://doi.org/10.1207/s15327558ijbm0401_6 (1997).\u003c/li\u003e\n\u003cli\u003eGross, J. J., \u0026amp; John, O. P. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. \u003cem\u003eJournal of personality and social psychology\u003c/em\u003e, \u003cstrong\u003e85(2), \u003c/strong\u003e348\u0026ndash;362. https://doi.org/10.1037/0022-3514.85.2.348 (2003).\u003c/li\u003e\n\u003cli\u003eMerton, R. K. The Focused Interview and Focus Groups. Continuities and Discontinuities, \u003cem\u003ePublic Opinion Quarterly, \u003c/em\u003e\u003cstrong\u003e51,\u003c/strong\u003e 550-566, https://www.jstor.org/stable/2749327 (1987).\u003c/li\u003e\n\u003cli\u003eMorgan, D. L. \u003cem\u003eFocus groups as qualitative research\u003c/em\u003e, \u003cstrong\u003e16,\u003c/strong\u003e Sage publications. (1996). \u003c/li\u003e\n\u003cli\u003eStewart, D. W., \u0026amp; Shamdasani, P. N. \u003cem\u003eFocus groups: Theory and practice,\u003c/em\u003e \u003cstrong\u003e20,\u003c/strong\u003e Sage publications (2014). \u003c/li\u003e\n\u003cli\u003eDenzin, N. K., \u0026amp; Lincoln, Y. S. Handbook of qualitative research. \u003cem\u003eJournal of Leisure Research\u003c/em\u003e, \u003cstrong\u003e\u003cem\u003e28\u003c/em\u003e(2),\u003c/strong\u003e 132, (1996).\u003c/li\u003e\n\u003cli\u003eMerton, R. K. \u003cem\u003eSocial theory and social structure\u003c/em\u003e. Free Press, (1968).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"stress, game, cortisol, stress coping, resilience, COVID-19","lastPublishedDoi":"10.21203/rs.3.rs-5269742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5269742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eStress is an inherent and inextricable aspect of the live. When stress is excessive, it become chronic and has a negative impact on health. There is a need to disseminate knowledge about stress management techniques in order to reduce stress levels. In response to this demand, STRESmission, a psycho-educational tool was designed. It comprises task cards (grouped according to Aristel's triad of soma, psyche and polis), stress event cards (scored based on the Holmes and Rahe stress event scale), power and place cards, and a game board. We have tested if STRESmission (1) reduces perceived stress levels immediately and on a one-off basis, and whether it is an educational tool that helps in the acquisition of coping strategies, (2) can reduce stress levels in the long term, (3) is useful and attractive enough to encourage its use and therefore practical use of its benefits. A series of studies was conducted on groups of University students. We have found that STRESSmission decreased both subjective stress levels (psychological tests) and objective stress levels (lowering cortisol - CORT levels in the saliva). We concluded that the board game could be a stress-releasing and a learning tool to help cope with stressors.\u003c/p\u003e","manuscriptTitle":"Stress – mission possible! The STRESSmission game as a psychoeducational tool in coping with stress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-29 09:15:19","doi":"10.21203/rs.3.rs-5269742/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8194cd0f-ef81-432a-8acd-df5f5d531784","owner":[],"postedDate":"November 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40893358,"name":"Biological sciences/Neuroscience"},{"id":40893359,"name":"Biological sciences/Psychology"}],"tags":[],"updatedAt":"2025-02-05T17:38:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-29 09:15:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5269742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5269742","identity":"rs-5269742","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}