Mixed-method feasibility outcomes for a novel ACT-based videogame ‘ACTing Minds’ to support mental health

Objectives: To determine the feasibility and acceptability of ‘ACTing Minds’, a novel single-player adventure videogame based on acceptance and commitment therapy (ACT). Design: A single arm, mixed-methods repeated measures feasibility study. Setting: Intervention and questionnaires were completed at home by participants. Semi-structured interviews were also conducted at home via the Zoom platform. Participants: Thirty-six participants were recruited into the study, 29 of whom completed all phases of the feasibility design. Eligibility criteria required participants to be over the age of 18 and self-reporting experiencing ongoing depression, anxiety, or stress.Intervention: Participants completed a single session of the ‘ACTing Minds’ videogame, lasting approximately 1-hour, designed to educate users on key principles from acceptance and commitment therapy (ACT), including ‘acceptance’, ‘commitment to values’ and ‘cognitive defusion’.Primary outcome measures: Primary outcomes related to participant recruitment and retention, questionnaire completion, long-term intervention adherence, and acceptability of the intervention. Reflexive thematic analysis was conducted on semi-structured interviews run immediately postintervention and 3-weeks later.Secondary outcome measures: Measures of depression, anxiety, stress, psychological flexibility, social connectedness, and wellbeing were assessed at baseline, immediately following intervention completion, and at a 3-week follow-up period using a standardised battery of questionnaires. Primary results: Twenty-nine participants completed the study (7 were lost through attrition – 6 did not show up for the first phase of the study, and 1 completed the baseline measurements only). A reflexive thematic analysis indicated that participants responded positively to the intervention and the study at both postintervention and 3-week follow-up timepoints. Themes reflect participants’ desire for an engaging therapeutic experience, use of the game as a base for exploring emotions, their feelings on what they learned and the content within the game, as well as their perspectives on how they had applied their learning to the real-world and whether there were any consequences associated.Secondary results: Quantitative results showed that playing 'ACTing Minds' resulted in small to medium effect sizes associated with decreases in depression (ηp2 = .011), anxiety (ηp2 = .096), and stress (ηp2 = .108), as well as increases in psychological flexibility (ηp2 = .060), social connectedness (ηp2 =.021), and well-being (ηp2 =.011). Conclusions: Implementation of the 'ACTing Minds' intervention into a full-scale randomised control trial (RCT) is warranted. Based on displayed effect sizes, the effectiveness of the intervention is promising and further investigation in a fully powered trial is now needed to determine treatment effectiveness of ‘ACTing Minds’.