(PS12-64) Development of CLEAR Path, a Serious Game for Co-occurring Depression and PTSS

Abstract Text:

Background: After a traumatic event, individuals may experience comorbid depression and post-traumatic stress symptoms (PTSS). Digital interventions can help manage symptoms, allowing for greater access and reduced stigma. However, high dropout rates for online programs indicate the need for strategies to increase adherence and engagement. Gamification, including serious games (games that aim to educate rather than entertain), is an effective strategy (Ibrahim et al., 2021; Litvin et al., 2020). The aim of this study is to understand the adherence to, engagement with, and effectiveness of CLEAR Path, a serious game aimed at educating users about the management of symptoms of comorbid depression and PTSS. 
Game development: The premise of CLEAR Path is to help a character who has experienced a traumatic incident (mugging), and who is struggling with depression and PTSS, go through a week (seven “game days”) in their life while managing their mood and distress. Participants follow the character from awakening to bedtime, and each day, the character faces numerous choices and decision points that mimic real-life situations (work-related, personal, social situations, self-care). Each part of the story, including decision points and their outcomes, are presented via text and pictures. To maximize similarity to real life, some situations were predictable (i.e., expected outcomes from past decisions), and others were random (e.g., friends changing plans last minute). At each decision point, participants choose from a list of options that include helpful, unhelpful, and neutral coping strategies. Helpful choices are based on tools from cognitive behavioral therapy and dialectical behavior therapy; these were chosen for CLEAR Path because they are effective, can be easily understood, and can be illustrated in a game-like environment.  After a choice is selected, participants are presented with an outcome of the choice, both in terms of events that occur as a result and the effect of the choice on emotional well-being. Emotional well-being is illustrated via a “health bar” and colored banners representing the avatar’s current mood, which brighten or darken in response to a better or worse choice, respectively. At the conclusion of each “game day,” participants rate the character’s perceived mood and distress. 

Methods: Individuals are eligible if they report at least mild symptoms of depression (via PHQ9) and at least one lifetime traumatic event. Once consented, participants choose whether they wish to play a male or a female avatar. To understand the effect of game delays (forced waiting time) on adherence, participants are randomized into one of three time delay groups: no delay between “game days,” a 10-minute delay, or a 1-hour delay. Adherence is measured in two ways: the number of days completed and return for follow-up. Engagement is measured as: total time spent using CLEAR Path, average time per “game day,” and number of times mood and distress ratings were recorded. Improvement in mood management strategies knowledge is assessed by comparing baseline and follow-up measures and examining decisions made in the game. The results of the study will be available by the ABCT 2024 Annual Convention.