A stepped-down adaptive trial of online CBT-based game and mobile ecological interventions for improving child mental health.

Therapeutic games represent a promising and efficient format by which access to, and engagement with evidence-based content can be enhanced. REThink Game is such an online CBT-based intervention which was tested to be efficient in addressing the youngers mental health needs. In the current study, we recruited 85 children from an urban school (51 girls, Mage of 10.95, SD = 1.64) and were offered the REThink Game to play each level for a period of 4 weeks. Using a stepped-down adaptive design approach, those participants who did not register a reliable change after playing the game were further instructed to use a CBT-based ecological momentary intervention app, called PsyPills, while the rest were instructed to continue with monitoring their affective state using an ecological momentary assessment app, called MoodWheel. Results showed that after the participants played the game, their levels of mental health symptoms and irrational beliefs have significantly improved (d = 0.30, 95% CI [0.07, 0.53], and d = 0.27, 95% CI [0.04, 0.50], respectively). Participants who did not initially show reliable change achieved additional improvement over time and displayed outcomes comparable to those of early responders at post-intervention and 3-month follow-up. When examining potential moderators of intervention effects, the results suggested a consistent pattern: among participants with greater difficulties in attachment security, the game-based intervention combined with the PsyPills app appeared to be more effective. In conclusion, digital interventions can be used to enhance and tailor the intervention's content based on children's needs.