TRACK 7 (2)| SELF MANAGEMENT PART 2 | DAY 2 - 1 NOV 2016 Wouter Boendermaker, Researcher | Utrecht University (NL) Games for Health Europe 2016

1. Introducing The Fling
A Serious Game to Train Behavioral
Control in Adolescents
Wouter Boendermaker, M.Sc.
Utrecht University
Games for Health: Europe, November 1st, 2016

2. Theory
Addiction and adolescents
• Underage alcohol consumption is relatively
high in The Netherlands.
• Reckless use in adolescence can lead to later
addiction problems
• Costly prevention campaigns:
explicit messages
seem ineffective

3. Dual Process Model of Addiction
• Dual Process Model
focuses on less visible (implicit) cognitive processes
• Imbalance between two processes
leads to and maintains addiction problems
Weak cognitive
control processes
Too strongly developed
automatic reactions
to drug-related cues
More info: Wiers, RW, Bartholow, BW, Wildenberg, E van den, Thush, C, Engels, RCME, Sher, KJ, Grenard, J, Ames, SL, & Stacy, AW (2007). Automatic and controlled processes and the development in addictive
behaviors in adolescents: A review and a model. Pharmacology, Biochemistry and Behavior, 86, 263-283.

4. Cognitive Training!
We can (re)train these processes using computerized trainings:
1. Cognitive Bias Modification (CBM)
• Interpretation or memory bias
• Biased attention or approach behavior towards substance
2. Executive Function (EF) training:
• Working memory (updating new information)
• Inhibition (stopping behavior)
Several online training projects: www.impliciet.eu

5. Problem with adolescents
• Drinking / blowing is very popular
• Substance use is high but seldom seen as problematic
• General lack of motivation to change behavior
• And: These tasks are boring, take a long time and are repetitive
 They have no (intrinsic) motivation to train
Solution(?): Motivate with game elements

6. Introducing The Fling
Training inhibition:
GO or STOP
Timing very important
The Fling adds:
Storyline, humor
Rhythm
3D (Unity)
Level structure

7. Study Design
• Three experimental conditions
• GAME – TRAINING vs. GAME PLACEBO vs. REGULAR TRAINING
• 160 Adolescents
• 13-17 years old
• School based, low-level vocational (VMBO-kader)
• Four training sessions
• Ten 3-4 minute levels (>1000 trials)
• Measures of inhibition, working memory, substance use
Data collection ongoing

8. First results
• General numbers:
• 154 participants finished; 4 dropped out
• 66 boys; 92 girls
• Mean age 14.8
• Game training rated much higher (6.5/10) than non-game (4.2/10)
• Some unexpected findings:
• Several kids did not understand written and verbal instructions
• The storyline did not draw much attention
• Training was harder than we imagined:
• Almost no perfect scores
• Bonus cues were confusing to some

9. Discussion
Careful scientific evaluation, before going public!
Some things to think about:
• How can we keep motivation high throughout the entire (multi-
session) training?
• Even commercial games become boring at some point!
• Could the word game create unrealistic expectancies?
• Commercial games are all regular youth are familiar with
• Crushed expectancies  disappointment  low motivation?
• What happens to motivation during post-training assessment, where
no game elements are used?

10. Future plans
• Continue development
• Mobile / tablet app
• More adaptive levels
• Use your own music
• Test among broader audience
• Fewer time limits: free play
• Stronger training effects?
• When does fatigue start?
• How long does the game remain fun to play?

11. Thank you!
Many thanks to:
• Margot Peeters
• Remco Veltkamp
• Robbert-Jan Beun
• Rens van de Schoot
• Harold de Groot (Shosho)
Questions?
www.uu.nl/onderzoek/beat-it
www.wouboe.nl