Habits of Gamers Study
Condition: Depression Mild; Depression, Anxiety; Anxiety; Attention Concentration Difficulty
MeSH terms: Depression; Depressive Disorder; Anxiety Disorders
Study type: Interventional

Summary: 
      Rationale:

      Mindfulness is a popular therapeutic strategy that has a growing body of evidence suggesting
      it can improve a wide range of physical and psychological symptoms. Yet, confusion exists as
      to why mindfulness is effective as well as the most effective ways in which to teach and
      practice mindfulness. The present study will test a mindfulness training protocol to better
      understand the most effective ways to teach and practice mindfulness.

      Intervention:

      A group of video game players, or "gamers", will be instructed on how to play a video game of
      their choice in a more mindful way and compare this to an activity of daily functioning
      (i.e., folding laundry). Outcomes from self-report measures taken both before and after study
      activities will be tested against a control group of gamers who will perform the same study
      activities without the mindfulness induction.

      Objective or Purpose:

      The purpose of the present study is to test the effects of a brief, standardized mindfulness
      prompt in order to better understand effective ways to train mindfulness concepts. The
      mindfulness prompt will be applied to an intrinsically motivated activity (i.e., video game
      play for experienced gamers) and an activity of daily functioning (i.e., laundry folding) in
      order to evaluate the different effects of mindfulness practice when implemented with a
      popular leisure activity versus a less engaging activity of daily living.

      Study Population:

      This study will include adult "gamers" ages 18-65. A gamer is someone who engages in some
      form of digital video game play for a minimal average of three hours per week. A
      pre-screening measuring will rule out any participants who do not play video games with
      enough frequency to be considered a gamer. Study sessions will take place remotely overseen
      via a Zoom-based video call with study personnel. Another exclusion criteria will be an
      inability to speak with study personnel via Zoom or do not have a private area to perform the
      study activities.

      Study Methodology:

      To address the aims of this study a mixed-method, between- and within-group, counterbalanced
      study design will be employed. Thus, participants will be randomized to either a mindfulness
      or control condition with pre- and post-study-task self-report measures collected at two
      separate study sessions in order to statistically analyze the study hypotheses.

      Study Aims:

      The present study has one primary aim and several secondary aims: The primary aim is to test
      the beneficial effects of a standardized, brief mindfulness induction prior to the completion
      of two different activities (i.e., play a video game or fold laundry). A secondary aim is to
      evaluate the impact that the type of activity has on one's ability to practice mindfulness.
      In addition to the primary and secondary aims, an exploratory analysis will be utilized in
      order to better understand what factors may have mediated the results from the first two
      aims.

      Study Outcomes or Endpoints:

      A main effect will be used to test the differences between the study manipulation (i.e.,
      mindfulness prompt) and control (i.e., perform the task as you usually do) conditions. The
      primary outcome will be a self-reported state-mindfulness scale that measures the degree to
      which one "mindfully" performed a specific activity. Secondary outcomes will capture changes
      in emotions from pre- to post-activity, level of engagement or "flow" during the activity,
      enjoyment performing study activities, and level of focus/concentration during study
      activities.

      Follow-up: No follow-up is planned at this time. A baseline screening measure as well as
      in-session pre and post-study task questions will be the only data collected.

      Statistics and Plans for Analysis:

      For the primary aim of the study, a repeated measures multivariate analysis of variance
      (MANOVA) with a 2 (study group) X 2 (activity type) X 2 (state mindfulness) matrix. The
      second study aim will be tested with a repeated measures multivariate analysis of covariation
      (MANCOVA) with the covariates of changes in emotions from pre- to post-activity, level of
      engagement or "flow" during the activity, enjoyment performing study activities, and level of
      focus/concentration during study activities.
    

Detailed description: 
      The present study has been designed to address several shortcomings in the "mindfulness"
      literature. Mindfulness has been defined as, "paying attention in a particular way: on
      purpose, in the present moment, and nonjudgmentally." Mindfulness-based interventions have
      shown an ability to alleviate a wide range of psychological disorders including anxiety and
      depression and have been integrated into many popular and evidence-based psychotherapeutic
      modalities including Cognitive Behavioral Therapy (CBT), Dialectical-Behavior Therapy (DBT),
      and Acceptance and Commitment Therapy (ACT), to name a few. Consequently, a better
      understanding of the most effective ways to teach mindfulness may help improve the positive
      effects of existing mindfulness-based interventions and may also inform future intervention
      and dissemination strategies based on this technique.

      One shortcoming of existing mindfulness research is that little consensus exists on how to
      operationalize the practice of mindfulness and few studies exist in which mindfulness is
      taught using a brief, standardized method. This is problematic because a lack of such brief
      and standardized training methods has led to inconsistencies and broad differences in how
      mindfulness interventions, to date, have defined, operationalized, and applied mindfulness
      principles and practice strategies. Moreover, it has been suggested that this literature
      suffers from an over-reliance on long-term, randomized clinical trials, which has resulted in
      a lack of controlled laboratory-based studies in which the mediating variables responsible
      for observed changes can be tested. Stated another way, mindfulness lacks research that is
      controlled, systematic and laboratory-based. Consequently, investigators still understand
      little about why mindfulness is effective as well as what factors may enhance or hinder one's
      ability to learn mindfulness strategies. A nebulous understanding of how to operationalize
      mindfulness and what mechanisms are responsible for change within mindfulness-based
      interventions should be addressed because the effectiveness of such interventions may be
      limited and may also lead to misattributions for what factors are mediating the positive
      effects demonstrated in these interventions. The present study will address this limitation
      by replicating an existing mindfulness study in which a brief, standardized mindfulness
      intervention was compared to a control group. The present study will apply similar
      mindfulness instructions to a different set of activities. This mindfulness manipulation will
      be compared to a control group receiving no mindfulness instructions.

      The first aim of this study, to test a brief, standardized mindfulness prompt prior to the
      completion of an activity, is meant to address the aforementioned shortcomings in current
      mindfulness literature. This study will be a partial replication of a systematic
      investigation conducted by Hanley, who tested a brief, standardized mindfulness induction
      prior to the completion of an instrumental activity of daily living (i.e., dishwashing) and
      compared the effects to a control group performing the same activity with no mindfulness
      prompt. Instrumental activities of daily living like meal preparation, shopping and cleaning
      are often used to teach mindfulness. Hanley found that participants in the mindfulness
      condition reported significantly greater levels of mindfulness during the activity, greater
      levels of positive emotions following the task, more engagement in the activity, and
      significantly lower levels of negative emotions as compared to the control condition. The
      present study will employ a similar set of mindfulness instructions prior to the completion
      of a different activity of instrumental daily living, folding laundry. A similar set of
      outcomes in relation to state-mindfulness, current emotional states, and experience
      performing the activity will also be utilized in the present study. This study will be a
      partial replication and extension of Hanley work. If similar results are observed in the
      present study it will suggest that brief, standardized mindfulness interventions may be
      flexibly applied to a wide range of activities. This, in turn, may help increase the
      opportunities one has to practice mindfulness throughout the day. Consistent practice has
      been demonstrated to be one of the most important factors in learning mindfulness. Thus, a
      brief, standardized set of mindfulness instructions that can be flexibly applied to a number
      of activities may improve the effectiveness of future mindfulness interventions.

      The second aim, which is intended to better understand the impact that type of activity has
      on a mindfulness prompt, may also help further mindfulness literature in several important
      ways. First, evidence suggests that in addition to consistent practice, feeling engaged and
      motivated while practicing may also help enhance mindfulness training. By asking participants
      to complete an activity after receiving mindfulness instructions for both video game play
      (VGP) and folding laundry the present study will be able to directly compare the differences
      between mindfulness training when applied to an engaging activity versus a routine activity.
      VGP was chosen to represent an engaging activity because VGP is a popular global activity
      that is practiced by millions of people on a daily basis. It has been suggested that VGP may
      represent an ideal platform in which to teach mindfulness because the real-time feedback and
      interactivity they provide can keep a user continuously engaged and immersed in the present
      moment. Much of the engagement and immersion observed during VGP studies may be attributed to
      the fact that many people find VGP to be a fun, enjoyable, intrinsically motivated activity.
      Intrinsic motivation, the motivation one feels to engage in activities that they enjoy, has
      been consistently shown to be one of the most powerful forms of human motivation. Further,
      people tend to feel the greatest sense of satisfaction and enjoyment when they engage in
      intrinsically motivated activities. Another reason VGP was selected as an activity for the
      present study is the emerging body of literature that suggests VGP can act as a platform for
      psychoeducation and enhance a wide range of behavioral and mental health functions including
      improved emotion regulation, ability to navigate negative emotions, problem solving, and
      social interactivity.

      In sum, this study is needed in order to better understand optimal ways in which to train and
      practice mindfulness. More studies like this are needed because the current mindfulness
      literature lacks systematic investigations of brief, standardized training methods. This has
      led to a dearth of knowledge about how to operationalize the term "mindfulness" as well as
      why existing mindfulness interventions have been effective. The present study will address
      these shortcomings by comparing a brief, standardized mindfulness manipulation when applied
      to VGP and laundry folding. A between-subjects analysis will be used to test the effects of
      the mindfulness prompt when compared to a control group. A within-subject analysis will be
      used to test whether the application of mindfulness to an enjoyable activity (i.e., video
      game play) produces greater effects than when it is applied to a more routine activity (i.e.,
      folding laundry). This is intended to help inform future mindfulness interventions by
      providing more insight into effective ways to teach and practice mindfulness.

      Risks to participants: This study will present minimal risk to the participants for a variety
      of reasons. First, a brief screening measure will be used to exclude participants who don't
      meet our inclusion criteria (including screen out minors). Second, the two study tasks are
      non-invasive and present no health risks to participants. Specifically, folding laundry and
      playing a self-selected video game are common activities that participants should be familiar
      with and that present no inherent dangers to the participants. Third, the questionnaires
      within the study will be focused on assessing how participants are currently feeling and how
      they felt about the performance of study task from a variety of questionnaires. Since the
      questions are tied to a specific task and current thoughts and feelings, they should not
      present any prompts that participants would find distressing or offensive. Fourth, the
      mindfulness prompt in this study will be modeled after an existing study which demonstrated
      effectiveness in teaching participants principles of mindfulness when compared to a control
      group while also presenting minimal risk to participants. Finally, it will be made clear to
      participants during the informed consent process that they will be able to leave the study at
      any time and that they are under no obligation to complete both study sessions. Given these
      reasons, it is believed the present study does not present any undue risks to participants.
    

Intervention name(s): Mindfulness
Intervention type(s): Behavioral
Intervention description(s): Pay attention to the present moment, on purpose, in a nonjudgemental way.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: 2 x 2 study design with four groups. Half the participants will be randomized to a control condition and half will be randomized to an experimental condition (i.e., mindfulness). All participants will complete each of two study activities, but the order of the activities will be crossed over so that order effects for the activity are minimized. Thus, the groups will be as follows:
Group 1: mindfulness condition and play video game first, fold laundry second Group 2: mindfulness condition and fold laundry first, play video game second Group 3: control condition and play video game first, fold laundry second Group 4: control condition and fold laundry first, play video game second
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: mindfulness