## 5 Conclusions and Future Directions  
In this qualitative literature review, we reported several serious game applications as therapy interventions for different affective disorders in both autistic and neurotypical individuals. In 30 out of 37 studies, at least one of the outcome measures showed the positive impact of the serious intervention for the specific affective disorder they investigated. Therefore, we argue that games created for affective disorder therapies are effective and patients and therapists can use the significant benefits of these games to recover from or mediate other therapies for certain affective disorders. Our analysis, which was reported in Sections 3 and 4, showed that for interventions for depression and its comorbidities, the most frequently utilized game design characteristics (player perspective, game dimensionality and genre, respectively) were 3D at 63.64%, first person/immersive at 36.36%, and racer at 27.27% respectively. For anxiety and its comorbidities, these were 3D (VR) at 57.14%, immersive at 50% and adventure at 28.57% while for phobias and their comorbidities, these were 3D (VR) at 83.33%, immersive at 100% and therapeutic VR/social VR at 33.33% respectively. Therefore, the literature suggests that the implementation of 3D, first person/immersive and racing games could be suitable as interventions for depression and its comorbidities, as well as the implementation of 3D (VR), immersive and adventure or social VR games, could be suitable as interventions for anxiety and its comorbidities and 3D (VR), immersive and therapeutic VR/social VR games could be suitable as interventions for phobias and their comorbidities. Due to a very small number of studies on applications of serious games on bipolar disorder and its comorbidities as well as emotional dysregulation of anger and aggression fitting our eligibility criteria for this study, we could not conclude on the appropriate game design characteristics for applications of serious games as therapies for these affective disorders. To prevent bias, factors such as the variety of criteria and differences in their measurement, small sample size, lack of accurate evaluations of clinical trials on games, etc., needed to be avoided. Another finding worth highlighting is the fact that, amongst the different affective disorders that had been studied in the reviewed studies, all instances of serious game applications as therapies for depression showed a positive impact on the participants of the related studies in both the ASD and neurotypical populations. Hence, we encourage further investigation of serious game applications as therapies for depression as there could be some underlying reason for the better efficacy of serious game therapies for depression therapies. Additionally, our literature review, as with most other reviews, has the pitfall of not being able to include all the instances of serious game interventions for the affective disorders we encountered in the reviewed articles for both positive, neutral and negative impacts on the outcome measures. This could be due to the fact that many unsuccessful interventions might not have been published in the scientific literature. Hence, our finding of the positive impact of such interventions in 30 out of 37 studies cannot be considered an absolute conclusion in favor of serious game interventions as affective disorder therapies for ASD and neurotypical populations but should be considered as an indication of the effectiveness of such interventions, and more research will be needed to reach a definitive conclusion in this matter. Furthermore, our search strategies seemed to have been too focused on the Emtree synonyms, which meant that only a few most frequently studied affective disorders were present in our search results and so applications of CSGs for other affective disorder therapies could not be included in this study.