JMIR Serious Games

Emotion recognition bias in depression is well documented [1] and is proposed to play a causal role in depression [2]. A Cognitive Bias Modification (CBM) intervention targeting the bias in emotional expression perception was developed, but despite robust training effects on emotion perception, the effect on mood was unreliable and weak [3]. We propose a new gamified version of CBM (GCBM) to address potential limitations that may attenuate therapeutic effects.

Overweight and obesity seriously affect physical and psychological health worldwide. They are common public health issues in young adults who are considered a 'vulnerable group' prone to adopt unhealthy lifestyles that can lead to overweight and obesity. Virtual reality exergames could help to increase balance performance among Parkinson’s disease patients and improve depression and pain interference among individuals with chronic neck pain. Still, limited research has been conducted on the use of virtual reality exergames among overweight and obese young adults and their willingness and acceptability remain unclear.

Immersive virtual reality (VR) and artificial intelligence have been used to determine whether a simulated clinical exam setting can reduce anxiety in first-year occupational therapy students preparing for objective structured clinical examinations (OSCEs). Test anxiety is common among postsecondary students, leading to negative outcomes such as increased dropout risk, lower grades, and limited employment opportunities. Students unfamiliar with specific testing environments are particularly prone to anxiety. VR simulations of OSCEs may allow students to become familiar with the exam setting and reduce anxiety.

Smartwatch-based gamification holds great promise for enhancing fitness apps and promoting physical exercise; however, empirical evidence on its effectiveness remains inconclusive, partly due to “one-size-fits-all” design approaches that overlook individual differences. While the emerging research area of tailored gamification calls for more accurate user modeling and better customization of game elements, existing studies have relied primarily on rating scale–based measures and correlational analyses with methodological limitations.

Online meetings have become an integral part of daily life for many people. However, prolonged periods of sitting still in front of screens can lead to significant, long-term health risks. While previous studies have explored various interventions to address sedentary lifestyles, few have specifically focused on mitigating sedentary behavior during online meetings. Furthermore, design opportunities to address this issue in the context of online meetings remain underexplored.

Virtual reality (VR) is a rapidly developing technology that has gained significant traction in the treatment and rehabilitation of individuals with stroke. Research on VR-based stroke treatment has garnered increasing attention.

Exergames are interactive solutions that require physical activity and are commonly used in learning or rehabilitation settings. For cognitive rehabilitation with exergames, the assessment of the intervention progress can be conducted by verifying the changes in brain activity. Electroencephalography (EEG) is a well-known method for this evaluation. However, motion artifacts due to large body movements can impede signal quality. No comprehensive guide on the artifact removal methods in the context of exergaming has been found.

This article (letter to the editor) discusses an overlooked, long-established technology within serious games research: the pinball machine. Pinball is a game that engages multiple cognitive processes, enhancing executive functions, as explored in the accompanying article. Its enduring presence in the gaming industry—spanning gameplay design, mechanics, electronics, and both kinetic and digital formats—raises important questions: Could pinball's unique format, rooted in both physical and digital realms, bridge the gap between traditional and modern approaches to serious gaming? Could it offer a more tangible, interactive experience as a promising therapeutic tool (or adjunct) compared to conventional serious games? Despite decades of studies examining the use of pinball machines as an intervention for individuals with various conditions, the role of pinball in serious game research remains underexplored. Why is this technology not more widely investigated, including its theoretical potential, even as it continues to evolve? Is pinball less adaptable or perhaps too costly compared to other technologies? While traditionally viewed as entertainment, the cognitive challenges pinball presents to players may provide an effective means to exercise executive function skills. To fully unlock its potential as a serious game, researchers must broaden their scope, integrating arcade technologies like the pinball machine into the increasingly digital-centric landscape of serious gaming.

We appreciate the insightful comments and reflections regarding our study on the impact of serious games on executive functions and their application in neurodiverse populations [1]. The suggestion to consider pinball machines as a tool within the serious games paradigm presents an interesting avenue for further exploration. At the time of our study, our focus was primarily on conventional and emerging digital technologies, such as virtual reality, mobile devices, and sensor-based interactions. However, we acknowledge that pinball, with its unique combination of physical and digital interactions, may offer valuable cognitive and therapeutic benefits, particularly in the context of executive function training. The references provided in the letter highlight historical and recent research supporting its potential applications in various populations, reinforcing the idea that this arcade technology could play a role in future serious game developments. Given the evidence presented on pinball’s ability to engage attention, impulse control, cognitive flexibility, and problem-solving skills, we recognize its potential as a tool to enhance executive function training. Future work in this area could explore the adaptation of pinball mechanics within digital serious games or investigate its direct application as a therapeutic tool in controlled settings. Additionally, we acknowledge that the development of assistive technologies for neurodiverse populations often encounters blind spots, where certain tools or approaches are overlooked. Our intention with the published article is to provide a roadmap for researchers, highlighting that there remains substantial work to be done in this area. By identifying these gaps, we aim to offer a starting point for ongoing and future investigations. Several studies have underscored the challenges and opportunities in designing technologies for neurodiverse users. For instance, Frauenberger et al. discuss the importance of involving neurodiverse children in the technology design process to ensure that their unique needs are met [2]. Similarly, Benton and Johnson highlight lessons from neurodiverse communities, emphasizing the necessity of tailored technological interventions [3]. These perspectives reinforce the need for comprehensive research and development efforts to address the diverse requirements of neurodiverse populations. We thank the authors of the letter for broadening the discussion on serious game technologies. Their insights open the door to new interdisciplinary research possibilities that could further enrich this field.

Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD.

Virtual reality (VR) active gaming is growing in popularity but little is known about physical activity during gameplay. Two popular VR games are Gorilla Tag and Beat Saber. Little is known about physical activity during these games in youth.

In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically.