New systemic review/meta-analysis explores digital interventions for emotion regulation in youth

Reynard, S., Dias, J., Mitic, M., Schrank, B., & Woodcock, K. A. (2022). Digital interventions for emotion regulation in children and early adolescents: Systematic review and meta-analysis. JMIR Serious Games, 10(3), e31456. https://doi.org/10.2196/31456

Summarized by Ariel Ervin

Notes of Interest: 

• Emotion regulation challenges correlate with negative mental health and social outcomes.
• While digital interventions are a promising and more accessible approach to addressing this, there are no comprehensive insights about existing emotion regulation digital interventions and how effective they are for youth.
• This meta-analysis/systemic review assesses current emotion regulation digital interventions for children and early adolescents.
• Digital games were the prevailing intervention type 27/39, 69%).
  • They notably lowered negative emotional experience with a small effect. This mainly applied to participants who were at risk for anxiety.
•  Although digital interventions tend to boost emotion regulation, this effect turned out to be non-significant.
• Findings indicate that digital games are the most effective and advanced youth digital interventions.
• A majority of the study’s feasibility problems were pinpointed in diagnosed youth. Acceptability was overall high across samples and intervention types.

Introduction (Reprinted from the Abstract)

Background: Difficulties in emotion regulation are common in adolescence and are associated with poor social and mental health outcomes. However, psychological therapies that promote adaptive emotion regulation may be inaccessible and unattractive to youth. Digital interventions may help address this need.

Objective: The aim of this systematic review and meta-analysis was to synthesize evidence on the efficacy, feasibility, and acceptability of emotion regulation digital interventions in children and early adolescents aged 8 to 14 years.

Methods: Systematic searches of Web of Science, MEDLINE, PsycINFO, EMBASE, Education Resources Information Centre, ACM Digital Library, and IEEE Xplore up to July 2020 identified 39 studies, of which 11 (28%) were included in the meta-analyses (n=2476 participants). A bespoke tool was used to assess risk of bias.

Results: The studies evaluated digital games (27/39, 69%), biofeedback (4/39, 10%), virtual or augmented reality (4/39, 10%), and program or multimedia (4/39, 10%) digital interventions in samples classified as diagnosed, at risk, healthy, and universal. The most consistent evidence came from digital games, which reduced negative emotional experience with a small significant effect, largely in youth at risk of anxiety (Hedges g=–0.19, 95% CI –0.34 to –0.04). In general, digital interventions tended to improve emotion regulation, but this effect was not significant (Hedges g=0.19, 95% CI –0.16 to 0.54).

Conclusions: Most feasibility issues were identified in diagnosed youth, and acceptability was generally high across intervention types and samples. Although there is cause to be optimistic about digital interventions supporting the difficulties that youth experience in emotion regulation, the predominance of early-stage development studies highlights the need for more work in this area.

Implications (Reprinted from the Discussion)

Summary

This systematic review and meta-analysis aimed to evaluate current digital interventions that train emotion regulation in children and early adolescents published in peer-reviewed articles up to July 2020. In summary, digital games were the most prevalent intervention type: 69% (27/39) of the studies

evaluated digital games. Digital games decreased negative emotional experience with a small significant effect, mainly in samples at risk of anxiety. In addition, digital interventions improved emotion regulation; yet, this effect was nonsignificant. Furthermore, acceptability was strong across all intervention types and samples, and most feasibility-related problems were in samples who had received a diagnosis. In the following sections, we discuss the key findings and provide recommendations for the field’s progression.

Efficacy

Examined through meta-analysis and systematic review, digital games provided evidence for a significant reduction in negative emotional experience with a small effect, largely in samples at risk of anxiety, using validated and reliable outcome measures. This suggests that digital games are the most advanced and efficacious digital interventions for training emotion regulation in children and early adolescents. This important finding may be partly explained with cognitive load theory, which postulates that limited novel information can be processed at once in working memory [114]. Indeed, to optimize learning in a digital environment, balance must be sought between presenting information in a manner that meets an individual’s cognitive needs, yet with sufficient complex information to facilitate understanding of the given topic, and learning must be active to enhance the development of cognitive schemas [114,115]. Such optimization may be achieved with certain pedagogical techniques. For example, pacing serves to decrease cognitive load on working memory by relying on the user or system to control information presentation (eg, by pausing material delivery or going back to look at previous material) [115]. In line with these digital pedagogical principles, the included digital game studies largely presented learning tasks that focused on different emotion regulation strategies within separate parts of the game, with gradual user-led increases in difficulty and complexity, and a simple user-friendly interface, with animated characters that provided information about different emotion regulation strategy elements and in-game support.

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