Evaluating the effect of an online game on depression symptoms in trans young people

The project aims to evaluate the efficacy, acceptability and feasibility of a mobile serious game adapted specifically for and with trans young people (SPARX-T) in preventing the onset and exacerbation of depressive symptoms, compared to a waitlist control. SPARX is an online, serious game; an intervention that uses gaming for serious purposes. Developed by researchers at the University of Auckland, the program was designed to be unguided and interactive, using a fantasy game format to provide cognitive behavioural skills to treat mild to moderate symptoms of depression in young people. SPARX users choose and personalise an avatar and are led through the program by a virtual guide who provides context and links the content of the program to their real-life experiences. Prior research by members of this project’s investigation team has found that the use of personalised avatars to express and realise gender identity by trans young people in a virtual space confers benefits such as increased wellbeing (Morgan et al., 2020). In SPARX, the user navigates their way through a series of challenges within a fantasy world that has been overrun by GNATs (gloomy, negative, automatic thoughts), with the mission of restoring balance in the game world. Phase I of this research project involved working with trans young people aged 11-18 to form focus groups that engaged in semi-structured group discussions. These young people were also given access to existing versions of SPARX (SPRAX-R and Rainbow SPARX) and were asked to maintain an online diary to track their experiences. This phase concluded with focus groups following this access period to discuss the games and determine the desired changes of the applications in order to create SPARX-T. Following the processes in Phase I of this research project, in Phase II we determined the changes required to successfully adapt SPARX to the SPARX-T prototype and our developers produced the SPARX-T app for evaluation in Stage 3. Specifically, we adapted aspects of the game such as introducing a customisable avatar, including language, content and supportive resources tailored to the trans-specific context, and adapting the ‘notebook’ to allow personalised content to be added by users. These changes have been embedded throughout the game with the inclusion of characters that use they/them pronouns, example scenarios that have been adapted to be potential situations young trans people may face and the removal of gender options for the customisable avatar. SPARX-T consists of 7 levels that take approximately 20 minutes to complete. Participants will be encouraged to complete 1/2 levels per week over a 5-week period and whilst this will be monitored, the user is able to complete the levels at their discretion. Adherence to the intervention will be monitored using app data and a single reminder text will be sent those in the intervention group 3 weeks into the intervention period to only participants who have not completed a module or only completed module 1. The titles of the levels and a brief overview of the core focus are listed below: Level 1—cave province: finding hope Psychoeducation about depression and an introduction to the cognitive behavioural therapy model Introducing GNATs (Gloomy Negative Automatic Thoughts) Level 2 ice province: being active Activity scheduling and behavioural activation Level 3—volcano province: dealing with emotions Dealing with strong emotions: anger and hurt feelings Level 4—mountain province: overcoming problems Problem solving using STEPS: Say the problem, Think of solutions, Examine the pros and cons, Pick one and try it, See what happens Level 5—swamp province: recognising unhelpful thoughts Cognitive restructuring—recognising different types of GNATs Level 6—bridgeland province: challenging unhelpful thoughts Cognitive restructuring—learning to challenge or “swap” negative thoughts for helpful ones Level 7—canyon province: bringing it all together Recap of all skills