A remotely-applied, cognitive control-based video game intervention to reduce depressive symptoms in a sub-clinical population: A randomized controlled trial (RCT)

Noa Givon Schacham; Angela Pasqualotto; Naamah Lerner; Marios Fanourakis; Zeno Menestrina; Daphne Bavelier; Mor Nahum

doi:10.1016/j.comppsych.2025.152645

A remotely-applied, cognitive control-based video game intervention to reduce depressive symptoms in a sub-clinical population: A randomized controlled trial (RCT)

Compr Psychiatry. 2026 Jan:144:152645. doi: 10.1016/j.comppsych.2025.152645. Epub 2025 Oct 30.

Authors

Noa Givon Schacham¹, Angela Pasqualotto², Naamah Lerner³, Marios Fanourakis⁴, Zeno Menestrina⁵, Daphne Bavelier⁴, Mor Nahum⁶

Affiliations

¹ School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel; Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel.
² Faculty of Psychology and Education Sciences (FPSE), University of Geneva, Geneva, Switzerland; Department of Education and Learning, University of Applied Sciences and Arts of Southern Switzerland, Locarno, Switzerland.
³ School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
⁴ Faculty of Psychology and Education Sciences (FPSE), University of Geneva, Geneva, Switzerland; Campus Biotech, University of Geneva, Geneva, Switzerland.
⁵ Faculty of Psychology and Education Sciences (FPSE), University of Geneva, Geneva, Switzerland.
⁶ School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel. Electronic address: mor.nahum@mail.huji.ac.il.

PMID: 41187581
DOI: 10.1016/j.comppsych.2025.152645

Abstract

Depressive symptoms are prevalent among young adults, with cognitive theories suggesting that impaired cognitive control contributes to sustained negative mood and depressive symptoms. This study investigated the feasibility and efficacy of a remotely-applied, tablet-based cognitive control video game, Legends of Hoa'manu (LoH), for reducing depressive symptoms in subclinical adults. A randomized controlled trial (NCT05447091) was conducted with 173 participants (mean age 33 ± 11.6 years; 75.1 % female) exhibiting at least a minimal level of depressive symptoms (PHQ-8 ≥ 5). Participants were randomized into three groups: high-dose experimental game (HD_EG; N = 58), low-dose experimental game (LD_EG; N = 61), and high-dose control game (HD_CG; N = 54), with interventions spanning three weeks. The intervention demonstrated high feasibility and adherence (69.5-76.5 % of sessions completed) without direct study contact. Overall depressive symptoms (BDI-II total score) improved across all groups, with a significant main effect of time, but no significant group differences. Still, group differences were found for the cognitive-affective BDI-II subscale, where the HD_EG group showed the largest reduction (4.5 points vs. 2.3 and 2.1 in the LD_EG and HD_CG, respectively). These improvements were maintained at 3-week and 3-month follow-ups. Secondary outcomes, including anxiety and rumination, also improved across all groups. Overall cognitive control performance did not differ between groups; however, significant improvements in inhibitory control emerged exclusively in the HD_EG group. The results highlight the feasibility of this novel, cost-effective, and remotely-applied cognitive control-based intervention. These findings underscore the potential of LoH as a scalable solution for addressing depressive symptoms in subclinical populations.

Keywords: Cognitive control; Depression; Intervention; Remote application; Tablet game.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognition
Cognitive Behavioral Therapy* / methods
Depression* / psychology
Depression* / therapy
Feasibility Studies
Female
Humans
Male
Treatment Outcome
Video Games* / psychology
Young Adult

Associated data

ClinicalTrials.gov/NCT05447091