Evaluation of personalized video gaming therapy in patients with depression - motivational, behavioral, and neuronal mechanisms

Abstract

This thesis examines the efficacy of personalized video game-based cognitive training (VGT) as an adjunctive treatment in patients with Major Depressive Disorder (MDD), focusing on its motivational, behavioral, and neuronal effects. MDD is characterized not only by emotional disturbances but also significant cognitive deficits, notably in visuospatial memory, executive functioning, and attention, impairments that frequently persist even after remission of mood symptoms. This research evaluates the impact of a commercially available 3D video game training (VGT) using "Super Mario Odyssey" on cognitive performance, depressive symptoms, motivation, and neuroplasticity in the entorhinal cortex (EC), a relevant brain area for spatial memory and navigation. <br/> In three separate research phases, participants with moderate to severe MDD were randomly assigned to one of three treatment groups: a 3D video gaming group ("Super Mario Odyssey"), an active control group ("CogPack"), or a treatment-as-usual (TAU) control group. Participants underwent cognitive assessments, motivational evaluations, and functional magnetic resonance imaging (fMRI) to measure cognitive and neuronal changes pre- and post-intervention. <br/> Results demonstrate that participants in the VGT group experienced a significant reduction in depressive symptoms over time. Moreover, the VGT group demonstrated a significant higher mean level of training motivation compared to the control groups. Exploratory analyses indicate trends of within-group improvements in visuospatial memory, but VGT does not show statistically significant superiority over CogPack. Furthermore, VGT does not significantly improve executive functioning, attention, verbal working memory, or psychological quality of life beyond traditional training methods. Moreover, contrary to initial hypotheses no significant structural or functional neuroplastic changes are observed in the EC following the VGT intervention. <br/> These findings highlight the therapeutic potential of VGT as an engaging and motivating adjunctive treatment capable of reducing depressive symptoms and enhancing engagement in cognitive training. However, the absence of broader cognitive benefits and measurable EC neuroplasticity suggests the need for longer training durations, larger sample sizes, adaptive gaming mechanics, and consideration of game-specific cognitive demands. Despite these challenges, the increasing accessibility of video game-based training presents an exciting opportunity for innovative, cost-effective, and engaging mental health interventions that could benefit individuals with MDD.