title: Feasibility and Efficacy of an mHealth Game for Managing Anxiety: "Flowy" Randomized Controlled Pilot Trial and Design Evaluation.
abstract: OBJECTIVE
  Meeting the complex needs of patients with chronic common mental health disorders (CMHDs) may be the greatest challenge facing organized medical practice. On the basis of a well-established and proven theoretical foundation for controlled respiration as a behavioral intervention for CMHDs, as well as preliminary evidence that gamification can improve health outcomes through increasing patient engagement, this randomized controlled pilot study evaluated the feasibility and clinical efficacy of a mobile health game called "Flowy" ( www.flowygame.com ) that digitally delivered breathing retraining exercises for anxiety, panic, and hyperventilation symptom management.
  
  
  METHODS
  We designed an unblinded, Web-based, parallel-group randomized controlled trial focusing on feasibility, clinical efficacy, and design proof of concept. In the intervention condition (n = 31), participants received free access to "Flowy" for 4 weeks. In the control condition (n = 32), participants were placed on a waitlist for 4 weeks before being offered free access to "Flowy." Online measurements using psychological self-report questionnaires were made at 2 and 4 weeks post-baseline.
  
  
  RESULTS
  At trial conclusion, participants found "Flowy" acceptable as an anxiety management intervention. "Flowy" engaged participants sufficiently to endorse proactive gameplay. Intent-to-treat analysis revealed a reduction in anxiety, panic, and self-report hyperventilation scores in both trial arms, with the intervention arm experiencing greater quality of life. Participants perceived "Flowy" as a fun and useful intervention, proactively used "Flowy" as part of their care, and would recommend "Flowy" to family and friends.
  
  
  CONCLUSIONS
  Our results suggest that a digital delivery of breathing retraining exercises through a mobile health game can manage anxiety, panic, and hyperventilation symptoms associated with CMHDs.
authors.affiliation: 1 Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London, United Kingdom .|2 Playlab London , London, United Kingdom .
authors.forename: Quynh
authors.initials: Q
authors.lastname: Pham
authors.affiliation: 1 Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London, United Kingdom .
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Khatib
authors.affiliation: 1 Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London, United Kingdom .
authors.forename: Stephen
authors.initials: S
authors.lastname: Stansfeld
authors.affiliation: 2 Playlab London , London, United Kingdom .
authors.forename: Simon
authors.initials: S
authors.lastname: Fox
authors.affiliation: 2 Playlab London , London, United Kingdom .
authors.forename: Tobias
authors.initials: T
authors.lastname: Green
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy*; D001008:Anxiety Disorders / Q000628:therapy*; D001945:Breathing Exercises / Q000379:methods*; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000628:therapy; D008297:Male; D063731:Mobile Applications; D016584:Panic Disorder / Q000628:therapy*; D012648:Self Care / Q000379:methods*; D017216:Telemedicine; D018910:Video Games / Q000523:psychology*