title: Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game.
abstract: BACKGROUND
  Young adults often experiment with heavy use of alcohol, which poses severe health risks and increases the chance of developing addiction problems. In clinical patients, cognitive retraining of automatic appetitive processes, such as selective attention toward alcohol (known as "cognitive bias modification of attention," or CBM-A), has been shown to be a promising add-on to treatment, helping to prevent relapse.
  
  
  OBJECTIVE
  To prevent escalation of regular use into problematic use in youth, motivation appears to play a pivotal role. As CBM-A is often viewed as long and boring, this paper presents this training with the addition of serious game elements as a novel approach aimed at enhancing motivation to train.
  
  
  METHODS
  A total of 96 heavy drinking undergraduate students carried out a regular CBM-A training, a gamified version (called "Shots"), or a placebo training version over 4 training sessions. Measures of motivation to change their behavior, motivation to train, drinking behavior, and attentional bias for alcohol were included before and after training.
  
  
  RESULTS
  Alcohol attentional bias was reduced after training only in the regular training condition. Self-reported drinking behavior was not affected, but motivation to train decreased in all conditions, suggesting that the motivational features of the Shots game were not enough to fully counteract the tiresome nature of the training. Moreover, some of the motivational aspects decreased slightly more in the game condition, which may indicate potential detrimental effects of disappointing gamification.
  
  
  CONCLUSIONS
  Gamification is not without its risks. When the motivational value of a training task with serious game elements is less than expected by the adolescent, effects detrimental to their motivation may occur. We therefore advise caution when using gamification, as well as underscore the importance of careful scientific evaluation.
authors.affiliation: Utrecht University, Department of Child and Adolescent Studies, Utrecht, Netherlands.|Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Wouter J
authors.identifier: http://orcid.org/0000-0002-8783-9030
authors.initials: WJ
authors.lastname: Boendermaker
authors.affiliation: Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Soraya
authors.identifier: http://orcid.org/0000-0002-0705-8964
authors.initials: S
authors.lastname: Sanchez Maceiras
authors.affiliation: Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Marilisa
authors.identifier: http://orcid.org/0000-0003-4730-7838
authors.initials: M
authors.lastname: Boffo
authors.affiliation: Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Reinout W
authors.identifier: http://orcid.org/0000-0002-4312-9766
authors.initials: RW
authors.lastname: Wiers
keywords: adolescents; attentional bias; cognitive bias modification (CBM); cognitive training; motivation; serious games