{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:36:18Z","timestamp":1792290978038,"version":"4.4.0"},"reference-count":95,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T00:00:00Z","timestamp":1446595200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Games for Health Journal"],"published-print":{"date-parts":[[2016,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      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 \u201cFlowy\u201d (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.flowygame.com\">www.flowygame.com<\/jats:ext-link>\n                      ) that digitally delivered breathing retraining exercises for anxiety, panic, and hyperventilation symptom management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200931), participants received free access to \u201cFlowy\u201d for 4 weeks. In the control condition (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200932), participants were placed on a waitlist for 4 weeks before being offered free access to \u201cFlowy.\u201d Online measurements using psychological self-report questionnaires were made at 2 and 4 weeks post-baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At trial conclusion, participants found \u201cFlowy\u201d acceptable as an anxiety management intervention. \u201cFlowy\u201d 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 \u201cFlowy\u201d as a fun and useful intervention, proactively used \u201cFlowy\u201d as part of their care, and would recommend \u201cFlowy\u201d to family and friends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/g4h.2015.0033","type":"journal-article","created":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T16:49:08Z","timestamp":1446655748000},"page":"50-67","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":95,"title":["Feasibility and Efficacy of an mHealth Game for Managing Anxiety: \u201cFlowy\u201d Randomized Controlled Pilot Trial and Design Evaluation"],"prefix":"10.1177","volume":"5","author":[{"given":"Quynh","family":"Pham","sequence":"first","affiliation":[{"name":"Queen Mary University of London","place":["United Kingdom"]},{"name":"Playlab London","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Khatib","sequence":"additional","affiliation":[{"name":"Queen Mary University of London","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Stansfeld","sequence":"additional","affiliation":[{"name":"Queen Mary University of London","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Fox","sequence":"additional","affiliation":[{"name":"Playlab London","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Green","sequence":"additional","affiliation":[{"name":"Playlab London","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,11,4]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"The Global Burden of Disease: 2004 Update","author":"Mathers C","year":"2008","unstructured":"Mathers C, , Fat DM, , Boerma JT; World Health Organization. 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