{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:53Z","timestamp":1785545093662,"version":"3.56.0"},"reference-count":56,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR XR Spatial Comput"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Anxiety-related symptoms are prevalent and can negatively affect concentration, motivation, and overall well-being. Traditional treatments such as cognitive behavioral therapy and medication work well for clinical anxiety disorders. However, individuals with anxiety often struggle with access, adherence, and staying engaged in treatment. Emerging technologies such as virtual reality (VR) and gamification offer new opportunities to enhance user engagement and motivational processes within digital mental health applications.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study introduces\n Cleanify<\/jats:italic>\n , a gamified VR cleaning simulation designed using the Octalysis framework and the persuasive system design model. The objective was to evaluate whether gamification elements improve user engagement, focus, and satisfaction compared to a nongamified version among individuals experiencing anxiety symptoms. We hypothesized that the gamified version would outperform the nongamified version in enhancing user engagement, immersion, and overall user experience.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A pilot experimental study was conducted with 50 participants aged 18 to 39 years recruited from the general population in northern Sweden. Participants were randomly assigned to either a gamified or nongamified version of the\n Cleanify<\/jats:italic>\n VR application and completed a single 15-minute VR session using the Oculus Quest headset. Baseline anxiety symptoms were assessed using the Generalized Anxiety Disorder\u20137 scale for descriptive purposes only. Postintervention outcomes included focus and immersion measured using the Flow State Scale and user experience measured using the short version of the User Experience Questionnaire. Group differences were analyzed using 2-tailed independent-sample\n t<\/jats:italic>\n tests.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants using the gamified VR version demonstrated higher engagement and immersion than those using the nongamified version. The gamified group reached higher in-game levels overall, with a greater proportion of participants reaching level 3 (17\/25, 68% vs 8\/25, 32%), and reported higher recommendation scores (mean 4.20, SD 0.76 vs 3.36, SD 0.86). Significant group differences were observed for overall flow (\n t<\/jats:italic>\n 48<\/jats:sub>\n =3.87;\n P<\/jats:italic>\n <.001), fluency (\n t<\/jats:italic>\n 48<\/jats:sub>\n =4.36;\n P<\/jats:italic>\n <.001), and absorption (\n t<\/jats:italic>\n 48<\/jats:sub>\n =2.80;\n P<\/jats:italic>\n =.008). User Experience Questionnaire results indicated higher pragmatic quality, hedonic quality, and overall user experience in the gamified condition.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Integrating gamification into a VR environment significantly enhanced user engagement, focus, and immersion in this pilot sample. These findings provide preliminary evidence that gamified VR design elements can positively influence user experience outcomes. Further research incorporating longitudinal designs and clinical outcome measures is needed to determine potential relevance.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/66713","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:11:56Z","timestamp":1782331916000},"page":"e66713-e66713","source":"Crossref","is-referenced-by-count":0,"title":["Persuasive Gamified Virtual Reality Experience to Enhance Engagement and Focus in Young Adults With Mild Anxiety Symptoms: Randomized Pilot Experimental Study"],"prefix":"10.2196","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4384-7743","authenticated-orcid":false,"given":"Mahlet Misrak","family":"Argaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6265-1074","authenticated-orcid":false,"given":"Nuru","family":"Jingili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9895-6796","authenticated-orcid":false,"given":"Solomon Sunday","family":"Oyelere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0536-2890","authenticated-orcid":false,"given":"Markus B T","family":"Nystr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.33545\/26164485.2022.v6.i4c.650","article-title":"An overview of psychosomatic diseases and homoeopathy","volume":"6","author":"SV","journal-title":"Int J Homoeopathic Sci"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003901","article-title":"The global gap in treatment coverage for major depressive disorder in 84 countries from 2000-2019: a systematic review and Bayesian meta-regression analysis","volume":"19","author":"Moitra","journal-title":"PLoS Med"},{"issue":"10312","key":"R3","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"COVID-19 Mental Disorders Collaborators","journal-title":"Lancet"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.00055","article-title":"Evaluation of a mindfulness-based intervention with and without Virtual Reality Dialectical Behavior Therapy\u00ae mindfulness skills training for the treatment of generalized anxiety disorder in primary care: a pilot study","volume":"10","author":"Navarro-Haro","journal-title":"Front Psychol"},{"issue":"4","key":"R5","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.euroneuro.2005.04.010","article-title":"The epidemiology of generalized anxiety disorder in Europe","volume":"15","author":"Lieb","journal-title":"Eur Neuropsychopharmacol"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2006.04.002","article-title":"Generalized anxiety disorder: what are we missing?","volume":"16 Suppl 2","author":"Allgulander","journal-title":"Eur Neuropsychopharmacol"},{"issue":"9553","key":"R7","doi-asserted-by":"publisher","first-page":"2156","DOI":"10.1016\/S0140-6736(06)69865-6","article-title":"Generalised anxiety disorder","volume":"368","author":"Tyrer","journal-title":"Lancet"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.beth.2008.04.001","article-title":"Mindfulness and emotion regulation difficulties in generalized anxiety disorder: preliminary evidence for independent and overlapping contributions","volume":"40","author":"Roemer","journal-title":"Behav Ther"},{"issue":"8","key":"R9","doi-asserted-by":"publisher","first-page":"786","DOI":"10.4088\/JCP.12m08083","article-title":"Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity","volume":"74","author":"Hoge","journal-title":"J Clin Psychiatry"},{"issue":"8","key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/20889","article-title":"Evidence on virtual reality-based therapies for psychiatric disorders: meta-review of meta-analyses","volume":"22","author":"Dellazizzo","journal-title":"J Med Internet Res"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/44998","article-title":"The use of virtual reality interventions to promote positive mental health: systematic literature review","volume":"10","author":"Li Pira","journal-title":"JMIR Ment Health"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"89","DOI":"10.52982\/lkj202","article-title":"Application of VR-technology methods in psychology and psychotherapy","volume":"3","author":"Olenichenko","journal-title":"Global Psychother"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"533","DOI":"10.54254\/2755-2721\/6\/20230853","article-title":"Application of virtual reality technology in the psychological field","volume":"6","author":"Liu","journal-title":"Appl Comput Eng"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2023.1239435","article-title":"A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression","volume":"5","author":"Jingili","journal-title":"Front Digit Health"},{"issue":"9","key":"R15","doi-asserted-by":"publisher","first-page":"5621","DOI":"10.3390\/ijerph20095621","article-title":"Virtual reality for addressing depression and anxiety: a bibliometric analysis","volume":"20","author":"Jingili","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"R16","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s00127-022-02417-5","article-title":"Virtual reality relaxation for people with mental health conditions: a systematic review","volume":"58","author":"Riches","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"1-2","key":"R17","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/s0304-3959(99)00275-4","article-title":"Virtual reality as an adjunctive pain control during burn wound care in adolescent patients","volume":"85","author":"Hoffman","journal-title":"Pain"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S89542","article-title":"Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability","volume":"11","author":"Botella","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1089\/cyber.2015.0412","article-title":"Future directions: how virtual reality can further improve the assessment and treatment of eating disorders and obesity","volume":"19","author":"Guti\u00e9rrez-Maldonado","journal-title":"Cyberpsychol Behav Soc Netw"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.586379","article-title":"Recommendations for implementing gamification for mental health and wellbeing","volume":"11","author":"Cheng","journal-title":"Front Psychol"},{"issue":"8","key":"R21","doi-asserted-by":"publisher","first-page":"4888","DOI":"10.1080\/10447318.2024.2355395","article-title":"A two-stage co-design process of Battleship-AST persuasive game for active school transportation in Northern Sweden","volume":"41","author":"Jingili","journal-title":"Int J Hum Comput Interact"},{"key":"R22","doi-asserted-by":"crossref","unstructured":"Deterding S Dixon D Khaled R Nacke L . From game design elements to gamefulness: defining \u201cgamification\u201d. In: MindTrek \u201911: Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments. Association for Computing Machinery; 2011. [doi: 10.1145\/2181037.2181040]","DOI":"10.1145\/2181037.2181040"},{"key":"R23","doi-asserted-by":"crossref","unstructured":"P\u00e1ez-Quinde C Arroba-Freire E Espinosa-Jaramillo MT Silva MP . Gamification as collaborative learning resources in technological education. In: 2023 IEEE Global Engineering Education Conference (EDUCON). IEEE; 2023. [doi: 10.1109\/EDUCON54358.2023.10125264]","DOI":"10.1109\/EDUCON54358.2023.10125264"},{"key":"R24","doi-asserted-by":"crossref","unstructured":"Sun A Conde S Elor A . Increasing sociability in a virtual world: a serious game for social anxiety disorder. In: 2021 IEEE 9th International Conference on Serious Games and Applications for Health (SeGAH). IEEE; 2021. [doi: 10.1109\/SEGAH52098.2021.9551867]","DOI":"10.1109\/SEGAH52098.2021.9551867"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","DOI":"10.1186\/s40561-019-0094-1","article-title":"Designing a VR game for public speaking based on speakers features: a case study","volume":"6","author":"El-Yamri","journal-title":"Smart Learn Environ"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2019.04.004","article-title":"Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: a randomized non-inferiority trial","volume":"118","author":"Miloff","journal-title":"Behav Res Ther"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvp.2021.101553","article-title":"Home and the extended-self: exploring associations between clutter and wellbeing","volume":"73","author":"Rogers","journal-title":"J Environ Psychol"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpnec.2021.100090","article-title":"The causal effect of household chaos on stress and caregiving: an experimental study","volume":"8","author":"Bodrij","journal-title":"Compr Psychoneuroendocrinol"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1177\/0146167209352864","article-title":"No place like home: home tours correlate with daily patterns of mood and cortisol","volume":"36","author":"Saxbe","journal-title":"Pers Soc Psychol Bull"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1523\/JNEUROSCI.3766-10.2011","article-title":"Interactions of top-down and bottom-up mechanisms in human visual cortex","volume":"31","author":"McMains","journal-title":"J Neurosci"},{"issue":"5","key":"R31","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s12671-014-0360-9","article-title":"Washing dishes to wash the dishes: brief instruction in an informal mindfulness practice","volume":"6","author":"Hanley","journal-title":"Mindfulness"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.17705\/1CAIS.02428","article-title":"Persuasive systems design: key issues, process model, and system features","volume":"24","author":"Oinas-Kukkonen","journal-title":"Commun Assoc Int Syst"},{"key":"R33","doi-asserted-by":"crossref","unstructured":"Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; 2013. [doi: 10.1176\/appi.books.9780890425596]","DOI":"10.1176\/appi.books.9780890425596"},{"issue":"7","key":"R34","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1097\/PSY.0b013e3181ad7978","article-title":"Association of enjoyable leisure activities with psychological and physical well-being","volume":"71","author":"Pressman","journal-title":"Psychosom Med"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1089\/acm.2008.0495","article-title":"Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis","volume":"15","author":"Chiesa","journal-title":"J Altern Complement Med"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"15","DOI":"10.2190\/PM.41.1.c","article-title":"Exercise for the treatment of depression and anxiety","volume":"41","author":"Carek","journal-title":"Int J Psychiatry Med"},{"issue":"7","key":"R37","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.cpr.2010.06.003","article-title":"Positive Clinical Psychology: a new vision and strategy for integrated research and practice","volume":"30","author":"Wood","journal-title":"Clin Psychol Rev"},{"key":"R38","doi-asserted-by":"crossref","unstructured":"Fogg BJ . Persuasive Technology: Using Computers to Change What We Think and Do. Morgan Kaufmann; 2003. URL: https:\/\/books.google.co.in\/books\/about\/Persuasive_Technology.html?id=gfiYh_BHj94C&source=kp_book_description&redir_esc=y [Accessed 15-06-2026]","DOI":"10.1145\/764008.763957"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1007\/s40474-021-00227-z","article-title":"Inclusive practices for neurodevelopmental research","volume":"8","author":"Fletcher-Watson","journal-title":"Curr Dev Disord Rep"},{"key":"R40","unstructured":"Gillihan SJ . Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety. Althea Press; 2016. ISBN: 9781623157807"},{"issue":"1","key":"R41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01490400.2011.533103","article-title":"How is leisure time interacting with nature related to the need for recovery from work demands? Testing multiple mediators","volume":"33","author":"Korpela","journal-title":"Leis Sci"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvp.2016.03.003","article-title":"The dark side of home: assessing possession \u2018clutter\u2019 on subjective well-being","volume":"46","author":"Roster","journal-title":"J Environ Psychol"},{"key":"R43","doi-asserted-by":"crossref","unstructured":"Craven MP Groom MJ . Computer games for user engagement in Attention Deficit Hyperactivity Disorder (ADHD) monitoring and therapy. Presented at: 2015 International Conference on Interactive Technologies and Games (ITAG); Oct 22-23, 2015; Nottingham, UK. [doi: 10.1109\/iTAG.2015.9]","DOI":"10.1109\/iTAG.2015.9"},{"issue":"11","key":"R44","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s11920-023-01453-5","article-title":"Gamification: a novel approach to mental health promotion","volume":"25","author":"Cheng","journal-title":"Curr Psychiatry Rep"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","DOI":"10.2196\/14746","article-title":"Leaderboard design principles to enhance learning and motivation in a gamified educational environment: development study","volume":"9","author":"Park","journal-title":"JMIR Serious Games"},{"issue":"6","key":"R46","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1007\/s10461-024-04290-6","article-title":"Dose\u2012response effects of patient engagement on anxiety and depression in a cognitive-behavioral intervention: secondary analysis of a pilot randomized controlled trial and a clinical controlled trial","volume":"28","author":"Yang","journal-title":"AIDS Behav"},{"issue":"6","key":"R47","doi-asserted-by":"publisher","DOI":"10.1136\/ebm.11.6.184","article-title":"The GAD-7 scale was accurate for diagnosing generalised anxiety disorder","volume":"11","author":"Swinson","journal-title":"Evid Based Med"},{"issue":"6","key":"R48","doi-asserted-by":"publisher","first-page":"103","DOI":"10.9781\/ijimai.2017.09.001","article-title":"Design and evaluation of a short version of the User Experience Questionnaire (UEQ-S)","volume":"4","author":"Schrepp","journal-title":"Int J Interact Multim Artif Intell"},{"key":"R49","doi-asserted-by":"crossref","unstructured":"Schwind V Knierim P Haas N Henze N . Using presence questionnaires in virtual reality. In: CHI \u201919: Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery; 2019. [doi: 10.1145\/3290605.3300590]","DOI":"10.1145\/3290605.3300590"},{"issue":"3","key":"R50","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/s11031-008-9102-4","article-title":"Flow, performance and moderators of challenge-skill balance","volume":"32","author":"Engeser","journal-title":"Motiv Emot"},{"issue":"3","key":"R51","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1026\/0932-4089.51.3.105","article-title":"Flow during work but happiness during leisure time: goals, flow-experience, and happiness [Article in German]","volume":"51","author":"Rheinberg","journal-title":"Zeitschrift Arbeitsund Organisationspsychologie"},{"issue":"10","key":"R52","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","journal-title":"Arch Intern Med"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","DOI":"10.24924\/ijise\/2013.04\/v1.iss1\/86.97","article-title":"Persuasive technology for learning in business context","volume":"1","author":"Behringer","journal-title":"Int J Inf Syst Eng"},{"issue":"Suppl 1","key":"R54","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s00508-021-01991-z","article-title":"Virtual reality biofeedback interventions for treating anxiety: a systematic review, meta-analysis and future perspective","volume":"134","author":"Kothgassner","journal-title":"Wien Klin Wochenschr"},{"key":"R55","doi-asserted-by":"crossref","unstructured":"Lin AJ Cheng F Chen CB . Use of virtual reality games in people with depression and anxiety. In: ICMIP \u201920: Proceedings of the 5th International Conference on Multimedia and Image Processing. Association for Computing Machinery; 2020. [doi: 10.1145\/3381271.3381299]","DOI":"10.1145\/3381271.3381299"},{"issue":"3","key":"R56","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1097\/00002508-200009000-00010","article-title":"Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study","volume":"16","author":"Hoffman","journal-title":"Clin J Pain"}],"container-title":["JMIR XR and Spatial Computing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/xr.jmir.org\/2026\/1\/e66713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:33Z","timestamp":1785536913000},"score":1,"resource":{"primary":{"URL":"https:\/\/xr.jmir.org\/2026\/1\/e66713"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":56,"URL":"https:\/\/doi.org\/10.2196\/66713","relation":{},"ISSN":["2818-3045"],"issn-type":[{"value":"2818-3045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"v3i4e66713"}}