The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis

Serious games represent an emerging digital intervention for anxiety management, yet their clinical efficacy remains a subject of ongoing debate. By synthesizing data from 33 randomized controlled trials, this analysis evaluates the therapeutic potential of eight distinct game modalities, including computerized cognitive behavioral therapy, biofeedback, and exergames. The primary objective is to determine whether these digital tools can serve as viable alternatives or supplements to traditional mental health treatments across diverse clinical and educational settings.

The findings indicate that computerized cognitive behavioral therapy and biofeedback games offer statistically and clinically significant benefits in reducing anxiety, with computerized cognitive behavioral therapy demonstrating notably higher efficacy in adult populations compared to adolescents. Conversely, categories such as exergames, brain training, and social skills training fail to show significant advantages over conventional exercise or standard control interventions. Despite these positive signals, the overall quality of evidence is constrained by high risks of bias, substantial heterogeneity among studies, and the frequent reliance on purpose-shifted commercial software rather than purpose-built therapeutic tools.

Given these limitations, serious games should currently be positioned as complementary interventions rather than primary substitutes for established clinical care. The current landscape is hindered by the use of obsolete hardware and a lack of rigorous, large-scale research targeting specific clinical populations. Future advancements in the field require a shift toward standardized, high-quality clinical trials that prioritize purpose-built therapeutic designs. Establishing a more robust evidence base is essential before these digital interventions can be fully integrated into mainstream mental health practice.