It is no secret that the UK is also struggling to address the mental health crisis alongside the rest of the global community. Young adults 18 - 28 years old are the most vulnerable population to mental health issues of which 29% are living with a diagnosed mental illness. Of these, less than 35% have access to therapy and psychological care, making it pressing to develop therapeutic tools that are cost-efficient, effective and ‘sticky’. The broad distribution of smartphones offers a compelling platform in the form of applications, but evidence-based apps struggle with high attrition rates. Additionally, prevention programs have attrition rates of up to 99%, making them difficult to implement. Research suggests gamification to be a valid strategy to intrinsically motivate patients to adhere to prevention and early-stage mobile interventions.

eQuoo, the Emotional Fitness Game, with a top ORCHA Score, teaches psychological skills, such as emotional bids, generalization, and reciprocity - which are needed to prosses emotional and mental stress - through psychoeducation, storytelling, and gamification. It is a 5-week course, with 2 skills per level, where the player goes on to implement the skills in the safe yet stimulating environment of a choose-your-own-adventure game

eQuoo was tested with 358 participants in a 5-week, 3-armed randomized controlled clinical trial, of which a third used eQuoo, a third used a ‘Treatment as Usual’ CBT Journal app and a third was on a waitlist with no intervention. All 3 groups filled out the following questionnaires at 3 time-points: The Adult Resilience Scale, The Personal Growth Inventory Scale, the Psychological well-being: Positive Relations With Others Scale by Ryff and a 1 Item Anxiety Likert scale.

eQuoo users showed statistically significant increases in the well-being metrics and a significant decrease in anxiety when using the app over a timeframe of 5 weeks. The app significantly increased resilience as measured with the ARS by d .37, personal growth as measured by PGIS by d .67, positive relations with others as measured by Ryff’s PWB by d .42 and anxiety as measured with a 1 Item Ankiety Likert Scale lowered by d .20. With 90% adherence, eQuoo was able to retain 21% more participants than the control or waitlist group.

By being able to prove that eQuoo, as a mental health game, significantly raises mental well-being and lowers anxiety as well as maintains high adherence, there is now a much-needed tool for prevention and early intervention that young adults actually stick to. With 35k downloads worldwide, eQuoo sports a 17% course completion rate - more than 5 times higher than average mental health apps.

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