Attitudes Toward a Game-Based Approach to Mental Health Christine P. Kreutzer, BS, and Clint A. Bowers, PhD Abstract Based on preliminary research, game-based treatments appear to be a promising approach to post-traumatic stress disorder (PTSD). However, attitudes toward this novel approach must be better understood. Thus, the objective of this study was to determine if video game self-efficacy mediates the relationship between expectations and reactions to a game-based treatment for PTSD. Participants played the serious game ‘‘Walk in My Shoes’’ (Novonics Corp., Orlando, FL) and completed a series of scales to measure attitudes toward the intervention. Video game self-efficacy was found to be a partial mediator of expectancies and reactions. These results suggest that enhancing attitudes via self-efficacy in a clinical setting may maximize treatment effectiveness. Introduction N early two million troops have been deployed since the start of Operation Iraqi Freedom (OIF) and Opera- tion Enduring Freedom (OEF). There have been significantly high levels of combat exposure acknowledged among OEF/ OIF–deployed soldiers. It has been estimated that 10–17% of soldiers deployed to OIF/OEF have been faced with the onset of post-traumatic stress disorder (PTSD). 1 The prevalence of PTSD among OIF/OEF veterans seeking help from the De- partment of Veterans Affairs (VA) is even greater. 2 Further- more, the Ombudsman for National Defense and the Canadian forces determined PTSD to be an issue faced by a multitude of Canadian Forces members, and that the military is in need of efficacious preventative measures for mental health issues. The current literature on the use of serious games and virtual learning environments suggests that this method is among the few successful approaches for PTSD. The most effective techniques are those that comprise a combination of training and education, target mental health knowledge ac- quisition, and facilitate stress management strategies. 3 By allowing opportunities to simulate real-life situations, games are an excellent option for teaching behavioral and cognitive skills. Due to the engaging nature of gameplay, cognitive maps are formed, resulting in the retention of information. 3 While serious games have emerged as a promising tool within the domain of mental health, attitudes toward this novel approach must be better understood before widespread dissemination and use can occur. In order to maximize the effectiveness of serious games for health, many researchers have set out to explore psy- chological variables that influence the gaming experience and vice versa. The role of self-efficacy has been of con- siderable interest. Self-efficacy can be broadly defined as the confidence in one’s abilities to meet the demands of a given task successfully. 4 Within the serious game literature, self- efficacy has been largely examined as a predictor of differ- ent gaming outcomes, such as enjoyment, immersion and achievement motivation, and performance. 5–7 As previously mentioned, with the novelty of game- based treatments, attitudes toward them must be better understood. In particular, many researchers note the im- portance of expectations and reactions. 8 Expectations of the intervention play a critical role in a user’s willingness to utilize the game in the first place. Games for health are judged similarly to an actual physician. Similarly, reactions to serious games have been considered in multiple studies. Positive reactions toward the game are among the most desired outcomes, as they play a large role in predicting future usage. 9,10 Within the game-based treatment literature, expectancies and reactions have typically been looked at separately. However, pulling from the training literature, there is a strong relationship between expectations and reactions; pre- training expectations predict post-training reactions. 11 This would suggest that attitudes toward the intervention do not change, regardless of how effective it may actually be. This is problematic, given that a change in attitude is a primary objective of serious games. 9 Therefore, the purpose of the study is to explore if this predictive relationship generalizes to a game-based treatment context, and how self-efficacy plays a role in that relationship. RETRO Lab, Department of Psychology, University of Central Florida, Orlando, Florida. CYBERPSYCHOLOGY,BEHAVIOR, AND SOCIAL NETWORKING Volume 18, Number 1, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/cyber.2014.0382 20