Social anxiety can significantly impair quality of life, leading to isolation, academic underperformance, and increased risk of depression.
It may stem from genetic predisposition, negative social experiences, or environmental factors like parental absence.
Studying alternative management options is crucial as traditional therapies may be inaccessible or ineffective for some, necessitating innovative, culturally appropriate interventions to address unique challenges and promote healthy social-emotional development.
Peng, D., Wu, X., Yang, Y., Li, X., Shu, A., Liang, J., Tu, Z., Liu, L., Yang, Q., Dong, W., & Lu, C. (2024). The effects of interactive video games combined with LEGO game therapy on social anxiety in rural left-behind children. Frontiers in Psychology, 15, 1423755. https://doi.org/10.3389/fpsyg.2024.1423755
Key Points
- Interactive video games (IVG) and LEGO game therapy (LGT) can significantly reduce social anxiety in rural left-behind children (LBC) in China.
- A combined intervention using both IVG and LGT showed the strongest effect in reducing social anxiety among LBC.
- The study involved 84 LBC aged 9-11 years, randomly assigned to four groups: IVG, LGT, combined intervention, and control.
- The 12-week intervention resulted in significant decreases in social anxiety scores for all treatment groups compared to the control group.
- The combined intervention group showed significantly lower social anxiety scores than both the IVG and LGT groups at post-intervention and follow-up.
- The study highlights the potential of structured, peer-focused interventions in addressing social anxiety among LBC.
- Limitations include the single-blind design, small sample size, and potential regional bias.
Rationale
China’s rapid urbanization has led to a significant population of left-behind children (LBC) in rural areas, with parents migrating to cities for work.
This situation has resulted in higher rates of social anxiety among LBC compared to non-LBC (Li et al., 2019).
Social anxiety in LBC is exacerbated by prolonged parental separation, leading to emotional deficits and avoidant behaviors in social contexts (Zhang & Shi, 2021).
Previous research has shown that increasing opportunities for positive social interactions can alleviate symptoms of social anxiety in children (Cordier et al., 2021).
This study explores the potential of interactive video games (IVG) and LEGO game therapy (LGT) as structured, peer-focused interventions to address social anxiety in LBC.
These approaches aim to foster collaborative environments and enhance social skills, potentially offering a novel and effective solution to the mental health challenges faced by this vulnerable population.
Method
The study employed a single-blind randomized controlled experiment with 84 rural left-behind children randomly assigned to four groups: interactive video game group, LEGO game group, combined intervention group, and control group.
The intervention lasted 12 weeks, with three sessions per week.
Social anxiety levels were assessed at three points: before the intervention (T0), immediately after the intervention (T1), and 6 weeks post-intervention (T2).
Procedure
Participants in the IVG group engaged in 45-minute sessions of interactive video games three times a week.
The LGT group participated in 45-minute LEGO therapy sessions three times a week. The combined intervention group received both IVG and LGT interventions, with 45 minutes of each activity per session.
The control group continued their regular activities without intervention.
Sample
The study included 84 left-behind children (46 male, 38 female) aged 9-11 years (mean age 10.405 years, SD = 0.873) from a rural primary school in Shaodong City, Hunan Province, China. All participants had experienced parental separation for more than 2 years.
Measures
The Social Anxiety Scale for Children (SASC) was used to measure social anxiety levels.
The scale contains 10 questions across two dimensions: Fear of Negative Evaluation (FNE) and Social Avoidance and Distress (SAD). Scores were measured on a three-level scale (0 = never, 1 = sometimes, 2 = always), with higher scores indicating more severe social anxiety.
Statistical measures
Statistical analysis was conducted using GraphPad Prism (9th edition). A repeated-measures ANOVA with a 4 (group) × 3 (time) design was used to evaluate the effects of different intervention programs on social anxiety levels.
The significance level was set at p < 0.05.
Results
Hypothesis 1: IVG, LGT, and combined interventions will reduce social anxiety in LBC compared to the control group.
Result: Confirmed. All intervention groups showed significantly lower social anxiety scores at T1 and T2 compared to T0 (p < 0.05), while the control group showed no significant change.
Hypothesis 2: The combined intervention will be more effective in reducing social anxiety than individual IVG or LGT interventions.
Result: Confirmed. The combined intervention group demonstrated significantly lower scores than the IVG group and LGT group at both T1 and T2 (p < 0.05).
Hypothesis 3: There will be differences in effectiveness between IVG and LGT interventions.
Result: Partially confirmed. While there were no statistically significant differences between IVG and LGT groups, the IVG group scored lower than the LGT group at both T1 and T2.
Insight
The study demonstrates that structured, peer-focused interventions like interactive video games and LEGO game therapy can effectively reduce social anxiety in left-behind children.
The combined intervention’s superior effectiveness suggests that a multi-faceted approach addressing both virtual and physical social interactions may be most beneficial.
These findings extend previous research by applying these interventions specifically to the context of left-behind children in rural China, a population particularly vulnerable to social anxiety.
The study highlights the potential of engaging, collaborative activities in fostering social skills and reducing anxiety symptoms.
Future research could explore the long-term effects of these interventions, their applicability to different age groups or cultural contexts, and the potential for integrating such approaches into school curricula or community programs for left-behind children.
Implications
The findings have significant implications for addressing mental health issues among left-behind children in rural China.
The effectiveness of IVG and LGT interventions suggests that schools and community centers could implement these relatively low-cost, engaging activities to support LBC’s social-emotional development.
The superior results of the combined intervention indicate that a diverse, multi-modal approach may be most beneficial in addressing social anxiety.
This could inform the design of comprehensive mental health programs for LBC, integrating both digital and hands-on activities.
Future research should investigate the long-term impacts of these interventions and explore their potential integration into broader educational and social support systems for LBC.
Strengths
This study had several methodological strengths, including:
- The study employed a randomized controlled design, enhancing the validity of the findings.
- The use of multiple intervention types (IVG, LGT, and combined) allowed for comparison of effectiveness.
- The inclusion of a follow-up assessment (T2) provided insights into the sustainability of intervention effects.
- The study focused on a specific, vulnerable population (rural left-behind children), addressing an important social issue in China.
- The interventions used (IVG and LGT) are relatively low-cost and easily implementable, increasing the practical applicability of the findings.
Limitations
This study also had several methodological limitations, including:
- The study used a single-blind design, which may have introduced some bias in participants’ self-reported outcomes.
- The sample size (84 participants) was relatively small, potentially limiting the generalizability of the findings.
- The study was conducted in one specific region of China (Shaodong City, Hunan Province), which may not be representative of all rural areas or left-behind children in the country.
- The follow-up period was relatively short (6 weeks), limiting insights into long-term effects of the interventions.
- The study relied solely on self-reported measures of social anxiety, which may be subject to response bias.
- The combined intervention group received more total intervention time than the individual IVG or LGT groups, which may have influenced the results.
These limitations suggest that future research should consider using larger, more diverse samples, employing double-blind designs where possible, incorporating longer follow-up periods, and using multiple methods (e.g., behavioral observations, physiological measures) to assess social anxiety.
References
Primary reference
Peng, D., Wu, X., Yang, Y., Li, X., Shu, A., Liang, J., Tu, Z., Liu, L., Yang, Q., Dong, W., & Lu, C. (2024). The effects of interactive video games combined with LEGO game therapy on social anxiety in rural left-behind children. Frontiers in Psychology, 15, 1423755. https://doi.org/10.3389/fpsyg.2024.1423755
Other references
Cordier, R., Speyer, R., Mahoney, N., Arnesen, A., Mjelve, L. H., & Nyborg, G. (2021). Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis. Plos one, 16(7), e0254117. https://doi.org/10.1371/journal.pone.0254117
Li, M. L., Ren, Y. J., & Jiang, F. (2019). A meta-analysis of social anxiety in left-behind children in rural areas of China. Chin. Ment. Health J, 11, 839-844.
Zhang, T. P. M., & Shi, Z. L. (2021). The influence of parents’ migration for work on the rural left-behind children’s mental health. Northwest Pop J, 42(04), 31-43.
Keep Learning
Socratic questions for a college class to discuss this paper:
- How might the cultural context of rural China influence the effectiveness of these interventions? Would similar approaches work in other cultures?
- What ethical considerations should be taken into account when implementing interventions for left-behind children?
- How might the age range of the participants (9-11 years) affect the results? Would the interventions be equally effective for younger children or teenagers?
- What are the potential long-term implications of reducing social anxiety in left-behind children? How might this impact their future development and life outcomes?
- How could technology be further leveraged to address mental health issues in rural or underserved populations?
- What role should schools play in implementing mental health interventions for left-behind children? What are the potential benefits and challenges of school-based interventions?
- How might gender differences affect the experience of being a left-behind child and the effectiveness of these interventions?
- What are the potential drawbacks or risks of using interactive video games as a therapeutic tool for children?
- How could the LEGO game therapy be adapted or modified to be more culturally relevant in different contexts?
- What policy changes might be necessary to better support the mental health of left-behind children on a larger scale?
