What This Means
This paper describes the design and protocol for a study called SMILE (Supporting Mental Health in Young People), which is testing a smartphone-based game designed to help young people aged 10-24 manage anxiety and depression. The game is based on cognitive behavioral therapy (CBT) — a well-established psychological approach — and is being tested across seven European countries in schools, universities, and community settings. The study involves nearly 1,500 young participants who are assigned to play different amounts of the game, with some also receiving automated personalized feedback on their progress. Researchers are measuring whether the game reduces anxiety and depression, as well as its effects on well-being, resilience, and emotion regulation.
This research suggests that serious games and gamified apps could be a promising way to reach young people who might not otherwise seek mental health support, since they are accessible, engaging, and do not require a clinical appointment. The study is designed not just to measure whether the intervention works, but also to understand how and why it works — or doesn't — in different real-world settings. Interviews with young people, parents, school staff, and clinicians are being conducted alongside the trial to capture these contextual factors.
The SMILE trial is a 'proof-of-concept' study, meaning its purpose is to gather early evidence to guide the development of a larger, more definitive trial. If the results show the game is feasible, acceptable, and shows signs of reducing mental health difficulties, the next step would be a full-scale randomized controlled trial. Primary results are expected in September 2026, and findings could inform how gamified mental health tools are incorporated into schools and healthcare settings across Europe.