A Systematic Review of Narrative Game-based Interventions for Mental Health

Video games have increasingly been used to support mental health through various game-based interventions (GBIs), including exergames, virtual reality therapy, and cognitive behavioral therapy-based games. While these approaches often emphasize novel game mechanics and gamification, such features may undermine intrinsic motivation, which is critical for meaningful internalization of mental health messaging. Narrative, a well-studied mechanism in communication theory for fostering engagement and persuasion, remains underexplored in GBIs for mental health. This systematic review investigates narrative GBIs (NGBIs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies met the inclusion criteria. The majority addressed depression and anxiety, and CBT was common as an evidence-based grounding. However, few of the studies investigated the narrative factorially, and the disparate measures used to evaluate success made it difficult to determine the overall efficacy of NGBIs for mental health. We conclude with suggestions for future directions for research and design of NGBIs.