334 Chapter 8 same data set (Tabachnick & Fidell, 2014). To be able to examine all associations within the same study, a stricter significance level (< 0.05) should be adopted to correct for multiple testing (e.g., Bonferroni adjustment; Streiner & Norman, 2011; Tabachnick & Fidell, 2014). Furthermore, this dissertation encompasses studies involving children, adolescents and/or young adults. The inclusion of diverse age groups may hinder our ability to draw general conclusions about the impact of nonspecific factors as predictors of effectiveness. Nonspecific effects might manifest differently in children compared to adolescents and young adults. Research on placebo effects may inform us in this regard, as placebo effects can be considered as a nonspecific factor, theorised to arise from expectancies and Pavlovian conditioning (Enck et al., 2008; Peiris et al., 2018; Rief et al., 2011). Examining the limited available data on placebo effects in children and adolescents versus adults, systematic reviews and meta-analyses indicate variations in placebo responses across age groups. Notably, (younger) children exhibit higher placebo response rates than (older) adolescents and adults, meaning that there is a negative correlation between age and the size of the placebo response (Janiaud et al., 2017; Parellada et al., 2012; Weimer et al., 2013). Explanations for the observed differences in placebo effects and the underlying mechanisms remain speculative (Weimer et al., 2013). Compared to adults, children may possess heightened associative learning capacities (i.e., Pavlovian conditioning and instrumental learning), potentially contributing to increased placebo responses (Weimer et al., 2013). Furthermore, children more frequently presume they are assigned to the intervention arm rather than the control condition in studies (Rothner et al., 2006), and parental expectations and behaviours may foster higher expectations in children (Gniß et al., 2020). Thus, although the mechanisms underlying placebo effects in children and adults are not fully understood, the negative correlation between age and the size of the placebo response is evident (Janiaud et al., 2017; Parellada et al., 2012; Weimer et al., 2013). Consequently, it can be hypothesised that nonspecific factors affecting mental health improvements in applied games may vary between children and young adults. This warrants further investigation in future research to better understand the nuances of these effects across different age groups. In addition to age, exploring various other individual differences becomes crucial in understanding the effectiveness and eventual adoption of applied games once they enter the public domain. As these games become more widely available, factors such as gender, cultural differences, and socio-economic
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