A review of gamification approaches in commercial cognitive bias modification gaming applications (2018)

Technol Health Care. 2018 Jul 11. doi: 10.3233/THC-181313.

Zhang MWB1,2, Ying JB3, Song G1, Ho RCM4.



Cognitive biases are mostly automatic processes that result in individuals giving increased attention to threatening stimuli, with the difficulties in disengaging from these stimuli. Recent reviews have reported the presence for attention bias in several psychiatric conditions and provided evidence that such biases could be subjected to modification. Web-based and mobile based bias modification have mixed efficacy and gamification techniques proposed as a solution. There remains a gap in knowledge pertaining to the gamified applications for bias modification that are commercially available.


An analysis of their gamification approach will help in identification of common gaming elements adopted for use.


To identify commercial applications, a manual cross-sectional search was conducted between 1st through to 11th November 2017 on the Google Play store. The following search terminologies were used, namely that of “Attention bias” and “Cognitive bias”. The classification of the gamification technique for both the published applications and commercial applications were based on the six approaches described by Wouter et al. [17] and the 17 gamification techniques described by Hoffman et al. [18].


A total of nine applications were included in the current review. Five out of the nine applications involved the addition of gaming elements to an evidence-based task, and three involved the usage of intrinsic integration while leaving the evidence-based task intact. Other common gamification strategies used are that of the inclusion of digital rewards (n= 8) and the provision of feedback (n= 7). The average number of gamification techniques across all the nine applications is 3.2.


Even though most commercial applications appear to have their basis on a validated gamification approach for the delivery of attention bias modification, there remains a need for further research in evaluating these applications clinically.

KEYWORDS: Attention bias; M-health; cognitive bias; gamification; smartphone

PMID: 30040771

DOI: 10.3233/THC-181313