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Table 1 Content of the video game-based cognitive-behavioral intervention for active aging

From: Cognitive-behavioral intervention via interactive multimedia online video game for active aging: study protocol for a randomized controlled trial

Module/componentNarrativeTechniques and strategiesApp companion support
1
Mental health, cognitive stimulation
From Roncesvalles to Pamplona
Presentation of the main character (Jacob) and start of the trip. Jacob is at a stage in which he feels older, tired, sad, does not sleep or eat properly, does not perform physical exercise.
He starts the French Way of St. James to find the peace he needs. An old man invites him to take a book to guide him through the stages. The book will show him the way and will give him knowledge to reach his personal goal. To begin, it explains the relationship between our behaviors, thoughts, and emotions. He meets Txomin, who teaches him to monitor his emotions and a group of pilgrims who teach him a relaxation technique. He must pass through challenges (microgames of cognitive stimulation) to continue the path.
He meets the first illustrious pilgrims (e.g., Jean de Brienne), historical figures (e.g., King Alfonso II, Isabel the Catholic), and visits places of interest along the way: Albergue de Roncesvalles, Puente de Zubiri, Albergue Casa Paderborn.
-Presentation of the protagonist and The Way.
-Active aging: importance of emotional, physical, and cognitive well-being for healthy active aging.
-Mental health: explanation of mood problems and the need for active coping for optimal mental health; mood state diary.
-Healthy habits: training in relaxation (diaphragmatic breathing) through modeling.
-Cognitive stimulation: mnemonic strategies, verbal and visual memory tasks.
-Social skills, assertive communication.
-Review of what has been learned.
-Map of the path: shows progress and places and significant learning at this stage of the trip.
-Homework (with reminder notifications).
- Mood tracking (self-report).
- Practice relaxation (diaphragmatic breathing technique).
-Trophies: can be obtained through adherence and weekly compliance with tasks.
2
Mental Health, cognitive stimulation
From Pamplona to Estella
He meets the legend of the Source Reniega. Belfegor appears (minion of Lucifer) and tries to snatch the book. The Apostle James comes to his defense. Jacob is attacked and falls unconscious and in dreams he performs a challenge in order to continue on his way. He gets the indication to search and find nine groups of emotional vitamins in the road symbols (scallops); to get hold of them, he must pass several challenges (microgames of cognitive stimulation).
Another pilgrim teaches him the value of self-reinforcement and how to put it into practice.
He visits places of interest along the way: Source Reniega, Alto del perdón, Brigde and Square de Puente la Reina, Church and hospital of pilgrims of Estella.
- Positive or corrective feedback of weekly homework compliance.
-Review of contents of Module 1. Long-term memory exercises.
- Mental health: effect of pleasant activities on mood, guidelines for identifying personal pleasant activities; self-reinforcement.
- Cognitive stimulation: mnemonic strategies, verbal fluency tasks, visual tracking, cancellation, ideomotor praxia, verbal and visuospatial short-term and working memory.
-Social skills, assertive communication.
Previous and:
- List of personal pleasant activities.
3
Mental Health, cognitive stimulation, sleep habits
From Estella to Nájera
Jacob does not sleep well. He is tired, but various characters like Hirobumi and other pilgrims give him guidelines to improve his sleep habits. He is reunited with Txomin, who teaches him to plan pleasant activities and make contracts with himself. By doing this he declares, unknowingly, the war on Disnergia (fantastic character), who wants his book. In order to fight against her, he must get the cross of Tau, and to achieve it, he must solve microgames of cognitive stimulation. A battle with Disnergia takes place, and he expels her by performing a challenge
He visits places of interest along the way: Pamplona Park, Logroño.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 2. Long-term memory exercises.
- Mental health: scheduling pleasant activities.
-Healthy sleep habits: discovering sleep hygiene guidelines.
-Cognitive stimulation: mnemonic strategies, verbal reasoning, working memory, executive functions (planning) and spatial orientation.
-Social skills, assertive communication.
Previous and:
- Perform the weekly pleasant activities schedule.
4
Mental Health, cognitive stimulation, physical activity
From Nájera to Burgos
His mood is improving. Jacob and Guillen (another pilgrim who accompanies him throughout this stage of the journey and the next) are victims of the theft of the book by Disnergia and Morbilius (fantastic characters). Templar monks help them chase them away and give them physical activity guidelines to stay in good physical condition. He must solve puzzles to unlock information. The confrontation with Disnergia takes place and he defeats her doing a challenge, but not Morbilius, who escapes. He recovers his book.
He visits places of interest along the way: Botanical park of La Rioja, Hayedo de Urrez, San Juan de Ortega Church.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 3. Long-term memory exercises.
- Mental health: scheduling pleasant activities.
-Physical activity: essential information and intrinsic motivation (choosing personal value statements to improve this area); setting of a final goal and graduated subgoals; planned action (what, with whom, when, where, and how).
-Cognitive stimulation: verbal work memory, executive functions (planning), ideational praxia.
- Social skills, assertive communication.
Previous and:
- Perform the plan to achieve the weekly goal of physical activity; self-monitoring and self-reinforcement.
5
Mental health, cognitive stimulation, physical activity, healthy eating habits
From Burgos to Sahagún
The monks tell him that a wise man knows how to defeat Morbilius. The book, after conducting challenges (micropuzzles of cognitive stimulation) gives clues about the wise man and healthy eating patterns. They go to a restaurant to eat, where they meet the wise man and a woman (Venustea), but Morbilius kidnaps her and takes the book away, and they must help the wise cook by taking memory challenges related to information about food and memory. They get objects that will help them fight against Morbilius. They fight with Morbilius, save Venustea and recover the book. Guillen decides to stay with Venustea and Jacob continues on his way.
He visits places of interest along the way: San Tirso de Sahagún Church.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 4. Long-term memory exercises.
-Healthy eating habits: essential information and intrinsic motivation (choosing personal value statements to improve this area); eating pyramid (food groups and frequency intake); meal planning (portions and cooking).
- Cognitive stimulation: mnemonic strategies, visual and work memory, ideomotor praxis, executive functions (planning).
- Social skills, assertive communication.
Previous and:
-Daily record of food intake.
- Healthy eating plan: changes according to three priority levels.
6
Mental health,
cognitive stimulation, physical activity, healthy eating habits
From Sahagún to Rabanal
The book provides an explanation of the thoughts and their influence on mood. He meets the architect Antón Gaudín (historical character), whom he helps rid of cognitive distortions by overcoming challenges. The book teaches him to identify and record their own negative thoughts.
He visits places of interest along the way: Pantheon Museum of the Royal Collegiate of San Isidoro de León, Episcopal Palace of Astorga, Rabanal Hostel.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 5. Long-term memory exercises.
- Mental health: connection situation-thought-emotion; the effect of negative thoughts on mood; main cognitive distortions (e.g., overgeneralization); self-registration of negative thoughts.
- Cognitive stimulation: attention and concentration, language, verbal and visual memory, ideomotor praxia.
- Social skills, assertive communication.
Previous and:
- Negative thought detection.
7
Mental health,
cognitive stimulation, physical activity, healthy eating habits
From Rabanal to Triacastela
He finds a muleteer in his trip (a carrier of merchandise in a cart drawn by horses) when he is attacked by the cognitive distortions (minions of Lucifer). The muleteer, and later a Templar, teach him to substitute his negative and irrational thoughts for more rational and positive ones. Finally, Jacob helps the muleteer when he is attacked.
He visits places of interest along the way: El Bierzo, Ponferrada, O Cebreiro, Triacastela.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 6. Long-term memory exercises.
- Mental health: cognitive restructuring strategies (direct approach, the worst that could happen, opinion survey, how does this thought help?).
- Cognitive stimulation: attention, working memory, long-term memory, ideomotor praxia, cognitive functions (planning).
- Social skills, assertive communication.
Previous and:
- Use of cognitive restructuring strategies record.
8
Mental health,
cognitive stimulation, physical activity, healthy eating habits
From Triacastela to Santiago
He meets again with the muleteer, who gives him a valuable object: the cognitero, similar to the botafumeiro that serves to keep the treasures of our mind. He is reunited with Hirobumi, who gives him the seed of the tree of self-esteem and teaches him how to strengthen it so that it grows healthy and strong. Txomin teaches him the priming technique to inject positive thoughts. Before reaching the goal, he fights the boss (Lucifer); all the characters whom Jacob met along the way appear, contributing their teachings and thus helping to defeat Lucifer. Jacob makes an offering to Santiago, who gives him the Compostela (a document given to all pilgrims who complete the pilgrimage) in recognition for having completed the path and acquire healthy lifestyle habits. Jacob prepares himself for a new life with more illusion; he knows himself better and has the strategies to live happier.
He visits places of interest along the way: Monte del Gozo, Cathedral of Santiago de Compostela.
-Positive or corrective feedback about the completion of the weekly homework.
- Review of contents of Module 7. Long-term memory exercises.
- Mental health: techniques for managing thoughts (distraction, priming); self-esteem enhancement (identifying personal strengths and achievements).
-Cognitive stimulation: attention, ideomotor praxis, language, working memory, planning, long-term memory.
-Social skills, assertive communication.
- Progress maintenance, farewell and closing.
 
  1. Note: Throughout the game, when participants pass each challenge they get points (positive reinforcement). The challenge gradually increases the level of difficulty