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TRAC: A randomised clinical trial testing the acceptability and preliminary efficacy of an exergame-augmented dynamic
Alexandru Tiba1, Marius Drugaş1, Ioana Sîrbu1
1Department of Psychology, University of Oradea, Romania.
Background:
Residual symptoms such as anhedonia and rumination often persist after depression treatment. We tested whether adding a brief exergame-augmented dynamic imagery module to behavioural activation (BA) improves outcomes versus BA alone.
Methods:
Two-arm parallel-group RCT (1:1; N = 99; BA n = 50, BA PLUS n = 49) in adults with major depressive disorder. Both arms received eight weekly BA sessions; BA PLUS added a 5-10-min module combining low-intensity Kinect® (Microsoft) exergaming (exercise-based video gaming requiring body movement), guided "actfulness," and dynamic motor imagery, plus daily imagery homework. Assessments were conducted at baseline, post-treatment, and 3-month follow-up. The primary outcome was Beck Depression Inventory-II (BDI-II) at post-treatment. Primary analyses used ITT constrained longitudinal data analysis/MMRM (REML; unstructured covariance); baseline-adjusted ANCOVA served as sensitivity.
Results:
Both conditions showed substantial improvements across outcomes. No additional average reduction in depressive severity (BDI-II) was detected for BA PLUS versus BA at post-treatment. For anhedonia, cLDA/MMRM suggested a post-treatment advantage for BA PLUS, although the corresponding ITT MI-ANCOVA contrast was not statistically significant. Exploratory baseline-anhedonia moderation was observed in per-protocol models but was not supported in ITT MI-pooled analyses. For rumination, per-protocol analyses suggested a post-treatment advantage for BA PLUS. ITT contrasts were not significant. Follow-up contrasts were imprecise due to high attrition. Acceptability and adverse events were broadly similar across arms.
Conclusions:
A brief BA programme produced strong post-treatment improvements. The exergame-augmented dynamic imagery add-on was acceptable and may yield domain-specific benefits for anhedonia. Larger, fully pre-specified trials are needed to test small incremental effects, durability, and involved mechanisms.
