Developing a Game-Based, Single-Session Intervention for Youth Anxiety: Early Translational Findings Targeting “Flashforwards”

Abstract Background Anxiety disorders are the most prevalent form of psychopathology and place a high burden on youth transitioning into adulthood. Scalable, effective, and appealing early interventions are urgently needed. We take initial steps to precisely target a key cognitive mechanism–future, distressing, and imagery-based mental simulations (“flashforwards”). Methods A digital, game-based, single-session, researcher-guided intervention was administered over videoconferencing. It involved brief flashforward recall followed by a cognitive task (playing Tetris to tax working memory). In a translational case series, 20 young adults (aged 16–24), with anxiety problems and recurrent flashforwards, received the intervention. Participants tracked daily flashforwards during Week 1 (pre-intervention), completed the guided session, and continued tracking during Weeks 2 (post-intervention) and 5 (follow-up). A nonconcurrent, fixed-baseline, repeated-measures AB design was used to demonstrate preliminary target engagement, contrasting daily flashforwards between Weeks 1 and 2 while accounting for baseline time trends. Anxiety symptoms (GAD-7), broader clinical impact, and acceptability feedback were also collected. Results Intervention and procedures were rated as highly acceptable. Flashforward frequency showed a mean reduction of 33.96% from Weeks 1 to 2, and 50.94% from Weeks 1 to 5. Daily reductions in Week 2 remained after accounting for baseline trends at Week 1. GAD-7 scores followed a similar pattern (mean 4-point reduction). Conclusions These early findings support intervention acceptability and suggest preliminary signal of reducing flashforwards and anxiety. Further controlled testing is warranted to evaluate this intervention as a scalable and digital early approach for youth anxiety.