Co-designing and evaluating a digital therapeutic for childhood anxiety: Lumi Nova

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Executive summary

NIHR HealthTech Research Centre Mental Health (MindTech) partnered with BfB Labs Ltd in 2019-2020 to develop and evaluate their digital therapeutic mobile game, Lumi Nova: Tales of Courage, and advise on implementation. Lumi Nova: Tales of Courage helps manage difficulties with fears, worries or anxiety for children aged 7-12 years with mild to moderate needs, helping them learn skills to self-manage their mental health in an engaging intergalactic adventure game (app). In 2023, Lumi Nova was recommended by the National Institute for Health and Care Excellence (NICE) by early value assessment, as a first line treatment for children and young people with mild to moderate symptoms of anxiety, and has since been implemented into over 20 NHS services in the UK.

Clear purpose and why

Anxiety disorders are some of the most common and increasingly reported mental health difficulties among children and young people. When not treated successfully, these young people are at increased risk for prolonged difficulties and adverse outcomes. In England, approximately 20% of children aged 8-16 have a mental health difficulty, and the number of young people accessing mental health services nearly doubled between 2019 and 2023. Whilst effective treatments exist, few children gain access to the specialist support they need and less than 3% receive cognitive behavioural therapy (CBT), an evidence-based talking therapy.

According to OFCOM data (2024), almost all parents of young people aged 3–17 say that their child plays games using a tablet or mobile phone. This means that mobile technology is a clear and accessible route for delivering evidence-based digital gamified interventions, helping widen the availability and reach of therapeutic and mental health support, especially to children and young people.

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BfB Labs developed Lumi Nova: Tales of Courage as an immersive digital therapeutic game where the user (supported by their guardian) works through a series of personalised challenges to learn about and overcome their fears or worries, using clinically grounded exposure therapy techniques in a game-based immersive experience.

Approach

Lumi Nova was co-created with children & young people, guardians, school staff, health professionals, clinicians, academics and game experts to translate traditional cognitive behavioural therapy (CBT) techniques into a widely applicable and non-stigmatising game model.

NIHR HRC Mental Health (MindTech)’s involvement from the start was instrumental to BfB Labs’s success with Lumi Nova. MindTech supported a collaborative partnership between academics at the University of Nottingham and the education sector to evaluate the game in a real world setting with children and their parents. 

In 2020, MindTech led on the evaluation of Lumi Nova through a pilot over a period of 8 weeks, in partnership with 12 schools in Southwark (London). One hundred and twenty young people and their parents played a beta version of the game at home, completing outcome measures at the beginning and end of the study.

Throughout the whole process, experts from MindTech (including experts by experience) advised on the technology’s introduction into healthcare systems, while academics gathered and synthesised research evidence, and gave early stage advice about evidence generation for regulatory and NICE assessments.

Insights and impact

The trial found that 86% of users showed reliable improvement and a reduction in anxiety symptoms as well as progress towards the treatment goals that the children set themselves. Parents who took part also reported tangible changes in their children’s symptoms and increased understanding of their anxiety.    

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Lumi Nova gave Emi, an 8-year-old girl, the courage to speak in front of a crowd.

Since 2023, Lumi Nova has supported over 15,000 children and families. It has been deployed to NHS Trusts, healthcare providers, VCSEs and schools in over 20 places in the UK. Not all families can access health services in the same way, so being able to give children and families access to a digital intervention through their phone or tablet, meant it was more accessible to children from different cultures and social groups. 

Almost two thirds of those using the game have reported improvements to their anxiety symptoms, to the point where they no longer needed support from NHS services. The benefits were greater for neurodivergent children who find face-to-face interactions more challenging. The wide accessibility also resulted in greater health equity. 

Many important benefits were also reported by health and social care services. Not only did this intervention help the children and families using it, but it also alleviated pressure on health services by reducing symptoms for patients and preventing progression to more serious symptoms requiring more specialist services. It also helped to reduce waiting times for services, a major challenge for youth services across the UK.

Reflections

The initial stage of testing Lumi Nova took place during the Covid pandemic, which meant some willingness to interact with the study may have been difficult for certain participants. There were also some issues with the data collection on the beta version of the game as data was initially only collected when users were online, meaning that any data generated while they were offline couldn't be used.

MindTech continues to support BfB Labs with opportunities to grow their network and to meet relevant stakeholders and other researchers. BfB Labs have since partnered with the Mental Health Research for Innovation Centre (M-RIC) on a forthcoming project to evaluate their new app, Oshn, a gamified therapeutic app for young people aged 13-25 in Merseyside with low mood and motivation.

NIHR HRC MindTech supports innovators, developers and researchers of transformative healthcare technologies to improve the lives of patients, find innovative ways to deliver healthcare, develop digital interventions tailored to prevention and make a real difference in the health tech landscape.

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