JMIR Publications

ABSTRACT

Background:

Current online interventions for managing stress and negative emotions can be time-consuming and inconvenient, leading to high dropout rates. There is a need for brief digital activities that people can easily reference or practice when they experience negative thoughts and emotions in their daily life.

Objective:

The objective of the study is to explore the possibility of using a brief digital exercise, such as a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure.

Methods:

We conducted three simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys or semi-structured interviews. In the second study, we compared the perceived benefits and time commitment of our RQA intervention to a single-question activity using a between-subjects design with 215 participants recruited from Amazon Mechanical Turk. Hypotheses related to perceived benefits and elapsed time were evaluated through multiple self-reported scores and survey completion time, respectively. In the third study, we evaluated the impact of the RQA by delivering it to 11 participants repeatedly over two weeks and conducting follow-up interviews.

Results:

Participants from the first study appreciated the structured nature of the RQA and found venting negative thoughts through writing helpful, although some experienced incidental negative side-effects such as confusion and frustration. In the second study, the RQA condition resulted in significantly higher ratings (p = 0.016) for the utility of the activity and a statistically significant decrease (p < 0.001) in perceived stress rating compared to the single-question activity. Although the RQA required significantly more effort, there was no statistically significant difference in people’s subjective perception of the activity duration (p = 0.17). Deploying the RQA over two weeks in the third study identified some potential challenges to consider for such activities, such as: the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations.

Conclusions:

The paper describes the design and evaluation of a brief online self-reflection activity based on CBT principles. This can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles.