JMIR Publications

ABSTRACT

Background:

Cognitive behavioral therapy is effective in reducing posttraumatic stress disorder (PTSD) symptoms and posttraumatic cognitions in women who have experienced sexual assault. Online interventions are a potentially effective and accessible treatment modality for this population, but engagement issues have been documented. Design strategies such as gamification and personalization to the needs of a target population may help address these challenges by enhancing acceptability, user experience and engagement.

Objective:

This pilot study evaluated a gamified, online cognitive restructuring intervention personalized to women who have experienced sexual assault. A mixed-methods design was used to assess (1) changes in PTSD, anxiety, depression, posttraumatic cognitions, and self-blame, as well as perceived changed reported by participants; (2) acceptability and user experience, as well as participants’ subjective experiences, and (3) quantitative engagement, as well as perceived engagement reported by participants.

Methods:

Seventeen women who have experienced sexual assault were given access to the five-session intervention. They completed self-reported questionnaires evaluating symptoms and cognitions at three time points during treatment. At post-treatment, they also completed questionnaires about acceptability and user experience and participated in a qualitative interview. Usage data was collected to describe engagement with the intervention.

Results:

Twelve participants completed the intervention and all three measure points. Quantitative results showed significant reductions in severity of all symptoms and endorsement of negative cognitions (all P<.05), high acceptability and user experience, and good engagement. Qualitative findings revealed perceived improvements, including reduced anxiety and avoidance, and increased ability to restructure one’s thoughts. Personalized content was described as relevant to participants’ needs, as well as validating and empowering. Gamification features were perceived as supporting learning and engagement. However, some participants reported design-related challenges, including insufficient relevance for repeated sexual trauma and discouragement from unmet gamified goals.

Conclusions:

Overall, these findings highlight personalization and gamification as promising design considerations for online interventions targeting PTSD symptoms in women who have experienced sexual assault. Future research should aim to isolate the specific effects of design strategies such as personalization and gamification on effectiveness, user experience, acceptability, and engagement through controlled experimental trials.