Background Talking about experiences of sexual abuse in therapy is difficult for children and adolescents, amongst others due to a lack of vocabulary to describe the situation, avoidance, or feelings of shame, fear, and self-blame. The serious game Vil Du?! was developed to help children open up about sexual experiences. Vil Du?! is a non-verbal communication game, which resembles a dress-up game, in which children can show the therapist what happened to them. The current study examined how and for which therapy components Vil Du?! was used by therapists. Methods We used a mixed-methods triangulation design. Therapists filled out online surveys about the use of Vil Du?! with 23 clients (Mage = 11.38 years, SD = 3.96; 61 % female). We also conducted semi-structured interviews with 10 therapists. The data were analyzed in SPSS (quantitative) and Nvivo (qualitative) following the stepwise guidelines of Zhang and Wildemuth. Results Merged qualitative and quantitative data revealed that therapists acknowledged the usefulness of Vil Du?! mostly for the therapy components trauma narration and processing, and psycho-education about sexuality. In addition, Vil Du?! might be most useful for clients who have difficulty with disclosing sexual abuse experiences, due to limited verbal abilities or feelings of guilt, shame, avoidance, and tension. Conclusions Recommendations from this study were incorporated in a user manual as a first step toward more systematic and broad implementation of Vil Du?! in the treatment of young sexual abuse victims. A next step is to test whether implementing Vil Du?! in therapy is effective in reducing the negative mental health consequences of sexual abuse for children and adolescents.

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This chapter narrates the design process of VilDu?!, a game, or therapeutic tool, for sexually abused children. The game was developed during the Lyst Summit game jam and proved an important milestone for the Games [4Therapy] Project. Lessons learned from the design experience and the game’s implementation process in therapy sessions have contributed to a design approach for therapeutic games. This article will elaborate upon this by chronologically describing the initial challenges of the project, the design process and insights gained from developing VilDu?!, and how the game is now used in therapy sessions.

BACKGROUND Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. OBJECTIVE This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). METHODS The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. RESULTS Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! CONCLUSIONS The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients.

BACKGROUND With the digitalization of society and increasing loneliness due to population aging, the potential for digital loneliness interventions is growing. This article describes the mixed methods process evaluation of a digitally conducted randomized controlled trial, evaluating a mobile gaming application newly designed to improve the social connectedness of community-dwelling older adults. OBJECTIVE This paper aims to evaluate a social gaming application in community-dwelling older adults through a mixed-methods process evaluation of a digitally conducted randomized controlled trial (RCT). METHODS The RCT compared two gaming conditions with a control group. We included adults aged 65 years and over. The process evaluation involved a focus group and semi-structured interviews with the RCT participants and welfare organizations to explore barriers and facilitators for app usage and gameplay and analyzed questionnaire adherence, game engagement, network measures, and retention. RESULTS Of the 372 people who signed up for the RCT, 76 adults installed the app and signed informed consent, of whom 33 were 65+. The baseline completion rate of questionnaires was 36%, rapidly declining during follow-up. Participants experienced the app differently, varying from engaging to too simple or too complex. Participants suggested challenging and competitive games with increasing difficulty levels. Repeated instruction and in-person and personal contact were deemed essential to reach and engage the intended population. CONCLUSIONS Conducting a digital trial of a social gaming intervention for older adults is a great challenge. Evaluation of future digital gaming interventions should start with small-scale studies with personal contact and fewer questionnaires. CLINICALTRIAL ClinicalTrials.gov NCT04733898