Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders

Abstract

BackgroundNumerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS).ObjectivesThe objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes.MethodsParticipants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored.ResultsIn total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms.ConclusionsIt is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cogni...

Potential Benefits of Incorporating Peer-to-Peer Interactions Into Digital Interventions for Psychotic Disorders: A Systematic Review

“…Biagianti and colleagues (53) developed an integrated platform called Creating Live Interactions to Mitigate Barriers (CLIMB) to improve social functioning among individuals with chronic psychotic disorders. CLIMB integrates computerized, neuroscience-informed, social cognition training; remote weekly group therapy sessions that are held via videoconferencing; and moderated peer-to-peer multimodal messaging.…”

“…The feasibility of CLIMB was investigated in a six-week, single-arm, pilot study with 27 participants who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features and who participated in the intervention remotely (53). Study retention was 78%.…”

“…In PRIME, users have the ability to share goal achievements and rewarding experiences by using the community “moments feed,” which in turn promote support and encouragement via peer-to-peer interactions (52). In CLIMB, peer-to-peer multimedia messaging is used between video calls to consolidate rapport, create opportunities for social engagement, and encourage participants to share personal content through links, videos, pictures, drawings, poems, and quotes (53). Taken together, these findings suggest that social media technology can be used in creative and flexible manners not only to promote social interactions and support among peers but also to enhance engagement with other treatment components.…”

“…On average, a PRIME participant posted 3.24 messages, comments, or “likes” per week (52). Finally, an average of 10.34 messages were posted per participant per week on the CLIMB messaging platform (53). Therefore, the average rate of social networking use was 16.66 social media actions per participant per week.…”

Internet- und mobilbasierte Interventionen bei Schizophrenie

“…[Välimäki et al, 2016]. Eine Gruppentherapie per Video-Chat, unterstützt durch Gruppen-Textnachrichten zwischen den Sitzungen, wurde in einer unkontrollierten Pilotstudie von vielen der 27 Teilnehmenden positiv aufgenommen, ging aber nicht mit einer Symptomverbesserung einher [Biagianti et al, 2016] Blended Treatment, also die Verbindung von persönlichen (face-to-face) Kontakten und Internet-oder mobilbasierten Interventionen, wird bei der Schizophrenie-Behandlung zunehmend aktiv beforscht. Eine Pilotstudie ohne Vergleichsbedingung mit 9 Teilnehmenden mit Schizophrenie [Depp et al, 2010] konnte die prinzipielle Machbarkeit von Blended Treatment bei dieser Patientengruppe aufzeigen.…”