HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services

Abstract

IntroductionSpecialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care.Methods and analysisThis study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16–27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool.Ethics and disseminationMelbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website.Trial registration numberACTRN12614000009617; Pre-results.

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

“…Importantly, the majority of participants (95%) in this study engaged with the peer-to-peer networking feature of the program, with many reporting increases in perceived social connectedness and empowerment in their recovery process (Alvarez-Jimenez et al 2013). This moderated online social therapy program is now being evaluated as part of a large randomized controlled trial for maintaining treatment effects from first episode psychosis services (Alvarez-Jimenez et al 2019).…”

“…These examples highlight the promise of incorporating the features of popular social media into existing programs, which may offer opportunities to safely promote engagement and program retention, while achieving improved clinical outcomes. This is an emerging area of research, as evidenced by several important effectiveness trials underway (Alvarez-Jimenez et al 2019;Aschbrenner et al 2018a), including efforts to leverage online social networking to support family caregivers of individuals receiving first episode psychosis services (Gleeson et al 2017).…”

The “online brain”: how the Internet may be changing our cognition

“…The main reasons include high attrition rates, poor study designs which reduce translational potential, and a lack of consensus around the required standards of evidence for widespread implementation of Internet‐delivered therapies. Efforts are currently underway to determine the long‐term effects of the first generation of social media‐based interventions for mental illness via large randomized controlled trials. Alongside this clinical use, developing public health strategies for young adults in the general population to avoid the potential adverse effects and negative aspects of typical social media are also warranted.…”

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

“…Currently, a full trial utilising a single-blind RCT design to evaluate the effectiveness of this intervention over an 18-month follow-up period is taking place for young people with FEP [107]. In another recent feasibility trial [96], authors developed a digital smartphone application (app) named +Connect, which sought to utilise a positive psychology intervention (PPI) for young adults with early psychosis.…”