Mobile Assessment and Treatment for Schizophrenia (MATS): A Pilot Trial of An Interactive Text-Messaging Intervention for Medication Adherence, Socialization, and Auditory Hallucinations

Abstract

Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia.

Online, social media and mobile technologies for psychosis treatment: A systematic review on novel user-led interventions

“…It used video tutorials, interactive games and quizzes to enhance engagement and an anonymous social feed or forum Delivery: Sessions took place in offices at the mental health centers integrated web-based therapy, social networking and peer and expert moderation (Alvarez-Jimenez et al, 2013); web-based CBT (Gottlieb et al, 2013); personalized advice based on routine clinical monitoring (van der Krieke et al, 2012), and mobile-based interventions (Spaniel et al, 2008a;Granholm et al, 2012;Spaniel et al, 2012). Six interventions were evaluated in admission units or controlled environments (Valimaki et al, 2008;Yakirevitch et al, 2010;Steinwachs et al, 2011;Anttila et al, 2012;van der Krieke et al, 2012;Gottlieb et al, 2013) and 6 were delivered remotely in real world settings via Internet enabled or mobile devices (Spaniel et al, 2008a;Glynn et al, 2010;Rotondi et al, 2010;Granholm et al, 2012;Spaniel et al, 2012;Alvarez-Jimenez et al, 2013). Table 1 depicts the characteristics of the selected studies.…”

“…Patients' mean age ranged from 20.3 to 50 years and supporters' mean age varied from 47 to 57 years. Seven studies recruited patients with chronic schizophrenia (Valimaki et al, 2008;Yakirevitch et al, 2010;Steinwachs et al, 2011;Anttila et al, 2012;Granholm et al, 2012;van der Krieke et al, 2012;Gottlieb et al, 2013), 4 studies recruited patients with chronic schizophrenia and their relatives/supporters (Spaniel et al, 2008a;Glynn et al, 2010;Rotondi et al, 2010;Spaniel et al, 2012), and 1 recruited young people with first-episode psychosis (FEP) (Alvarez-Jimenez et al, 2013). Four studies employed a randomized controlled design (Rotondi et al, 2010;Yakirevitch et al, 2010;Steinwachs et al, 2011;Spaniel et al, 2012), 2 studies included nonrandomized comparison groups (Glynn et al, 1990;Spaniel et al, 2008a), 4 used uncontrolled single-group pre-post designs (Anttila et al, 2012;Granholm et al, 2012;Alvarez-Jimenez et al, 2013;Gottlieb et al, 2013), and 2 tested the acceptability/usability of an online intervention in a single session (Valimaki et al, 2008;van der Krieke et al, 2012).…”

“…For those studies including comparison groups control interventions comprised treatment as usual (TAU) (Glynn et al, 1990;Spaniel et al, 2008a;Rotondi et al, 2010;Yakirevitch et al, 2010;Spaniel et al, 2012) and videos and information about schizophrenia treatment (Steinwachs et al, 2011). Five studies were conducted in the United States (Han et al, 2008;Glynn et al, 2010;Rotondi et al, 2010;Steinwachs et al, 2011;Granholm et al, 2012;Gottlieb et al, 2013), 5 in Europe (Spaniel et al, 2008a;Anttila et al, 2012;Spaniel et al, 2012;Välimäki et al, 2012;van der Krieke et al, 2012), 1 in Australia (Alvarez-Jimenez et al, 2013) and 1 in Israel (Yakirevitch et al, 2010).…”

“…One 12-week pilot study examined the feasibility of a mobile-based SMS intervention targeting auditory hallucinations, medication adherence and socialization for patients with chronic schizophrenia delivered in a real world setting (Granholm et al, 2012). Forty-two participants (76%) completed the intervention and 13 (26%) were considered noncompleters (i.e., did not send any valid messages or stop sending messages within 2 weeks despite repeated reminders).…”

Self-report measures of medication adherence behavior: recommendations on optimal use

“…The viability of interactive text-messaging for monitoring medication adherence remains unclear. This method appears to overestimate adherence when compared with MEMS or laboratory-based measures of symptom status and functioning [93,94]. One study found text message reminders to be feasible and acceptable, however, response rates to requests about adherence were low (48 %) [95].…”