Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders
Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders
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DOI：
10.2196/mental.6671
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发表时间：
2016-10-01
影响因子：
5.2
通讯作者：
Vinogradov, Sophia
中科院分区：
文献类型：
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作者：
Biagianti, Bruno;Schlosser, Danielle;Vinogradov, Sophia
工作背景：对慢性精神障碍（CPD）患者的许多心理社会干预措施对社会认知和功能结局指标产生了积极影响。然而，获得和参与这些干预措施的机会仍然有限。这部分是因为这些干预措施需要经过专门培训的治疗师，并非在所有临床环境中都可用，并且对参与者的日程安排负担很高，通常需要几周的承诺。通过移动的设备远程提供干预可以促进访问，提高调度灵活性，并减少参与者负担，从而提高对干预要求的依从性。为了满足这些需求，我们设计了创造实时互动以减轻障碍（CLIMB）数字干预，旨在增强CPD患者的社会功能。CLIMB由两个治疗组成部分组成：计算机化社会认知训练（SCT）计划和优化远程团体治疗（ORGT）。ORGT是一种创新的治疗方法，它将远程小组治疗与小组短信相结合（短消息服务，SMS）。目的：这项单臂研究的目的是调查向CPD患者提供6周CLIMB的可行性，并探索对结果的初步影响。方法：参与者通过互联网招募、筛选和登记，并使用提供的平板电脑（iPad）远程提供评估和干预措施。参与者被要求完成18小时的SCT，并参加6次远程小组治疗。为了评估可行性，对研究程序的依从性、脱落率、参与指标和干预的可接受性进行了评价。还探讨了社会认知、生活质量和症状指标的变化。结果：12个月内总共招募了27名参与者。96%（26/27）的入组受试者成功完成了远程评估。6周试验中的保留率为78%（21/27）。在所有使用的iPad中，95%（22/23）在干预结束时返回时完好无损。参与者平均参加了84%的小组治疗课程，完成了9.5小时的SCT中位数，并在小组文本聊天中每周发布5.2条消息。参与者对CLIMB的可用性、可接受性、享受性和感知效益进行了中等程度的评价。参与者在韵律幸福（P =.001），韵律幸福强度（P =.04）和面部愤怒（P =.001）的情绪识别能力方面表现出显着的改善。组内效应量较大（d = 0.60~0.86）。在生活质量方面观察到趋势水平的改善（P值小于0.09）。没有改善观察symptoms.Conclusions：这是可行的，可以接受的远程提供的干预，旨在提高社会功能的人与CPD使用移动的设备。这种方法可以代表一种可扩展的方法，以增加治疗的访问和遵守。我们的试验数据还表明，CLIMB 6周后，在社会认知的某些方面，组内收益。未来的大样本随机对照研究应该评估CLIMB在多大程度上显著改善CPD患者的社会认知、症状和生活质量。
Background: Numerous 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).Objectives: The 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.Methods: Participants 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.Results: In 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.Conclusions: It 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 cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD.