Evaluation of Internet-based cognitive behavioral self-help treatments for persecutory ideation and auditory verbal hallucinations

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Schizophrenia is a severe mental disorder which is accompanied by an enormous individual and societal burden. Despite established efficacy of cognitive behavioral therapy for psychosis (CBTp), its dissemination into routine mental health care remains poor. National regulations such as the NICE guideline in the United Kingdom recommend that CBTp should be offered to every person with psychotic symptoms, but more than 50% do not receive even a single session of CBTp. In Germany, CBTp is "virtually not represented in the psychotherapy health service" (Klingberg & Wittorf, 2012, p. 916; own translation). Internet-based cognitive behavioral therapy (CBT) in a self-help format has been proven feasible and effective in anxiety and depressive disorders. Recently, Internet-based (self-help) interventions are also deployed via smartphone apps. The feasibility of Internet-based treatments for people with schizophrenia is well documented for Internet-based interventions (e.g., medication management) and also reported for smartphone interventions. However, there is a dearth of empirical studies precluding a conclusive picture. As far as we know, there is only one study encompassing 90 participants with psychosis that investigated an Internet-based intervention with symptom-specific, cognitive behavioral interventions, which is from our research group. The unique features of the proposed project are 1) the first-time evaluation of a symptom-oriented, CBTp-based self-help treatment for people with psychotic symptoms via Internet and 2) the investigation of the enhancement of Internet-based self-help with smartphone assistance. The two studies are set up as randomized controlled trials (RCTs) with each two active treatment versus a wait-list control group. Study I evaluates an Internet-based guided self-help treatment for persecutory ideation, whereas Study II evaluates an analog self-help treatment for auditory verbal hallucinations. The two active treatment conditions are 1) access to a self-help website including regular written electronic contact with a guide, and 2) access to the guided self-help website plus access to additional smartphone-based interactive worksheets (apps). The trials combine the low-threshold advantages of an online approach (e.g., anonymity) with the virtues of a clinical trial (e.g., symptom assessment and diagnostic verification via Interview). Primary outcome measures are persecutory delusions (Study I) and AVH (Study II). Secondary outcome measures include completion rates, drop-out from the intervention, general symptomatology, side-effects, and client satisfaction. The project will be the first that contributes to answering the empirical question whether CBTp-based interventions in a purely Internet-based self-help format are effective. Positive findings would pave the way for an easy-to-access treatment option for patients with psychotic symptoms who currently are deprived of psychotherapeutic treatment.