iTEST: Introspective Accuracy as a Novel Target for Functioning in Psychotic Disorders

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PROJECT SUMMARY/ABSTRACT This resubmission responds to PAR-MH-21-135 (Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders, R61/R33), addressing the PAR by sequentially testing a new intervention that is translated from basic science and that uses a multi-modal approach to assessing and modifying an objectively measured target. The overarching goal is to evaluate a new blended mobile intervention that is aimed at improving introspective accuracy (IA) in people with psychotic disorders, with the ultimate goal of improving functional outcome. Introspective accuracy is the degree to which one’s self-assessment of task performance or abilities corresponds with objective data. Our group and others have demonstrated that poor IA is a strong and independent predictor of functional disability. Yet, there are currently no treatments that directly target IA. Basic experimental research and other lines of evidence suggest IA is malleable, and that improvement in task-based IA transfers to untrained tasks. This project’s premise is that task-based IA training could be delivered in a remote mobile health format and coupled with coaching in applying improved IA to real- world functional behaviors, creating a novel avenue for functional rehabilitation in psychotic disorders. We have developed and completed usability testing of iTEST, a novel blended mobile intervention. iTEST integrates graduated drill-and-practice training delivered on a mobile device that targets IA with personalized coaching in applying IA to everyday compensatory behaviors. In the R61 phase, we will recruit people with psychotic disorders with at least minimal functional impairment. We will first conduct a pilot study to finalize a fully ready-for-deployment version of iTEST. Next, we propose an open trial of iTEST, evaluating whether the intervention leads to clinically significant changes in task-based IA along with transfer to an untrained task (target mechanisms). We will also determine the dose of intervention needed to achieve clinically significant improvement in IA targets, by evaluating change at 8, 12, or 16 weeks. If go/no go criteria (clinically significant increases in trained and untreated introspective accuracy) are met in the R61 phase, the R33 phase includes a randomized controlled trial contrasting iTEST with a control condition that provides training in goal setting and cognitive compensation but does not include task-based IA training. We will evaluate whether iTEST leads to greater improvement in IA and functional outcome, whether these improvements are sustained at follow up, and whether increases in IA mediate improvements in functional outcome. This project responds directly to NIMH Strategic Aim 3.1, by evaluating a new intervention that targets functioning by modifying an objectively measured target. Our project also responds to the NIMH Digital Health Priority Area by advancing mobile interventions for cognitive rehabilitation. If effective, iTEST could be integrated with many cognitive training and other rehabilitative interventions to boost impact on functional outcomes.