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

项目摘要/摘要 此重新提交响应PAR-MH-21-135(心理社会治疗和预防的发展 精神障碍的干预措施，R61/R33)，通过顺序测试新的干预措施来解决PAR 这是从基础科学翻译过来的，它使用多模式方法来评估和修改 客观测量的目标。首要目标是评估一种新的混合式移动干预 旨在提高精神障碍患者的内省准确性(IA)，最终目标是 改善功能结果。内省精确度是一个人对任务的自我评估的程度 表现或能力与客观数据相对应。我们的团队和其他人已经证明了穷人 IA是功能性残疾的一个强有力的独立预测因子。然而，目前还没有治疗方法 直接瞄准内务部。基础实验研究和其他证据表明，IA是可塑性的，而且 改进了基于任务的IA向未经训练的任务的转移。该项目的前提是基于任务的信息技术培训 可以以远程移动健康模式提供，并结合指导将改进的IA应用于实时 世界功能行为，为精神障碍的功能康复创造了一条新的途径。我们 已经开发并完成了iTEST的可用性测试，这是一种新型的混合式移动干预。ITEST 将在针对IA的移动设备上提供的分级演练和实践培训与个性化 在日常代偿行为中应用IA的指导。在R61阶段，我们将招聘以下人员 至少有轻微功能损伤的精神障碍。我们会首先进行一项试验研究，以敲定 完全可供部署的iTEST版本。接下来，我们建议对iTEST进行公开试验，评估 干预导致临床上基于任务的IA的显著变化以及转移到未经训练的任务 (目标机制)。我们还将确定达到临床意义所需的干预剂量。 通过在8周、12周或16周评估变化来改进IA目标。如果通过/不通过的标准(临床上 训练和未经处理的内省准确率的显著提高)在R61阶段、R33阶段达到 包括一项随机对照试验，将iTEST与提供目标训练的对照条件进行对比 环境和认知补偿，但不包括任务型信息素养培训。我们将评估是否 无论这些改善是否持续，iTEST都会导致IA和功能结果的更大改善 在随访时，以及IA的增加是否中介功能结果的改善。该项目响应了 直接到NIMH战略目标3.1，通过评估新的干预措施，通过修改 客观测量的目标。我们的项目也响应NIMH数字健康优先领域 用于认知康复的流动干预。如果有效，iTEST可以与许多认知能力相结合 培训和其他康复干预措施，以提高对功能结果的影响。

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.