Elsevier

Schizophrenia Research

Volume 202, December 2018, Pages 369-377
Schizophrenia Research

Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy

https://doi.org/10.1016/j.schres.2018.07.022Get rights and content

Abstract

Background

Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments.

Aims

The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning.

Methods

An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants.

Results

System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage.

Conclusion

MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.

Introduction

Interventions have shown to be effective in reducing transition to psychosis in young people at Ultra High Risk (UHR) of developing psychosis (van der Gaag et al., 2013). However, these first generation UHR interventions have had little to no impact on social functioning deficits (Hutton and Taylor, 2014; van der Gaag et al., 2013), which are pervasive, significant (Addington et al., 2008; Cotter et al., 2014), and predictive of both transition to psychosis (Cornblatt et al., 2012) and poor long-term functional outcomes (Carrion et al., 2013; Cotter et al., 2014). Notably, while social functioning often remains impaired regardless of transition to psychosis status (Addington et al., 2011; Carrion et al., 2013; Cotter et al., 2014), those who transition are more likely to function poorly (43.8%) at long-term follow-up (i.e., up to 14 years) compared with those who do not develop psychosis (17.4%) (Yung et al., 2015). Indeed, the onset of psychosis can have a devastating psychosocial impact at a critical developmental stage, which may result in entrenched social disability (Crumlish et al., 2009). It is therefore essential to address social functioning deficits before psychosis develops: targeted interventions in the UHR period are more likely to halt and reverse these deficits, reduce their duration and impact and bring about long-term functional improvements (Carrion et al., 2013; Cotter et al., 2014; Crumlish et al., 2009).

In this paper we seek to: i) provide a rationale for the integration of a strengths and mindfulness-based approach, the self-determination theory of motivation, and online social media as a new avenue to improve social functioning in UHR young people; ii) describe the therapeutic targets and features of a world-first, theory-driven online psychosocial intervention (MOMENTUM) designed to improve social functioning in this population; and iii) examine the acceptability, safety and preliminary effect on social functioning of MOMENTUM through a pilot study.

Section snippets

Strengths-based models, broaden-and-build and self-determination theories

Recent evidence-based psychotherapy models emphasise the role of personal strengths and self-efficacy in fostering social functioning in psychosis (Browne et al., 2018; Vaskinn et al., 2015). A pilot RCT showed that a 7-week intervention focused on eliciting and practicing personal strengths in patients with psychosis was associated with increased self-esteem, decreased psychotic symptoms and improved social functioning compared with treatment as usual (Hall and Tarrier, 2003). Similarly, a

MOMENTUM: development and features

MOMENTUM has been developed by an international team of researchers, clinicians, programmers, creative writers, comic developers, young people and experts in human computer-interaction. MOMENTUM has been designed following persuasive systems design (Kelders et al., 2012) and participatory design principles (Hagen et al., 2012), which increase user engagement and intervention relevance (Kelders et al., 2012). Young people can log on to MOMENTUM 24 h/day on computer or Internet-enabled mobile

The MOMENTUM Pilot study

The aim of the pilot study was to conduct an initial evaluation of MOMENTUM regarding its acceptability, safety and potential to improve social functioning in UHR young people. We hypothesised that MOMENTUM would be regularly used, favourably received, and safe. In addition, we expected that using MOMENTUM would: 1) engage the theory derived therapeutic targets (i.e., strengths usage, mindfulness skills and social support); and 2) be positively correlated with improved social functioning in UHR

Discussion

To the best of our knowledge, this is the first study to develop and test an online intervention designed for UHR young people, with a particular focus on improving social functioning. The results of this pilot study indicated that MOMENTUM was safe, feasible and appealing to UHR young people. The high level of use and indicators of satisfaction provide initial support for the relevance of the intervention content and features for UHR young people.

Our findings indicated that MOMENTUM engaged

Contributors

M.A.-J., J.F.G. and N.B. led the overall design and conduct of the study. S.B. and S.R. contributed to the supervision of the moderation of the online intervention. M.A.-J wrote the first draft of the manuscript. D.P., A.R.Y., R.R., S.D., C.M., P.R., R.L., R.C., C.G.-B., M.L., E.K., and P.D.M. contributed to the design of the online intervention and critically revised the manuscript. All authors contributed to and have approved the final manuscript.

Role of funding source

This work was supported by grants from the Victorian Government's Mental Illness Research Fund (MIRF), the Telstra Foundation and the Colonial Foundation to Orygen, The National Centre of Excellence in Youth Mental Health. MA was supported via a Career Development Fellowship (APP1082934) by the National Health and Medical Research Council (NHMRC). The sponsors did not participate in the design or conduct of this study; in the collection, management, analysis, or interpretation of data; in the

Conflict of interest

The authors report no additional financial or other affiliation relevant to the subject of this article.

Acknowledgements

The authors wish to thank the young people who generously participated in this study.

The authors wish to thank Lisa Rumney, Jacquie Mackinnon, Jess Phillips and the study participants for their generosity and valuable contributions to this research.

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