The use of a mobile-based digital health intervention program showed benefits in mood and motivation in young patients with recent-onset schizophrenia spectrum disorders, according to a study in Schizophrenia Bulletin.
The researchers of this randomized study recruited participants who were diagnosed with schizophrenia, schizophreniform, or schizoaffective disorder within the previous 5 years, who were between 16 and 36 years of age, and who were clinically stable without substance dependency or a neurological disorder. These participants had baseline interviews that included demographic information, self-reported measures, and behavior tasks. Participants then were randomly assigned to 12 weeks of either the intervention arm — access to Personalized Real-time Intervention for Motivational Enhancement (PRIME) — or the control arm — consisting of normal treatment while they were on the waitlist for PRIME. Both arms concluded with a 3-month follow-up evaluation.
The control arm gained access to PRIME after the 12-week study protocol. The focus of the study was to assess changes in motivated behavior, defeatist beliefs, self-efficacy, and positive and negative symptoms. Acceptability and feasibility of PRIME were also assessed.
PRIME is a mobile application designed to provide users with an online support system to reach health, social interaction, productivity, and creativity goals. Each participant selected a long-term goal, and then PRIME suggested daily challenges to help reach that goal. Participants were also connected to a motivational coach and other peers through the PRIME interface. They could communicate through messaging, FaceTime, or phone calls.
Results indicated that participants who used PRIME had significant improvements in anticipated pleasure (t(55) = -2.39; P =.02, d=0.64) and effort to increase social interactions with positive outcomes (t(55) = -2.17; P =.03, d=0.58). PRIME participants also had a significant decline in defeatist beliefs (t(56) = 2.22, P =.03, d=0.59) and improvements in depression symptoms (t(53) = −2.30, P =.03, d=0.63) and self-efficacy (t(56) = −2.39, P =.02, d=0.64). These improvements remained at the 3-month post trial assessment as well, suggesting long-term beneficial outcomes.
When the waitlisted participants completed PRIME for 12 weeks, their results were consistent with the original findings for improvements in anticipated pleasure, effort to increase social interactions with positive outcomes, defeatist beliefs, and depression symptoms, but they did not show improvements in self-efficacy. PRIME’s acceptability ranked at 8.21 (SD: 1.9) on a scale of 1 to 10. Feasibility was assessed by participant usage. Over the 12 weeks, participants logged in an average of 4 times a week, sent a total of 5152 direct messages to motivational coaches, used the peer-to-peer interaction feature 497 times, and completed an average of 1.5 challenges a week; 88% of the challenges were completed overall. PRIME had its highest usage over the first month, and then usage slowed over the next 2 months.
Future studies need to increase sample size to be more inclusive of overall population, analyze PRIME against other mobile interventions, and increase follow-up time frames.
In conclusion, this study showed that PRIME was an effective behavioral activation intervention that was acceptable and feasible for young patients with schizophrenia spectrum disorders and improved motivation, depression, and self-efficacy.
Schlosser DA, Campellone TR, Truong B, et al. Efficacy of PRIME, a mobile app intervention designed to improve motivation in young people with schizophrenia [published online June 22, 2018]. Schizophr Bull. doi: 10.1093/schbul/sby078