Digitally Supported Reasoning Intervention Improved Well-Being, Quality of Life and Paranoia Among Patients With Psychosis

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In this study, the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared with usual care only were investigated.

Digitally supported face-to-face reasoning intervention improved paranoia among patients with psychosis. These findings, from a parallel-arm, assessor-blinded, randomized clinical trial, were published in JAMA Psychiatry.

Patients (N=361) with psychosis were recruited from 3 community mental health centers in the United Kingdom between 2017 and 2019. In a 1:1 ratio, patients were randomized to receive SlowMo and usual care or usual care alone. SlowMo was a digitally supported cognitive behavioral therapy for psychosis intervention with 8 face-to-face 60-90-minute sessions over 12 weeks. Patients were assessed at baseline, 12, and 24 weeks by the Green et al Paranoid Thoughts Scale (GPTS), the Psychotic Symptom Rating Scales (PSYRATS), and the Scales for Assessment of Positive Symptoms (SAPS).

Patients were majority White (69.0%) men (69.8%) aged mean 42.6 (standard deviation [SD], 11.6) years. The participants had been diagnosed with schizophrenia (62.3%), other psychosis (18.3%), schizoaffective disorder (17.7%), or delusional disorder (1.7%).

Most patients randomized to receive SlowMo attended all 8 sessions (80.1%) and few attended no session (7.2%). The average session lasted 75 (SD, 29) minutes.

At 12 weeks, a significant change in GPTS scores were observed on the basis of treatment (d, 0.30; 95% CI, 0.09-0.51; P =.005). At 24 weeks, the group differences in GPTS scores were no longer significant (d, 0.20; 95% CI, -0.02 to 0.40; P =.06).

At 24 weeks, significant differences were observed for GPTS Part B score (d, 0.25; 95% CI, 0.01-0.49; P =.04), GPTS persecution score (d, 0.25; 95% CI, 0.02-0.48; P =.04), PSYRATS distress score (d, 0.50; 95% CI, 0.20-0.80; P =.001), PSYRATS conviction score (d, 0.43; 95% CI, 0.18-0.68; P =.001), SAPS persecutory delusions score (d, 0.54; 95% CI, 0.14-0.94; P =.009), and SAPS ideas and delusions of reference score (d, 0.24; 95% CI, 0.02-0.45; P =.03). Significant groups differences were not observed for GPTS Part A (P =.180) or GPTS social reference score (P =.099).

Belief flexibility (d, 0.28; 95% CI, 0.08-0.49; P =.005), well-being (d, 0.32; 95% CI, 0.12-0.51; P =.001), quality of life (d, 0.27; 95% CI, 0.09-0.45; P =.003), worry (d, 0.21; 95% CI, 0.05-0.38; P =.01), negative self-concept (d, 0.21; 95% CI, 0.04-0.38; P =.01), and positive self-concept (d, 0.20; 95% CI, 0.06-0.35; P =.006) improved at 24 weeks among the SlowMo group.

Serious adverse events were reported by 19 participants in the SlowMo and 21 participants in the usual care groups.

This study may have been limited by not correcting for time spent with the therapist. It remains unclear whether the significant group differences were due to the design of SlowMo or the additional time spent with the therapist.

These data indicated SlowMo did improve paranoia among patients with psychosis, and, that this digitally supported cognitive behavioral therapy also improved well-being, self-concept, and quality of life.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Garety P, Ward T, Emsley R, et al. Effects of SlowMo, a blended digital therapy targeting reasoning, on paranoia among people with psychosis: A randomized clinical trial. JAMA Psychiatry. Published online April 7, 2021. doi:10.1001/jamapsychiatry.2021.0326.