Technology-Based Interventions Effective in the Setting of Schizophrenia, Psychosis

Technology-based interventions can be helpful in providing therapy to patients with psychosis.

A systematic review and meta-analysis published in Psychological Medicine found that technology-based interventions (TBIs) are likely an effective adjunct to usual care for managing neurocognitive, functioning, and social cognitive outcomes among patients with psychosis.

Investigators from the Universidad Complutense de Madrid and Universidad Internacional de La Rioja in Spain searched publication databases through September 2020 for randomly assigned controlled trials comparing TBI interventions with face-to-face interventions in the setting of first-episode psychosis, high-risk for psychosis, schizophrenia, schizoaffective disorder, schizophreniform psychotic disorder, or nonaffective psychosis. Comparisons were made grouping control treatments into psychotherapy, technology, and pharmacotherapy interventions.

A total of 58 articles comprising 4394 patients were included in this analysis.

The patients had a mean age of 36.58 (SD, 9.50) years, 64.31% were men, and they had obtained 11.37 (SD, 2.97) years of education.

TBIs could foster recovery in patients with psychosis beyond the capacity of face-to-face interventions and mainly when environmental circumstances limit access to on-site therapy.

In general, the TBIs were tested over an average of 12 weeks without contact with therapists or other patients and accompanied by antipsychotic prescriptions. Many studies (n=41) included a cognitive training therapy component to the interventions.

Compared with face-to-face interactions, TBI plus usual care associated with improvements to neurocognition (d, 0.133; P <.0001), functioning (d, 0.245; P =.006), and social cognition (d, 0.317; P <.05). Furthermore, TBI tended to be favored over face-to-face interventions for the quality-of-life (QOL) outcomes (d, 0.142; P =.076).

Stratified by types of control interventions, for the neurocognitive outcomes, TBI was favored over psychotherapy (P ≤.01) and technology (P ≤.001) interventions. In the network meta-analysis, TBI combined with cognitive training with vocational therapy was the most effective at improving cognitive outcomes, followed by TBI with cognitive training. In general, the patient’s level of education positively moderated the cognitive outcomes associated with TBI whereas the frequency of interventional sessions negatively moderated the effects.

For functioning outcomes, TBI with social cognition (P <.001), with psychoeducation (P <.001), or with cognitive training and social cognition (P <.05) were favored over psychotherapy. In the network analysis, TBI with cognitive training and social cognition was most effective for functioning outcomes, especially for patients with schizophrenia or those aged >25 years. No moderators were observed.

In the case of social cognition outcomes, only TBI with cognitive training was favored over technology control (P <.01). Significant effects were observed for patients aged >25 years. No significant moderators were observed.

The major limitation of this analysis was the different interventions in the studies.

Study authors concluded, “TBIs can complement treatment as usual and face-to-face interventions. TBIs could foster recovery in patients with psychosis beyond the capacity of face-to-face interventions and mainly when environmental circumstances limit access to on-site therapy. TBI will enable patients and professionals to develop flexible and personalized interventions to ensure patients’ needs in such a way that therapeutic objectives can be more personalized.”

References:

Morales-Pillado C, Fernández-Castilla B, Sánchez-Gutiérrez T, González-Fraile E, Barbeito S, Calvo A. Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis. Psychol Med. 2022;1-12. doi:10.1017/S0033291722003610