TechCare : Mobile-Assessment and Therapy for Psychosis
An intervention for clients within the early intervention service: Improving mental health and tackling health inequalities
Background
Mobile phones are widely available and increasingly affordable. A 2015 meta-analysis of 12 studies with 3,227 participants found:
Mobile phones provide connectivity to multimedia resources anywhere, allowing rapid delivery of interventions. This connectivity may help overcome barriers to accessing care. In Pakistan, the telecommunications sector is growing significantly:
Web and mobile-based technology have been used to deliver interventions in Pakistan. Reduced costs of devices and widespread user acceptability offer a practical solution to addressing the mental health treatment gap in Pakistan.
Effective treatment of mental illness can have a significant economic and societal impact, especially in low-resource settings.
Aim
The aim of this study was to refine, and feasibility test a culturally adapted mobile based CBT intervention for individuals experiencing Suicidal Ideation (SI) in First Episode Psychosis (FEP) (TechCare-SI-FEP).
Objectives
The key objectives of the study, was to determine the feasibility and acceptability of the TechCare-SI-FEP as followed:
What is TechCare-SI-FEP?
A mobile app based on the intelligent real-time therapy (iRTT) model by Kelly et al. Developed from the NIHR-funded PhD work combined with the ClinTouch system.
Key Features:
Symptom Tracking: Users can record and track psychosis symptoms and mood.
Personalized Interventions: Provides CBT-based interventions tailored to the user’s symptoms and preferences.
Interactive and Multimedia Support: Includes self-help strategies like music, psychoeducation, goal setting, and problem-solving.
Real-Time Responses: Uses machine learning to detect issues like low mood or suicidal thoughts and offers immediate interventions.
How It Works:
User Customization: Participants personalize the app to track their specific symptoms.
Trigger-Based Interventions: The app triggers specific interventions based on symptom severity.
Self-Help Strategies: Offers digital self-help tools inspired by CBT for Psychosis (CBTp).
Special Adaptations:
Cultural Relevance: Adapted for effectiveness and acceptability in Pakistan.
Suicide Prevention: Incorporates content from the CBT-based life after self-harm manual (C-MAP).
Why It's Important:
Accessibility: Overcomes barriers to face-to-face therapy in Pakistan, such as cultural and political issues and limited mental health services.
Growing Mobile Market: Leverages Pakistan’s rapidly expanding telecommunications market, with over 169 million cell-phone subscribers.
Next Steps
Feasibility and Acceptability: Establishing that TechCare-SI-FEP is a viable and welcomed intervention for those at risk of suicide.
The Results
The participants provided their views relating to their experience of using the App and the consensus was that it was an acceptable method for receiving psychological interventions. The views on research related procedures included length of time taken to complete assessments and the research recruitment procedures, which were considered acceptable.
“Overall, I think the App was a really good idea, it’s a new way of doing treatments and it works alongside your medication”
“The process of the using the TechCare App was empowering and was an achievement as I normally struggle to come outside”
The usability of the device in terms of its day-to-day usage was found to be easy to manage with reference to the easy navigation of the TechCare App. This was suggested to be an important factor in the App usage. It was also highlighted that the psychoeducational links were a useful tool to understand specific information on psychosis.
“It was very easy to use, very easy, very simple, there wasn’t any obstacles using it or anything, think it was made very simple, which is a good thing”
“Yeah like the time taken to complete the questions … I liked how quick it was”
The TechCare App software was developed specifically for use on a smartphone device, requiring a touchscreen interface. The mobile phone App would alert participants via notifications and ask a series of questions. Based on the participants’ responses, the App would provide a tailored Cognitive Behavioural Therapy (CBT)-based intervention, which could include participants’ preferred multimedia such as music, images or videos.
The app employed Experiential Sampling Methodology (ESM) to let participants record their real-time thoughts, moods, and experiences. This data was used with Intelligent Real-Time Therapy (iRTT), a model providing immediate interventions based on the recorded experiences. These interventions included various formats such as media, images, or MP3s.
Notifications were sent three times daily between 10:00 and 22:00. If low mood or paranoia was detected, participants received tailored interventions. The system would send additional notifications every hour for up to 4 hours if symptoms persisted. If symptoms continued beyond 4 hours, a pre-agreed response was triggered. Crisis planning, involving collaboration with care coordinators, was part of the treatment.
The TechCare App’s ESM and iRTT system used intelligence in two ways. First, it increased assessment notifications if low mood or paranoia was detected, monitoring symptoms over time and deploying a tailored crisis plan if these persisted for around 4 hours. Second, it used a machine learning algorithm to provide real-time interventions when certain thresholds were exceeded, recommending the most popular interventions selected by participants.
