Title: Development and feasibility testing of a digital intervention to promote posttraumatic growth in psychosis
Funder: Department of Health and Social Care

Abstract: Background Psychosis is a mental illness affecting 4.6 million individuals in the UK. Individuals with psychosis have high trauma rates, arising from a combination of the high prevalence of childhood trauma, comorbid posttraumatic stress disorder, and re-traumatisation through psychotic symptoms and negative healthcare experiences.Some individuals with psychosis report positive psychological changes or posttraumatic growth when traumatic experiences shatter their core beliefs. The PROSPER framework describes seven facilitators of posttraumatic growth in psychosis and stands for: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, Relationships.No existing intervention targets all components of the PROSPER framework.This fellowship aims to address this clinical need by developing and feasibility testing a digital intervention, called Positive Changes in Psychosis (PosiChiP), to support posttraumatic growth in psychosis. Objectives O1. Validate the PROSPER conceptual framework O2. Develop a change model for how posttraumatic growth occurs in psychosis O3. Modify two existing interventions to develop the PosiChiP intervention O4. Develop and deliver training for peer support workers in the moderation of online discussion forums O5. Evaluate the usability and acceptability of the PosiChiP intervention O6. Establish trial parameters and optimise the PosiChiP intervention Methods and timelines The five-year fellowship has four linked work packages (WP), based on the Medical Research Council's guidance on complex interventions.WP1. Theory development The PROSPER framework will be validated through interviews (30 individuals with psychosis). Responses will inform the PosiChiP change model, which will be refined using a longitudinal online survey (200 individuals with psychosis). (months 1-14)WP2. Intervention developmentThe PosiChiP intervention will comprise a maximum of 15 modules and a moderated online discussion forum. The development will involve focus groups (20 individuals with psychosis, 20 mental health clinicians), workshops (five peer support workers), and reviews (five Lived Experience Advisory Panel members, five international experts). Findings will inform the content, online platform design, and ethical guidelines of online moderation. (months 15-32) WP3. Usability study Think-aloud interviews (30 individuals with psychosis) will evaluate the usability and acceptability of the online platform. Responses will inform platform refinements. (months 29-34) WP4. Feasibility studyA two-arm randomised feasibility study (48 individuals with psychosis) will be conducted. Participants will be randomised in permuted blocks 1:1, stratified for psychosis severity (24 per arm) into the intervention arm (PosiChiP intervention + TAU) or a control arm (TAU). Outcome measures will be completed at four time points (baseline, weeks one, 15, and 26). The feasibility study will assess rates of recruitment, retention, and outcome measure completion, and inform sample size estimation for a future definitive trial to be developed and submitted if indicated. (months 35-60) Impact/dissemination The fellowship will develop a first-in-field intervention to support PTG in psychosis as a novel extension to current treatment. Individuals may benefit through an improved sense of self, skill development in coping and meaning-making, and support recovery. Findings will be disseminated through service user, clinical, social, and academic networks.

Lay abstract: Background Psychosis is a mental health condition affecting 4.6 million people in the UK. People may see or hear things that other people do not (hallucinations) or believe things that are not real (delusions). People with psychosis often experience trauma in their life. Psychologically traumatic experiences can happen when a person is a child, through symptoms, or due to bad healthcare experiences. Some people with psychosis also talk about the positive psychological changes that happen following trauma. This is called posttraumatic growth.I previously summarised research about facilitators of posttraumatic growth. This resulted in the PROSPER framework, which stands for: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, Relationships. Helping people with psychosis grow from trauma may build their understanding of themselves and promote recovery. No existing program targets all parts of the PROSPER framework and an online program can help reach more people. This fellowship will develop and test a new online program, called 'Positive Changes in Psychosis'. This will support positive psychological changes and posttraumatic growth in people with psychosis. Design and Methods The research will involve four stages: Stage 1. Explain how posttraumatic growth in psychosis happens I will develop a framework to explain how posttraumatic growth in psychosis happens. I will talk to 30 individuals with psychosis to understand the positive changes they experienced after trauma. I will then develop an initial framework by combining these responses with two existing frameworks. Two hundred people with psychosis will then fill in an online survey to test the framework. Stage 2. Develop the online program I will work with 20 people with psychosis, 20 mental health clinicians, five peer support workers, five clinical experts, and our Lived Experience Advisory Panel to create the online program. We will discuss what is needed in an online program to support posttraumatic growth, and how to help people use it. These responses will be used to design the program content and website. The online program will include up to 15 modules, where people can work through activities and share stories on a discussion board. Stage 3. Test the usability of the online program Thirty people with psychosis will test the program and give comments on the layout and user-friendliness.Stage 4. Test the feasibility of the online program Forty-eight people with psychosis will be randomly assigned to one of two groups, that is 24 people in each group. Both groups will continue with treatment as usual, and one group will also get the new online program. People will fill in 30 minute online surveys four times (when starting and after one, 15, and 26 weeks). The study will assess how many people with psychosis take up and finish the online program, complete the online surveys, and how many people are needed for a larger future trial. The findings will inform the decision whether to make a future funding application for a larger trial to test if it works and is value-for-money. Public Involvement Five individuals with psychosis helped shape the ideas for this fellowship. Individuals talked about needing help to understand themselves after trauma and how they could have been helped through this kind of online program. They will continue to provide guidance throughout the fellowship. Dissemination Findings will be published in scientific journals and presented at conferences and events aimed at different audiences. Reports and summaries will be sent to participants, service user groups, social media, the Recovery Research Network, and a new international PTG in mental health group.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH