Feasibility and Acceptability of Remote Cognitive Training Combined with a Mobile App Intervention in Psychosis (Preprint)
Authors: Fisher Melissa , Etter Kevin , Ghiasi Neelu , Murray Aimee , Ramsay Ian , Currie Ariel , Fitzpatrick Karrie , Biagianti Bruno , Schlosser Danielle , Vinogradov Sophia 
Published: September 2022

BACKGROUND

Impairments in cognition and motivation are core features of psychosis and strong predictors of social and occupational functioning. Accumulating evidence indicates cognitive deficits in psychosis can be improved by computer-based cognitive training programs; however, barriers include access and adherence to cognitive training exercises and limited evidence-based methods to enhance motivated behavior.

In this study, we tested the effects of online targeted cognitive and social cognitive training (TCT), delivered in conjunction with an innovative digital smartphone app called Personalized Real-Time Intervention for Motivational Enhancement (PRIME). The PRIME app provides users with a motivation coach to set personalized goals and secure social networking for peer support.

OBJECTIVE

We investigated whether deficits in cognition and motivation in people with a psychosis spectrum illness can be successfully addressed by comparing the effects of 30 hours of TCT+PRIME to 30 hours of a computer games control condition plus PRIME (CG+PRIME). Here, we describe our study procedures; the features of the interventions; our recruitment of individuals across the United States and internationally; and the feasibility and acceptability of the intervention in 98 randomized participants.

METHODS

In this double-blind, randomized, controlled trial (ClinicalTrials.gov Identifier: NCT02782442), English-speaking participants completed all cognitive training, PRIME activities, and assessments remotely. Participants completed a diagnostic interview and remote cognitive, clinical, and self-report measures at baseline, post training, and at a six-month follow-up.

RESULTS

Our feasibility results include participants from 27 states across the U.S. and 8 countries worldwide. Our study population was 59% female and a mean age of 33.87 (SD=10.75). On average, participants completed more than half of the cognitive training regimen (M=19.12, SD=12.38 hours of training), logged into the PRIME application 4.72 (SD=1.57) times per week, interacted with their PRIME coach 78.47 (SD=89.05) times during the 16 week intervention, and achieved 14.03 (SD=14.63) goals. The attrition rate of 20% was lower than our previous studies of remote cognitive training (30%). Hours of cognitive training or computer games completed was significantly associated with the number of PRIME logins, coach interactions, and goals achieved. In addition, the number of goals achieved was significantly associated with the number of logins, and with coach and peer interactions. Overall satisfaction with the PRIME app was rated at 7.74 (SD=2.05) on a scale of 1-10, with higher values indicating more satisfaction.

CONCLUSIONS

These results demonstrate the feasibility and acceptability of remote cognitive training combined with the PRIME application. Importantly, more hours of cognitive training were completed and a greater number of goals were achieved in participants who engaged more with the app. These results and our lower attrition rate suggest that PRIME may improve motivation and adherence with cognitive training. Future analyses will test for group differences in changes in cognition, symptoms, and functioning.

CLINICALTRIAL

ClinicalTrials.gov Identifier: NCT02782442