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A pilot digital intervention targeting loneliness in young people with psychosis

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks.

Materials and methods

Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user’s experience of +Connect.

Results

We found evidence for the feasibility of +Connect. All but two participants completed the +Connect program, completing 95% (40.10 out of 42 days) of the program. Furthermore, 66.67% (8 out of the 12 participants) remained engaged with the program 3-months post-intervention. Our data indicates preliminary evidence that +Connect may reduce loneliness, with scores from pre-intervention (M = 50.00, SD = 8.47) to post-intervention (M = 48.10, SD = 10.38) and 3-months post-intervention (M = 42.89, SD = 7.04). We found that positive reinforcement of in-game rewards and evidence of positive mood changes added to the feasibility of the app. Regarding acceptability, while 10% (1/10 participants) reported not finding +Connect useful or enjoyable, 90% of participants agreed that +Connect helped them to increase their social confidence, enjoy life, look forward to being with other people, and feel more connected with others. Participant interviews supported these results, with participants highlighting the app’s strengths in providing useful information, stimulating self-reflection, fostering positive affect, and encouraging transfer of skills into their social interactions.

Discussion

While preliminary findings indicated that +Connect yielded high levels of acceptability and feasibility, it is important to consider that we recruited a small and selected sample of lonely young people. Further iterations of this proof of concept app, which can incorporate participant feedback such preferences for increased personalisation, in-app feedback, and gamification, may allow an opportunity to test an improved version in the future.

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Notes

  1. There is no known threshold for problematic or severe loneliness but a score of 38 and above was used to indicate above the median score across different samples (Russell [58]).

  2. A rating of moderate or more on any positive psychotic symptoms as assessed by the Positive and Negative Syndrome Scale (Kay et al. [52]).

  3. Assessed by the SCID 5 risk section.

  4. Manuscript submitted for publication. Contact first author of manuscript and group program.

  5. Points were provided to participants when they correctly answered a question, but no penalty was given for incorrect responses. Challenges involved participants relating the information and skills learnt during the daily tasks to real-world situations. An example of a challenge was responding in an active and constructive manner to someone when they heard positive news. Badges were assigned for either progression through the app, completing the mood log over a particular period, or completion of a challenge.

  6. Measures were administered at all timepoints except for the SCID-5-RV and NART which were administered only once at T1.

  7. The coders did not code the SSPA grooming question as only audio coding was available. The research assistant conducting the assessment however coded this item.

  8. The interview schedule is available upon request from the first author.

  9. Percentage figures reported refer to the % out of 10 completers.

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Acknowledgements

Acknowledgements to Claire Peck, Julia Cheah, Carla McEnery for assistance throughout the development phase, to Amplified Software for digital development, and Ryan O’Hehir for video development. Acknowledgements to staff and consumers of Eastern Health Child and Adolescent Services, Headspace Alfred.

Funding

Barbara Dicker Brain Sciences Foundation Grant funding awarded to Lim, Thomas, and Abbott. Funding awarded to Lim, M.H. Higher Education Participation and Partnerships Program for development.

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Author notes

  1. Jo-Anne M. Abbott

    Present address: Australian Psychological Society, Melbourne, Australia

Authors and Affiliations

  1. Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Melbourne, 3122, Australia

    Michelle H. Lim, Robert Eres & Katrina M. Long

  2. Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, 3122, Australia

    Michelle H. Lim, Robert Eres, Kit Casey & Neil Thomas

  3. School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia

    John F. M. Gleeson & David L. Penn

  4. Department of Psychological and Brain Sciences, Washington University in St Louis, St. Louis, USA

    Thomas L. Rodebaugh

  5. Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Chapel Hill, USA

    David L. Penn

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Correspondence to Michelle H. Lim.

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This article is part of the focused issue ‘Loneliness: contemporary insights on causes, correlates, and consequences’.

Jo-Anne M. Abbott was at the National eTherapy Centre, Swinburne University of Technology, Melbourne, Australia at the time of this research.

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Lim, M.H., Gleeson, J.F.M., Rodebaugh, T.L. et al. A pilot digital intervention targeting loneliness in young people with psychosis. Soc Psychiatry Psychiatr Epidemiol 55, 877–889 (2020). https://doi.org/10.1007/s00127-019-01681-2

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