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Hsu CW, Stahl D, Mouchlianitis E, Peters E, Vamvakas G, Keppens J, Watson M, Schmidt N, Jacobsen P, McGuire P, Shergill S, Kabir T, Hirani T, Yang Z, Yiend J. User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia. JMIR Hum Factors 2023; 10:e45453. [PMID: 38064256 PMCID: PMC10746980 DOI: 10.2196/45453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/13/2023] [Accepted: 09/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP ("Successful Treatment of Paranoia"). OBJECTIVE This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. METHODS We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. RESULTS All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. CONCLUSIONS Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users.
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Affiliation(s)
- Che-Wei Hsu
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - George Vamvakas
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jeroen Keppens
- Department of Informatics, King's College London, London, United Kingdom
| | - Miles Watson
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Nora Schmidt
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sukhi Shergill
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tia Hirani
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Ziyang Yang
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jenny Yiend
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Botelho C, Pasion R, Prata C, Barbosa F. Neuronal underpinnings of the attentional bias toward threat in the anxiety spectrum: Meta-analytical data on P3 and LPP event-related potentials. Biol Psychol 2023; 176:108475. [PMID: 36503040 DOI: 10.1016/j.biopsycho.2022.108475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This systematic review analyzes brain responses at later stages of neuronal processing (P3 at 300-500 ms, and LPP at 300-700 ms). Both P3 and LPP are implicated in attentional threat bias in disorders grouped into fear and distress dimensions of the anxiety spectrum described by the Hierarchical Taxonomy Model of Psychopathology (HiTOP), but there are no consistent findings so far. METHOD Meta-analyses with between- (32 studies, n = 1631) and within-groups design (31 studies, n = 1699) were performed for assessing P3 and LPP modulation in negative, positive, and neutral stimuli, while also considering differences between controls and anxious individuals. Relevant moderators (e.g., age, sex, task) were controlled for and negative stimuli were further decomposed in terms of category (Relevant, Fear/Threat, or Unpleasant). RESULTS Increased P3 and LPP amplitudes were found for negative and positive stimuli, when compared to neutral stimuli (within-subjects analysis), confirming that both components are elicited by emotionally arousing information. Within-effects for negative and positive stimuli were higher for the anxious groups. Nonetheless, between-groups analyses showed that attentional threat bias occurs only in anxious groups when negative, personally relevant-threat information is presented. The HiTOP fear dimension moderated the findings. LIMITATIONS Potential missed studies; ERPs time windows' heterogeneity; adult sample only; the uneven number of computed effects; categorical analyses. CONCLUSION Attentional bias toward disorder-congruent threatening cues can be a transdiagnostic mechanism of HiTOP fear disorders, clustered within the anxiety spectrum.
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Affiliation(s)
- Catarina Botelho
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 535, 4200-135 Porto, Portugal.
| | - Rita Pasion
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 535, 4200-135 Porto, Portugal; Digital Human-Environment Interaction Lab (HEI-LAB), Lusófona University, Portugal
| | - Catarina Prata
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 535, 4200-135 Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 535, 4200-135 Porto, Portugal
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Li M. Application of sentence-level text analysis: The role of emotion in an experimental learning intervention. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2022; 99:104278. [PMID: 35110783 PMCID: PMC8803271 DOI: 10.1016/j.jesp.2021.104278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This registered study aimed at testing the role of emotion in the intervention effect of an experimental intervention study in academic settings. Previous analyses of the National Study of the Learning Mindset (Yeager et al., 2019) showed that in a randomized controlled trial, high school students who were given the growth mindset intervention had, on average higher GPA than did students in the control condition. Previous analyses also showed that school achievement levels moderated the intervention effect. This study applied a sentence-level text analysis strategy to detect participants' attentional focus in five emotional dimensions (valence, arousal, dominance/control, approach-avoidant, and uncertainty) across three writing prompts students wrote during the intervention. Linear mixed models were conducted to test if emotional dimension scores computed using the text analysis predicted a higher intervention effect (i.e., higher post-intervention GPA given pre-intervention GPA). The moderating role of school achievement levels was also examined. The results of this study have implications on the possibility of applying text analysis strategies on open-ended questions in interventions or experimental studies to examine the role of the emotion-attentional focus of participants during intervention or experimental studies on the intervention or experimental outcomes, especially those that are conducted in academic settings.
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Affiliation(s)
- Manyu Li
- University of Louisiana at Lafayette
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