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Litvin S, Saunders R, Jefferies P, Seely H, Pössel P, Lüttke S. The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial. JMIR Ment Health 2023; 10:e47285. [PMID: 37477955 PMCID: PMC10403802 DOI: 10.2196/47285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.
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Affiliation(s)
- Silja Litvin
- Department Psychologie, Ludwig-Maximilians-Universität, München, Germany
| | - Rob Saunders
- Division of Psychology and Language Sciences, Clinical Education and Health Psychology, University College London, London, United Kingdom
| | - Philip Jefferies
- Resilience Research Centre, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Hayley Seely
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Patrick Pössel
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Stefan Lüttke
- Department für Klinische Psychologie und Psychotherapie, Institute für Psychologie, Universität Greifswald, Greifswald, Germany
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Lawlor C, Vitoratou S, Duffy J, Cooper B, De Souza T, Le Boutillier C, Carter B, Hepworth C, Jolley S. Managing emotions in psychosis: Evaluation of a brief DBT-informed skill group for individuals with psychosis in routine community services. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:735-756. [PMID: 35130354 PMCID: PMC9543194 DOI: 10.1111/bjc.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Objectives Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight‐session Dialectical Behavioural Therapy (DBT)–informed skills group specifically adapted for individuals with psychosis: the Managing Emotions Group (MEG) in diverse, inner‐city community services. Method A mixed‐method design was utilised to assess the feasibility (acceptability and potential clinical impact) of local delivery of MEG. Uptake, completion (≥50% of sessions), post‐session satisfaction ratings, and thematic analysis of qualitative feedback from 12 completers assessed acceptability. Pre–post‐intervention changes in psychological distress, self‐reported ER difficulties, and adaptive ER skill use assessed potential clinical impact. Results Forty‐eight individuals (81% of attenders) completed the intervention (Mage = 43, 54% female) of whom 39 completed pre‐ and post‐group measures. Participants reported high satisfaction and meaningful improvements in understanding and managing emotions, with positive impact on daily life. Self‐reported psychological distress, ER difficulties, and adaptive ER skill use significantly improved, with medium‐to‐large pre‐post effects (d = 0.5–0.7) except lack of emotional clarity (d = 0.3). Conclusions MEG was feasible and acceptable, and a future feasibility randomised controlled trial is warranted. Practitioner points Individuals with psychosis report that support with their emotions is a priority. Brief interventions for emotion regulation difficulties are acceptable to individuals with psychosis and can be feasibly delivered in a local outpatient service. Distress and emotion regulation difficulties and skills improved significantly from pre–post treatment for clients completing the managing emotions group. Further implementation and evaluation are needed to support continued refinement to meet the needs and priorities of individuals with psychosis.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Duffy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Cooper
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Clair Le Boutillier
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ben Carter
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Greenwood K, Robertson S, Vogel E, Vella C, Ward T, McGourty A, Sacadura C, Hardy A, Rus-Calafell M, Collett N, Emsley R, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Garety P. The impact of Patient and Public Involvement in the SlowMo study: Reflections on peer innovation. Health Expect 2021; 25:191-202. [PMID: 34585482 PMCID: PMC8849241 DOI: 10.1111/hex.13362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 09/11/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The SlowMo study demonstrated the effects of SlowMo, an eight-session digitally supported reasoning intervention, on paranoia in a large-scale randomized-controlled trial with 362 participants with schizophrenia-spectrum psychosis. AIM The current evaluation aimed to investigate the impact of Patient and Public Involvement (PPI) in the SlowMo study. METHOD PPI members were six women and three men from Sussex, Oxford and London with experience of using mental health services for psychosis. They received training and met at least 3-monthly throughout the project. The impact of PPI was captured quantitatively and qualitatively through (i) a PPI log of recommendations and implementation; (ii) written subjective experiences of PPI members; (iii) meeting minutes; and (iv) outputs produced. RESULTS The PPI log revealed 107 recommendations arising from PPI meetings, of which 87 (81%) were implemented. Implementation was greater for recruitment-, data collection- and organization-related actions than for dissemination and emergent innovations. Qualitative feedback revealed impacts on study recruitment, data collection, PPI participants' confidence, knowledge, career aspirations and society more widely. Outputs produced included a film about psychosis that aired on BBC primetime television, novel webpages and journal articles. Barriers to PPI impact included geography, travel, funding, co-ordination and well-being. DISCUSSION A future challenge for PPI impact will be the extent to which peer innovation (innovative PPI-led ideas) can be supported within research study delivery. PATIENT AND PUBLIC CONTRIBUTION Planned Patient and Public Contribution in SlowMo comprised consultation and collaboration in (i) design, (ii) recruitment, (iii) qualitative interviews and analysis of service users' experiences of SlowMo therapy and (iv) dissemination.
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Affiliation(s)
- Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Sam Robertson
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Evelin Vogel
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Claire Vella
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Cat Sacadura
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Freeman
- Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Oxford University, Oxford, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Graham Dunn
- Centre for Biostatistics, School of Health Sciences, Manchester Academic Health Science CentreManchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Webb R, Bartl G, James B, Skan R, Peters E, Jones AM, Garety P, Kuipers E, Hayward M, Greenwood K. Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery. Schizophr Bull 2020; 47:653-661. [PMID: 33215190 PMCID: PMC8084424 DOI: 10.1093/schbul/sbaa173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported "Psychological Recovery" outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity to change, for use in future research and practice. CHOICE-SF was developed and validated using 3 separate samples, comprising 640 service users attending 1 of 2 transdiagnostic clinics for (1) CBTp or (2) therapies for voice hearing or (3) who took part in the treatment as usual arm of a trial. In the initial subsample of 69 participants, items from the original CHOICE measure with medium to large effect sizes for change pre- to post-CBTp were retained to form the CHOICE-SF. Internal consistency, construct validity, and sensitivity to change were confirmed, and the factor structure was examined in 242 participants. Specificity was confirmed by comparison with 44 participants who completed CHOICE at 2 time points but did not receive therapy. Validation of CHOICE-SF was carried out by confirming factor structure and sensitivity to change in a new sample of 354 and a subsample of 51 participants, respectively. The CHOICE-SF comprised 11 items and 1 additional personal goal item. A single-factor structure was confirmed, with high internal consistency, construct validity, and sensitivity to change. The CHOICE-SF is a brief, psychometrically robust measure to assess change following psychological therapies in research and clinical practice for people with psychosis and severe mental illness.
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Affiliation(s)
- Rebecca Webb
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Bryony James
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Rosie Skan
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Philippa Garety
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK,To whom correspondence should be addressed; tel: +44 1273 678409, fax: +44 1273 678058, e-mail:
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5
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Greenwood K, Alford K, O'Leary I, Peters E, Hardy A, Cavanagh K, Field AP, de Visser R, Fowler D, Davies M, Papamichail A, Garety P. Correction to: The U&I study: study protocol for a feasibility randomised controlled trial of a pre-cognitive behavioural therapy digital 'informed choice' intervention to improve attitudes towards uptake and implementation of CBT for psychosis. Trials 2018; 19:677. [PMID: 30541622 PMCID: PMC6290513 DOI: 10.1186/s13063-018-3085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kathryn Greenwood
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ, UK. .,School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex, BN1 9RP, UK.
| | - Katie Alford
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RP, UK
| | - Iain O'Leary
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.,PICuP Clinic, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8NZ, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex, BN1 9RP, UK
| | - Andy P Field
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex, BN1 9RP, UK
| | - Richard de Visser
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex, BN1 9RP, UK
| | - David Fowler
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ, UK.,School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex, BN1 9RP, UK
| | - Matthew Davies
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Alexandra Papamichail
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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