User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia

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.

Content specificity of attentional bias to COVID-19 threat-related information in trait anxiety

Introduction

Anxious individuals selectively attend to threatening information, but it remains unclear whether attentional bias can be generalized to traumatic events, such as the COVID-19 pandemic. Previous studies suggested that specific threats related to personal experiences can elicit stronger attentional bias than general threats. The current study aimed to investigate the relationship between content-specific attentional bias and trait anxiety during the COVID-19 pandemic.

Methods

Attentional bias was assessed using the dot-probe task with COVID-19-related, general threat-related, and neutral words at two exposure times, 200 and 500 ms.

Results

We found participants with high trait anxiety exhibited attentional bias toward COVID-19- related stimuli and attentional bias away from general threat-related stimuli, while participants with low trait anxiety showed attentional bias away from both types of stimuli.

Discussion

Results suggest that individuals with high trait anxiety show a content-specific attentional bias to COVID-19-related information during the COVID-19 pandemic. Apart from the innate attentional bias toward biological threats, individuals with high trait anxiety may also learn from trauma and develop trauma-specific attentional bias.

Research Review: Is anxiety associated with negative interpretations of ambiguity in children and adolescents? A systematic review and meta-analysis

BACKGROUND

The tendency to interpret ambiguity as threat (negative interpretation) has been implicated in cognitive models of anxiety. A significant body of research has examined the association between anxiety and negative interpretation, and reviews suggest there is a robust positive association in adults. However, evidence with children and adolescents has been inconsistent. This study aimed to provide a systematic quantitative assessment of the association between anxiety and negative interpretation in children and adolescents.

METHOD

Following systematic searches and screening for eligibility, 345 effects sizes from 77 studies were meta-analysed.

RESULTS

Overall a medium positive association was found between anxiety and negative interpretation in children and adolescents ( d ^  = .62). Two variables significantly moderated this effect. Specifically, the association increased in strength with increasing age and when the content of ambiguous scenarios matched the anxiety subtype under investigation.

CONCLUSIONS

Results extend findings from adult literature by demonstrating an association in children and adolescents with evidence for content specificity in the association. Age effects imply a role for development. Results raise considerations for when and for whom clinical treatments for anxiety focusing on interpretation bias are appropriate. The vast majority of studies included in the review have used correlational designs and there are a limited number of studies with young children. The results should be considered with these limitations in mind.