Online social therapy helps prevent relapse in patients with first-episode psychosis

A novel digital peer-support intervention can help sustain the benefits of specialist first-episode psychosis (FEP) services, a study has found.

Known as Horyzons, the intervention is a comprehensive digital platform that incorporates the following: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery, and relapse prevention; expert clinician and vocational support; and peer support and moderation.

This study randomized 170 patients who had undergone 2 years of specialized support for FEP to receive treatment as usual (TAU; n=84) alone or in combination with Horyzons (n=86) for 18 months. TAU involved various treatment options provided by generic medical or mental health services.

In the Horyzons plus TAU group, 47 participants (55.5 percent) engaged in the online intervention for at least 6 months, while 40 (47.0 percent) did for at least 9 months.

At month 18, the primary outcome of social functioning (measured using the Personal and Social Performance Scale [PSP]) remained high and stable in both groups, with no evidence of significant between-group differences (PSP mean difference, –0.29, 95 percent confidence interval [CI], –4.20 to 3.63; p=0.77).

Patients who used Horyzons were 5.5 times more likely to find employment or enrol in education compared with those who received TAU only (odds ratio [OR], 5.55, 95 percent CI, 1.09–28.23; p=0.04), with evidence of a dose-response effect.

Moreover, the Horyzons plus TAU group less frequently visited emergency services than the TAU alone group (39 percent vs 19 percent; OR, 0.31, 95 percent CI, 0.11–0.86; p=0.03; number needed to treat [NNT], 5). Hospitalizations due to psychosis tended to be lower also in the former (13 percent vs 27 percent; OR, 0.36, 95 percent CI, 0.11–1.08; p=0.07; NNT=7).

The findings indicate that Horyzons is a promising intervention to improve vocational recovery, reduce utilization of emergency services, and provide continuous support for young people with FEP beyond specialized care.