Blended digital therapy improves paranoia among people with psychosis

SlowMo, a digitally supported reasoning intervention, used together with treatment as usual (TAU), offers a beneficial effect on paranoia at 12 weeks and on observer-rated paranoia and self-reported persecution at 12 weeks and 24 weeks compared with TAU, according to results of a randomized controlled study.

“Although no effect was demonstrated on the primary outcome of paranoia at 24 weeks, our study’s findings showed that SlowMo had a positive effect on paranoia, mostly sustained at follow-up [ie, week 24], that matched or exceeded effects observed for standard cognitive-behavioural therapy for psychosis [CBTp] albeit delivered in fewer sessions. Enhancements in well-being, quality of life, and self-concept were also observed in the study. Thus, the results indicated the effectiveness of the intervention, in part, through helping people to slow down their thinking and to worry less,” said the authors. “Further research in deepening the understanding of its mechanism of action, and on optimizing and translating the effects of SlowMo are warranted.” [JAMA Psychiatry 2021;doi:10.1001/jamapsychiatry.2021.0326]

The parallel-arm, assessor-blinded, randomized trial included 361 patients (male, 69.8 percent; White, 69 percent; mean age, 42.6 years) with schizophrenia-spectrum psychosis and distressing, persistent (≥3 months) paranoia recruited from the UK community health service in 1 May 2017–14 May 2019. Enrolled patients were randomized (1:1) to receive SlowMo, consisting of eight digitally supported face-to-face CBTp sessions (60–90 minutes) and a mobile app, plus TAU, or TAU alone.

Baseline clinical characteristics, including diagnosis, years in contact with services, and medication equivalent doses, were comparable between groups. Data on the primary outcome were available for 90.6 percent of participants at week 12 and 92.0 percent of participants at week 24.

Of 181 participants in the SlowMo group, 80.1 percent completed the therapy, with mean session duration of 29 minutes.

SlowMo plus TAU demonstrated no significant effect on the primary outcome of self-reported paranoia assessed by the Green et al Paranoid Thoughts Scale (GPTS) total score at week 24 vs TAU alone (Cohen d, 0.20; 95 percent confidence interval [Cl], -0.02 to 0.40; p=0.06).

Nonetheless, significant reductions in GPTS total score (Cohen d, 0.30; 95 percent CI, 0.09 to 0.51; p=0.005), Part A score (reference, Cohen d, 0.22; 95 percent CI, 0.06 to 0.39; p=0.009) and Part B score (persecutory, Cohen d, 0.32; 95 percent CI, 0.08 to 0.56; p=0.009) were shown with SlowMo plus TAU vs TAU alone at week 12, as well as in part B score at 24 weeks (Cohen d, 0.25; 95 percent CI, 0.01 to 0.49; p=0.04).

SlowMo plus TAU significantly improved observer-rated measure of persecutory delusions (assessed by psychotic symptom rating scales [ie, PSYRATS Delusion]) and belief flexibility vs TAU alone (assessed by the Maudsley Assessment of Delusions Schedule) at week 12 and week 24 (PSYRATS, week 12: Cohen d, 0.47; 95 percent CI, 0.17 to 0.78; p=0.002) (PSYRATS, week 24: Cohen d, 0.50; 95 percent CI, 0.20 to 0.80; p=0.001) (belief flexibility, week 12: Cohen d, 0.29; 95 percent CI, 0.09 to 0.49; p=0.004) (belief flexibility, week 24: Cohen d, 0.28; 95 percent CI, 0.08 to 0.49; p=0.005).