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Program Reviews

Actissist

Overview

Actissist is a cognitive behavioral therapy (CBT)-based smartphone application intervention for early psychosis.

Actissist is a theory-driven smartphone app whose 5 intervention domains (Voices, Suspicious Thoughts, Socializing, Criticism, and Cannabis) address signs and symptoms linked to early psychosis relapse (auditory verbal hallucinations, paranoia, perceived criticism, socialization, and cannabis use). Developers used an iterative, cognitive-model design approach and incorporated input from individuals with psychosis. Multimedia intervention components include symptom fact sheets, a diary, guided relaxation and mindfulness exercises, patient recovery video stories, links to relevant resources (e.g. TED talks), and emergency contacts. Actissist prompts users to engage with the app 3 times per day, 6 days per week and users can access app content at any time. When users open the app, Actissist prompts the user to select one of the 5 intervention domains and complete assessments of thoughts, beliefs, emotions, and behavior. Actissist then provides tailored normalizing messages, and cognitive or behavioral coping strategies. Messages and images that accompanied each question-exchange domain varied to reduce boredom and repetition. Actissist also features a user-customizable display (users set app wallpaper from smartphone photo album).

Delivery:
Mobile App

Theoretical Approach(es):
Cognitive Behavioral Therapy
Relapse Prevention

Target Outcome:
Symptoms of psychosis

Ages:
Adolescents (16+)
Young Adults (18-30)
Adults (30+)

Genders:
Female
Male

Races/Ethnicities:
Unspecified

Setting(s):
Remote Access

Geographic Location(s):
United Kingdom

Language:
English

Evaluations

  • Actissist: proof-of-concept trial of a theory-driven digital intervention for psychosis.

    Bucci S, Barrowclough C, Ainsworth J. Schizophrenia Bulletin. 2018. 44(5):1070–1080. doi: 10.1093/schbul/sby032

    Summary: Researchers recruited 36 individuals in early psychosis aged 16+ from the United Kingdom through professional referral to participate in a 12-week pilot randomized controlled trial (RCT) of Actissist. Researchers randomized participants into an intervention group that received TAU and Actissist (n = 24) group or an active control group that received treatment as usual (TAU) and ClinTouch, a symptom-monitoring app (n = 12). Researchers requested participants use Actissist for 12 weeks. Most participants used a study-provided smartphone (n = 31). Researchers trained participants on how to use smartphones and Actissist. Researchers assessed participant symptoms of psychosis and positive and negative affect at baseline, 12-weeks (post-treatment), and 22-weeks (follow-up). Compared with the active control, Actissist promoted higher retention, satisfaction, and engagement levels in participants. Almost all Actissist participants completed the trial (97%), would recommend Actissist to others (90%), used the app at least once per day (75%), and responded to Actissist’s alerts (71%). Actissist participants selected the Voices (545 entries) and Suspicious Thoughts (501 entries) domains most often, on average. At post-treatment, Actissist participants benefited from significant reductions (relative to active control) in symptoms of blunted affect, stereotyped thinking, emotional/social withdrawal, unusual thoughts, impaired judgement/insight, and depression (hopelessness, referential thoughts, pathological guilt, and suicidality). While beneficial clinical outcomes in the Actissist group maintained through follow-up, ClinTouch control group outcomes improved such that, by follow-up, there was not a significant difference in measured clinical outcomes between groups. Personal smartphone users did not exhibit significant differences from participants who received study phones. Actissist ameliorated general psychosis and mood symptoms in the short-term, outcomes that exceeded TAU and routine symptom-monitoring app capabilities.

    Take Away: Results suggest that Actissist is a feasible, viable app intervention for individuals experiencing symptoms of early psychosis.

  • Related Articles

    “They are not hard-to-reach clients. We have just got hard-to-reach services.” Staff views of digital health tools in specialist mental health services. Bucci S, Berry K, Morris R, et al. Frontiers in Psychiatry. 10 May 2019. 10: 344. doi: 10.3389/fpsyt.2019.00344

    Early psychosis service user views on digital technology: Qualitative analysis. Bucci S, Morris R, Berry K, et al. Journal of Medical Internet Research. 31 October 2018. 5(4): e10091. doi: 10.2196/10091

    Digital interventions in severe mental health problems: lessons from the Actissist development and trial. Bucci S, Lewis S, Ainsworth J, et al. World Psychiatry. 01 June 2018. 17(2):230-231. doi: 10.1002/wps.20535

    Using mobile technology to deliver a cognitive behaviour therapy-informed intervention in early psychosis (Actissist): study protocol for a randomised controlled trial. Bucci S, Barrowclough C, Ainsworth J, et al. Trials. 10 September 2015. 16(1): 404. doi: 10.1186/s13063-015-0943-3

    Developing a Theory-Informed Smartphone App for Early Psychosis: Learning Points from a Multidisciplinary Collaboration. Berry N, Machin M, Ainsworth J, Berry K, Edge D, Haddock G, Lewis S, Morris R and Bucci S (2020). Front. Psychiatry 11:602861. doi: 10.3389/fpsyt.2020.602861