Psychosis support at the touch of a button
Up to 2% of the UK population will experience psychosis in their lifetime, with symptoms including hallucinations and intrusive voices, but access to mental health support services can be limited. A team at Manchester have developed Actissist, an app to support people in the early stages of psychosis when they need help.
People with psychosis can be faced with a huge number of challenges. They often report feeling that they are in danger or that others are intending to harm them. This can affect their emotions and ability to concentrate, which can be detrimental to their self-esteem and day-to-day functioning.
“Psychosis has the potential to impact relationships with friends and family; it can affect a person’s ability to work or to study, which has a knock-on effect on their living conditions,” says Professor Sandra Bucci, the lead researcher on the Actissist project.
“Alongside prejudice from the rest of society, people with mental health problems can also experience internalised stigma. The distress associated with having a severe mental health problem such as psychosis can prevent people from accessing help from services when they need it most.”
Professor Sandra Bucci
Sandra is Professor of Clinical Psychology and specialises in evaluating innovative methods to make digital health interventions for severe mental health problems more accessible.
Using technology to empower service users
Actissist aims to reduce the distress associated with psychotic experiences, helping people to cope with negative symptoms.
It’s designed to promote self-management and to make people feel more in control of their mental health. If people experience troubling thoughts overnight or during long waiting times for scheduled appointments, round-the-clock tips are available through the app.
“We’re aiming to improve the efficiency of care delivery by offering people coping strategies at their time of need,” says Professor Bucci.
Actissist is based on cognitive behavioural therapy (CBT), a talking therapy that helps people examine the link between their thoughts, feelings and behaviours. However, the provision of this type of support is extremely limited.
“Not everyone has access to traditional face-to-face clinic appointments,” Professor Bucci explains.
“Not everybody responds to, or indeed wants, medication. We also do not have enough trained staff available to meet the demand for CBT, so digital interventions are a way to scale up access to support and deliver help to people at their time of need.”
“Even though CBT is recommended in our national guidelines, only a small percentage of people who could benefit will end up receiving this type of therapy. Globally, the figures are even less than they are in the UK, so this lack of access is what inspired us to create Actissist.”
About half of people who develop psychosis will do so by the time they are in their early twenties. This made smartphones the obvious choice for the team when deciding how best to deliver an easily available mental health support tool.
The app targets five main issues commonly faced by people with psychosis: hearing voices, paranoia, reduced socialisation, perceived criticism and cannabis misuse.
App users receive invitations to engage in a series of question and answer exchanges throughout the day. They can also interact with the app spontaneously, giving them a toolkit of mental health resources they can access whenever they need it.
At the touch of a button, they can watch service-user recovery stories, access relaxation and mindfulness exercises, and use a diary function to record their mood and feelings.
The team worked with service users to develop the app’s content, ensuring that every feature fits users’ requirements.
“Throughout the development and design process, it was essential for us to consult people with personal experience of psychosis who advised on the look, feel and main features of the app,” Professor Bucci explains. “The University has good links with local mental health trusts so that helped us to link up with our end-users.”
As well as consulting people with first-hand knowledge of mental health services, a host of other specialists contributed to the development of the app.
“Clinicians advised us on the content and features as well; their involvement was particularly important when considering how Actissist fits in the context of current service delivery,” says Professor Bucci.
“Manchester has been a pioneer in CBT for psychosis trials, so making use of the University’s clinical psychology expertise enabled us to identify the key features of CBT. We could then adapt those specific elements from this type of therapy and make them available through the app.”
“We worked with a technical team from the informatics department and a trial methodologist to plan how a randomised controlled trial would work with constantly evolving software. Manchester is unique in this sense, and makes it a very good place to carry out this kind of interdisciplinary collaboration.”
“Participants said that, after using the app, their mood was improved and negative symptoms were reduced.”
Assessing the impact
The app was trialled with a group of 36 people with personal experience of psychosis. Participants said that, after using the app, their mood was improved and negative symptoms were reduced. Users found the app to be safe and acceptable, with 90% of participants reporting that they would recommend it to somebody else experiencing psychosis.
The trial also demonstrated that people would realistically use the app on a regular basis. 75% of participants used the app at least once a day over a twelve week period.
“Participants told us that the app’s constant availability was one of its most helpful features, so that they could access it at their time of need,” explains Professor Bucci.
The team are set to develop Actissist further, with a larger trial already underway to assess the app’s efficacy in improving psychosis symptoms.
“We have recruited 170 people into the next phase of the study,” says Professor Bucci.
“Actissist 2.0 is what’s called an efficacy study, where we are trying to determine more definitively whether the app results in a direct reduction in symptoms and impacts other things like functioning and quality of life.”
If Actissist proves to be beneficial then Professor Bucci hopes that it would be embedded in routine service delivery and that clinicians would be able to use it to support therapeutic work. It might also be used as a stand-alone app when people are not able to access mental health services as a way of starting the therapy process.
The app’s ability to capture real-time data could prove useful for both service users and clinicians when tracking and recording symptoms so that their treatment can be adjusted accordingly.
“It records people’s thoughts and feelings in real-time rather than having to rely on their memory of how they might have felt over the preceding weeks or months”, Professor Bucci explains.
“People can share this information with their clinician to ensure that they both have access to an accurate record of their feelings or worries since the last appointment.”
“We hope that Actissist will be used to help to improve the accuracy of people’s treatment regimes so that they can lead happier, healthier lives.”
Find out more about the Actissist 2.0 project.