title: Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders.
abstract: BACKGROUND
  Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS).
  
  
  OBJECTIVE
  The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes.
  
  
  METHODS
  Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored.
  
  
  RESULTS
  In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms.
  
  
  CONCLUSIONS
  It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.|Department of Psychiatry, University of Milan, Milano, Italy.|Posit Science, Inc., San Francisco, CA, United States.
authors.forename: Bruno
authors.identifier: http://orcid.org/0000-0002-5955-3019
authors.initials: B
authors.lastname: Biagianti
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.
authors.forename: Danielle
authors.identifier: http://orcid.org/0000-0001-7652-0924
authors.initials: D
authors.lastname: Schlosser
authors.affiliation: Posit Science, Inc., San Francisco, CA, United States.|Hebrew University, Jerusalem, Israel.
authors.forename: Mor
authors.identifier: http://orcid.org/0000-0002-2861-6486
authors.initials: M
authors.lastname: Nahum
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.
authors.forename: Josh
authors.identifier: http://orcid.org/0000-0002-4378-0014
authors.initials: J
authors.lastname: Woolley
authors.affiliation: Department of Psychiatry, University Of Minnesota, Minneapolis, MN, United States.
authors.forename: Sophia
authors.identifier: http://orcid.org/0000-0003-4746-3347
authors.initials: S
authors.lastname: Vinogradov
keywords: digital health; mobile health; psychosis; social cognition