Research by a team of psychologists at the University of Manchester has the potential to help people suffering from psychosis take control of their mental health through the use of a smartphone app.

Author: Jo Sharpe

The term “psychosis” refers to experiences in which an individual interprets reality in a different way to other people, usually involving hallucinations such as hearing voices. This is known as a psychotic episode and can be a symptom of many different mental health disorders such as depression, schizophrenia, and can arise postpartum as a result of trauma during birth. You can also experience psychosis due to lack of sleep, a high fever, or drug abuse. People may experience just one episode of psychosis in their lifetime, or it may recur frequently. There is often a stigma surrounding psychosis; it can be misunderstood and being psychotic can be confused with being dangerous. In fact people experiencing psychosis rarely behave aggressively towards others.

Current clinically recommended treatments for psychosis include cognitive behavioural therapy (CBT) as well as antipsychotic drugs. Despite this, only around 1 in 10 people with psychosis receive CBT; delays in treatment often lead to repeated relapse, highlighting the importance of developing innovative and efficient solutions to improve the speed of treatment delivery.

Healthcare providers worldwide are increasingly recognising the need for self-management strategies in long-term conditions. Digital strategies are emerging as a potential solution to address mental health challenges.  Smartphones provide the perfect vehicle to deliver such interventions; most people already own one and are comfortable using it as part of their daily routine. Real-time data gathered from mobile phone apps can provide a more detailed understanding of day-to-day fluctuations to clinicians, as well as facilitating self management and providing an enjoyable user experience.

Dr. Sandra Bucci and her team at the University of Manchester are developing an app based on feedback from users and mental health staff aimed at those who have  experienced a first episode of psychosis. The app, Actissist, uses question and answer dialogues to provide feedback to the user in areas that might be particularly distressing, such as hearing voices or paranoia. Actissist offers hints and tips on how the user could manage these experiences as well as providing a graphical representation of their experiences over time, enabling the user to become more aware of how their experiences and symptoms have fluctuated. In addition to this, a “toolkit” menu allows the user access to helpful resources such as fact sheets encompassing mood, anxiety, self-esteem and goal-setting that the user can work through. There is also a “chillout area” that contains mindfulness and relaxation exercises.

In order to test the accessibility and efficacy of the app, a proof-of-concept study was launched in 2014. The trial yielded promising results. Actississt appeared safe to use and showed promise for treatment efficacy, more so than a routine symptom monitoring-only app called ClinTouch. The user feedback was overwhelmingly positive; people enjoyed using the app and 90% would recommend it to others. Speaking in one-on-one interviews after the trial, participants emphasised how they felt more in control and empowered to manage their own symptoms and reduce their reliance on professional services.

This success led to further funding to improve and build on Actissist and run a larger randomised controlled trial. Improvements are being implemented based on the feedback received from service users and staff, and the new trial will recruit 170 people from the Greater Manchester Mental Health and Pennine Care NHS Foundation Trusts.

The user and staff involvement in developing Actissist may well be the key to its success, and this approach could prove fruitful for other groups embarking on developing similar apps for other mental health problems. There is no doubt that with increasing strain on mental health services, timely and efficient treatment and prevention strategies are urgently needed. Digital interventions are emerging as a possible solution to the crisis that services are currently facing; Actissist is a prime example of how mobile phone apps can effectively work alongside services to improve patient outcomes and empower people to manage their mental health.