(PS3-B46) Horyzons USA: Open Pilot Trial Findings and the Mediating Effect of Engagement on the Alliance-outcome Relationship

Digital interventions offer novel strategies to serve unmet needs in first episode psychosis (FEP) and appear to be most effective when users maintain high engagement. The presence of professional human support may facilitate a robust therapeutic alliance that enhances the level of engagement necessary for optimal clinical and functional change. However, the therapeutic alliance has received scant attention in digital intervention research to date and the putative mediation of engagement upon the alliance-outcome relationship remains untested. The current study seeks to broaden the current literature on the relationship between the alliance, engagement, and psychosocial outcomes in an open trial of the current version of the Horyzons digital intervention among FEP clients (N = 25) in the United States. We will (1) extend prior findings of Horyzons in the U.S. on primary and secondary social recovery outcomes, feasibility, and acceptability, (2) investigate whether a composite index of engagement mediates the effect of the overall alliance on key outcomes and (3) explore whether engagement mediates the relationship between individual components of the alliance (i.e., goals, tasks, and bond) and outcomes. Analyses are currently in progress, and additional exploratory results may be presented. We will discuss how findings from this study may advance our understanding of the individual factors and pathways through which digital interventions facilitate positive recovery outcomes.