(PS3-B44) The Feasibility of Digitally Delivered Cognitive Behavioural Therapy for Psychosis: A Systematic Review

Cognitive behavioural therapy for psychosis (CBTp) is an evidence-based treatment for the amelioration of symptoms related to psychotic disorders, including positive symptoms, depression, and anxiety. During the COVID-19 pandemic, there has been a rapid uptake of remote delivery strategies to preserve mental healthcare while restricting in-person services. However, it is currently unclear to what extent remote delivery of CBT for psychosis is feasible and acceptable. The current systematic review examined the feasibility, useability, and acceptability of digitally delivered and augmented CBTp. Literature searches were conducted following PRISMA guidelines using three databases: Ovid MEDLINE, EMBASE, and PsycINFO from January 1990 to May 2020 in order to capture all remotely delivered approaches. Included studies were full-text studies in peer-reviewed journals that met the following criteria: 1) participant diagnosis was majority ( >50%) schizophrenia spectrum disorders, 2) the intervention was CBT, 3) intervention was delivered via digital/remote means, 4) controlled and non-controlled study designs were accepted. All titles and abstracts were reviewed for relevance followed by a full-text review by two raters and conflicts were resolved by PI (MWB). The initial search resulted in 1595 articles. After title and abstract review, 1117 were screened out and another 54 were found ineligible, resulting in the inclusion of 15 unique articles. Results yielded 7 internet-delivered interventions, 6 smartphone apps, 1 text message intervention, and 1 blended internet-text message intervention published between 2012 and 2021. Regarding engagement, the average study attrition rate was approximately 10% (range: 0% - 23%) which is considerably lower than the average attrition rate reported for clinical trials in general which is 30% attrition. Other objective measures of technology engagement such as login frequency show an overall average of approximately 3 logins per week per user, and a range of intervention task completion rates (27% to 86%). Some studies note high intervention/technology engagement early on in the study, which steadily declines over the course of the intervention. Included studies demonstrate high levels of subjective acceptability, useability, and satisfaction with the technology and interventions by individuals with psychosis, despite previous concerns about affordability, use, and lack of understanding of the limits of digitally delivered/augmented care. Remaining barriers to technologically delivered mental healthcare include engagement with technology over time, requiring technology training for both clinicians and patients, and a minority of studies reporting adverse events related to the intervention. Future directions may include strategies to increase engagement such as the gamification of therapeutic content within smartphone apps or self-guided online platforms, the use of co-designing approaches with clients to increase acceptability and relevance of technology features, and the consideration of blended approaches which include both clinician/therapist lead or assisted content and self-guided content.