CLIMB: A Mobile Intervention to Enhance Social Functioning in People With Psychotic Disorders: Results From a Feasibility Study

Background: Access and engagement with psychosocial interventions for people with psychotic disorders (PD) remain limited. This is because these interventions require specially trained therapists, are often not available in clinical settings, and have a high scheduling burden, requiring a commitment of hours of clinic visits per week for several months. Delivering interventions remotely via mobile devices increases scalability and facilitates access, while also improving scheduling flexibility and decreasing burden, thus improving adherence to intervention requirements. To address these needs, we designed CLIMB, a digital intervention that aims to enhance social functioning in people with PD. CLIMB consists of 2 treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy—an innovative treatment that combines remote group therapy with group texting. In this pilot study, we investigated the feasibility of delivering 6 weeks of CLIMB remotely to people with PD and explored effects on outcomes. We recruited, screened and enrolled participants online, and delivered assessments and intervention remotely using provided iPads. Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. Methods: To assess feasibility, we evaluated adherence to study procedures, attrition rates, engagement metrics, and reported acceptability of the intervention. We also explored changes on measures of social cognition, quality of life, and symptoms. Results: Twenty-seven participants were enrolled. Remote assessments were completed successfully on 96% of enrolled participants. Retention in the trial was 77.7%. Ninety-five percent of the iPads were returned undamaged after intervention. Participants on average attended 84% of the group tele-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 to high 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). Trend-level improvements were observed on aspects of quality of life (P’s < .09). Conclusion: It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with PD, using mobile devices. This approach may represent a scalable method to increase treatment access, reduce participant burden, and facilitate adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies will evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in PD.