JMIR Publications

ABSTRACT

Background:

Impairments in cognition and motivation are core features of psychosis and strong predictors of social and occupational functioning. Accumulating evidence indicates cognitive deficits in psychosis can be improved by computer-based cognitive training programs; however, barriers include access and adherence to cognitive training exercises. Limited evidence-based methods have been established to enhance motivated behavior. In this study, we tested the effects of online targeted cognitive and social cognitive training (TCT), delivered in conjunction with an innovative digital smartphone app called Personalized Real-Time Intervention for Motivational Enhancement (PRIME). The PRIME app provides users with a motivation coach to set personalized goals and secure social networking for peer support.

Objective:

We investigated whether deficits in cognition and motivation in people with a psychosis spectrum disorder (N=100) can be successfully addressed with 30 hours of TCT+PRIME as compared to 30 hours of a computer games control condition plus PRIME (CG+PRIME). Here, we describe our study procedures, the feasibility and acceptability of the intervention, and the results on all primary outcomes.

Methods:

In this double-blind, randomized, controlled trial, English-speaking participants completed all cognitive training, PRIME activities, and assessments remotely. Participants completed a diagnostic interview and remote cognitive, clinical, and self-report measures at baseline, post training, and at a six-month follow-up.

Results:

Our results include participants from 27 states across the U.S. and 8 countries worldwide. Our study population was 60% female with a mean age of 33.77 (SD=10.70). On average, participants completed more than half of the cognitive training regimen (M=18.58, SD=12.47 hours of training), logged into the PRIME application 4.71 (SD=1.58) times per week, interacted with their PRIME coach 79.24 (SD=89.19) times during the 16 week intervention, and achieved 14.16 (SD=14.66) goals. The attrition rate of 22% was lower than our previous studies of remote cognitive training. The total sample showed significant gains in Global Cognition (P=.03) and Attention/Vigilance (P<.001). TCT+PRIME participants showed significantly greater gains in Emotion Recognition (P<.001) and Global Cognition at trend level significance (P=.09) relative to CG+PRIME participants. The total sample also showed significant improvement on multiple indices of motivation (P=.02-0.05), in depression (P=.04), positive symptoms (P=.04), and in negative symptoms at trend level significance (P=.09). Overall satisfaction with the PRIME app was rated at 7.74 (SD=2.05) on a scale of 1-10, with higher values indicating more satisfaction.

Conclusions:

These results demonstrate the feasibility and acceptability of remote cognitive training combined with the PRIME application, and that this intervention can improve cognition, motivation, and symptoms in individuals with psychosis. TCT+PRIME appears more effective in improving Emotion Recognition and Global Cognition relative to CG+PRIME. Future analyses will test the relationship between hours of cognitive training completed, PRIME usage, and changes in cognition, motivation, symptoms, and functioning. Clinical Trial: ClinicalTrials.gov NCT02782442