Mend the Gap: Online User-Led Adjuvant Treatment for Psychosis: A Systematic Review on Recent Findings.

Background/

Objectives

Schizophrenia Spectrum Disorders (SSDs) carry a debilitating burden of disease which, even after pharmacological and psychological treatment are optimized, remains difficult to fully target. New online-delivered and user-led interventions may provide an appropriate, cost-effective answer to this problem. This study aims to retrieve the currently gathered findings on the efficacy of these interventions across several outcomes, such as symptom severity, social cognition, functioning and others.

Methods

A systematic review of the current available literature was conducted. Of 29 potentially relevant articles, 26 were included and assigned at least one of four intervention types: Web-Based Therapy (WBT), Web-Based Psycho-Education (WBP), Online Peer Support (OPS) and Prompt-Based Intervention (PBI).

Results

The findings were grouped based on outcome. Of 24 studies evaluating the effects of symptom severity, 14 have achieved statistically significant results, and 10 have not. WBT (such as online-delivered Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, social cognition training and Mindfulness Training) seemed to be the most effective at targeting symptoms. Of 14 studies evaluating functioning, seven achieved significant results, four involving a form of social or neurocognitive training, suggesting a potential pathway towards functional improvements through interventions targeting cognition and motivation. Regarding social cognition, all seven studies measuring the effects of an intervention on this outcome produced significant results, indicating that this outcome lends itself well to remote, online administration. This may be linked with the nature of social cognition exercises, as they are commonly administered through a digital medium (such as pictures, videos and auditory exercises), a delivery method that suits the online-user led model very well.

Conclusions

Online user-led interventions show promise as a new way to tackle functional deficits in SSD patients and achieve these improvements through targeting social cognition, a hard-to-reach component of the burden of SSDs which seems to be successfully targetable in a remote, user-led fashion. Symptomatic improvements can also be achievable, through the combination of these interventions with treatment as usual.