Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial

Abstract

BackgroundFirst-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled ‘Altitudes’ that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period.Methods/designWe describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15–27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers’ perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool.DiscussionThis is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis.Trial registrationAustralian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471. Retrospectively registered on 22 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1775-5) contains supplementary material, which is available to authorized users.

The “online brain”: how the Internet may be changing our cognition

“…The main reasons include high attrition rates, poor study designs which reduce translational potential, and a lack of consensus around the required standards of evidence for widespread implementation of Internet‐delivered therapies. Efforts are currently underway to determine the long‐term effects of the first generation of social media‐based interventions for mental illness via large randomized controlled trials. Alongside this clinical use, developing public health strategies for young adults in the general population to avoid the potential adverse effects and negative aspects of typical social media are also warranted.…”

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

“…• Individuals with mental disorders can connect with care providers and access evidence-based services • Online peer support augments existing interventions to improve client engagement and compliance • Peer networks increase social connectedness and empowerment during recovery • Interactive peer-to-peer features of social media appear beneficial for social functioning • Mobile apps offer potential to monitor symptoms, prevent relapses and help users set goals • Digital peer-based interventions are feasible and acceptable for targeting fitness and weight loss in people with mental disorders • Online networks can extend support to caregivers of those with mental disorders (Alvarez-Jimenez et al 2013Aschbrenner et al 2018aAschbrenner et al , 2016bBiagianti et al 2018;Birnbaum et al 2017b;Gleeson et al 2017;Lal et al 2018;Naslund et al 2016bNaslund et al , 2018Schlosser et al 2016Schlosser et al , 2018 Challenges 1) Impact on symptoms…”

“…These examples highlight the promise of incorporating the features of popular social media into existing programs, which may offer opportunities to safely promote engagement and program retention, while achieving improved clinical outcomes. This is an emerging area of research, as evidenced by several important effectiveness trials underway (Alvarez-Jimenez et al 2019;Aschbrenner et al 2018a), including efforts to leverage online social networking to support family caregivers of individuals receiving first episode psychosis services (Gleeson et al 2017).…”

Moderated Online Social Therapy: A Model for Reducing Stress in Carers of Young People Diagnosed with Mental Health Disorders

“…To address the question of whether Altitudes is effective is reducing levels of stress in carers of young people diagnosed with psychosis we have initiated a cluster RCT comparing stress outcomes in carers randomized to usual care at EPPIC plus the Altitudes application, vs. usual care alone, with research assistants undertaking assessments kept blind to treatment allocation (Gleeson et al, 2017). Families comprise the cluster.…”