Exploring engagement with the CBT-informed Actissist smartphone application for early psychosis

Background: Individuals with psychosis report favourable attitudes towards psychological interventions delivered via smartphone apps. Evidence for acceptability, safety, feasibility and efficacy is promising but in-depth reporting of app engagement in trials is sparse.
Aims: To examine how people with psychosis engaged with the CBT-informed Actissist app over a 12-week intervention period, and to examine factors associated with app engagement.
Methods: Secondary data from participants in the intervention arm (n=24) of a proof-of-concept randomised controlled trial of the Actissist app were analysed. The app prompted participants to engage with app-based CBT-informed material in five domains (voices, socialization, cannabis use, paranoia, perceived criticism) at pseudo-random intervals (3 notifications per day, 6 days per week). Participants could self-initiate use any time. App use was financially incentivised.
Results: Participants responded to 47% of app notifications. Most app engagements (87%) were app-initiated rather than self-initiated. Participants engaged most with the voices domain, then paranoia. Age and employment status were significantly associated with overall app engagement.
Conclusions: Individuals with psychosis engaged well with Actissist, particularly with areas focussing on voice-hearing and paranoia. App-generated reminders successfully prompted app engagement. As financial incentives may have increased app engagement, future studies of non-incentivized engagement in larger samples are needed.