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

J Ment Health. 2023 Jun;32(3):643-654. doi: 10.1080/09638237.2023.2182429. Epub 2023 Feb 27.


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 cognitive behaviour therapy (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 (three notifications per day, six 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.

Conclusion: 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.

Keywords: Psychosis; cognitive behavior therapy; digital; m-health; mobile; schizophrenia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cognitive Behavioral Therapy*
  • Humans
  • Mobile Applications*
  • Psychosocial Intervention
  • Psychotic Disorders* / therapy
  • Smartphone