New CAMH app aims to boost motivation in people with schizophrenia
A new mobile app created by CAMH researchers is aiming to treat motivation problems in people with schizophrenia. It also offers a new way for health care providers to support and collaborate with clients during their treatment.
The app is in the final testing stages of development, and the researchers are investigating potential ways to bring it to market.
While hallucinations and delusions, referred to as positive symptoms, may be the most likely symptoms to come to mind when we think of schizophrenia, the negative symptoms such as motivation problems are the most debilitating for people in their everyday lives.
"The positive symptoms of schizophrenia may be the reason why people end up in hospital or seeking other care, and those can generally be treated relatively well," says Dr. George Foussias, Clinician Scientist in CAMH's Campbell Family Mental Health Research Institute. "But motivation challenges start early and continue throughout the illness, with no treatment options currently available. They hold people back in their recovery. With this new app, our goal is to help patients improve their functioning over time."
Co-developed by Dr. Foussias and PhD candidate Ishraq Siddiqui, the app draws on research and evidence gathered in Dr. Foussias' clinical practice and his research lab. It's a goal assistant and scheduler designed to objectively assess behaviour and promote motivation in real time. To study motivation difficulties, he uses several methods, including brain imaging, virtual-reality and motion-tracking devices and computer-based tools.
(From left) Dr. George Foussias and Ishraq Siddiqui
A targeted intervention
"What sets the app apart is that it's geared with this population in mind," says Dr. Foussias. "We see that people with schizophrenia have difficulties in exerting effort in pursuit of a goal." For example, in tests in his lab, individuals will often choose the easier, more passive task over the more rewarding option that takes more effort. As well, individuals often stick to activities and locations they know because these are safe and comfortable.
The app also addresses challenges that health care providers and researchers face. For one, there is no objective way to measure motivation difficulties in the real world – assessments today rely on the individual's recollections of events. Plus, while doctors and case workers support their clients with motivation during appointments, helping clients to take action and stay motivated between appointments is a challenge.
All of these insights, and the fact that most clients are using cell phones, led the researchers to create a mobile intervention. After the user enters a goal into the app, such as attending a dentist appointment or buying groceries, the app then uses location sensing and other information to track the individual’s progress toward achieving the goal. The app sends prompts and reminders, and provides rewarding feedback when the user completes the goal. "The type and frequency of prompts, and the kind of feedback is focused toward people with schizophrenia," says Dr. Foussias. Based on the user's activities, the app also suggests new goals and novel experiences, such as going to the library or a coffee shop.
A collaborative tool
The app can also be a collaborative tool for those who wish to use it with health care providers, family members, caregivers or friends who are part of their treatment team. If a user grants access, a doctor, case worker or other trusted individual can then see how the user is progressing, send reminders or messages of encouragement, and recommend new goals. "A light message can help people feel connected with their treatment team and prompt behavioural changes," says Dr. Foussias.
The app can help the user and their treatment team identify when it’s a struggle to complete a goal, so they can come up with strategies for the future, such as setting earlier reminders or scheduling appointments later in the day if the person frequently misses morning appointments.
The mobile intervention can also be useful to assess if a new medication or a change in medication affects an individual's motivation.
The researchers worked closely with the web team from CAMH's Information Management Group to build the app, and the CAMH team is testing a fully functioning version. The next step is for clients to test the app, and the eventual goal is to study outcomes in a randomized controlled trial.
Dr. Foussias and CAMH's Industry Partnerships and Technology Transfer Office are exploring ways to bring the app to market, including licensing the app to a commercial partner, co-developing the app with a partner or starting a CAMH spinoff company.
Dr. Foussias believes the app could also be beneficial for individuals with other neuropsychiatric illnesses that are also linked with difficulties with motivation, including depression, Parkinson's disease and Alzheimer’s disease.