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Background: Access and engagement with psychosocial interventions for people with psychotic disorders (PD) remain limited. This is because these interventions require specially trained therapists, are often not available in clinical settings, and have a high scheduling burden, requiring a commitment of hours of clinic visits per week for several months. Delivering interventions remotely via mobile devices increases scalability and facilitates access, while also improving scheduling flexibility and decreasing burden, thus improving adherence to intervention requirements. To address these needs, we designed CLIMB, a digital intervention that aims to enhance social functioning in people with PD. CLIMB consists of 2 treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy—an innovative treatment that combines remote group therapy with group texting. In this pilot study, we investigated the feasibility of delivering 6 weeks of CLIMB remotely to people with PD and explored effects on outcomes. We recruited, screened and enrolled participants online, and delivered assessments and intervention remotely using provided iPads. Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. Methods: To assess feasibility, we evaluated adherence to study procedures, attrition rates, engagement metrics, and reported acceptability of the intervention. We also explored changes on measures of social cognition, quality of life, and symptoms. Results: Twenty-seven participants were enrolled. Remote assessments were completed successfully on 96% of enrolled participants. Retention in the trial was 77.7%. Ninety-five percent of the iPads were returned undamaged after intervention. Participants on average attended 84% of the group tele-therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium to high range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P = .001), prosodic happiness intensity (P = .04), and facial anger (P = .04). Trend-level improvements were observed on aspects of quality of life (P’s < .09). Conclusion: It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with PD, using mobile devices. This approach may represent a scalable method to increase treatment access, reduce participant burden, and facilitate adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies will evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in PD.

Objective Individuals at clinical high risk (CHR) for psychosis demonstrate cognitive impairments that predict later psychotic transition and real-world functioning. Cognitive training has shown benefits in schizophrenia, but has not yet been adequately tested in the CHR population. Methods In this double-blind randomized controlled trial, CHR individuals (N = 83) were given laptop computers and trained at home on 40 hours of auditory processing-based exercises designed to target verbal learning and memory operations, or on computer games (CG). Participants were assessed with neurocognitive tests based on the Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative (MATRICS) battery and rated on symptoms and functioning. Groups were compared before and after training using a mixed-effects model with restricted maximum likelihood estimation, given the high study attrition rate (42%). Results Participants in the targeted cognitive training group showed a significant improvement in Verbal Memory compared to CG participants (effect size = 0.61). Positive and Total symptoms improved in both groups over time. Conclusions CHR individuals showed patterns of training-induced cognitive improvement in verbal memory consistent with prior observations in schizophrenia. This is a particularly vulnerable domain in individuals at-risk for psychosis that predicts later functioning and psychotic transition. Ongoing follow-up of this cohort will assess the durability of training effects in CHR individuals, as well as the potential impact on symptoms and functioning over time. Clinical Trials Number: NCT00655239. URL: https://clinicaltrials.gov/ct2/show/NCT00655239?term=vinogradov&rank=5.