User experiences of an American-adapted moderated online social media platform for first-episode psychosis: Qualitative analysis (Preprint)

BACKGROUND Increasingly, digital technology is used to engage individuals with first episode psychosis (FEP) with continued evidence-based recovery support beyond traditional outpatient mental health settings. Young people with FEP respond positively to the idea of receiving mental health support online, with many actively seeking information about and support for their mental illness through social media. Based on the moderated online social therapy (MOST) model and informed by self-determination theory (SDT), the Horyzons USA digital intervention blends interactive therapy material, peer-to-peer social networking, and expert moderation. OBJECTIVE The current study sought to qualitatively characterize the experiences of American users in a recent open trial of the Horyzons platform. METHODS Twenty users on Horyzons USA completed semi-structured interviews at post-treatment, 12 weeks after their orientation to the platform. The interview guide was built around questions addressing (1) the platform, (2) their online therapist, and (3) the peer workers and community space to elicit expressions of specific user experiences across different aspects of the platform in addition to potential suggestions for improvement. A hybrid inductive-deductive coding strategy was used to conduct a thematic analysis of the data. RESULTS The authors identified seven prominent themes of user experiences with Horyzons USA which were subsequently mapped onto one or more of the three primary components of SDT: Autonomy, competence, and relatedness. CONCLUSIONS Features of the platform itself as well as inter- and intra-personal factors supported autonomous use of Horyzons. Users also reflected that their perceived competence in social settings as well as their competence in managing mental health, was increased respectively by the familiarity, privacy, and perceived safety of the platform and an emphasis on personalized therapeutic content. We additionally found that users expressed satisfaction of a need for relatedness by the behaviors or traits of their online therapists or accessing shared experiences with peers and peer support specialists (PSS). This sense of community was further facilitated by bi-weekly virtual get-togethers which promoted further confidence in social settings. Users also described aspects of Horyzons USA that challenged their satisfaction of autonomy, competence, and relatedness, highlighting potential areas for future iteration of the platform’s content and interface. Based on these findings, Horyzons USA is a promising digital tool that provides young adults with psychosis with the means to access tailored therapy material on demand and a supportive digital community to aid in the recovery process.