Enhancing Social Functioning in Young People at Ultra High Risk for Psychosis: Randomised Controlled Trial of a Novel Strengths-based Online Social Therapy

Participants will receive their usual treatment and have access a moderated online social networking system, called Momentum. Momentum is an online intervention specifically designed to enhance social functioning in young people at ultra-high risk for psychosis (UHR). The Momentum system is based on the Moderated Online Social Therapy (MOST) platform developed by eOrygen. Momentum includes therapeutic activities and information about mental health, mindfulness, personal strengths, and other topics relevant for UHR young people, in the form of text and comics designed by eOrygen specifically for this study. Momentum also includes a social network where participants can communicate via posts and comments in a newsfeed and a problem-solving forum. The online platform will be moderated by experienced mental health workers based at Orygen Youth Health. Trained peer workers with lived experience of mental ill-health will also provide support to participants through the Momentum social network. Following randomisation, participants allocated to the Momentum intervention will complete an online orientation and follow-up phone call with the online moderator. Participants will access Momentum (including individualised therapist support) for 12 months. During this period, participants may access Momentum as often as they like, at any time, from any internet-enabled device. Momentum integrates online personal therapist support (by clinical psychologists). Their role is to provide guidance, monitor participant’s clinical status and ensure the safety of the social network. Each therapist is assigned a caseload, which they follow for the duration of the trial. Moderators send each client tailored content suggestions weekly (e.g. a module or action) based on their needs and interests. Clients can rate the helpfulness of the suggestions, which moderators use to recommend subsequent content. To promote engagement, retention of participants, and behavioural change, Momentum was developed following persuasive system design including primary task support (i.e., modularisation and personalisation of content), social support (i.e., fully integrated, purpose-built social network) and dialogue support (i.e., reward provided by therapists, peer-supporters and automated functions). Users will be invited by moderators to meet other users at ‘Momentum Workshops’, which will occur which will occur approximately every 3-4 months. Meet-ups will consist of an interactive 1-hour session on ‘how to make Momentum work for you’ and will provide users with the opportunity to ask questions and give feedback on the system. Participants will be reimbursed for their time. In the event of a clinically significant deterioration of psychotic symptoms, transition to psychosis, increased risk or a hospital admission, the clinical moderators in conjunction with the CI team will perform an assessment to determine the risks and benefits of a temporary withdrawal from Momentum. Based on this assessment, and in consultation with the young person, the team will determine whether the account is temporarily suspended, or level of access restricted (e.g., participant can access therapeutic content and support from moderators, and view content in the social network, but cannot post comments or participate in existing threads within the social network). Following suspensions or restrictions to a user’s account, the study coordinator or moderator will contact the young person at fortnightly intervals to ascertain whether the account is to be reactivated.