Developing a qualitative and quantitative ambulatory assessment-based feedback system within cognitive behavioural interventions for people with persecutory beliefs

Background: Although the application of self-monitoring (ambulatory assessment) and visual feedback in psychological interventions has yielded promising results, there are currently no reports on using self-monitoring and feedback during a complete therapy. The online m-Path platform provides a tailorable framework for integrating self-monitoring and visual feedback within different psychological interventions. Methods: Therapy-specific questionnaires and visual feedback were developed within the online m-Path platform as part of the Feeling Safe-NL trial (registration number: ISRCTN25766661) for regular CBT for psychosis (CBTp) and the Feeling Safe Programme combined with peer counselling (the Feeling Safe-NL Programme). The design process involved people with lived experience, psychologists, peer counsellors, researchers, and software developers. The design principles included that the system should be 1) easy to use, 2) suitable for use during a six-month therapy, 3) focussed on positive and goal-aligned outcomes, 4) understandable by patients and professionals, and 5) informing, guiding, and promoting therapy. Design principles were evaluated using compliance data and a patient questionnaire. Results: The system was used by 21 patients, of which nine completed the questionnaires for the full therapy period, 168 days on average. Usability data from patients revealed that the system was easy to use, well-explained, and suitable for use over six months of therapy. The patients also reported that the questions overall positively affected their emotions and that the feedback was insightful. Conclusion: The results support the successful application of the design principles to promote the integration of the self-monitoring and visual feedback system within specific CBTp interventions.