PROJECT SUMMARY/ABSTRACT
This resubmission responds to PAR-MH-21-135 (Development of Psychosocial Therapeutic and Preventive
Interventions for Mental Disorders, R61/R33), addressing the PAR by sequentially testing a new intervention
that is translated from basic science and that uses a multi-modal approach to assessing and modifying an
objectively measured target. The overarching goal is to evaluate a new blended mobile intervention that is
aimed at improving introspective accuracy (IA) in people with psychotic disorders, with the ultimate goal of
improving functional outcome. Introspective accuracy is the degree to which one’s self-assessment of task
performance or abilities corresponds with objective data. Our group and others have demonstrated that poor
IA is a strong and independent predictor of functional disability. Yet, there are currently no treatments that
directly target IA. Basic experimental research and other lines of evidence suggest IA is malleable, and that
improvement in task-based IA transfers to untrained tasks. This project’s premise is that task-based IA training
could be delivered in a remote mobile health format and coupled with coaching in applying improved IA to real-
world functional behaviors, creating a novel avenue for functional rehabilitation in psychotic disorders. We
have developed and completed usability testing of iTEST, a novel blended mobile intervention. iTEST
integrates graduated drill-and-practice training delivered on a mobile device that targets IA with personalized
coaching in applying IA to everyday compensatory behaviors. In the R61 phase, we will recruit people with
psychotic disorders with at least minimal functional impairment. We will first conduct a pilot study to finalize a
fully ready-for-deployment version of iTEST. Next, we propose an open trial of iTEST, evaluating whether the
intervention leads to clinically significant changes in task-based IA along with transfer to an untrained task
(target mechanisms). We will also determine the dose of intervention needed to achieve clinically significant
improvement in IA targets, by evaluating change at 8, 12, or 16 weeks. If go/no go criteria (clinically
significant increases in trained and untreated introspective accuracy) are met in the R61 phase, the R33 phase
includes a randomized controlled trial contrasting iTEST with a control condition that provides training in goal
setting and cognitive compensation but does not include task-based IA training. We will evaluate whether
iTEST leads to greater improvement in IA and functional outcome, whether these improvements are sustained
at follow up, and whether increases in IA mediate improvements in functional outcome. This project responds
directly to NIMH Strategic Aim 3.1, by evaluating a new intervention that targets functioning by modifying an
objectively measured target. Our project also responds to the NIMH Digital Health Priority Area by advancing
mobile interventions for cognitive rehabilitation. If effective, iTEST could be integrated with many cognitive
training and other rehabilitative interventions to boost impact on functional outcomes.