Centre for Youth Mental Health - Theses
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Item“It Was a Nice Place to Be.” A Phenomenological Exploration of Young People’s Experience of Moderated Online Social Therapy (MOST) For First-Episode Psychosis( 2021)First-episode psychosis (FEP) is a serious mental health condition that can effect a person’s thoughts, perception, mood, and behaviour (American Psychiatric Association, 2013) and is often characterised by a “loss of contact with reality (Bosnjak Kuharic, Kekin, Hew, Rojnic Kuzman, & Puljak, 2019).” As it typically emerges in late adolescence and early adulthood (Alvarez-Jimenez et al., 2019), psychosis can significantly disrupt a young person’s confidence and interrupt their social, emotional, and vocational life trajectories (Alvarez-Jimenez et al., 2013; Bucci et al., 2018). While the introduction of early intervention services has improved the short term outcomes for people experiencing psychosis (Cotton et al., 2016; A. Malla et al., 2017), overtime, psychotic disorders are still associated with poor long-term outcomes in regard to education, housing, physical health, employment, social inclusion, and poverty (Alvarez-Jimenez et al., 2012; Cotton et al., 2017). Evidence suggests that long-term maintenance care is required to prevent relapse and to preserve the clinical and functional gains achieved during early intervention (Alvarez-Jimenez et al., 2021; A. Malla et al., 2017). Digital mental health intervention has been identified as one possible way to provide long term maintenance support to young people with first episode psychosis. The use of digital mental health interventions in the treatment, management, and support of first-episode psychosis is a burgeoning area of interest in the mental health field as it presents an opportunity to provide lower intensity treatment over an extended period of time (Alvarez-Jimenez et al., 2019; Bell & AlvarezJimenez, 2019; Gumley et al., 2020). However, while digital mental health interventions have been trialled in first-episode psychosis populations, there is limited research exploring young people’s experiences of using digital technology and engagement with such interventions have tended to vary substantially. A better understanding of the subjective experience of the user is valuable in and of itself and can be used to improve interventions and identify facilitators and barriers to use. Thus, the knowledge gained via an in-depth exploration of young people’s experience could be harnessed to increase engagement levels of digital mental health interventions for first-episode psychosis. Aim: The primary aim of this thesis was to examine young people's experiences of the therapeutic and social network components of a long-term digital mental health intervention for first-episode psychosis. The secondary aim was to investigate young people's perspectives on the development of blended models of treatment for FEP. Two qualitative studies were conducted to achieve these aims. Study One: Study One used an interpretative phenomenological analysis approach to explore young people's subjective experiences of a long-term digital mental health platform, Horyzons, for FEP, with a particular focus on the experience of online therapy and the social network components. Twelve in-depth phenomenological interviews were conducted with young people who used the Horyzons platform to varying degrees. The data was split meaningfully into two sub-studies during the analysis process due to the breadth of information collected. Sub-study one became an exploration of young people's experience of social connection on the Horyzons platform. We found that the social network nurtured a sense of connection among community members. The platform became an embodied experience that gave young people a sense of self-recognition and belonging. This research also identified significant barriers to engagement, including social anxiety, paranoia, internalised stigma, lack of autonomy, and social protocol confusion. Sub-study two explored young people's experience of online therapy and found that the self-directed nature of the platform was beneficial and motivating to some and overwhelming for others. Moreover, the online therapy experience was idiosyncratic and took on different meanings for different young people. The online therapeutic content led to on-demand help-seeking, positive distraction, revision, generalisation and translation, and normalisation. On-demand help-seeking and positive distraction were identified as two ways in which online therapy was experienced differently from face-to-face therapy and spoke to the unique contribution that online therapy can make to a therapeutic intervention. Study Two: Study two used an end-user design approach combined with thematic analysis to explore young people's perspective of blended models of face-to-face and digital treatment in first-episode psychosis. The sample included ten participants. We found that young people strongly endorsed the use of blended models of care, in so far, as it enhances their treatment experience but does not replace the face-to-face care altogether. Increased accessibility to, and continuity of, care, a channel to access posttherapy support from peers, consolidation of psychoeducation and a way to strengthen the bond between a young person and clinician were identified as benefits of blended models of care. Conclusions: This thesis used two qualitative approaches to better understand young people's experience of digital mental health intervention for first-episode psychosis and young people's perspectives on blended models of mental health care for first-episode psychosis. By exploring experience and perspective, this research was able to shed light on different aspects of a digital mental health interventions for first-episode psychosis and identify facilitators and barriers to young people's engagement that has not been previously identified. This new knowledge constitutes a timely and relevant contribution to the field of digital mental health literature.