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Abstract
Background:
Cognitive bias modification for interpretation (CBM-I) is a technique to modify interpretation and is used to reduce unhelpful negative biases. CBM-I has been extensively studied in anxiety disorders where interpretation bias has been shown to play a causal role in maintaining the condition. Successful Treatment of Paranoia (STOP) is a CBM-I smartphone app targeting interpretation bias in paranoia. It has been developed following research on the feasibility and acceptability of a computerized version. This qualitative study extended that research by investigating the acceptability of STOP in individuals with paranoia. The study design and implementation were informed by the Evidence Standards Framework for Digital Health Technologies (DHTs) published by the UK National Institute for Health and Care Excellence (NICE).
Objective:
The aim of the study was to involve service users in the design, development, and testing of STOP and understand the degree of satisfaction with the product. We aimed to establish the extent to which STOP met the NICE minimum and best practice standards for DHTs, specifically its acceptability to intended end users.
Methods:
In total, 12 participants experiencing mild to moderate levels of paranoia were recruited to complete 6 weekly sessions of STOP before being invited to a feedback interview to share their experiences. Interview questions revolved around the acceptability of the app, its perceived usefulness, and barriers to the intervention, as well as practicality and views on the use of a digital intervention in principle. Interviews were coded and analyzed using the framework analysis method, combining both deductive and inductive approaches.
Results:
Framework analysis yielded 6 themes: independent use and personal fit; digital versus traditional approaches; user reactions and emotional impact; impact on thinking, awareness, and well-being; design, engagement, and usability; and intervention relevance and practical fit.
Conclusions:
STOP was found to be a broadly acceptable intervention and was positively received by most participants. The study findings are in line with the NICE Evidence Standards Framework for DHTs, as intended end users were involved in the development, design, and testing of STOP and were mostly satisfied with it. These findings will contribute to the further iterative development of this intervention that targets interpretation bias in paranoia.
Cognitive bias modification for interpretation (CBM-I) is a technique to modify interpretation and is used to reduce unhelpful negative biases. CBM-I has been extensively studied in anxiety disorders where interpretation bias has been shown to play a causal role in maintaining the condition. Successful Treatment of Paranoia (STOP) is a CBM-I smartphone app targeting interpretation bias in paranoia. It has been developed following research on the feasibility and acceptability of a computerized version. This qualitative study extended that research by investigating the acceptability of STOP in individuals with paranoia. The study design and implementation were informed by the Evidence Standards Framework for Digital Health Technologies (DHTs) published by the UK National Institute for Health and Care Excellence (NICE).
Objective:
The aim of the study was to involve service users in the design, development, and testing of STOP and understand the degree of satisfaction with the product. We aimed to establish the extent to which STOP met the NICE minimum and best practice standards for DHTs, specifically its acceptability to intended end users.
Methods:
In total, 12 participants experiencing mild to moderate levels of paranoia were recruited to complete 6 weekly sessions of STOP before being invited to a feedback interview to share their experiences. Interview questions revolved around the acceptability of the app, its perceived usefulness, and barriers to the intervention, as well as practicality and views on the use of a digital intervention in principle. Interviews were coded and analyzed using the framework analysis method, combining both deductive and inductive approaches.
Results:
Framework analysis yielded 6 themes: independent use and personal fit; digital versus traditional approaches; user reactions and emotional impact; impact on thinking, awareness, and well-being; design, engagement, and usability; and intervention relevance and practical fit.
Conclusions:
STOP was found to be a broadly acceptable intervention and was positively received by most participants. The study findings are in line with the NICE Evidence Standards Framework for DHTs, as intended end users were involved in the development, design, and testing of STOP and were mostly satisfied with it. These findings will contribute to the further iterative development of this intervention that targets interpretation bias in paranoia.
| Original language | English |
|---|---|
| Article number | e70181 |
| Journal | JMIR Human Factors |
| Volume | 12 |
| Early online date | 7 Aug 2025 |
| DOIs | |
| Publication status | Published - 7 Aug 2025 |
Bibliographical note
Publisher Copyright:©Laura Eid, Alexandra Kenny, Rayan Taher, Pamela Jacobsen, Che Wei Hsu, Jenny Yiend.
Acknowledgements
The authors would like to express their gratitude to the National Institute for Health and Care Research Biomedical Research Centre hosted at South London and Maudsley NHS Foundation Trust in partnership with King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health and Care Research, the Department of Health and Social Care, or King’s College London. The authors acknowledge with thanks the contributions made to this work by the Successful Treatment of Paranoia study lived experience panel supported by the McPin Foundation. The authors would like to thank Avegen Health, the digital health care product development company that developed and hosted Successful Treatment of Paranoia throughout this work.Funding
This work was supported by the Medical Research Council Biomedical Catalyst: Developmental Pathway Funding Scheme (MR/V027484/1). The authors would like to express their gratitude to the National Institute for Health and Care Research Biomedical Research Centre hosted at South London and Maudsley NHS Foundation Trust in partnership with King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health and Care Research, the Department of Health and Social Care, or King’s College London. The authors acknowledge with thanks the contributions made to this work by the Successful Treatment of Paranoia study lived experience panel supported by the McPin Foundation. The authors would like to thank Avegen Health, the digital health care product development company that developed and hosted Successful Treatment of Paranoia throughout this work.
| Funders | Funder number |
|---|---|
| National Health Service Corps | |
| Avegen Health | |
| National Institute for Health and Care Research | |
| South London and Maudsley NHS Foundation Trust | |
| McPin Foundation | |
| Medical Research Council | MR/V027484/1 |
Keywords
- cognitive bias modification
- digital health technologies
- framework analysis
- interpretation bias
- paranoia
- qualitative
ASJC Scopus subject areas
- Human Factors and Ergonomics
- Health Informatics
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