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Brief Reports   |    
Safety and Privacy Outcomes From a Moderated Online Social Therapy for Young People With First-Episode Psychosis
John F. Gleeson, M.Psych., Ph.D.; Reeva Lederman, Ph.D.; Greg Wadley, M.Sc., Ph.D.; Sarah Bendall, M.A., Ph.D.; Patrick D. McGorry, M.B.B.S., Ph.D.; Mario Alvarez-Jimenez, D.Clin.Psy., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300078
View Author and Article Information

Dr. Gleeson is with the School of Psychology, Australian Catholic University, Melbourne (e-mail: john.gleeson@acu.edu.au). Dr. Lederman and Dr. Wadley are with Department of Computing and Information Systems, University of Melbourne, Victoria, Australia. The other authors are with the Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne.

Copyright © 2014 by the American Psychiatric Association


Objective  Internet-based treatments for early psychosis offer considerable promise, but safety and security need to be established. This study pilot tested Horyzons, a novel online treatment application that integrates purpose-built moderated social networking with psychoeducation for recovery from early psychosis.

Methods  Safety, privacy, and security were evaluated during a one-month single-group trial with 20 young consumers recovering from early psychosis who were recruited in Melbourne, Australia. Known clinical risk factors informed the safety protocol. Safety, privacy, and security were evaluated with respect to relapse and self-harm, users’ perceptions of safety and privacy, and activity using Horyzons.

Results  No clinical or security problems with use of Horyzons were noted. Participants described feeling safe and trusting Horyzons.

Conclusions  Private moderated online social networking combined with psychoeducation was a safe and secure therapeutic environment for consumers recovering from a first episode of psychosis. Testing the intervention in a randomized controlled trial is warranted.

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Table 1Framework for design of Horyzons risk management strategies
Table Footer Note

a Participants could be excluded from Horyzons if they did not comply with terms of use. Moderators could remove offending material or deactivate user account.

Table Footer Note

b Indications of increased clinical risk activated the Horyzons safety protocol, which stipulated that the moderator would conduct a risk assessment on the basis of available information, inform the senior researchers, contact the emergency contact nominated by the participant, and contact appropriate clinicians when necessary.

Table Footer Note

c Psychotic relapse and subsequent withdrawal from Horyzons was defined either by ratings of 6 or 7 on any one of three Brief Psychiatric Rating Scale (BPRS) items—unusual thought content, hallucinations, and conceptual disorganization—with a duration criterion of one week or by a score of 5 on any of the three BPRS items plus a 2-point increase on one of the three items.



Gafoor  R;  Nitsch  D;  McCrone  P  et al:  Effect of early intervention on 5-year outcome in non-affective psychosis.  British Journal of Psychiatry 196:372–376, 2010
Alvarez-Jimenez  M;  Bendall  S;  Lederman  R  et al:  On the HORYZON: moderated online social therapy for long-term recovery in first episode psychosis.  Schizophrenia Research 143:143–149, 2013
Nitzan  U;  Shoshan  E;  Lev-Ran  S  et al:  Internet-related psychosis: a sign of the times.  Israel Journal of Psychiatry and Related Sciences 48:207–211, 2011
Beck-Sander  A;  Clark  A:  Psychological models of psychosis: implications for risk assessment.  Journal of Forensic Psychiatry 9:659–671, 1998
Online Social Networking Guidelines. Canberra, Australian Communications and Media Authority, Commonwealth of Australia, 2010. Available at www.webcitation.org/68m4u8MLl
Livingstone  S;  Brake  DR:  On the rapid rise of social networking sites: new findings and policy implications.  Children and Society 24:75–83, 2010
Large  MM;  Nielssen  O:  Violence in first-episode psychosis: a systematic review and meta-analysis.  Schizophrenia Research 125:209–220, 2011
Gleeson  JFM;  Chanen  A;  Cotton  SM  et al:  Treating co-occurring first-episode psychosis and borderline personality: a pilot randomized controlled trial.  Early Intervention in Psychiatry 6:21–29, 2012
Robinson  J;  Harris  MG;  Harrigan  SM  et al:  Suicide attempt in first-episode psychosis: a 7.4 year follow-up study.  Schizophrenia Research 116:1–8, 2010
Takahashi  Y;  Uchida  C;  Miyaki  K  et al:  Potential benefits and harms of a peer support social network service on the internet for people with depressive tendencies: qualitative content analysis and social network analysis.  Journal of Medical Internet Research 11:e29, 2009
Dean  K;  Walsh  E;  Morgan  C  et al:  Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study.  Psychological Medicine 37:547–557, 2007
Birchwood  M;  Trower  P;  Brunet  K  et al:  Social anxiety and the shame of psychosis: a study in first episode psychosis.  Behaviour Research and Therapy 45:1025–1037, 2007
Glaser  B;  Strauss  A:  The Discovery of Grounded Theory: Strategies for Qualitative Research .  London,  Wiedenfeld and Nicholson, 1967
Neuman  W:  Social Research Methods: Qualitative and Quantitative Approaches , 4th ed.  Boston,  Allyn & Bacon, 2000
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