Dose-response relationship in digital psychological therapies for people with psychosis: a systematic review, meta-analysis, and meta-regression.

Journal article

Fialho, Carolina, Yiend, Jenny, Hampshire, Chloe, Taher, Rayan, Shergill, Sukhi and Stahl, Daniel 2025. Dose-response relationship in digital psychological therapies for people with psychosis: a systematic review, meta-analysis, and meta-regression. Frontiers in Psychiatry. 16, p. 1621009. https://doi.org/10.3389/fpsyt.2025.1621009
AuthorsFialho, Carolina, Yiend, Jenny, Hampshire, Chloe, Taher, Rayan, Shergill, Sukhi and Stahl, Daniel
Abstract

Introduction: Recent digital technological advances have emerged with the aim of improving accessibility, engagement, and effectiveness of psychological interventions for psychosis. Systematic reviews have provided preliminary evidence that digital health technologies for psychosis may improve symptoms. However, little research has examined how treatment effect is related to dose of therapy. Thus, we planned to investigate the association between treatment outcome and different dose characteristics, such as session length, number of sessions and their frequency.

Methods: This systematic review followed the PRISMA guidelines, including a risk of bias assessment utilizing the Cochrane Collaboration’s tool. Searches were completed in November 2023 using Embase, Ovid MEDLINE(R) and APA PsychInfo, and were limited to English language and peer-reviewed journal articles. Studies included any randomised controlled trial (including pilot/feasibility studies) in adults that reported a non-interventional control condition and included clinical symptom outcome measurement and dose information. Meta-analyses and meta-regressions were completed.

Results: 19 studies were included in this review. 14 studies included web, mobile or computer-based interventions, and 5 included virtual reality interventions. Digital interventions significantly improved clinical symptoms, with a small effect size (Cohen’s d = -0.14, p < 0.001, 95% CI [-0.23 to -0.05]). Although subgroup analyses were not significant, data patterns favoured interventions focusing on clinical outcomes over cognitive outcomes, and interventions that included therapist support, over those without. Due to the small overall effect size, we were not able to explore dose predictors.

Discussion: This meta-analysis provided preliminary evidence that digital mental health interventions for psychosis are effective, even when not targeting symptoms directly. Despite exploring multiple dose characteristics, no significant dose-response relationship was found. Further research is needed to understand the role of dose in digital interventions for psychosis.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023411836, identifier CRD42023411836.

KeywordsMeta-analysis; Systematic review; Psychosis; Dose-response; Meta-regression
Year2025
JournalFrontiers in Psychiatry
Journal citation16, p. 1621009
PublisherFrontiers
ISSN1664-0640
Digital Object Identifier (DOI)https://doi.org/10.3389/fpsyt.2025.1621009
Official URLhttps://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1621009/full
Related URLhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023411836, identifier CRD42023411836.
Publication dates
Online26 Sep 2025
Print01 Jan 2025
Publication process dates
Accepted25 Aug 2025
Deposited13 Oct 2025
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Output statusPublished
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Matteo Cella, Tom Price, Holly Corboy, Juliana Onwumere, Sukhi Shergill and Antonio Preti 2020. Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis. Psychological Medicine. 50 (7), pp. 1062-1076. https://doi.org/10.1017/S0033291720000872
Biased interpretation in paranoia and its modification
George Savulich, Annabel Edwards, Sara Assadi, Husniye Guven, Emily Leathers-Smith, Sukhi Shergill and Jenny Yiend 2020. Biased interpretation in paranoia and its modification. Journal of Behavior Therapy and Experimental Psychiatry. 69, p. 101575. https://doi.org/10.1016/j.jbtep.2020.101575
Acute oxytocin effects in inferring others' beliefs and social emotions in people at clinical high risk for psychosis
André Schmidt, Cathy Davies, Yannis Paloyelis, Nicholas Meyer, Andrea De Micheli, Valentina Ramella-Cravaro, Umberto Provenzani, Yuta Aoki, Grazia Rutigliano, Marco Cappucciati, Dominic Oliver, Silvia Murguia, Fernando Zelaya, Paul Allen, Sukhi Shergill, Paul Morrison, Steve Williams, David Taylor, Stefan Borgwardt, Hidenori Yamasue, Philip McGuire and Paolo Fusar-Poli 2020. Acute oxytocin effects in inferring others' beliefs and social emotions in people at clinical high risk for psychosis. Translational Psychiatry. 10 (203). https://doi.org/10.1038/s41398-020-00885-4
Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study
Cecilia Casetta, Fiona Gaughran, Ebenezer Oloyede, Juliana Onwumere, Megan Pritchard, Sukhi S. Shergill, Eromona Whiskey and James Hunter MacCabe 2020. Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study. BJPsych Open. 6 (5), p. E82. https://doi.org/10.1192/bjo.2020.51
Dopamine manipulations drive changes in information sampling in healthy volunteers
Shergill, S. 2019. Dopamine manipulations drive changes in information sampling in healthy volunteers. Journal of Psychopharmacology. 33 (6), pp. 670-677. https://doi.org/10.1177/0269881118822080
Integrated care in mental health: Next steps after the NHS Long Term Plan
Derek K. Tracy, Kara Hanson, Tom Brown, Adrian J. B. James, Holly Paulsen, Zoé Mulliez and Sukhwinder Shergill 2019. Integrated care in mental health: Next steps after the NHS Long Term Plan. British Journal of Psychiatry. 214 (6), pp. 315-317. https://doi.org/10.1192/bjp.2019.46
Cognitive correlates of abnormal myelination in psychosis
Lucy D. Vanes, Elias Mouchlianitis, Erica Barry, Krisna Patel, Katie Wong and Sukhwinder S. Shergill. 2019. Cognitive correlates of abnormal myelination in psychosis. Scientific Reports. 9 (5162). https://doi.org/10.1038/s41598-019-41679-z
Clozapine and cardiotoxicity – A guide for psychiatrists written by cardiologists
Rishi K. Patel, Alice M. Moore, Susan Piper, Mark Sweeney, Eromona Whiskey, Graham Cole, Suhki Shergill and Carla M. Plymen 2019. Clozapine and cardiotoxicity – A guide for psychiatrists written by cardiologists. Psychiatry Research. 282, p. 112491. https://doi.org/10.1016/j.psychres.2019.112491
Understanding and managing cardiac side-effects of second-generation antipsychotics in the treatment of schizophrenia
Mark Sweeney, Eromona Whiskey, Rishi K. Patel, Derek K. Tracy, Sukhi S. Shergill and Carla M. Plymen 2019. Understanding and managing cardiac side-effects of second-generation antipsychotics in the treatment of schizophrenia. BJPsych Advances. 26 (1), pp. 26-40. https://doi.org/10.1192/bja.2019.49
Real-world outcomes in the management of refractory psychosis
Amir Krivoy, Dan Joyce, Derek Tracy, Fiona Gaughran, James MacCabe, John Lally, Eromona Whiskey, S. Neil Sarkar and Sukhwinder S. Shergill 2019. Real-world outcomes in the management of refractory psychosis. Journal of Clinical Psychiatry. 80 (5), p. 18m12716. https://doi.org/10.4088/JCP.18m12716
Neural correlates of positive and negative symptoms through the illness course: an fMRI study in early psychosis and chronic schizophrenia
Lucy D. Vanes, Elias Mouchlianitis, Krisna Patel, Erica Barry, Katie Wong, Megan Thomas, Timea Szentgyorgyi, Dan Joyce and Sukhwinder Shergill 2019. Neural correlates of positive and negative symptoms through the illness course: an fMRI study in early psychosis and chronic schizophrenia. Scientific Reports. 9, p. 14444. https://doi.org/10.1038/s41598-019-51023-0
Girls-boys: an investigation of gender differences in the behavioral and neural mechanisms of trust and reciprocity in adolescence
Imke L. J. Lemmers-Jansen, Anne-Kathrin J. Fett, Sukhi Shergill, Marlieke T. R. van Kesteren and Lydia Krabbendam 2017. Girls-boys: an investigation of gender differences in the behavioral and neural mechanisms of trust and reciprocity in adolescence. Frontiers in Human Neuroscience. 13 (257).