An examination of neurocognition and theory of mind as predictors of engagement with a tailored digital therapeutic in persons with serious mental illness.

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There is an increasing interest in the development and implementation of digital therapeutics (apps) in individuals with serious mental illness (SMI). However, there is limited understanding of the role of neurocognition and social cognition on engagement with apps. The present study is a secondary analysis of a pilot randomized controlled trial (N = 62) comparing a tailored digital intervention to treat tobacco use disorder in individuals with SMI to a standard of care digital intervention for the general population. The purpose of this study was to examine the impact of neurocognition, social cognition, and clinical characteristics on indices of app engagement in users of the tailored app compared to users of the standard of care app. Correlational analyses demonstrated that individuals with low levels of neurocognition and social cognition engaged more often and for longer duration with the tailored app compared to the standard of care app. In a series of multilevel zero-inflated negative binomial models, assignment to the tailored app remained the most robust predictor of app interactions (Risk Ratio [RR] = 1.72; p < .01), duration of app use (RR = 6.47; p < .01), and average length of interaction (RR = 2.70; p < .01), after adjusting for key demographic and clinical characteristics, and two measures of cognition. This is one of the first studies to demonstrate that digital therapeutics can be designed to mitigate the impact of neurocognition and social cognition on device engagement in SMI populations. Recommendations are made to advance the use of new analytic models to uncover patterns of engagement with digital therapeutics.





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Halverson, Tate F, Julia Browne, Samantha M Thomas, Paige Palenski and Roger Vilardaga (2022). An examination of neurocognition and theory of mind as predictors of engagement with a tailored digital therapeutic in persons with serious mental illness. Schizophrenia research. Cognition, 28. p. 100236. 10.1016/j.scog.2022.100236 Retrieved from

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Roger M Vilardaga

Associate Professor in Psychiatry and Behavioral Sciences

Roger Vilardaga Viera, Ph.D. is an Associate Professor at the Department of Psychiatry and Behavioral Sciences at Duke University. He is also Affiliate Professor a the Department of Human Centered Design and Engineering at the University of Washington. Dr. Vilardaga studied psychology at the Universitat de Barcelona in Spain and received his doctoral degree in clinical psychology from the University of Nevada, Reno. He has contributed to the study and development of several digital interventions, including Mindful Daily, SmartQuit, Tummy Trials, Eyes Free Yoga, Mindful Powers, and Pain Tracker Self Management. He created and designed Learn to Quit, the first NIH-funded digital therapeutic to deliver smoking cessation treatment for individuals with serious mental illness. This application won the Gold W3 Award in 2016 by the Academy of Interactive and Visual Arts and the Silver Davey International Award in 2016 for best wellness and health application. His work has been featured in FastCompany, The Drum, Seattle K5 News and Psychiatric News. His laboratory has been funded by the National Institute on Drug Abuse, the National Cancer Institute, the University of Washington Innovation Award, Pfizer and Duke University.

He directs the Duke's Access to Behavioral Health for All (ABHA) Laboratory. The focus of the ABHA Lab is to ideate, develop, and test digital behavioral health interventions for underserved populations, such as individuals who experience persistent mental health symptoms, addiction, or chronic pain. The laboratory specializes in: (1) designing digital tools to foster behavioral health and psychological resilience, (2) the application of rigorous strategies to evaluate them, and (3) examining barriers and facilitators of digital health equity. The laboratory uses a multi-method approach that includes user-centered design research, small-n experimental designs, clinical trials methodology, digital phenotyping, and participatory research to better understand the behavior of digital therapeutics' users.

Dr. Vilardaga consults with Duke's Clinical Research Institute (DCRI) where he provides thought leadership about digital therapeutics and serves as an investigator in several industry funded digital therapeutic trials. Finally, Dr. Vilardaga has served as ad-hoc reviewer for more than 25 scientific journals and 9 granting institutions. Currently he is a standing member of a study section for NIH's Center for Scientific Review.

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