Use of Palm computer as an adjunct to cognitive-behavioural therapy with an ultra-high-risk patient: a case report

Recently, attempts have been made to develop cognitive-behaviour therapy (CBT) treatment models to target negative symptoms in individuals with schizophrenia, as well as individuals at ultra-high risk (UHR) for psychosis. Successful CBT treatment is founded on active patient participation including completion of homework assignments such as daily logs of activities and experiences. However, these very negative symptoms may themselves hinder the rate of homework assignment completion. We describe a case report of using experience sampling method with a Palm computer as an adjunct to CBT with a female patient at UHR status with predominantly negative symptoms. Our aim was to assess the feasibility and effectiveness of this methodology to improve homework completion and overcome treatment barriers associated with negative symptoms.

Over the course of treatment, the patient was provided with a Palm computer to carry with her throughout her daily activities. The Palm computer was pre-programmed to beep randomly 10 times per day (10 a.m.-12 a.m.) over each three-day assessment period to elicit information on daily functioning.

The use of the Palm computer was acceptable to the patient and resulted in a substantial increase in homework completion. This methodology resulted in rich information about the patients' daily functioning and patterns of improvement during treatment. The experience sampling method data were also successfully used in the application of treatment interventions.

The findings support the feasibility and effectiveness of using Palm computers as adjunct to CBT with UHR individuals with predominantly negative symptoms. The implications for treatment and future research directions are discussed.