Digital therapeutics for negative symptoms of psychosis: Where do we go from here?

Some of the most pressing unmet needs in the treatment of psychosis spectrum disorders are negative symptoms. Digital therapeutics (DTx) have been touted as a transformative approach to advancing mental health treatment, including for negative symptoms. Although existing trials demonstrate that DTx are feasible, acceptable, and efficacious for improving negative symptoms in psychosis, in this review we argue that the field has yet to capitalize fully on their potential. We describe several opportunities for future directions, including leveraging the unique strengths of digital tools to deliver adaptive, engaging, personalized interventions in real-time, precisely when individuals need support. We also discuss pressing needs around identifying how to best integrate DTx into routine clinical care, including the level and type of clinical staff support needed to effectively support the integration of DTx into real-world settings. We also highlight the need for negative symptom DTx to move beyond feasibility and acceptability evaluations and more toward rigorous evaluation of effectiveness and implementation. This includes expanding traditional pharmaceutical evaluation models and using novel clinical trial designs such as micro-randomized trials (MRT), sequential, multiple assignment, randomized trials (SMART), quasi-experimental designs, or stepped wedge designs to optimize intervention content and timing, identify barriers and facilitators to sustainable adoption in clinical practice, and identify the most effective implementation clinical supports. Advancing each of these domains will help to push the field of DTx forward and optimize DTx to treat negative symptoms more effectively.