Over the next hour, we'll talk about your thoughts about the content that you read last week

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Grant number: 1R34MH108781

Texting for Relapse Prevention: Improving Outcomes for People with Schizophrenia CAT MODERATOR’S GUIDE

Patient Group NOTES TO THE RESEARCH TEAM:

Main goal: Elicit group feedback about the content experience INTRODUCTION

Welcome to today’s discussion. My name is Michele and I will be leading the discussion.

Over the next hour, we'll talk about your thoughts about the content that you read last week. I am interested to hear what you liked about the messages, what you think we could do better with the messages, and whether there are things to add. It is going to be a great hour!

So, let's get started Text messaging use

First, let’s first talk about the way you use text messaging in a typical day.

1. How many text messages do you send and receive?

2. What do you like about texting?

3. What are some challenges you experience when texting?

a. Probe: How have you found the medication that you are on can affect the way that you text message?

b. Probe: How have you found your symptoms change the way that you text?

4. Do you prefer to text or to talk to someone? Does this depend on the person or something else that’s going on?

5. What other things do you think it would be helpful for us to know about the way you use text messaging?

General feedback

Ok. Now let’s talk about your ideas about the messages in general.

1. How would you describe the tone of the messages? For example, did you feel like they were supportive? Or like they were talking down to you?

2. Were there messages or ideas that did not make sense?

3. Did the messages feel repetitive or like they were saying the same thing over and over. Is it a problem to say the same thing twice?

4. What other feedback do you think would be helpful for us to hear to make the messages better?

Symptom check in

Ok. All of that was super helpful. Thanks!

Now, let’s change topics a bit and talk about the content. You read a lot of messages in the last week. First, I want to focus on the messages that asked you about your symptoms. An example of this type of message is:

“Did you have any problems sleeping last night? Text me 'no' if you did not and 'yes' if you did.”

Modified version approved by CIRBI June 16, 2016 1

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1. Our plan is to send a symptom check in once a day. We will ask about different symptoms across the week, but the same symptoms over time. What are your thoughts about getting the same message about the same symptom each week?

2. I have a question about the depressed mood message. Right now, we say:

“How would you rate your mood today? Text me a number between 1 (very depressed) and 10 (best mood ever). A ‘5’ is average.”

a. We are wondering if “best mood ever” makes sense or if there is another way to describe feeling REALLY happy and excited?

b. Also, if you say you are in your best mood ever, we will follow up and ask if you are possibly manic. What is your reaction to this? Would you feel like we are saying it’s not ok to feel really, really good?

3. If people in the program text us back and let us know that they are doing ok with the symptom, then we will send a response that is something like: “Glad to hear that you are feeling good. I hope you have a great day!” What do you think it would be like for you to get a message like this in response?

Probe: Would you want a response? Does this response sound like we are talking down to you?

Great! What about other responses that we have? Examples include:

 Great! Make it a carefree day!

 Great to hear that you are feeling calm today.

What do you think it would be like getting messages like these if you said that you are feeling ok today?

Coping skills

That was super helpful. Now I would like to move on to another type of messages: those that give you advice on how to cope with symptoms that you might be experiencing.

1. Did the advice seem useful and like it might be worth trying? Did you learn anything new / get some advice that you have not tried before?

2. What other ways of coping have you found helpful that you didn’t see there that you think we could add?

3. Great! I also wanted to check in about some of the language.

a. In one of the messages, we use “good vibes”: “When we're sad, we might not feel like doing anything at all. When you feel like this, turn on happy music. You don’t have to do anything except let the good vibes roll.” What does this message mean to you? Do you think most people will understand what we’re trying to say?

b. In another message, we suggest memes: “Looking at your favorite pictures (or even funny memes) is a great way to remind you of happy times and to help reduce your feelings of tension and calm your nerves.” What is your experience with memes? Do you think this would be useful advice?

c. What about Angry Birds?

4. Were there ever times when you feel like we weren’t taking your problems seriously and giving advice that was ‘too easy’ or didn’t reflect how hard it can be sometimes to feel these ways (e.g., to hear voices)? Or were the messages supportive?

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Happy friend and wrap up

You all are doing great. We are almost done here. Before you go, I want to get your ideas about HappyFriend, which is a feature that will send inspirational messages. Here are some examples:

“Breathing in, I calm body and mind. Breathing out, I smile. Dwelling in the present moment I know this is the only moment.” What Thich Nhat Hanh writes is true: It's all about your breath.

“To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.” Thich Nhat Hanh

As Anaïs Nin reminds us, “We don't see things as they are, we see them as we are.”

What would it be like for you to receive messages like these on your phone?

Do you mind who the quotes are by?

Fantastic. This has been an incredibly helpful discussion. My last question is this:

What else about the program have we not yet talked about you think is important for us to know?

That was everything. Thanks so much for your help and time!