Transdiagnostic App-Based Cognitive Bias Modification Intervention for Paranoia (Successful Treatment of Paranoia; STOP): Protocol for a Mixed Methods Process Evaluation Embedded in a Randomized Controlled Trial.

backgroundParanoia (unfounded concerns that other people are deliberately trying to harm you) can be a distressing experience that impacts day-to-day functioning for many people. Digitally delivered interventions are a promising mode of treatment that can increase access to support and reach populations underserved by current provision. One such intervention is the Successful Treatment of Paranoia (STOP) intervention, which is a transdiagnostic self-administered smartphone app for paranoia that was evaluated in England for efficacy in a large, multisite randomized controlled trial. Although there is growing evidence regarding how STOP may work, little is known about the factors that influence its implementation during or after a trial. Understanding these factors is critical for supporting the future adoption of STOP and may inform the implementation of other digital mental health interventions.

objectiveThis paper aims to describe the protocol for a process evaluation that will explore intervention implementation to understand how much, by whom, and under what circumstances STOP was used in a trial context and what factors might influence future implementation in routine practice.

methodsWe will conduct a mixed methods process evaluation informed by guidance published by the Medical Research Council in the United Kingdom and embedded in the main STOP efficacy randomized controlled trial, with the aim of understanding who agreed to try STOP, how they used STOP, and users' and health care professionals' views on factors that will affect future implementation, including barriers and facilitators. Process evaluation participants will include three samples: (1) STOP trial participants (randomized participants and nonrandomized referrals who agreed to try STOP), (2) individuals experiencing paranoia who participated in the Adult Psychiatric Morbidity Survey in England, and (3) health care professionals in England. We will use mixed methods data collected in the STOP trial (demographics, app use, recruitment data, and qualitative data exploring intervention acceptability from the perspectives of users and health care professionals) and demographic data from another paranoia population collected in the Adult Psychiatric Morbidity Survey.

resultsThe STOP trial was completed in December 2024, having recruited 274 participants. The process evaluation received funding in winter 2023. As of December 2025, data analysis for process evaluation studies 2 and 3 is ongoing following preregistration in July 2025. Results are expected to be completed and submitted for publication by February 2027.

conclusionsFindings from this process evaluation will help develop an evidence-based understanding of implementing STOP, including identifying suitable implementation strategies for posttrial delivery both inside and outside mental health services. Our findings will inform future iterations and the upscaling of STOP and may inform implementation of other self-administered digital mental health interventions.

trial registrationInternational Standard Registered Clinical/Social Study Number ISRCTN17754650; https://www.isrctn.com/ISRCTN17754650. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/81167.