Telehealth Adaptation of Group and Family-Based Cognitive Behavioral Therapy for Youth at Risk for Psychosis

PROJECT SUMMARY/ ABSTRACT Psychosis typically emerges in late adolescence or early adulthood, which is a vital stage in social and cognitive development, and can therefore have a profoundly adverse impact on an individual’s long-term functioning. The onset of psychosis is preceded by a clinical high risk (CHR) phase characterized by attenuated psychotic symptoms and functional decline. CHR programs have enormous potential to reduce the long-term severity of the illness, and the suffering and cost associated with it. Youth at CHR also typically have environmental and individual-level barriers to accessing and engaging in services, including stigma, a dearth of trained providers, clinic location and transportation issues, suspiciousness, and a tendency to socially isolate. Reducing some of these barriers via telehealth interventions may improve treatment accessibility and engagement, thereby improving clinical outcomes. There is a substantial need to evaluate the feasibility of different CHR interventions to determine which may be most promising and for whom. There is also a significant need to systematically investigate remote delivery methods as a way of increasing access to critical services for CHR. We have established a comprehensive Group and Family-Based Cognitive Behavioral Therapy (GF-CBT) program for youth at CHR. GF-CBT aims to facilitate psychosocial recovery, decrease symptoms, and prevent or delay transition to psychosis in youth at CHR. GF-CBT is grounded in sociocultural ecological systems theory, psychosocial resilience models, and research on information processing in delusions. GF-CBT has been implemented as part of SAMHSA funded CHR services in New York, Missouri, and Delaware and has been adapted for telehealth delivery (GF-CBT-TH). This study will evaluate the feasibility and acceptability of GF-CBT-TH and gather data on the preliminary efficacy of GF-CBT-TH compared to individual CBT for CHR delivered via telehealth (I-CBT-TH). Subjects between the ages of 14 and 25 who meet CHR criteria on the SIPS (n=60) and their families will be randomly assigned to receive GF-CBT- TH or I-CBT-TH for a period of 15 weeks. Data will be collected at baseline, post-treatment, and 3-month follow-up. Feasibility of GF-CBT-TH will be measured by recruitment rate, session attendance, dropout rate, and subjects’ satisfaction with the interventions. The following intervention targets will be assessed in both groups: cognitive biases, social connectedness, family emotional climate, and family members’ proficiency in CBT and communication skills at post-treatment and follow-up. The GF-CBT-TH and I-CBT-TH groups will be compared across the following domains: psychosocial functioning, symptom severity, rates of remission from CHR, and rates of transition to psychosis. We will also explore whether patient treatment preference (for GF- CBT-TH vs. I-CBT-TH), family emotional climate and sociodemographic factors will differentially moderate treatment outcomes. In depth qualitative interviews will be conducted with patients, families, and clinicians to inform dissemination of GF-CBT-TH and make adaptations to the implementation manuals as needed.