A Culturally-Based Family Therapy for Schizophrenia

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DESCRIPTION (provided by applicant): Schizophrenia, a serious mental disorder marked by cognitive, affective, and socio-occupational dysfunction, affects approximately one percent of the population worldwide. Although clearly a biologically induced disorder, mounting evidence now indicates that the illness is also highly responsive to the sociocultural and emotional atmosphere of the family. Existing therapies have shown an improvement in symptoms following family oriented interventions. However, most programs in the United States are offered only in English and are not culturally informed. Therefore, existing programs fail to meet the needs of many Hispanics, the fastest growing and now largest minority group in the United States. The purpose of this application is to request funds to support the development, implementation, and evaluation of a family-focused, Culturally Informed Therapy for Schizophrenia (CIT-S) conducted in both English and Spanish. This treatment will incorporate elements found to be effective in prior family treatment studies of mental illness, while adding new cultural components hypothesized to enhance treatment efficacy. The intervention will include 15 sessions with emphasis on: Fortifying a strong sense of family unity; educating relatives about the illness; helping participants tap into cultural, spiritual and/or existential beliefs that may aid them in conceptualizing and coming to terms with the illness; and teaching effective communication and problem solving skills to help create a stable and therapeutic home environment. Comprehensive assessments will be conducted prior to treatment, after the 15th session (termination), and at 6-month and 12-month follow-up points (from date of first treatment session) to evaluate participants' emotional and mental health and to assess beliefs, values, and attributions targeted by the intervention. Monthly hospitalization/relapse phone screenings and general "check-ins" will also be conducted. To maintain treatment gains, after completing the 12-month study, participants will be invited to attend weekly drop-in multifamily support groups, where CIT-S skills will be reinforced. In the pilot phase of the study (described in this application), treatment efficacy will be evaluated by comparing CIT-S with a Treatment as Usual (TAU) control condition. In subsequent years, the PI will assess which aspects of the treatment are most closely associated with unproved patient and family functioning. The treatment will then be refined, retaining beneficial elements, and revising or discarding those that do not appear to enhance participant well-being. In subsequent stages a full-scale clinical trial (funded through an RO1 or similar award) will be conducted comparing CIT-S to a traditional family focused therapy that is matched in length. The Pi's long term goal is to develop effective culturally informed family interventions for schizophrenia and related disorders, in Spanish and in English.