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

对有精神病风险的青少年进行基于团体和家庭的认知行为治疗的远程医疗适应

• 批准号: 10574240
• 负责人: Yulia Landa
• 金额: $ 32.47万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-07 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10574240
• 关键词: Address; Adolescence; Aftercare; Age; Attenuated; Caregivers; Climate; Clinic; Clinical; Cognitive; Cognitive Therapy; Communication; Data; Decision Making; Delaware; Delusions; Distress; Dropout; Economics; Ecosystem; Educational process of instructing; Emotional; Family; Family member; Funding; Future; Geographic Locations; Goals; Hallucinations; Health Personnel; Health Services; Health Services Accessibility; Health system; Incidence; Individual; Intervention; Interview; Knowledge; Learning; Location; Manuals; Measures; Mental Health; Methods; Minority; Missouri; Modality; Modeling; New York; Outcome; Patients; Persons; Phase; Population; Provider; Psychoses; Randomized; Randomized, Controlled Trials; Recovery; Research; Services; Severities; Severity of illness; Social Development; Social isolation; Social support; Societies; Stress; Symptoms; Systems Theory; Testing; Training; Transportation; Treatment outcome; Underserved Population; United States Substance Abuse and Mental Health Services Administration; Videoconferencing; Vocation; Youth; acceptability and feasibility; clinical high risk for psychosis; clinical remission; cognitive development; cognitive function; comparative efficacy; cost; design; emerging adult; experience; follow-up; functional decline; functional improvement; geographic disparity; high risk; improved; information processing; pandemic disease; peer; peer support; pilot trial; preference; prevent; programs; psychiatric disability; psychosis risk; psychosocial; psychotic symptoms; psychotic-like experiences; public health relevance; recruit; reduce symptoms; remote delivery; resilience; response; satisfaction; skills; social; social culture; social stigma; sociodemographic factors; symptomatic improvement; telehealth; treatment response

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.

项目总结/摘要 精神病通常出现在青春期后期或成年早期，这是社会和心理健康的重要阶段。 认知发展，因此可能对个人的长期发展产生深远的不利影响。 功能精神病发作之前是临床高风险（HRD）期，其特征在于 减轻精神病症状和功能衰退。可持续发展计划具有巨大的潜力，可以减少 疾病的长期严重性，以及与之相关的痛苦和成本。在美国的年轻人通常也有 获得和参与服务的环境和个人层面的障碍，包括污名化、缺乏 受过训练的提供者，诊所位置和交通问题，可疑性，以及社会孤立倾向。 通过远程保健干预措施减少其中一些障碍可能会改善治疗的可及性， 参与，从而改善临床结果。有必要评估以下方面的可行性： 不同的可持续发展干预措施，以确定哪些可能是最有希望的，对谁来说。还有一个 非常需要系统地研究远程交付方法，以增加获得关键的 为CHR服务。我们已经建立了一个全面的小组和家庭为基础的认知行为 该方案旨在促进心理社会康复，减少 症状，并防止或延迟在CHR青年过渡到精神病。 生态系统理论，心理社会弹性模型，以及信息处理研究， 妄想GF-CBT已作为SAMHSA资助的服务的一部分在纽约，密苏里州， 和特拉华州，并已调整为远程保健提供（GF-CBT-TH）。本研究将评估 GF-CBT-TH的可行性和可接受性，并收集GF-CBT-TH的初步疗效数据 与通过远程医疗提供的个人CBT（I-CBT-TH）相比。年龄在14岁和 25名符合SIPS标准的患者（n=60）及其家人将被随机分配接受GF-CBT- TH或I-CBT-TH治疗15周。将在基线、治疗后和3个月时收集数据 随访将通过招募率、上课出勤率、辍学率、 以及受试者对干预措施的满意度。以下干预目标将在两个阶段进行评估： 群体：认知偏见、社会联系、家庭情感氛围和家庭成员的CBT熟练程度 以及治疗后和随访时的沟通技巧。GF-CBT-TH组和I-CBT-TH组将在 在以下领域进行比较：心理社会功能，症状严重程度， 以及转化为精神病的比率。我们还将探讨患者的治疗偏好（对于GF- CBT-TH与I-CBT-TH），家庭情绪气候和社会人口因素将差异调节 治疗结果。将对患者、家属和临床医生进行深入的定性访谈， 为传播GF-CBT-TH提供信息，并根据需要对执行手册进行调整。