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

项目摘要/摘要 精神病通常出现在青春期晚期或成年期早期，这是社会和 认知发展，因此会对个人的长期健康产生深远的不利影响 功能正常。精神病的发病之前有一个临床高危阶段，特征是 减轻精神病症状和功能衰退。CHR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代价。在CHR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、缺乏 训练有素的提供者，诊所的位置和交通问题，怀疑，以及社会孤立的倾向。 通过远程保健干预减少其中一些障碍可能会改善治疗的可及性和 参与，从而改善临床结果。很有必要评估……的可行性。 不同的CHR干预措施，以确定哪些可能是最有希望的，对谁最有希望。还有一个 非常需要系统地调查远程交付方法，以此作为增加对关键服务的访问的途径 CHR的服务。我们已经建立了一个全面的小组和基于家庭的认知行为 中华儿科青年治疗(GF-CBT)计划。GF-CBT旨在促进心理社会康复，减少 症状，并防止或延迟过渡到精神错乱的青年在中国。GF-CBT植根于社会文化 生态系统理论、心理社会复原力模型及信息加工研究 妄想症。GF-CBT已作为SAMHSA资助的CHR服务的一部分在纽约、密苏里州、 和特拉华州，并已改装为远程医疗交付(GF-CBT-TH)。这项研究将评估 GF-CBT-TH的可行性和可接受性及GF-CBT-TH初步疗效的资料收集 与通过远程医疗(I-CBT-TH)提供的单个CBT相比。受试者年龄在14岁至14岁之间 25名符合SIPs(n=60)CHR标准的患者及其家人将被随机分配接受GF-CBT- TH或I-CBT-TH，为期15周。数据将在基线、治疗后和3个月时收集 后续行动。GF-CBT-TH的可行性将通过招聘率、课程出勤率、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地区进行评估 群体：认知偏差、社会联系、家庭情绪氛围和家庭成员在CBT中的熟练程度 以及在治疗后和随访中的沟通能力。GF-CBT-TH和I-CBT-TH组将是 在以下领域进行比较：心理社会功能、症状严重程度、 CHR，以及向精神病转变的比率。我们还将探讨患者的治疗偏好(对于GF- CBT-TH与I-CBT-TH相比)，家庭情感氛围和社会人口学因素会有不同程度的调节 治疗结果。将与患者、家属和临床医生进行深入的定性访谈，以 通报GF-CBT-TH的传播情况，并根据需要对实施手册进行调整。

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.