Cognitive Training vs. Treatment as Usual to Improve Functioning and Reduce Transition Rates in Tunisian CHR Youth: A Feasibility Study

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Brief Description / Abstract: This study will use standardized and well-established approaches that have been culturally adapted for early detection, identification, assessment, and treatment of Clinical High Risk (CHR) youth in Tunisia, a low- and middle-income country (LMIC) in North Africa. Being at CHR means that these are young people are at greater risk than the general population for developing psychosis, a serious mental illness (SMI). This study proposes to use an active, educational, community outreach approach to reduce both stigma and increase community awareness about the availability and importance of mental health services aimed at early intervention. This approach will aid in the identification of individuals at CHR who can receive study related treatment services. Assessment of the CHR state will be performed by a clinical team trained to high levels of accuracy on assessment tools that were used successfully in high income countries and have been culturally adapted and found to be feasible for use in LMIC such as Tunisia. Once identified, these young Tunisian individuals will be provided with a non-stigmatizing treatment that is an evidence-based practice (EBP) used in high income countries in the delivery of mental health care. The intervention will consist of computer-based cognitive training which is youth friendly and has been adapted culturally for use with Tunisian youth. This form of cognitive training has been shown to improve cognitive functioning and reduce key symptoms related to impaired functioning. The treatment will be provided in the type of rehabilitation setting which has been shown to increase the likelihood of success. Motivational factors that increase the likelihood of participation will be identified and strengthened. Engaging and improving cognitive performance and daily functioning is the proposed mechanism of action for reducing the rate of conversion to more severe mental illness in these at risk youth. The goal is to reduce the risk of progression to more serious mental illness by improving school, work, and social functioning. These improvements in functioning are aimed at reducing the high level of distress that is invariably experienced by individuals who suffer from difficulties in functioning. In this way, reducing stress and improving cognitive functioning is hypothesized to improve daily functioning and decrease the downward trajectory toward serious mental illness. Reliable and valid measurements that will be repeated over time will be used to evaluate the impact and success of this innovative use of treatment. This study involves strengthening an ongoing collaboration between the Principal Investigator who is a UCLA Research Psychologist and member of the UCLA Department of Psychiatry faculty and professors from the University of Tunis, El Manar who are published researchers and experienced clinicians. The development of this model CHR program in Tunisia that is being proposed will be manualized and disseminated to other Middle East North African (MENA) countries to encourage the use of similar assessment and treatment programs for CHR youth.