3/3-Cognitive Behavioral Social Skills Training for Youth at Risk of Psychosis

描述(申请人提供)：精神分裂症和其他精神障碍是严重的和衰弱的精神疾病，会给患者带来巨大的痛苦，并对我们的医疗保健和法律制度构成重大挑战。前驱症状是精神病发病前的一段时间，此时功能衰退和临床症状逐渐显现。在年轻人中出现临床高危(CHR)综合征与后来发展为精神病的高风险(25%-35%)有关，对于那些不一定继续发展为精神疾病的人，研究表明，大多数人继续具有波动的阈值下症状和较差的社会和角色功能。目前还没有专门的治疗方法来帮助解决这些功能障碍。然而，最近的研究结果表明，在精神分裂症患者中，认知行为和社会技能训练(CBSST)导致的社会功能活动频率比通常治疗或目标为重点的支持性治疗增加的频率要大得多，初步数据表明CBSST是一种可行的CHR治疗方法。这项申请是一项三点纵向研究的竞争性应用，旨在测试CBSST干预的有效性和可行性以及介体和作用机制，该干预将针对与精神病临床风险状态相关的功能困难。研究的目标是：1)检验CBSST与安慰剂干预(心理教育)相比，在群体参与度和治疗师时间上相匹配是否改善了CHR青年的功能；2)确定CBSST中失败主义信念的减少和社会能力的提高是否中介了CBSST中CHR青年的心理社会功能的变化。在这项单盲随机双臂试验中，参与者将被随机分为两组：CBSST，为期18周的小组，由三个模块组成；1)认知技能；2)社交技能；3)解决问题，或不教授主动认知行为治疗或社交技能培训的心理教育支持小组。在五年的时间里，TE多地点合作将跟踪大的CHR样本，这些样本将接受心理社会和行为变化的全面评估，以检查社会和角色功能的变化，以及从基线到治疗结束的症状变化，以及到6个月的随访。这种方法将证明一种治疗的可行性，这种治疗很容易培训治疗师，并且可以很容易地传播到常规的临床社区实践中。此外，它还将为阻止或减轻病理性疾病的可能方法提供见解。 处理和增进我们对风险预测的理解；这两个步骤都是预防的关键步骤。

DESCRIPTION (provided by applicant): Schizophrenia and other psychotic disorders are serious and debilitating mental illnesses that incur substantial suffering for patients and major challenges to our health care and legal systems. The prodrome is the period prior to onset of psychosis when functional decline and clinical symptoms gradually emerge. The presence of a clinical high-risk (CHR) syndrome in young adults is associated with heightened risk (25-35%) for the later development of psychosis, and for those who do not necessarily go on to develop a psychotic illness, research has suggested that the majority continue to have fluctuating subthreshold symptoms and poor social and role functioning. There are no specific treatments to help with these functional difficulties. However, recent findings suggest that in people with schizophrenia, Cognitive Behavioral and Social Skills Training (CBSST) leads to significantly greater increase in the frequency of social functioning activities compared to treatment as usual or goal- focused supportive therapy, and preliminary data suggest CBSST is a feasible treatment for CHR. This application is a competitive application for a three-site, longitudinal study aimed at testing the effectiveness and feasibility as well as mediators and mechanisms of action of a manualized CBSST intervention that will target functional difficulties associated with clinical risk states for psychosis. The goals are 1) to examine whether CBSST compared to a placebo intervention (psychoeducation) matched for group involvement and therapist time improves functioning in youth at CHR and 2) to determine whether reduction in defeatist beliefs and improvement in social competence mediate change in psychosocial functioning in CHR youth in the CBSST. In this single-blind randomized 2-arm trial participants will be randomized to one of two treatments: CBSST, an 18-week group comprised of three modules; 1) Cognitive Skills; 2) Social Skills; and 3) Problem Solving, or a psychoeducation support group that does not teach active cognitive behavioral therapy or social skills training. Over a five-year period, te multi-site collaboration will follow large CHR sample that will undergo comprehensive assessments of psychosocial and behavioral changes, to examine changes in social and role functioning, as well as symptom changes from baseline to the end of treatment, and to 6 month follow-up. This approach will demonstrate the feasibility of a treatment for which it is easy to train therapists and which can readily be disseminated to regular clinical community practice. In addition, it will provide insights into likely approaches to halting or mitigating the pathological process and advance our understanding of risk prediction; both critical steps in prevention.