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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要/摘要精神病通常在青少年或成年初出现，这在社会和认知发展，因此可能对个人的长期产生深远的不利影响功能。精神病的发作之前是临床高风险（CHR）阶段，其特征是减弱的精神病症状和功能下降。 CHR计划具有减少的巨大潜力疾病的长期严重程度以及与之相关的苦难和成本。 CHR的青年通常也有环境和个人级别的障碍，访问和参与服务，包括污名，死亡受过训练的提供者，诊所的位置和运输问题，可疑性以及社交分离的趋势。通过远程医疗干预措施减少其中一些障碍可以改善治疗可及性和参与，从而改善临床结果。有很大需要评估的可行性不同的CHR干预措施以确定哪种可能是最有前途的以及为谁提供的。还有一个非常需要系统地研究远程交付方法，以增加对关键的访问 Chr的服务。我们已经建立了一个全面的团体和基于家庭的认知行为 Chr的青年治疗（GF-CBT）计划。 GF-CBT旨在促进社会心理恢复，减少症状，并防止或延迟过渡到Chr的青年的精神病。 GF-CBT基于社会文化生态系统理论，社会心理弹性模型以及有关信息处理的研究妄想。 GF-CBT已作为SAMHSA资助的CHR Services在密苏里州的CHR Services的一部分实施和特拉华州，已改编成远程医疗（GF-CBT-TH）。这项研究将评估 GF-CBT-Th的可行性和可接受性，并收集有关GF-CBT-TH的初步效率的数据与通过Telehealth（I-CBT-Th）交付的CHR的单个CBT相比。 14岁和岁月之间的受试者 25符合SIPS（n = 60）的CHR标准的25名，他们的家人将被随机分配接受GF-CBT- TH或I-CBT-TH-TH-15周。数据将在基线，治疗后和3个月收集后续。 GF-CBT-TH的可行性将通过招聘率，会议出勤率，辍学率，和受试者对干预措施的满意。将在两者中评估以下干预目标小组：认知偏见，社会联系，家庭情感氛围以及家庭成员在CBT中的熟练程度以及治疗后和随访时的沟通技巧。 GF-CBT-TH和I-CBT组将是比较以下领域：心理社会功能，症状严重程度，从 CHR和过渡到精神病的速度。我们还将探讨是否患者治疗偏好（对于GF- cbt-th与i-cbt-th），家庭情感气氛和社会人口统计学因素将有所不同治疗结果。将对患者，家庭和临床医生进行深入的定性访谈告知传播GF-CBT-TH-并根据需要对实施手册进行改编。