HOPE TEAM - Clinical High Risk Group CBSST
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 13 - 19 |
| Updated: | 3/7/2019 |
| Start Date: | March 15, 2019 |
| End Date: | December 1, 2019 |
Help Overcoming Prodromal Experiences Through Early Assessment & Management - Clinical High Risk Group CBSST
Community-based treatments for adolescents at risk for psychosis are not widely available,
nor are there established, gold-standard psychosocial group interventions for this
population. The HOPE TEAM, Helping Overcome Prodromal Experiences through Treatment and
Evaluation of Adolescent Minds (PI: Bachman; funded by The Pittsburgh Foundation) is an early
detection and intervention program for youth at clinical high risk for psychosis which aims
to help them by engaging existing community resources, providing assessment, and offering
trauma-informed psychotherapy. Embedded within the Family Care Connection Center at Turtle
Creek, the HOPE TEAM offers individual psychotherapy as part of its clinical service model.
The present study seeks to evaluate, in a small and preliminary sample (n = 20), the
feasibility and effectiveness of a 24-week Cognitive-Behavioral Social Skills Therapy (CBSST)
group intervention for CHR adolescents who are part of the HOPE TEAM. To that end, the
current proposal will seek to conduct brief research assessments to assess the group members'
perceptions of the group's utility, as well as their current clinical symptoms and
functioning prior to, during, and after participating in this group. The goals of this pilot
project are to 1) identify which aspects of the group perceived to be most and least helpful
by participating adolescents, and 2) evaluate whether participation in the group meaningfully
improves participants' clinical symptoms and functioning. The investigators aim to use these
pilot data to guide future selection of treatment targets in this clinical practice, and to
identify future strategies for increasing satisfaction and retention in community-based group
interventions for CHR adolescents.
nor are there established, gold-standard psychosocial group interventions for this
population. The HOPE TEAM, Helping Overcome Prodromal Experiences through Treatment and
Evaluation of Adolescent Minds (PI: Bachman; funded by The Pittsburgh Foundation) is an early
detection and intervention program for youth at clinical high risk for psychosis which aims
to help them by engaging existing community resources, providing assessment, and offering
trauma-informed psychotherapy. Embedded within the Family Care Connection Center at Turtle
Creek, the HOPE TEAM offers individual psychotherapy as part of its clinical service model.
The present study seeks to evaluate, in a small and preliminary sample (n = 20), the
feasibility and effectiveness of a 24-week Cognitive-Behavioral Social Skills Therapy (CBSST)
group intervention for CHR adolescents who are part of the HOPE TEAM. To that end, the
current proposal will seek to conduct brief research assessments to assess the group members'
perceptions of the group's utility, as well as their current clinical symptoms and
functioning prior to, during, and after participating in this group. The goals of this pilot
project are to 1) identify which aspects of the group perceived to be most and least helpful
by participating adolescents, and 2) evaluate whether participation in the group meaningfully
improves participants' clinical symptoms and functioning. The investigators aim to use these
pilot data to guide future selection of treatment targets in this clinical practice, and to
identify future strategies for increasing satisfaction and retention in community-based group
interventions for CHR adolescents.
Accumulating evidence suggests that psychotherapy, particularly CBT (Cognitive-Behavior
Therapy) may effectively lower clinical high risk (CHR) youths' risk of developing psychosis.
This is consistent with converging evidence that CBT, in both individual and group delivery
formats, is effective for reducing positive symptoms of psychosis in those with a diagnosis
of schizophrenia. Social Skills Training (SST) for psychosis may be more beneficial for
treating negative symptoms and social impairment that accompany schizophrenia.
Given these findings, a group therapy modality combining CBT and SST (CBSST) has been
developed with the goal of addressing multiple domains of symptoms and impairments; outcomes
of randomized clinical trials have shown that individuals with schizophrenia who received
CBSST had improved functioning and less severe psychotic symptoms.4 Furthermore, CBSST is
also feasible and well accepted for adolescents and young adults with a first episode of
psychosis. However, there are no established, gold-standard psychosocial group interventions
for CHR youth, nor have studies specifically investigated the efficacy of CBSST for this
population. Since CBSST is effective in adult psychosis, a modified version of this group
treatment modality may be useful for CHR adolescents. Given the high levels of victimization,
adversity, and stress in community CHR samples, modifications to CBSST for CHR youth should
explicitly include a focus on stress coping.
Any clients ages 13-19 already enrolled in HOPE TEAM assessment will be informed about the
availability of the HOPE Group by their individual clinician. If interested, potential
participants (and their parents, if under age 18) will meet with study PI and Group Leader,
to discuss the study and complete the informed consent process. As part of this process,
adolescents (and their parents if under 18) will be made aware that their choice to
participate or not in the HOPE Group will not affect any other services proved through the
HOPE TEAM. Once a minimum of 4 participants are recruited for the HOPE group, the first
session will be scheduled.
Group therapy will occur once weekly (60-90-minute sessions) at the HOPE TEAM offices for 24
weeks. The group sessions with consist of 4 skill modules, each of which last 6 sessions.
Three of these--the Cognitive, Social Skills, and Problem-Solving Modules—will be modules
taken from Cognitive and Behavioral Social Skills Training (CBSST) and modified for use with
CHR adolescents. The fourth module—Stress Coping—will be adapted for this sample from an
established group CBT treatment for psychosis.
Within 2 weeks of the first group session, participants will complete a very brief (25-40
minute) pre-group assessment battery in the HOPE Team offices with the PI, consisting of the:
- Youth Inventory 4-Self-Report (YSI-4; ages 14-17) or Adult Self-Report Inventory-4
(ASI-4; ages 18) are 128-item measures that takes approximately 10-15 minutes to
complete. Assesses clinical symptoms, compared to a normed sample, across disruptive,
mood, anxiety, and other clinical disorders.
- Prodromal Questionnaire, Brief Version (PQ-B); a 21- item dimensional self-report
measure of psychotic symptoms, which takes approximately 5-10 minutes to complete.
- Defeatist Performance Attitudes Test, a 15-item questionnaire assessing dysfunctional
attitudes commonly targeted by CBT therapy. This measure takes approximately 5 minutes
to complete.
- HOPE Group Pre-Survey: A 5-item survey assessing open-ended thoughts about joining a
group; takes approximately 5-10 minutes.
To allow for flexibility in the community treatment setting, the HOPE Group will adopt a
modular rolling admissions approach to enrollment, in which new group members (up to a
maximum group membership of 10) can be enrolled at the start of each module (every 6
sessions). In this case, the pre-group assessment battery will be completed with the
participant within 2 weeks of their first group.
Each session will consist of collaborative agenda-setting, review of at-home practice,
introduction of a new skill, skill practice, and assigning in-home practice/ summarizing the
session. The end of each 60-90-minute group session will consist of 5 minutes of assessment.
Group members will complete the:
- Modified QuickLL, a 14-item measure assessing how participants currently view themselves
and their engagement in that day's group session. Each item is rated on a 3-point scale
and the measure is totaled, with higher totals indicating better self-perception and
greater engagement in the group. This measure takes approximately 2 minutes to complete.
- Simultaneously, both group leaders will complete the Participation Scale, a 9-item
checklist assessing the participation and behavior of each group member, with each item
rated from 0 (absence of behavior) to 4 (strong presence of behavior). A total score is
computed for each participant, as well as an average for all group members, with higher
scores indicated more group engagement and prosocial behaviors.
Within two weeks after completion of the 24-week Group, participants will complete a very
brief (25-40 minute) post-group assessment battery in the HOPE Team offices with the PI,
consisting of the:
- Youth Inventory 4-Self-Report, or Adult Self-Report Inventory-4
- Prodromal Questionnaire, Brief Version
- Defeatist Performance Attitudes test
- HOPE Group Post-Survey: A 5-item survey assessing open-ended thoughts about experiences
in a group; takes approximately 5-10 minutes.
Therapy) may effectively lower clinical high risk (CHR) youths' risk of developing psychosis.
This is consistent with converging evidence that CBT, in both individual and group delivery
formats, is effective for reducing positive symptoms of psychosis in those with a diagnosis
of schizophrenia. Social Skills Training (SST) for psychosis may be more beneficial for
treating negative symptoms and social impairment that accompany schizophrenia.
Given these findings, a group therapy modality combining CBT and SST (CBSST) has been
developed with the goal of addressing multiple domains of symptoms and impairments; outcomes
of randomized clinical trials have shown that individuals with schizophrenia who received
CBSST had improved functioning and less severe psychotic symptoms.4 Furthermore, CBSST is
also feasible and well accepted for adolescents and young adults with a first episode of
psychosis. However, there are no established, gold-standard psychosocial group interventions
for CHR youth, nor have studies specifically investigated the efficacy of CBSST for this
population. Since CBSST is effective in adult psychosis, a modified version of this group
treatment modality may be useful for CHR adolescents. Given the high levels of victimization,
adversity, and stress in community CHR samples, modifications to CBSST for CHR youth should
explicitly include a focus on stress coping.
Any clients ages 13-19 already enrolled in HOPE TEAM assessment will be informed about the
availability of the HOPE Group by their individual clinician. If interested, potential
participants (and their parents, if under age 18) will meet with study PI and Group Leader,
to discuss the study and complete the informed consent process. As part of this process,
adolescents (and their parents if under 18) will be made aware that their choice to
participate or not in the HOPE Group will not affect any other services proved through the
HOPE TEAM. Once a minimum of 4 participants are recruited for the HOPE group, the first
session will be scheduled.
Group therapy will occur once weekly (60-90-minute sessions) at the HOPE TEAM offices for 24
weeks. The group sessions with consist of 4 skill modules, each of which last 6 sessions.
Three of these--the Cognitive, Social Skills, and Problem-Solving Modules—will be modules
taken from Cognitive and Behavioral Social Skills Training (CBSST) and modified for use with
CHR adolescents. The fourth module—Stress Coping—will be adapted for this sample from an
established group CBT treatment for psychosis.
Within 2 weeks of the first group session, participants will complete a very brief (25-40
minute) pre-group assessment battery in the HOPE Team offices with the PI, consisting of the:
- Youth Inventory 4-Self-Report (YSI-4; ages 14-17) or Adult Self-Report Inventory-4
(ASI-4; ages 18) are 128-item measures that takes approximately 10-15 minutes to
complete. Assesses clinical symptoms, compared to a normed sample, across disruptive,
mood, anxiety, and other clinical disorders.
- Prodromal Questionnaire, Brief Version (PQ-B); a 21- item dimensional self-report
measure of psychotic symptoms, which takes approximately 5-10 minutes to complete.
- Defeatist Performance Attitudes Test, a 15-item questionnaire assessing dysfunctional
attitudes commonly targeted by CBT therapy. This measure takes approximately 5 minutes
to complete.
- HOPE Group Pre-Survey: A 5-item survey assessing open-ended thoughts about joining a
group; takes approximately 5-10 minutes.
To allow for flexibility in the community treatment setting, the HOPE Group will adopt a
modular rolling admissions approach to enrollment, in which new group members (up to a
maximum group membership of 10) can be enrolled at the start of each module (every 6
sessions). In this case, the pre-group assessment battery will be completed with the
participant within 2 weeks of their first group.
Each session will consist of collaborative agenda-setting, review of at-home practice,
introduction of a new skill, skill practice, and assigning in-home practice/ summarizing the
session. The end of each 60-90-minute group session will consist of 5 minutes of assessment.
Group members will complete the:
- Modified QuickLL, a 14-item measure assessing how participants currently view themselves
and their engagement in that day's group session. Each item is rated on a 3-point scale
and the measure is totaled, with higher totals indicating better self-perception and
greater engagement in the group. This measure takes approximately 2 minutes to complete.
- Simultaneously, both group leaders will complete the Participation Scale, a 9-item
checklist assessing the participation and behavior of each group member, with each item
rated from 0 (absence of behavior) to 4 (strong presence of behavior). A total score is
computed for each participant, as well as an average for all group members, with higher
scores indicated more group engagement and prosocial behaviors.
Within two weeks after completion of the 24-week Group, participants will complete a very
brief (25-40 minute) post-group assessment battery in the HOPE Team offices with the PI,
consisting of the:
- Youth Inventory 4-Self-Report, or Adult Self-Report Inventory-4
- Prodromal Questionnaire, Brief Version
- Defeatist Performance Attitudes test
- HOPE Group Post-Survey: A 5-item survey assessing open-ended thoughts about experiences
in a group; takes approximately 5-10 minutes.
Inclusion Criteria:
- Patients may be included if they are 13-19 years old and receiving individual therapy
or professional assessment/clinical evaluation as part of the HOPE TEAM.
- Due to the nature of the definition of "clinical high risk status," these patients may
have a variety of clinical diagnoses, but all will be receiving individual therapy or
clinical evaluation through the HOPE TEAM due to their elevated risk for developing a
psychotic disorder.
- The individual therapy being provided to patients who are also eligible for HOPE TEAM
Group may also vary based on their individual needs and therapy goals.
Exclusion Criteria:
- HOPE TEAM adolescents may be excluded if they express an unwillingness to participate
in weekly group therapy and abide by group rules.
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