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
different CHR interventions to determine which are most effective. There is also a
significant need to systematically investigate remote delivery methods as a way of
increasing access to critical services for CHR. The research team have established Group
and Family-Based Cognitive Behavioral Therapy (GF-CBT) program in order 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.
The research team have also established Family-Based CBT (F-CBT), in which youth and
families learn CBT skills as a family unit, rather than in groups. The research team have
adapted GF-CBT, F-CBT and individual CBT for telehealth delivery (GF-CBT-TH, F-CBT-TH and
I-CBT-TH). This study will investigate the feasibility of implementing these telehealth
interventions in the context of routine CHR services, evaluate the impact of the
interventions on engaging target mechanisms hypothesized to underlie their effects, and
conduct a preliminary evaluation of their comparative efficacy. Subjects between the ages
of 14 and 25 who meet CHR criteria on the SIPS (n=72) and their families will be randomly
assigned to receive GF-CBT-TH, F-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 will be
measured by recruitment rate, attendance, and retention. The following intervention
targets will be assessed: cognitive biases, social connectedness, family emotional
climate, and family members' proficiency in CBT skills. The three groups will be compared
across the following domains: psychosocial functioning, symptom severity, rates of
remission from CHR, and rates of transition to psychosis. The research team will also
explore whether patient treatment preference, family emotional climate and
sociodemographic factors differentially moderate treatment outcomes. Qualitative
interviews will be conducted with patients, families, and clinicians to inform
dissemination and make adaptations to the implementation manuals.