HOPE TEAM - Clinical High Risk Group CBSST

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.