Psychotherapy for Psychosis, Adverse Events, and Substance Misuse
Condition: Psychotic Disorders; Stress Disorders, Traumatic; Substance Use
MeSH terms: Substance-Related Disorders; Stress Disorders, Traumatic; Psychotic Disorders
Study type: Interventional

Summary: 
      People with psychosis have significantly higher rates of adversity (e.g., abuse) and
      substance misuse (i.e., problematic drug and alcohol use) than people with other mental
      illnesses. Research has found that adversity and substance use both negatively influence
      recovery from a psychotic disorder. Currently, there are few treatment options for people
      living with psychosis, substance misuse, and adversity-related symptoms (e.g., anxiety,
      depression). This is especially true for young adults who are in the first years of a
      psychotic illness (i.e., early phase psychosis; EPP) who may be in the best position to
      benefit from treatment because they have not been ill for as long as others with more chronic
      psychosis (i.e., >10 years). Research has demonstrated that Prolonged Exposure (PE), a
      psychological therapy that helps improve adversity-related symptoms, may be appropriate for
      people in EPP, although there is limited evidence regarding its adaptation from use in
      chronic psychosis to EPP. The aim of the proposed study is to adapt and optimize PE therapy
      for young adults in EPP. We aim to recruit 20 individuals from the Nova Scotia Early
      Psychosis Program (NSEPP) aged 19-35 who will participate in 15 sessions of adapted PE; we
      will compare their scores before and after treatment on measures of psychotic symptoms,
      amount and frequency of substance use, and adversity-related problems. Our goal is to target
      two factors that may be contributing to and maintaining negative outcomes: avoidance and
      hopelessness. These factors will be addressed by asking participants to face feared reminders
      of adversity and learn new ways to think about adverse experiences and mental health
      problems. The adaptation and application of this evidence-based intervention has the
      potential to create a new treatment avenue for EPP, reducing impairment and distress, and
      improving recovery rates.
    


Intervention name(s): Prolonged exposure (PE)+ therapy; Treatment as usual (TAU)
Intervention type(s): Behavioral; Other
Intervention description(s): The intervention will be adapted prolonged exposure therapy, called PE+ therapy. Participants will receive 15 weekly 90-minute sessions of PE+; these appointments will be divided into five sets of three sessions each: 1) psychoeducation about AEs, SM, and the interplay of both with psychosis; 2) emotion regulation strategies; 3) imaginal exposures, 4) in vivo exposures, and 5) review of treatment and planning for termination and maintenance.; The intervention will be antipsychotics prescribed by clinicians working within the Nova Scotia Early Psychosis Program (NSEPP) as well as case management supplied by their primary nurse. Program participants will have access to educational programs about psychosis, skills/vocational training, as well as familial education and support.
Other intervention name(s): PE+ therapy; Antipsychotics and program access
Intervention MeSH terms: Antipsychotic Agents
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: A single-case experimental design (SCED), specifically, a multiple-baseline design (MBD; Kratochwill et al., 2010) will be used; the MBD temporally staggers intervention start times across participants, thereby creating a control group composed of each individual's pre-intervention scores. Randomization of each participant's treatment start time will be used to increase internal validity and minimize bias (Kratochwill & Levin, 2010). Participants will be randomized using a random sampling/assignment generator (randomizer.org). An MBD is an ideal design for a study focused on the optimization of PE+ and this approach will allow a fine-grained assessment (Lobo et al., 2017) of its effectiveness in EPP. This design can also detect significant changes during each phase of the intervention. In order to meet standards of evidence for SCEDs, this study will include a total of five treatment phases, which exceeds the recommended minimum of three phases (Kratochwill et al., 2010).
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Substance misuse; Schizophrenia spectrum disorders; Adversity; Cognitive Behavioral Therapy (CBT)