Pilot RCT of Self-stigma Treatment for First Episode Psychosis

John Jay College of Criminal Justice, City University of New York40 enrolled

Overview

The overall purpose of the proposed exploratory intervention development application, is to conduct research that will inform the adaptation and preliminary testing of NECT modified for youth (aged 15-24) with first episode psychosis (FEP), targeting self-concept and illness conceptions to increase treatment engagement. The specific aims of the project are to: 1) adapt NECT to be responsive to the needs and preferences of youth with FEP, and 2) Assess the feasibility, acceptability and preliminary effectiveness of the modified intervention (NECT-YA) combined with coordinated specialty care (CSC) services, compared to CSC services alone, in a small (n = 40) RCT.

The investigators will conduct a small RCT of the modified intervention (NECT-YA), combined with CSC, in comparison with CSC alone, with 40 persons recruited from three FEP programs, assessing acceptability and feasibility, and collecting data on primary outcome (service engagement and therapeutic alliance), related outcomes (self-esteem, hopelessness, and social functioning) and mechanisms of action (self-stigma, illness conceptions and coping). The investigators will also collect qualitative data on participants' impressions of NECT-YA, which will inform additional revisions of the manual.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

First Episode Psychosis

Interventions

Narrative Enhancement and Cognitive Therapy- Young Adult, Combined with Coordinated Specialty CareBEHAVIORAL

NECT is a psychosocial intervention focused on addressing the effects of self-stigma on individuals diagnosed with severe mental illnesses. For the present study, the intervention has been modified to address the needs of youth who have recently experienced a first episode of psychosis.

Coordinated Specialty CareOTHER

Coordinated Specialty Care is an evidence-based, multimodal intervention for persons who have experienced a first episode of psychosis.

Eligibility

Sex: ALLMin age: 15 YearsMax age: 24 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Meets criteria for FEP youth based on the following definition: age 15-24, onset of psychotic symptoms within the last 5 years, and an absence of a primary substance use or mood disorder that could be causing the psychotic symptoms (confirmed by program eligibility); 2. Meets criteria for moderate (defined as a mean score of 1-1.5 on the 0-3 scale of the Internalized Stigma of Mental lllness Scale \[ISMI\]) or elevated (defined as a mean score of 1.5-3 on the 0-3 scale of the ISMI) self-stigma; 3. Speaks English well enough to complete assessments and participate in groups; 4. Is able to provide informed consent to participate. Exclusion Criteria: Does not meet any of the above inclusion criteria.

Outcomes

Primary Outcomes

Treatment Engagement

Quantity of service use will be measured using attendance records for groups collected by facilitators, as well as administrative data on total service use within the FEP programs.

Time frame: 0 minutes

Working Alliance Inventory Short Form-Client Version

A 12-item self-report measure of perception of relationship with the treatment team. Higher scores indicate better working alliance.

Time frame: 2 minutes

Coping with Symptoms Checklist

Assesses the use of problem-centered, neutral and avoidant coping strategies to deal with a variety of psychiatric symptoms commonly experienced by people with severe mental illnesses. Higher scores in each subscale indicate more use of that type of coping strategy.

Time frame: 15 minutes

Secondary Outcomes

Beck Hopelessness Scale

The Beck Hopelessness Scale is a well-established 20-item scale that will be used to measure pessimistic expectations of the future. Individual items are summed to provide an overall index of hope or its absence. Higher scores indicate less hope.

Time frame: 3 minutes

Rosenberg Self Esteem Scale

The Rosenberg Self Esteem Schedule will be used to measure self-esteem and self-deprecation. Higher scores indicate more self-esteem.

Time frame: 2 minutes

Quality of Life Scale

The Quality of Life Scale is a 21-item scale completed by clinically trained research staff following a semi-structured interview that assesses social functioning in multiple domains. Higher scores indicate great social functioning.

Time frame: 20 minutes