Culturally adapted cognitive behavioral therapy for psychosis (CaCBTp): A review of key features of cultural adaptation and considerations for psychologists.

Cognitive behavioral therapy for psychosis is an effective treatment for psychosis. However, psychosis presents differentially according to an individual's cultural context, and it is currently unclear which methods have been used to formulate culturally adapted cognitive behavioral therapy for psychosis (CaCBTp). The current systematic review examines the approaches to CaCBTp that have been evaluated to date and comments on preliminary evidence for the efficacy of CaCBTp. Key features of CaCBTp interventions are discussed in reference to broader cultural adaptations of psychosocial interventions for psychosis and culturally adapted cognitive behavioral therapy for other disorders. Overall, our results identified 12 studies and highlighted five overarching themes of cultural adaptation that clinicians should integrate into the design of future CaCBTp interventions, including family members in treatment, targeting stigma, relying on spiritual leaders, using multifaceted models of mental health, and ensuring adequate language match. The results of this review also highlight the paucity of literature in global CaCBTp interventions, as only 10 studies examining CaCBTp interventions were found. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the Role of Failure and Success Experiences on Task Persistence and Neurocognition in Schizophrenia-Spectrum Disorders.

BACKGROUND: Recent theoretical models suggest that a variety of psychological and contextual factors account for a significant proportion of the observed neurocognitive impairment in schizophrenia-spectrum disorders (SSD). Numerous non-neurocognitive mechanisms of neurocognitive functioning have been proposed that warrant investigation; however, few studies have empirically examined these factors. This cross-over study examined whether the experience of failure or success affects task persistence and neurocognition differentially between individuals with SSD and healthy controls. METHODS: Twenty-nine participants with SSD and 30 healthy controls (Mage = 29.33, SD = 10.72) completed success and failure inductions, psychological questionnaires, an anagram persistence task, and brief neurocognitive testing remotely at two time-points. RESULTS: Both groups demonstrated significantly lower persistence and worse decision-making skills in the failure condition relative to the success condition. Individuals with SSD demonstrated slower processing speed, but this was not affected by prior failure or success. CONCLUSIONS: This study demonstrates that the experience of failure is similarly detrimental to persistence and decision-making in healthy controls and individuals with SSD but does not contribute to processing speed performance. This suggests that higher-order executive functions are more susceptible to manipulation by contextual factors compared to lower-order cognitive functions.

Efficacy of Remotely Delivered Evidence-Based Psychosocial Treatments for Schizophrenia-Spectrum Disorders: A Series of Systematic Reviews and Meta-Analyses.

BACKGROUND: Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely. STUDY DESIGN: The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia. RESULTS: Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective. CONCLUSIONS: Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.

Examining the association of life course neurocognitive ability with real-world functioning in schizophrenia-spectrum disorders.

There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions.

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

Social and role functioning in youth at risk of serious mental illness.

AIM: Functional impairment is common in serious mental illness (SMI). This study assessed social and role functioning in a sample of youth at risk of SMI who met different stages of risk based on a transdiagnostic clinical staging model described by McGorry and colleagues. METHOD: The sample consisted of 243 male and female youths aged 12-26 and included: non-help-seeking youth with risk factors (stage 0; n = 41); youth with mild symptoms (stage 1a; n = 52); youth with attenuated psychiatric syndromes (stage 1b; n = 108); and healthy controls (HCs; n = 42). Social and role functioning were assessed with the Global Functioning: Social and Role scales. RESULTS: Participants in stage 1b (attenuated syndromes) had significantly poorer social and role functioning than stage 0 participants and HCs (P < .001) and poorer social functioning than stage 1a (P < .05). Stage 1a participants had significantly poorer social functioning than HCs (P < .01) and significantly poorer role functioning than stage 0 participants (P < .01). Participants in stages 1a and 1b did not significantly differ from each other in role functioning only. CONCLUSIONS: This study demonstrates that mild to moderate functional impairments are present in young people experiencing subthreshold psychiatric symptoms and distress in the absence of a diagnosable mental illness. Results partially validate the model in that social although not role functioning declines across the stages.

Neurocognitive deficits in a transdiagnostic clinical staging model.

There is a growing literature which suggests that neurocognitive deficits may be markers of susceptibility for serious mental illness development. This study assessed neurocognitive functioning in a sample of youth at risk of serious mental illness across different clinical stages as described by McGorry and colleagues and compared them to healthy controls. The sample was 243 male and female youths aged 12-26 and included: asymptomatic participants with psychiatric risk factors (Stage 0; n = 41); youth with early mood or anxiety symptoms (Stage 1a; n = 52); youth with attenuated psychiatric syndromes (Stages 1b; n = 108); and healthy controls (n = 42). The neurocognitive battery included IQ measures and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery. Participants in Stage 1b had lower scores than healthy controls on the composite score of neurocognitive performance, across all IQ measures, and in the domains of processing speed, working memory, attention and problem solving. They also had lower scores than subjects in Stage 0 across most IQ measures and in the domains of processing speed and working memory. This study increases what is known about neurocognitive performance associated with different stages of serious mental illness development.

Pilot study of cognitive remediation and motivational interviewing in youth at risk of serious mental illness.

AIM: The aim of this pilot project was to determine the recruitment feasibility for a computerized cognitive remediation treatment (CRT) for youth at-risk of serious mental illness (SMI), and treatment adherence following an adjunct treatment of motivational interviewing (MI). METHODS: Twelve youth at-risk of SMI were randomized to receive either CRT or CRT plus MI. CRT was conducted over 10 wk during which time 5 MI sessions were available for the CRT + MI group. RESULTS: The recruitment rate was 55%. The attrition rate from the study was 25% and on average participants completed 33% of the CRT sessions, with no group differences in the number of CRT sessions completed. CONCLUSIONS: Treatment adherence was low. Participants described the CRT as easy and unchallenging. Future recommendations include engaging youth at-risk into CRT programs based on cognitive deficits, measuring intervention satisfaction and offering access to supportive therapies for concerns other than cognition.