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Cognitive Behavioral Social Skills Training for Youth at Risk of Developing Psychosis

Article in Early Intervention in Psychiatry · October 2018

DOI: 10.1111/eip.12724

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Kali Brummitt Skylar Kelsven

The University of Calgary University of California, San Diego
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 Cognitive Behavioral Social Skills Training for Youth at Risk of Psychosis
Kali Brummitt1, Andrea Author2, Skylar Kelsven3, Dan Devoe1, Lauren Stern3, Eric Granholm3, Barbara Cornblatt2, Kristen Cadenhead3,
Jean Addington1
1University of Calgary, 2Zucker Hillside Hospital, 3University of California at San Diego

Introduction CBSST Modules Measures

Youth at clinical high risk (CHR) for psychosis often exhibit significant 1) Cognitive Module: Cognitive behavioral therapy is the main focus
deficits in social and role functioning and poor social functioning may be a Clinical Interview: Self Reports: Functioning:
of this module and CBT techniques are also used throughout the
predictor for later conversion to psychosis. Even in those at CHR who do
not ultimately develop psychosis, a large proportion have persisting Social Skills and Problem Solving Modules.
Structured Interview for Social Interaction Anxiety Global Functioning: Social
functional deficits. Cognitive Behavioral Social Skills Training (CBSST) is a Psychosis Risk Syndromes Scale (SIAS) & Social Anxiety (GF:S) & Role (GF:R)
intervention that may improve functioning and is increasingly being used in (SIPS) Scale (SAS)
psychosis treatment.
Scale of Psychosis Risk Self-Efficacy Scale Premorbid Adjustment
CBSST combines cognitive behavioral therapy (CBT) and social skills training Symptoms (SOPS) Scale (PAS)
(SST) interventions to target functional impairment in people with
psychotic disorders and has been adapted for youth at CHR.
Structured Clinical Defeatist Performance Social Skills Performance
The goal of this study is to compare the effectiveness of CBSST compared to Interview for DSM-V Beliefs (DPAS) & Asocial Assessment (SSPA)
psychoeducation and support, for the improvement of functioning and Beliefs Scale (ABS)
prevention of disability.
Neurocognition: Social Cognition: Treatment Logs:

Method Matrics The Awareness of Social Medication

Inference Test (TASIT)
v One hundred and ninety-five individuals at CHR have been recruited and
randomized to one of two treatment groups (CBSST or psychoeducation)
that run weekly for 18 weeks. 2) Social Skills Training Module: The primary goal of this module is
Wechsler Abbreviated Facial Affect Psychosocial
to improve communication and interpersonal skills (e.g., how to be Scale of Intelligence
v The primary outcome will be changes in social and role functioning. This will an active listener). (WASI-II)
be measured at baseline, end of treatment, and 6 months post treatment as
assessed by global social and role functioning scales.

v Secondary outcomes will include change in prodromal symptoms, Discussion

depression, and anxiety. v Adapting CBSST to fit into community based programs for youth at CHR of
psychosis creates an opportunity to increase the number of youth who
v Participants are randomized and stratified by sex and current antipsychotic could have access to and benefit from CBSST or psychoeducation.
medication use to CBSST or Psychoeducation at 3 sites: The University of
Calgary, Zucker Hillside Hospital (New York), and The University of California v As part of the implementation learning process, training materials and
at San Diego. treatment workbooks have been revised to promote easier use of CBSST in
the environment of brief community based visits.
v Each site will enroll 75 participants for a total of 225 CHR participants.
3) Problem Solving Module: Basic problem solving skills are taught v Additionally, we will identify key elements for developing effective CBSST
using the acronym, SCALE – Specify the problem, Consider all strategies for youth at CHR.

Participant Eligibility
1. Male and female between 12-30 years old
2. Understand and sign informed consent (assent for minors) in English
3. Currently meet or have met in the past four years diagnostic criteria for a
prodromal syndrome as per COPS criteria
4. At least one SOPS attenuated symptom rated 3 and no symptom rated a 6
5. Ratings on the Global Functioning Social or Role Scale must be 7 or less
Analysis
Differences in participant characteristics between groups will be examined
using chi-square analysis (categorical variables), and independent t-test or
Wilcoxon rank sum test for continuous variables.
possible solutions, Assess the best possible solution, Lay out a plan,
and Execute and Evaluate the outcome.
References
1. Addington J, Cornblatt B, Cadenhead K et al. At clinical high risk for
psychosis: outcome for non-converters. American Journal of Psychiatry
2011.
2. Carrion RE, McLaughlin D, Goldberg TE et al. Prediction of functional
outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry
2013;70:1133-1142.
3. Granholm E, Holden J, Link P.C, McQuaid J.R. Randomized controlled trial of
cognitive behavioral social skills training for schizophrenia: improvement in
functioning and experiential negative symptoms. J. Clin. Consult. Psychol.
2014.

Acknowledgements: The National Institute of Mental Health (NIMH) funding provided to Jean Addington (University of Calgary), Kristin Cadenhead (University of California at San Diego), and Barbara Cornblatt (Zucker Hillside Hospital)
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Contact: kali.Brummitt@ucalgary.ca