Psychotherapy for Psychosis, Adverse Events, and Substance Misuse

Nova Scotia Health Authority (NSHA)

Status: Completed

Conditions: Psychotic Disorders; Substance Use; Stress Disorders, Traumatic

Treatments: Other: Treatment as usual (TAU); Behavioral: Prolonged exposure (PE)+ therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT04546178

REB1025608

Details and patient eligibility

About

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.

Enrollment: 19 patients

Sex: All

Ages: 19 to 35 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Current patient at the Nova Scotia Early Psychosis Program (NSEPP) for the duration of the study
• Aged 19-35 years
• Diagnosis of a primary psychotic disorder (i.e., schizotypal disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, other specified schizophrenia spectrum and other psychotic disorder, unspecified schizophrenia spectrum and other psychotic disorder)
• Diagnosis of a primary psychotic disorder within the past 5 years; participants must not surpass this 5-year diagnostic window whilst enrolled in the study
• Have experienced 1 or more negative, distressing lifetime adverse events (e.g., child abuse, discrimination) listed on the Trauma and Life Events (TALE) checklist that the participant indicates still affects them now
• At least one score within the "moderate" or "high" risk range for any substance (except tobacco products) on the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
• Speaks and understands English

Exclusion criteria

• Aged 36 and older
• Aged 18 and younger
• Score in the 'high risk' range for cocaine use on the ASSIST
• Participant does not speak or understand English
• Current involuntary inpatient admission in a hospital or under a Community Treatment Order
• Documented, diagnosed intellectual disability (ID)
• Not currently participating in any intervention designed to reduce substance use or treat symptoms related to adverse events (e.g., PTSD)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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19 participants in 2 patient groups

PE+ intervention group

Experimental group

Description:

This group will participate in 15 sessions of PE+ therapy and participate in frequent symptom assessments; this is the same group of participants as the pre-intervention scores group, but they have crossed over from pre-intervention phase into intervention (active) phase.

Treatment:

Behavioral: Prolonged exposure (PE)+ therapy

Other: Treatment as usual (TAU)

Pre-intervention scores group (TAU)

Active Comparator group

Description:

This group will participate in symptom assessments but will not receive the PE+ intervention until the begin the active part of the trial. Participants in this group have been diagnosed with a psychotic disorder, have also experienced adversity, and use substances. This group will receive medication for psychosis as well as access to standard education programs and clinical care; thus treatment as usual (TAU).

Treatment:

Other: Treatment as usual (TAU)