10 years of CBT at PEPP-Montréal: A service level perspective

Transcription

1 10 years of CBT at PEPP-Montréal: A service level perspective Martin Lepage PhD Douglas Mental Health University Institute Department of Psychiatry McGill University April, 2014

2 PEPP-Montréal Program for the Early Detection and Prevention of Psychosis (PEPP-Montréal) : For people years who have untreated psychosis Provide optimal pharmacological and psychosocial interventions. Research and teaching activities are integrated to clinical activities.

3 CBT at PEPP Montréal Three key questions Is CBTp effective in helping young people with treatment resistant psychotic symptoms? Can we identify clients who are likely to benefit from CBT? Should CBT be limited to positive and negative symptoms?

4 Cognitive-Behavioral Therapy for the treatment of social anxiety : Developing a Novel Group Intervention for people with a first episode psychosis

5 Prevalence of social anxiety in the general population and in people with a psychotic disorder General Population First Episode Psychosis Schizophrenia Bipolar Disorders Pallenti et al., (2004); Freeman et al., (2002); Michail & Birchwood (2011)

6 What are the current limitations? Current intervention programs are: Too brief Do not target dysfunctional beliefs about the self (Stigma) Little emphasis is placed on social skills Birchwood (2007); Gumley et al., (2004)

7 Methods - Participants 29 participants (Age mean 22.4; range 16-31) PEPP Program, Douglas Institute FEPP Program, Jewish General Hospital Inclusion Criteria: Presence of Social Anxiety Disorder (meeting DSM- IV criteria) Clinically stable Level of Education > 8 years

8 Outcome measures Assessment of Social Anxiety Symptoms Social Interaction Anxiety Scale - SIAS (self report) Social Phobia Inventory - SPIN (self-report) Brief Social Phobia Scale - BSPS (clinician rated) SCID-I (Social Phobia Subscale) Assessment of Psychosis-related symptoms SAPS SANS Other Assessments The Calgary Depression Scale Schizophrenia Internalized Stigma of Mental Illness Scale ISMIS Indiana Psychiatric Interview - IPII

9 Design of the study T1: Baseline (prior to the onset of group therapy); T2: Post-treatment (within two weeks of having completed the intervention); T3: Follow-up (3-6 months following post-treatment). Start 14 Week group therapy End T1 T2 T3 Clinical assessment

10 Structure of the intervention 14 weeks / 1.5 hours weekly Week 1: Introduction Week 2: Psychoeducation on Social Anxiety Week 3: Psychoeducation on Stress Week 4: Psychoeducation on Psychosis / Stigma Week 5: Introduction to Cognitive Distorsions Week 6: Cognitive Restructuring Week 7: Social Skills Training Part I Week 8: Social Skills Training Part II Week 9: Exposure Part I Week 10: Exposure Part II Week 11: Exposure Part III Week 12: Relapse Prevention Week 13: Maintaining Gains Week 14: Social Activity

11 Pre-post comparison for social anxiety symptoms Pre Post * * * SIAS SPIN BSPS At the end of the 14-week group intervention there was a significant reduction in the severity of social anxiety symptoms

12 CBT at PEPP Montréal Three tentative answers Is CBTp effective in helping young people with treatment resistant psychotic symptoms? Yes! Can we identify clients who are likely to benefit from CBT? Still a difficult question to answer. Some problems/goals are more amenable to CBT than others Should CBT be limited to positive and negative symptoms? No! Following a first episode of psychosis, CBT is particularly useful for problems with mood and anxiety disorders and for low self-esteem