A randomized trial of family focused therapy with populations at clinical high risk for psychosis: Effects on interactional behavior.

Abstract

Objective This study investigated whether family focused therapy (FFT-CHR), an 18-session intervention that consisted of psychoeducation and training in communication and problem solving, brought about greater improvements in family communication than enhanced care (EC), a 3-session psychoeducational intervention, among individuals at clinical high risk for developing psychosis. Method This study was conducted within a randomized controlled trial across 8 sites. We examined 10-min problem-solving discussions at baseline and 6-month reassessment among 66 adolescents and young adults and their parents. Trained coders who were blind to treatment and time of assessment achieved high levels of interrater reliability when evaluating family discussions on categories of calm–constructive and critical– conflictual behavior. Results Individuals at high risk and their family members who participated in FFT-CHR demonstrated greater improvement from baseline to 6-month reassessment in constructive communication and decreases in conflictual behaviors during family interactions than those in EC. Participants in FFT-CHR showed greater increases from baseline to 6 months in active listening and calm communication and greater decreases in irritability and anger, complaints and criticism, and off-task comments compared to participants in EC. These changes occurred equally in high-risk participants and their family members. Conclusions A 6-month family skills training treatment can bring about significant improvement in family communication among individuals at high risk for psychosis and their parents. Future studies should examine the association between enhancements in family communication and reduced risk for the onset of psychosis among individuals at high risk.

A Conceptual Model of Irritability Following Traumatic Brain Injury

“…40,[49][50][51][52][53][54][57][58][59][60][61][62][63] Our findings support our clinical experiences and have provided greater depth to our understanding of this complex problem. Clinically, we observed that post-TBI irritability is often not discussed unless brought up by the provider.…”

“…40,54 We found that irritability is often experienced in interactions with one's spouse or significant other. In fact, interpersonal communication difficulties experienced by people with a history of TBI often exacerbate the irritability.…”

Emotional and behavioral symptomatology reported by help-seeking youth at clinical high-risk for psychosis

“…Further, our findings align with prior evidence that caregivers of youth with schizophrenia spectrum disorders in particular experience high levels of stress and psychological burden (Knock et al, 2011) that may negatively impact familial relationships that play an important role in treatment engagement and outcomes. Creating or maintaining positive parent-child relations can be an important prognostic factor for young people at risk for psychosis (O'Brien et al, 2008(O'Brien et al, , 2014, highlighting another potential target for CHR intervention.…”

Family-focused treatment improves attenuated psychotic symptoms, but does not differ from brief treatment in negative symptoms and social functioning in ultra high risk patients aged 12–35 years

“…Improvement in communication was reported elsewhere,4 but the effects of a prevention plan and acquiring coping and problem-solving skills were not evaluated.…”