Applying a Transdiagnostic Cognitive-Behavioral Treatment to Adolescents at High Risk for Serious Mental Illness: Rationale and Preliminary Findings. Issue 2 (May 2020)

• Record Type: Journal Article
• Authors: Weintraub, Marc J.; Zinberg, Jamie; Bearden, Carrie E.; Miklowitz, David J.
• Is Part Of: Cognitive and behavioral practice. Volume 27:Issue 2(2020)
• Page Start: 202
• Page End: 214
• Publication Date: 2020-05
• Subjects: unified protocol -- bipolar disorder -- prodromal psychosis -- youth -- CBT; Behavior therapy -- Periodicals; Cognitive therapy -- Periodicals; Behavior Therapy -- Periodicals; Cognitive Therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.cbpra.2019.07.007
• Languages: English
• ISSNs: 1077-7229

Abstract

Abstract: Given the chronic and deleterious course of serious mental illness (SMI; schizophrenia and bipolar disorder), significant efforts have been undertaken to improve prediction of SMI and provide treatment for adolescents in the early, putatively prodromal stage of these illnesses. While risk assessments and disorder-specific treatments for adolescents at risk for SMI have shown some efficacy, significant issues remain around disorder-specific treatments for these youth. There is substantial heterogeneity of psychopathology within adolescents at high risk for SMI that leads to many false-positives and varying diagnostic outcomes. As a result, initial treatment focusing on broad symptoms and skills has been proposed in place of disorder-specific treatments. We discuss the rationale for providing an already-developed and empirically supported transdiagnostic treatment for emotional disorders (termed the Unified Protocol) as a first-line staging of treatment for adolescents experiencing early SMI symptoms. Additionally, we outline the open trial we are piloting using this transdiagnostic treatment in adolescents between the ages of 13 – 17 who have begun experiencing distressing yet subsyndromal psychosis or bipolar mood symptoms. Preliminary findings suggest feasibility and acceptability as well as initial efficacy in improving psychiatric symptoms, quality of life, and difficulties regulating emotions. We also present case studies from our open trial. A unified, cognitive-behavioral treatment for early presentations of SMI has important clinical and public health benefits, including streamlining treatment and providing broad skills that are applicable to a wide range of psychopathology. Highlights: Most adolescents at high risk for SMI (schizophrenia or bipolar disorder) do not go on to develop a SMI Adolescents at high risk for SMI present with significant psychiatric heterogeneity, including high rates of depressive and anxiety disorders We discuss the rationale for providing a transdiagnostic, unified CBT as a first-line treatment for these youth We outline our open trial, which tests the acceptability, feasibility, and preliminary efficacy of a transdiagnostic CBT treatment for adolescents at high risk for SMI