Social cognition deficits are debilitating features of psychosis associated with poor outcome. Such deficits are evident in young people at clinical high risk (CHR) for psychosis. Several treatment procedures have been implemented to remediate these deficits. A limitation of these approaches is that they are all presented as treatment of mental illness to a population characterized in part by limited insight into the exten to which one's thoughts and behaviors are maladaptive. Acting ("Thespian") classes are a potential alternative more palatable to youths and yet honing skills that are at the core of social and emotional deficits in psychosis. Acting requires theory of mind, understanding other people, comprehending social dynamics, and expression and understanding of emotions. Acting Directors and programs have effective curricula to improve such skills through standard exercises. Because training requires teamwork toward a defined goal, it reduces the likelihood of dropout. By implementing Thespian Training Intervention for Promoting Social Skills (TIPS) we can offer this promising venue to CHR individuals. The proposed R34 capitalizes on convergence of expertise in social cognition and negative symptoms, the large community sample of CHR youths and the Aaron T. Beck Psychopathology Research Center at Penn. We collaborate in implementing CBT in patients with psychosis and met with considerable success. We have also worked with theatre directors to guide over 200 actors to generate emotional stimuli for social cognition studies. More recently, we have developed an 18-session curriculum that incorporates thespian principles into the CBT-guided treatment of social cognition deficits in CHR. We will apply the TIPS curriculum to a sample of 90 young CHR individuals and evaluate the effects on social cognition, symptoms and functioning in 3 successive cohorts of 30 participants stratified by age group. During this process, we will identify specific features most effective in producing socially adaptive behaviors. Strategies will be incorporated in the program to allow the results to generalize. We will obtain detailed documentation by clinical investigators theatre directors and staff. Results of this pilot will form the basis for implementing the TIPS approach in RCTs and the community.
The Specific Aims are: 1. Implement the TIPS curriculum in CHR to gauge its feasibility and effects on clinical symptoms and functioning. We propose to enroll CHR individuals age 14-25 with social cognition impairment. Thespian training will be performed in two groups (14-18,18-25) over 18 sessions. Participants will be evaluated at the start, upon completion and at 6 months follow-up. 2. Design a revised curriculum based on the experience from Specific Aim 1 and implement it in a new group of CHR participants with similar characteristics using the same evaluation schedule. 3. Design the final curriculum and manual and disseminate it for feedback to selected mental health professionals, in schools and the community, and to theatre directors. 4. Apply TIPS to a new sample of CHR youths in a community setting after training the local professionals.
A limitation of current treatments of negative symptoms in individuals at clinical high risk for psychosis (CHR), including cognitive behavioral therapy (CBT), is that they are all framed as therapy of mental illness to a population characterized in part by aversion to being considered as mentally ill. Acting (Thespian) classes are a potential alternative more palatable to youths and yet honing skills that are at the core of social and emotional deficits in psychosis. We will pilot a CBT-guided Thespian training curriculum to a sample of 90 young CHR individuals and evaluate the effects on social cognition, symptoms and functioning in 3 successive cohorts of 30 participants stratified by age group.