Psy-Q: Is it common for caregivers of individuals with psychosis to receive family interventions, such as psychoeducation and skills training? What are the guidelines for individuals with psychosis?

Sarah Kopelovich, PhDAnswer: No, it is not common. In fact, less than 2% of families receive a family intervention for psychosis in the US, despite national recommendations for it, according to a recent study led by Sarah L. Koplelovich, PhD. Her team presented a summary of the effects of their online training program for families and caregivers of individuals with psychosis, called Psychosis Recovery by Enabling Adult Carers at Home (REACH). Psychosis REACH is based on cognitive-behavioral therapy for psychosis (CBTp) and focuses on recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training.

Dr. Kopelovich, an assistant professor who holds the first Professorship in Cognitive Behavioral Therapy for Psychosis in the Department of Psychology and Behavioral Sciences at the University of Washington School of Medicine, shared her insights with Psycom Pro.

Psycom Pro: Your team found that the Psychosis REACH program improved the mental health of family, friends, and caregivers of people with psychosis as well as enhanced their relationships. Why it is important to offer this support to caregivers, and what feedback have you received from training participants thus far?

Dr. Kopelovich: Families are the unpaid, untrained shadow mental health workforce. They struggle to help their loved one manage their symptoms, often without knowing much about their loved one’s diagnosis. In fact, despite the fact that family education and skills training is recommended as the standard of care for treating a psychotic disorder, a report by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) found that fewer than 2% of American families received psychoeducation about their loved one’s psychosis diagnosis. Unfortunately, we see comparably poor penetration of CBT for psychosis, which is also a recommended component of standard care.

Psychosis REACH is a means of accomplishing three goals:

  1. First and foremost, it’s about giving families the information and skills training that they need to understand what their loved one is experiencing and how best to help.
  2. Second, it’s about teaching families that the same CBT and self-care skills that are indicated for their loved one with psychosis apply to them as well.
  3. And finally, by teaching them that CBTp is an indicated treatment for psychotic disorders, we hope that families will exert pressure on the systems and settings where their loved ones are accessing treatment to demand that CBTp is offered.

The feedback from participants has been remarkable. From the data, we see statistically significant improvements in trainees’ perceptions of psychosis and its treatability and their perceptions of their own skillfulness in interacting with their loved one. We also observed reductions in mood symptoms, caregiver burnout, and expressed emotion up to 4 months post-Psychosis REACH training. While this was not a randomized clinical trial, this was exciting preliminary data of this real-world, light-touch intervention. Anecdotally, trainees have shared remarkable stories about the changes they’ve observed in their own mental health, their loved ones’ symptoms, and the state of the relationship since incorporating Psychosis REACH skills.

Psycom Pro: Should clinicians recommend Psychosis REACH training to all families and caregivers of individuals with psychosis?

Dr. Kopelovich: Ideally, we would love to see family interventions for psychosis offered as part of a clinical care package to individuals with a diagnosed psychotic disorder. However, we know that we are far from that reality at the moment, and we know that there are a host of barriers that frustrate efforts to provide these interventions to families.

Psychosis REACH is accessible to all English- and Spanish-speaking families who have access to the Internet. Most of the training is offered on-demand, which means that families can access it 24/7 and get repeated exposure to the training content. We connect families from all over the world to the foremost experts on CBT for psychosis, and we also connect them to Psychosis REACH Family Ambassadors, who are using these same skills with their own loved ones. Those features have been critical to families. Most Americans with a serious mental illness (SMI) are not accessing treatment. Taking the intervention out of the clinic may give us the greatest likelihood of ensuring that family interventions for psychosis truly do become universal.

Psycom Pro: On the related topic of CBTp, can you comment on SAMHSA’s recent report that promotes expanding its use and making it the standard of care?

Dr. Kopelovich: This document has been called a watershed moment, not just for promoting greater access to CBT for psychosis, but for advancing evidence-based psychosocial interventions for individuals with psychosis more broadly. The document was informed by an expert panel that SAMHSA convened back in 2019 and which I had the honor of facilitating.

The consensus decision of the report was that we should unequivocally communicate to decision-makers at various levels of the mental health system ecology that CBT for psychosis is an evidence-based treatment for individuals with psychotic disorders and should be offered as part of the standard of care. This document would therefore serve as the first explicit, written position of its kind by a US federal entity. As such, the guide seeks to align federal recommendations on the treatment of individuals with a psychotic disorder with our national schizophrenia treatment guidelines. My hope is that the guidance and recommendations contained in the SAMHSA report will catalyze a course-correction in our approach to treating our most vulnerable patients.

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Last Updated: Jun 11, 2021