thinkSMART®: A pilot study of a transdiagnostic cognitive-behavioral treatment for adolescents with executive functioning weaknesses

-Alissa J. Ellis, Alexandra Sturm, Michelle Rozenman, Emma Smith, Ibukun Olabinjo

Executive functions are a broad term used to describe the cognitive functions nec- essary to help individuals complete tasks and achieve goals. Executive functioning weaknesses are a hallmark feature of psychopathology, particularly in youth. These weaknesses are associ- ated with chronic impairment across academic, social and family domains and do not typically improve into adulthood. Despite these negative outcomes, few behavioral interventions have been successfully developed to target executive functioning outside of ADHD, particularly in adolescents with various types of psychopathology. The thinkSMART® program was created to target the broad heterogeneity of adolescents with executive function weakness. We discuss the rationale for the development of the program, as well as outline the primary skill areas addressed. We also present an open-trial pilot study using the program in adolescents ages 12—17 who identify as having executive functioning weaknesses. Preliminary findings highlight the acceptability and feasibility of the program, as well as the initial efficacy in improving ado- lescents’ day-to-day executive functioning. We discuss the limitations and benefits of providing broad skills and compensatory strategies to improve adolescent executive functioning.

App-enhanced transdiagnostic CBT for adolescents with mood or psychotic spectrum disorders

-Marc J. Weintraub, Megan C. Ichinose, Jamie Zinberg, Monica Done, Georga M. Morgan-Fleming, Catherine A. Wilkerson, Robin D. Brown, Carrie E. Bearden, David J. Miklowitz

Background: Although transdiagnostic forms of cognitive-behavioral therapy (CBT) have been evaluated in individuals with depressive and anxiety disorders, few studies have examined their suitability for more severe disorders, such as recurrent or persistent major depressive disorderbipolar disorder, or psychotic spectrum disorders. This study examined the acceptability and initial efficacy of an app-enhanced Unified Protocol for Adolescents [UP-A] when including youth with more severe mood disorders or psychotic spectrum disorders.

Methods: We first adapted a mobile application (app), based on user-centered feedback from adolescents and their parents, to assist participants in reviewing session content, practicing skills learned in previous treatment sessions, and monitoring symptomatic progress. A total of 24 adolescents (M age = 15.2 years, SD = 1.6) with mood or psychotic spectrum disorders and their parents then participated in an open trial of the app-enhanced group treatment given over 9 weekly sessions.

Results: Adolescent participants and their parents rated the group treatment and mobile app as acceptable and useful. We observed significant improvements over the 9-week treatment in adolescents’ depressive symptoms, attenuated psychotic symptoms, and global functioning. The frequency with which adolescents used the mobile app between sessions was positively related to symptomatic and functional gains.

Conclusions: Initial findings suggest the acceptability and feasibility of a mobile app that enabled adolescent participants and their parents to review session content and practice treatment skills. Findings also indicated improvements in psychiatric and functional outcomes among the adolescent participants over the course of the app-enhanced treatment. Randomized clinical trials are needed to evaluate the efficacy of app-enhanced CBT in improving symptoms and functioning in adolescents with mood or psychotic spectrum disorders.

Psilocybin-Assisted Cognitive Behavioral Therapy for Adults with Major Depressive Disorder: Rationale and Treatment Development

-Marc J. Weintraub, Jessica K. Jeffrey, Charles S. Grob, Megan C. Ichinose, R. Lindsey Bergman, Ziva D. Cooper, and David J. Miklowitz

Background: Recent studies suggest that one to two administrations of psilocybin have acute antidepressant effects for people with major depressive disorder. These data on psilocybin have generated considerable enthusiasm, but little empirical attention has been paid to the therapy that adjoins psilocybin treatment (psychedelic-assisted therapy, or PAT).

Materials and Methods: In this study, we present the initial protocol and plans to empirically test the psychosocial therapy that adjoins psilocybin treatment with the goal of optimizing this therapeutic approach for adults with major depressive disorder. The psychotherapy is based on the principles of cognitive-behavioral therapy (CBT), an evidence-based treatment for major depressive disorder. Participants will be 30 adults with a history of major depressive disorder and current, active depressive symptoms. Following psychiatric and medical safety evaluations, eligible participants will be enrolled in a 12-session CBT that includes classic PAT safety elements (termed psilocybin-assisted CBT; PA-CBT). Following the third and sixth PA-CBT sessions, participants will engage in two psilocybin drug administration sessions (10 and 25 mg, respectively). Participants will provide feedback about the PA-CBT and complete measures of mood symptoms, psychosocial functioning, cognitive schemas, and affective experiences immediately following each drug administration session, at the completion of PA-CBT, and 3 months following treatment completion.

Conclusions: The trial will provide preliminary data on the feasibility, safety, acceptability, and psychosocial effects of PA-CBT. Results will inform randomized clinical trials to test the effects of PA-CBT for patients with depression and other mental health conditions, as well as hypotheses concerning mediating mechanisms at the cognitive and affective levels. ID: NCT05227612.

In-person versus remote CBT groups during COVID-19 for adolescents with mood disorders or psychosis-risk syndromes

-Marc J. Weintraub, Megan C. Ichinose, Jamie L. Zinberg, Carrie E. Bearden, David J. Miklowitz

Background: Since the COVID-19 pandemic, psychosocial therapies have been provided in varying formats, including remote, in-person, and hybrid services. It is unclear whether varying formats are similarly efficacious in improving psychiatric symptoms and functioning, lead to similar rates of treatment retention, and are equally acceptable to patients. This study compared youth with mood disorders and/or psychosis-risk syndromes who participated in a group cognitive behavioral therapy (CBT) in-person prior to COVID-19, to youth in the same treatment given remotely during the pandemic.

Methods: Adolescents ages 13–17 years participated in 9 sessions of group-based CBT given in-person (2018–2019) or remotely (2020−2021). Youth participants provided self-report ratings of psychiatric symptoms, psychosocial functioning, and emotional regulation at the study baseline and post-treatment and ratings of treatment satisfaction and burden at post-treatment.

Results: There were no differences between in-person and remote treatment improvements in psychiatric symptoms, psychosocial functioning or emotional regulation. However, youth in remote treatment had increased retention compared to youth who received treatment in person. Youth in the remote treatment reported similar levels of satisfaction but reported lower burden compared to those who received in-person treatment.

Limitations: Participants were not randomized into remote or in-person treatment. Participants prior to COVID did not have the same frame of reference for alternative treatment delivery options as those during or post-COVID.

Conclusions: Remote group treatment can provide similar levels of psychiatric benefit but less burden than in-person treatment for youth with mood disorders and/or psychosis-risk syndromes.