RESEARCH WEEKLY: Intensive outpatient program reduces symptoms of psychosis By Hope Parker (May 10, 2023) Psychotic disorders such as schizophrenia can be very debilitating and often require a combination of medication and psychotherapy in order for an individual to show improvements. However, intensive outpatient programs that include medication management and cognitive and behavioral psychotherapy rarely are specifically designed for individuals with psychosis. A new research study published in “Psychiatric Research and Clinical Practice” suggests that intensive outpatient programs targeted for individuals with psychosis are both feasible to implement and show improvements to the individuals who are enrolled. The UCLA Thought Disorder Inpatient Outpatient Program utilizes Cognitive Behavioral Social Skills Training, which is a combination of social skills training and cognitive behavioral therapy, as well as medication management. Previous studies have shown that it increases rates of achieving functional milestones, improves negative symptoms, and allows for a lower dose of antipsychotics. This study is the first that focuses on CBSST implementation in a community setting. Methods A total of 92 adults who had been previously diagnosed with a psychotic disorder were enrolled into the UCLA Thought Disorders Intensive Outpatient Program between May 2018 and June 2020. All clinical staff had a master’s level education and received training in CBSST. Participants met three times a week for three-hour sessions, including one hour of CBSST therapy and two hours of group therapy. Participants also attended a weekly meeting with a social worker, which consisted of case management and individualized psychotherapy, and regularly met with their psychiatrist for medication management. The program was designed to last at least six weeks but could be extended for an individual, if deemed necessary. The Clinician‐Rated Dimensions of Psychosis Symptom Severity scale was utilized to measure how effective the program is at symptom reduction. The scale has eight categories: hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, depression, and mania. Licensed clinical social workers administered this scale to participants every week. Key Findings Slightly more than three quarters (77%) of the original group of 92 participants completed the program. Reasons for participants leaving the program included COVID-19, transfer to residential center, transfer to impatient hospital, transfer to general intensive outpatient program, transportation issues, starting new employment, and suicide. On average, participants stayed in the program for 52 days, or approximately seven and a half weeks. In total, 86 program participants completed CRDPSS screenings before and after treatment and were included in this analysis. Almost all (93%) of participants saw at least some improvement in symptoms. Significant improvement was seen in symptoms of hallucinations, delusions, disorganized speech, depression, and mania. There were no significant improvements overall for symptoms of abnormal psychomotor behavior, negative symptoms, or cognitive impairment. Participants were highly satisfied with the program, rating it an average of 87 out of 100. Participants listed program strengths as socialization/support, therapy/skill building, provider access, psychoeducation, and self-confidence. Most participants had no barriers to participation, but others listed driving, parking, schedule, and fatigue as challenges. Implications It is a priority among public health professionals to improve quality of life for those with psychotic disorders. CBSST, combined with group therapy, case management, and medication management can greatly reduce symptoms in five out of the eight categories on the CRDPSS. Evidence also suggests that CBSST leads to improvements in social skills and daily functioning. Because 73% of individuals stayed at the same anti-psychotic dose or lowered their dose, the improvements in this study cannot be solely attributed to medication alone. More research is needed to explore the full extent of benefits from CBSST and the number of sessions required to provide results. CBSST also has the potential to be extremely cost-efficient, as it can be conducted in group sessions and utilizes fewer therapist hours than individualized counseling. More studies are needed to demonstrate the cost-effectiveness of this program in the long term, as current evidence is mixed. Reference Samplin, E., et al. (June 2022). Feasibility and Effectiveness of a Psychosis Specific Intensive Outpatient Program. Psychiatric Research and Clinical Practice. Hope Parker is a research assistant at Treatment Advocacy Center. 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