Virtual Cognitive Behavioural Therapy for Psychosis
Virtual Cognitive Behavioural Therapy for Psychosis
Participants with schizophrenia-spectrum disorders who are experiencing active symptoms of
 psychosis will randomized to either receive 6 months of individual cognitive behavioural
 therapy for psychosis or to receive treatment as usual. Participants will be assessed at
 baseline, 6 months, and 12 months.
Schizophrenia-spectrum disorders are the most persistent, debilitating, and economically
 burdensome mental illnesses worldwide, and are associated with the greatest per-patient
 expense of all mental health conditions. Schizophrenia is associated with a 15-20 year
 decrease in life expectancy, 5-fold increase in likelihood of death by suicide, and a
 significant decrease in quality of life. Antipsychotic medications are the first line
 treatment for individuals with schizophrenia spectrum disorders and are prescribed to nearly
 every service-user. However, in the Clinical Antipsychotic Trials of Intervention
 Effectiveness (CATIE) trial (one of the largest antipsychotic trials in 1493 individuals with
 schizophrenia), medication effects on psychosocial functioning were small (d = 0.25). Thus,
 the primary treatment available to all individuals with schizophrenia does little to improve
 community functioning. This may partially be a result of the limited efficacy of
 antipsychotic medication to improve neurocognitive abilities, widely recognized as a core
 feature of schizophrenia, and one recommendation stemming from the CATIE trial was that "more
 intensive psychosocial rehabilitative services, including cognitive rehabilitation, may be
 needed to affect more substantial gains in functioning."

 Cognitive behavioural therapy (CBT) is a psychological intervention originally developed to
 treat depression, and subsequently adapted to treat schizophrenia spectrum disorders. CBT has
 demonstrated moderate treatment effects (d = 0.36 - 0.44) in multiple meta-analyses and is
 widely recommended for the treatment of schizophrenia in international guidelines. CBT
 involves clients learning to evaluate their cognitive content in order to develop more
 accurate representations of the world. CBT has proven effective for improving hallucinations,
 delusions, negative symptoms, and personal recovery.

 Despite the established efficacy of CBT delivered through in-person methods, most clinics
 have discontinued in-person treatments as a result of the COVID-19 pandemic and have moved to
 virtual delivery methods. While it has been assumed that virtual delivery of CBT is
 equivalent to in-person delivery, our recent systematic review demonstrated that there has
 never been a trial examining the efficacy of virtually delivered CBT for psychosis.
 Characteristics of schizophrenia such as paranoia, and disorganization already present
 challenges to psychological treatment and it is possible that this challenge will be further
 exacerbated by treatment delivery through virtual methods. Additionally, it is unclear the
 extent to which individuals with schizophrenia-spectrum disorders will be interested in
 receiving virtual CBT and capable of using the technology that is required.

 Thus the goals of the current study are two-fold:

 1. Examine the efficacy of virtually delivered CBT for schizophrenia-spectrum disorders to
 reduce symptoms and improve community functioning.

 2. Examine the feasibility and acceptability of virtually-delivered CBT for individuals
 with schizophrenia-spectrum disorders.

 CBT will be delivered according to an established manual that the PI has previously used
 successfully for in-person treatment. Treatment will consist of individual sessions with a
 therapist for 1-hour per week for 6-months. Therapists will be either a registered clinical
 psychologist or a graduate student in clinical psychology under the supervision of a
 registered clinical psychologist. All treatment will be delivered virtually in the
 participant's home using the online platform Zoom which is PHIPA/PIPEDA compliant. If
 participants do not have the technology required for virtual sessions then a tablet will be
 loaned to them for the duration of treatment. This treatment will be delivered in addition to
 usual care and no changes to usual care will be required.
Inclusion Criteria:

 The inclusion criteria is anyone who meets the criteria of schizophrenia, schizoaffective
 disorder or any other psychotic disorder, are also 18-65 years of age, know how to use a
 computer, are not abusing drugs or alcohol and can read and speak English. Participants
 must be experiencing active symptoms of psychosis as indicated on the PANSS.

 Exclusion Criteria:

 Exclusion criteria include anyone who has received CBT in the past 6 months, or anyone with
 a neurological disease or neurological damage that would make it difficult to participate
 in a talk therapy.