Remote CBT for Psychosis During the COVID-19 Pandemic: Challenges and Opportunities
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BRIEF REPORT
Remote CBT for Psychosis During the COVID‑19 Pandemic: Challenges and Opportunities Sarah L. Kopelovich1 · Doug Turkington2 Received: 19 April 2020 / Accepted: 25 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The COVID pandemic is now leading to the emergence of a secondary mental health pandemic. Clients with psychosis are at increased risk of poorer medium- and long-term psychosocial and clinical outcomes. In response to the pressing need to flexibly deliver high-quality care to individuals with psychosis, this brief report proposes high yield cognitive behavioral techniques for psychosis (HY-CBt-p) facilitated by task sharing and digital enhancements. HY-CBt-p is delivered over fewer sessions than formulation-based Cognitive Behavioral Therapy for psychosis (CBTp), can be learned by a range of providers, and includes techniques such as developing a normalizing explanation; techniques to reduce anxiety, depression, and insomnia, which perpetuate psychotic symptoms; self-monitoring; reality testing; and wellness planning. Previous research suggests that effect sizes will be lower than that of 16-session formulation-driven CBTp, but additional research is needed to test the feasibility, acceptability, efficacy, and comparative effectiveness of different forms of remote-delivered CBTp. Keywords Cognitive behavioral therapy for psychosis · Serious mental illness · Telehealth · COVID-19 Individuals with serious mental illness (SMI) are particularly vulnerable during public health crises such as the COVID19 global pandemic (Druss, 2020). In a recent rapid review of the literature, Brown and colleagues (2020) suggest that the very public health measures that are intended to keep individuals safe from contracting COVID-19 may be exacerbating psychotic symptoms among those who have a preexisting psychotic diagnosis, and may also increase the risk of developing a new-onset psychotic episode among those who do not. This trend parallels that which we are witnessing among individuals with substance use, anxiety, and depression (Meadows Mental Health Policy Institute (2020). In light of these unprecedented circumstances, frontline providers have had to extemporize and adapt in-person services to meet the needs of their clients with SMI. This brief report is intended to advise community mental health practitioners in * Sarah L. Kopelovich [email protected] 1
Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA 98104, USA
Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Monkwearmouth Hospital, Newcastle Road, Tyne and Wear, Sunderland, UK
2
cognitive behavioral interventions for psychotic symptoms that are relatively easy to learn, to coach others (e.g., natural supports) in, and that are amenable to telephonic encounters, telehealth, or digital accompaniment. Similar explorations of practice considerations for CBT delivery during the pandemic have been pub
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