Family-Focused Treatment for Adolescents and Young Adults at High Risk for Psychosis: Results of a Randomized Trial
Open accessAbstract
Objective Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk.Method Adolescents and young adults (mean age 17.4 ± 4.1 years) with attenuated positive psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]). FFT-CHR included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning.Results Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC (F1,97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR, whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy.Conclusion Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis. Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency. Clinical trial registration information-Prevention Trial of Family Focused Treatment in Youth at Risk for Psychosis; http://clinicaltrials.gov/; NCT01907282.
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Only two included studies had an overall low risk of bias; five had unclear risk and nine had high risk.
“Only two studies had an overall low risk of bias 33,79 ; five had unclear risk [72][73][74][75][76] , and nine had high risk 30,31,36,37,39,41,77,78,81 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [41]
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References 40 · Cited by 200
Research works printed but not linked: 6
- [2]Fusar-Poli P Bonoldi I Yung AR Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk Arch Gen Psychiatry 2012 69 3 220 229 22393215
- [12]Miklowitz DJ Axelson DA Birmaher B Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial Arch Gen Psychiatry 2008 65 9 1053 1061 18762591 PMC2610285
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- Authors
- Miklowitz, D. J., O’Brien, M. P., Schlosser, D. A., Addington, J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., Zinberg, J. L., De Silva, S. D., Friedman-Yakoobian, M., & Cannon, T. D.
- Affiliations
- University of California, Los Angeles (US)
- Yale University (US)
- University of California, San Francisco (US)
- University of Calgary (CA)
- Zucker Hillside Hospital (US)
- University of California San Diego (US)
- Corresponding author
- Miklowitz, David J.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 53
- Issue
- 8
- Pages
- 848-858
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC4112074
- OpenAlex
- W2026500345
- Cited by
- 200
- References
- 40
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 14 · 2023: 10 · 2022: 10 · 2021: 20 · 2020: 21 · 2019: 19 · 2018: 14 · 2017: 9 · 2016: 17 · 2015: 35 · 2014: 7
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Yale University
- Hotchkiss Brain Institute, University of Calgary
- National Alliance for Research on Schizophrenia and Depression
- Attias Family Foundation
- University of California, San Diego
- University of California, San Francisco
- National Institute of Mental Health (R01MH093676, K23MH097795, R21MH097007, R33MH097007, RC1MH088546)
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- family-focused therapy, clinical high risk for psychosis, adolescents and young adults, family psychoeducation, negative symptoms, social role functioning, psychosis prevention, stress management
- MeSH terms
- Adolescent, Adult, Education, Nonprofessional, Family Relations, Family Therapy, Female, Humans, Male, Problem Solving, Psychotic Disorders, Self Care, Social Adjustment, Treatment Outcome, Consumer Health Information, Young Adult
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