Psychotherapy for Psychosis, Adverse Events, and Substance Misuse

This 20-item true/false scale measures hopelessness in participants; we will use the total score on this measure as an indicator of hopelessness. Scores range from 0 to 20; higher scores indicate greater hopelessness.

Detailed timeline: Pre-intervention baseline assessment (study week 1); pre-intervention follow-up appointments (study weeks 2; 2,3; or 2,3, and 4; depending on randomization); pre-intervention assessment 1 (study week 3,4, or 5, depending on randomization); intra-intervention assessment 2 (study week 6,7, or 8, depending on randomization); intra-intervention assessment 3 (study week 9,10, or 11, depending on randomization); intra-intervention assessment 4 (study week 12,13, or 14, depending on randomization); intra-intervention assessment 5 (study week 15,16, or 17, depending on randomization); intra-intervention assessment 6 (study week 18,19, or 20, depending on randomization); 8 weeks post-assessment 6 (week 18, 19, or 20); 9 weeks post-assessment 6

This 15-item scale measures avoidance in participants; we will use the overall score on this measure as an indicator of avoidance. Scores range from 15 to 90; higher scores indicate greater avoidance.

Detailed timeline: Pre-intervention baseline assessment (study week 1); pre-intervention follow-up appointments (study weeks 2; 2,3; or 2,3, and 4; depending on randomization); pre-intervention assessment 1 (study week 3,4, or 5, depending on randomization); intra-intervention assessment 2 (study week 6,7, or 8, depending on randomization); intra-intervention assessment 3 (study week 9,10, or 11, depending on randomization); intra-intervention assessment 4 (study week 12,13, or 14, depending on randomization); intra-intervention assessment 5 (study week 15,16, or 17, depending on randomization); intra-intervention assessment 6 (study week 18,19, or 20, depending on randomization); 8 weeks post-assessment 6 (week 18, 19, or 20); 9 weeks post-assessment 6 (week 18, 19, or 20)

The ASSIST measures substance use; we will use the total score for each substance as an indicator of substance use. Scores range from 0-39 for each subscale; higher scores indicate substance misuse.

Detailed timeline: Eligibility screening assessment (pre-study enrollment); pre-intervention assessment 1 (study week 3,4, or 5, depending on randomization); intra-intervention assessment 2 (study week 6,7, or 8, depending on randomization); intra-intervention assessment 3 (study week 9,10, or 11, depending on randomization); intra-intervention assessment 4 (study week 12,13, or 14, depending on randomization); intra-intervention assessment 5 (study week 15,16, or 17, depending on randomization); intra-intervention assessment 6 (study week 18,19, or 20, depending on randomization); 8 weeks post-assessment 6 (week 18, 19, or 20); 9 weeks post-assessment 6

The PANSS measures positive and negative psychotic symptoms; we will use the total score of the negative symptoms subscale on this measure as an indicator of negative symptoms. Scores range from 7 to 49; higher scores indicate greater negative symptoms.

This clinician-reported instrument measures social and occupational functioning. Scores on this measure range from 1 to 100; higher scores indicate greater functioning, lower scores indicate greater impairment in functioning.

Detailed timeline: Pre-intervention follow-up appointments (study weeks 2; 2 and 3; or 2,3, and 4; depending on randomization to intervention start time); pre-intervention assessment 1 (study week 3,4, or 5, depending on randomization); intra-intervention assessment 2 (study week 6,7, or 8, depending on randomization); intra-intervention assessment 3 (study week 9,10, or 11, depending on randomization); intra-intervention assessment 4 (study week 12,13, or 14, depending on randomization); intra-intervention assessment 5 (study week 15,16, or 17, depending on randomization); intra-intervention assessment 6 (study week 18,19, or 20, depending on randomization); 8 weeks post-assessment 6 (week 18, 19, or 20); 9 weeks post-assessment 6 (week 18, 19, or 20)

TSC-40 measures adversity sequelae. We will use the total score and the subscale scores (e.g., dissociation, anxiety, depression). Total scores range from 0 to 120; higher scores indicate greater psychopathology.

Detailed timeline: Pre-intervention baseline assessment (study week 1); pre-intervention follow-up appointments (study weeks 2; 2,3; or 2,3, and 4; depending on randomization to intervention start time); pre-intervention assessment 1 (study week 3,4, or 5, depending on randomization); intra-intervention assessment 2 (study week 6,7, or 8, depending on randomization); intra-intervention assessment 3 (study week 9,10, or 11, depending on randomization); intra-intervention assessment 4 (study week 12,13, or 14, depending on randomization); intra-intervention assessment 5 (study week 15,16, or 17, depending on randomization); intra-intervention assessment 6 (study week 18,19, or 20, depending on randomization); 8 weeks post-assessment 6; 9 weeks post-assessment 6

The PANSS measures positive and negative psychotic symptoms; we will use the total score of the positive symptoms subscale on this measure. Scores range from 7 to 49; higher scores indicate greater positive symptoms.

The CGI-S measures the clinician's judgement of the severity of the participant's mental illness at this time and the CGI-I measures the degree of improvement from baseline; we will use the total severity score of the CGI-S and the total improvement score of the CGI-I. CGI-I scores range from 1 (Very much improved) to 7 (Very much worse); higher scores indicate worsening, lower scores indicate improvement. CGI-S scores range from 1 (Normal, not ill at all) to 7 (Among the most extremely ill); higher scores indicate greater illness severity, lower scores indicate low severity.

Detailed timeline: Pre-intervention baseline assessment (study week 1); 8 weeks post-intervention session 15; 9 weeks post-intervention session 15

The 8-item PTSD Checklist-5 (PCL-5) will collect information about symptoms commonly associated with adversity, such as intrusive thoughts, avoidance of event reminders, loss of interest, etc. All items are on a 5-point scale ranging from "Not at all" to "Extremely"; higher scores suggest greater symptom severity. This questionnaire has previously been validated for use with individuals with psychosis.

Detailed timeline: Pre-intervention baseline assessment (study week 1); pre-intervention follow-up appointments (study weeks 2; 2,3; or 2,3, and 4; depending on intervention start time); pre-intervention assessment 1 (study week 3,4, or 5); intra-intervention assessment 2 (study week 6,7, or 8); intra-intervention assessment 3 (study week 9,10, or 11); intra-intervention assessment 4 (study week 12,13, or 14); intra-intervention assessment 5 (study week 15,16, or 17); intra-intervention assessment 6 (study week 18,19, or 20); 8 weeks post-assessment 6; 9 weeks post-assessment 6

The SRS is a measure of therapeutic alliance. This instrument measures the therapeutic relationship, goals and topics covered in session, therapist approach/method, and the therapy session overall for each therapy session. This information will allow us to assess the impact of therapeutic alliance on symptom change. Participants will fill out this form following each therapy session and will place it in a sealed envelope; therapists will not have access to this information. Total scores range from 0 to 40; higher scores indicate greater therapeutic alliance and lower scores indicate problems in one or more areas of session therapeutic alliance.

o This 21-item yes/no scale asks participants which of the listed events they have experienced in their lifetime (e.g., sexual abuse, traumatic entry into care). It also asks participants if any of the events they have experienced occurred more than once, and at what age(s) the event(s) occurred. This questionnaire also asks the participant whether those adverse events are affecting them now in any way. Two scores can be formed from this measure: 1) the total number of lifetime adverse events (ranging from 0-20) and 2) how much participants are currently affected by these events (0, "not at all" to 10, "extremely").