Seven-step Phenomenological Psychotherapy for Self-disorder - a Pilot Study

Self-disorders are considered as central features of schizophrenia spectrum disorders which may be present both before, during, and after psychotic episodes. They are characterized by disturbances in the sense of ownership to experiences and agency of action, as well as in the sense of presence, reality and existence. They are further considered to drive symptom development during prodromal schizphrenia. Self-disorders may be very painful, and associated with anxiety, disturbances in daily functioning and increased sucidality. There is a lack of studies investigating the effect of psychotherapy on self-disorders. Hence, there is a need for developing and testing new treatment approaches to these debilitating conditions.

In this pilot study the investigators want to test a new model and manual for the treatment of self-disorders, the Seven-Step Phenomenological Psychotherapy for Self-Disorder (SSPP-SD), first developed by Dr.Med Paul Møller. This model focuses on the phenomenological exploration of self-disorders, subjective understanding, meaning and associated behaviors, psychoeducation, and the joint exploration of new meanings and understanding related to the experiences. The length of the treatment is stipulated to 14 individual sessions over 7-10 weeks. The first step of the treatment involves a semi-structured interview with the Examination of Anomalous Self-Experience (EASE).

The study has a qualitative phenomenological design where the primary research question is how the participants experienced the treatment. In more detail, the investigators want to explore both positive and negative experiences, how useful or helpful the participants experienced the treatment, and how the treatment affected self-experience and experience of relations to others and the world. These experiences will be explored in a qualitative interview following the end of treatment. In addition, the participants will answer questionnaires regarding symptoms, functioning, life quality (before and after treatment) and satisfaction with the treatment (after treatment). The study will inform the planning of a larger clinical trial testing the effect of the SSPP-SD on self-disorders in participants with psychotic disorders at Vestre Viken Hospital, Norway. Hence, in this pilot study the investigators will also register and evaluate therapist experiences of the SSPP-SD, and fidelity to the manual. The therapists will be supervised by Dr.med Paul Møller.

Six participants with schizophrenia or other ICD-10 F20-29 disorders, or with psychosis risk syndromes as defined in the Structured Interview for Psychosis-risk Syndromes (SIPS) will be included. They will be included from an outpatient clinic for psychotic disorders at Akershus University Hospital, Norway. Two experienced therapists trained in the model will offer the therapy, including project leader Dr. Tor Gunnar Værnes at the Oslo University Hospital.

• General Anxiety Disorder-7 (GAD-7) [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• Patient Health Questionnaire-9 (PHQ-9) [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• Work and Social Adjustment Scale (WSAS) [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• Positive and Negative Syndrome Scale-6 (PANSS-6) [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• 10-point self-disorder questionnaire [Time frame: Before the SSPP-SD intervention and at the end of the intervention, up to 12 weeks after enrollment]
• Examination of Anomalous Self-Experience (EASE) [Time frame: During the first of sevens steps of treatment, session 1 and 2. Up to 3 weeks after study enrollment]
• Client Satisfaction Questionnaire (CSQ-8) [Time frame: After end of SSPP-SD treatment, up to 12 weeks after enrollment]