Tele-group Cognitive Behavioural Family Intervention for Individuals With Schizophrenia and Their Families (Definitive tgCBFI)

Recent network meta-analyses revealed that family interventions were superior to other psychosocial interventions in relapse prevention of people with schizophrenia. The current approaches to family intervention for schizophrenia are to provide support and offer psychoeducation and skill training for family caregivers, such as family psychoeducation and mutual support groups, and work with the whole family, stressing family structure, interaction, and dynamics, such as systemic therapy. A previous meta-analysis revealed that familial expressed emotion (EE), particularly critical comments, is a robust predictor of schizophrenic relapse, and it is one of the therapeutic foci of the family intervention to benefit the recovery of service users with schizophrenia. A proposed cognitive model of caregiving suggested that cognitive reappraisal, including reattribution of self-control on caregiving and reattribution of service users' control on illness progression, is one of the recommended therapeutic components to assist family caregivers in relieving their mood disturbances as well as negative expressed emotion. A framework of cognitive behavioural therapy (CBT) for service users with psychosis and their family caregivers has also been suggested to improve the clinical outcomes of the service users and extend the individual CBT to the family group. Built upon these two mainstream approaches of behavioural and structural family interventions, cognitive behavioural family intervention (CBFI) focuses on cognitive appraisals in family relationships between service users and their families, aligning with the proposed cognitive model of caregiving in resolving the two negative attrition-emotion pathways. A previous meta-analysis indicates that CBFI is superior to treatment as usual (TAU) in reducing the severity of positive and negative symptoms of people with schizophrenia immediately following the intervention. Recent systematic reviews supported that telepsychiatry/telehealth is a feasible and acceptable approach for people with severe mental illness and their family caregivers. This tgCBFI programme is a brief, novel group CBT-based family intervention using a telehealth delivery mode (i.e., via Zoom) to care for people with schizophrenia and their family caregivers in the community.

• Positive and negative symptoms of service users as assessed by the Positive and Negative Syndrome Scale (PANSS) [Time frame: From enrollment to twelve-week post-intervention follow-up]
• Perceived care burden of family caregivers as assessed by the Family Burden Interview Schedule (FBIS) [Time frame: From enrollment to twelve-week post-intervention follow-up]
• Mood disturbances of family caregivers as assessed by the Hospital Anxiety and Depression Scale (HADS) [Time frame: From enrollment to twelve-week post-intervention follow-up]
• Service satisfaction of participants from the tgCBFI group as assessed by the Client Satisfaction Questionnaire (CSQ-8) [Time frame: within one week after the intervention]
• Qualitative feedback from the participants in the tgCBFI group as assessed by focus group interviews [Time frame: within one month after the intervention]