Cognitive and Affective Correlates of Handedness: Interactions with Gender Dysphoria and Rumination.

Evidence from recent systematic reviews and network meta-analyses confirms that psychosocial and psychological interventions—including family interventions and cognitive behavioral therapy (CBT)—significantly reduce relapse risk in psychotic disorders (–), yet these interventions are difficult to access through clinic-based care settings (). Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a family intervention for psychosis (FIp) that aims to bridge the practice gap observed in routine clinical settings by providing psychoeducation and cognitive behavioral skills training directly to families caring for a loved one with psychosis (, ). To enhance applicability, the intervention was intentionally designed as a transdiagnostic family intervention applicable across illness stages. The intervention covers three domains of content: [1] recovery-oriented psychosis psychoeducation, [2] cognitive behavioral techniques for psychosis that can be implemented by non-clinicians, and [3] the role of caregiver self-care in psychosis recovery. Content is delivered by both clinical experts (licensed psychiatrists and psychologists with specialized training in CBT for psychosis), and trained family peers called Psychosis REACH Family Ambassadors (pRFAs) (, ). Because the intervention is grounded in Cognitive Behavioral Therapy for psychosis (CBTp), Psychosis REACH creates synergies between cognitive behavioral interventions provided to individuals experiencing psychosis by their clinical team and community-based caregiving provided by the client's natural or residential support team. The coactive approach between clinic-based and community-based supports, referred to in the global public health literature as can facilitate the reciprocal transfer of therapeutic skills across the healthcare setting and the home environment (, ). Furthermore, caregivers' self-application of CBT skills and other forms of self-care normalize and model CBT for the individual experiencing psychosis and the family system. Previous research suggests that the in-person Psychosis REACH training significantly enhanced caregivers' knowledge and skills and reduced caregivers' depressive and anxiety symptoms (). Moreover, results suggest that the intervention was associated with an enhanced recovery orientation, reductions in self-perceived caregiver burden, and reductions in caregivers' expressed emotion–a characteristic of the family milieu associated with high levels of criticism, hostility, or anxiety that is positively correlated with symptom relapse in a wide range of mental disorders, including psychosis spectrum disorders (). Caregivers reported significantly improved mastery over the five CBTp-informed skill domains in which they were trained. All intervention effects held at 4-months follow-up with one exception: caregivers reported decreased self-efficacy in delivering CBTp-informed skills to their loved ones at follow-up. The depreciation in skill mastery is consistent with the broader practice facilitation literature, which emphasizes the importance of rehearsal with feedback during the skill acquisition and generalization phases (, ). These findings suggest an important area of refinement in the approach to training families. In addition, the in-person training did not remedy inequities in access to evidence-based interventions among socially, geographically, and economically disadvantaged families, nor did it enhance access to FIp among non-maternal natural supports. (alternatively referred to in the literature as bichronous learning) utilizes technology to facilitate both asynchronous and synchronous pedagogic activities (). The learner-centric method enhances access through multimodal on-demand activities that can accommodate diverse learning styles through a range of instructional practices. Bichronous training has traditionally been applied to and studied in workplace and academic settings (, ) and little is known about the acceptability, feasibility, or learner outcomes associated with psychological intervention training for lay people. A recent systematic review found that caregiver interventions for psychosis that were entirely digitally delivered can improve caregiver stress, expressed emotion, and parental self-efficacy () although the included interventions were predominantly education and did not include facilitated skill rehearsal.