(PS13-D80) Exploring Attendance and Engagement in an Online Group Intervention for Internalized Stigma in First Episode Psychosis

Background: Internalized stigma is commonly experienced by individuals with psychosis and leads to poorer recovery and sustained functional impairment. Be Outspoken and Overcome Stigmatizing Thoughts (BOOST) is a group intervention that incorporates cognitive behavioural techniques, psychoeducation, and a peer support facilitator to reduce self-stigma in individuals with first episode psychosis. When delivered in-person, evidence supports that BOOST reduces stigma, increases hope, and increases self-esteem. However, little is known about how individuals with psychosis engage in online group interventions. As part of a larger study examining the therapeutic efficacy of BOOST in an online format, the present analyses explored attendance and engagement in online groups, and examined if baseline symptom severity was related to process variables.

Methods: Thirty-seven individuals from early psychosis clinics participated in the eight-session online BOOST intervention. Self-reported symptoms were assessed before and after the intervention using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Questionnaire about the Process of Recovery (QPR-15). Attendance was defined as having attended or not and was tracked for all eight sessions. Engagement across all sessions was measured by total verbal participation and engagement in role play activities. It was also noted whether individuals chose to have their cameras on or off.

Results: The mean number of sessions attended was 5.73 (SD = 1.68). 13.5% of participants attended all sessions, and 24.3% attended less than half of the sessions. 59.5% of participants had their cameras on for all sessions, while only 8% of participants had their cameras off for all sessions. 32.4% of participants had their cameras off for at least one-third of sessions. On average, participants engaged with in-session treatment activities 64% of the time. Symptom severity (GAD-7, PHQ-9) and degree of self-defined recovery (QPR) did not predict attendance or engagement. Having one’s camera off was also not associated with baseline symptom severity. Individuals who had their cameras on were more likely to participate in treatment activities (p < .001, η² = .33).

Implications: Individuals with early psychosis attended virtual sessions for an online self-stigma group treatment at a similar rate as the previous in-person format. There is considerable variability in how participants engage in the online environment with regards to being visible to others on camera and actively participating in treatment techniques and role plays. Despite this variability, we did not observe meaningful predictors of treatment process variables in our limited assessment battery. Future work might consider additional symptoms and features of psychosis that influence engagement with online therapies. Exploration of how people with psychosis access, interact with, and benefit from online treatments will help to improve the potential utility of these online services.