Development of the Brief Educational Guide for Individuals in Need (BEGIN): A psychoeducation intervention for individuals at risk for psychosis

Abstract

Aim: Identification of individuals with psychosis risk (PR) through screening and specialized assessment is becoming more widespread in an effort to promote early intervention and improve recovery outcomes. PR individuals report interest in psychoeducation, though such interventions are currently lacking. Our goal was to develop a structured PR psychoeducation intervention grounded in theory and stakeholder feedback.Methods: By following a step-by-step intervention development model, we identified relevant conceptual frameworks, developed the content and format, and obtained stakeholder feedback. This process resulted in a 5-session PR psychoeducation intervention, Brief Educational Guide for Individuals in Need (BEGIN), with content conveyed visually via a slideshow presentation. PR individuals (n = 5) and parents of PR individuals (n = 5) reviewed BEGIN's content and format, and provided feedback through semi-structured qualitative interviews. Major themes were identified through iterative thematic analysis.Results: PR individuals and parents had a positive impression of BEGIN's materials and step-by-step format and psychoeducation about the PR condition. They indicated that the intervention was likely to encourage agency. PR participants emphasized the importance of a patient's decision regarding whether their family member(s) should participate in BEGIN. Parents reported that BEGIN is an important first step in treatment and offers a safe therapeutic environment. Feedback was then utilized to modify the intervention.Conclusions: BEGIN is desired by consumers and may lay the foundation for future engagement with treatment by facilitating agency. A feasibility trial is underway and future studies are needed to measure outcomes (e.g., treatment engagement) and evaluate BEGIN as an evidence-based PR psychoeducation model.

The association between mental health stigma and face emotion recognition in individuals at risk for psychosis.

“…Stereotype awareness is an observation, whereas stereotype agreement and discrimination are internalized aspects of stigma that can be targeted through treatment. Helpful interventions may include providing feedback on one’s CHR status in a way that enhances the positive effects (e.g., relief, validation) of CHR labeling (Uttinger et al, 2018; Welsh & Tiffin, 2012), directly inquiring about the perceived impact of CHR labeling during feedback (Woodberry et al, 2021), and providing psychoeducation to increase understanding of the CHR condition (Herrera et al, 2021; McFarlane et al, 2012). Psychosocial interventions could also address stigma as a barrier to treatment engagement (Ben-David et al, 2019; Gronholm et al, 2017; He et al, 2020; Rusch et al, 2013).…”

A feasibility and pilot trial of the Brief Educational Guide for Individuals in Need (BEGIN): Psychoeducation for individuals at risk for psychosis.

“…Each session follows a similar structure in which the therapist and patient review the session agenda, discuss the previous session's homework assignment, receive education about the session topic and participate in relevant activities and discussions, complete a "check-in" in which patients reflect on their thoughts and emotional reactions, discuss the upcoming week's homework assignment, and complete session feedback in which patients are asked what they thought about the session and if they learned anything that was important to them. The session goals, psychoeducational lessons, activities, and homework assignments for each BEGIN session can be found in Supplemental Material 1, and a detailed description of BEGIN's development, content, and format can be found in Herrera et al (2022).…”

“…It differs from other CHR psychoeducation interventions in that it is brief and focuses only on the core elements of psychoeducation with a goal to facilitate engagement in subsequent treatment, utilizes structured visual material to guide each session, and can be delivered as an individual or family intervention depending on the patient's preference. Qualitative interviews with CHR individuals and parents who aided in the development and refinement of BEGIN's content and format indicated that it is a desirable intervention that provides key information about mental health, encourages agency, and facilitates a safe therapeutic environment (Herrera et al, 2022).…”

“…A recent scoping review of psychoeducation for CHR individuals (Herrera et al, 2023) identified three standalone CHR psychoeducation interventions that have been developed and piloted (Hauser et al, 2009; Herrera et al, 2022; McFarlane, 2001; O’Brien et al, 2007), showing improvements in knowledge gained, symptoms, functioning, locus of control, as well as reductions in illness burden and stigma. However, research on the impact of these standalone psychoeducation interventions for CHR is limited to development and piloting, and thus additional research is needed to determine the effectiveness of CHR psychoeducation.…”

“…One of these interventions is the Brief Educational Guide for Individuals in Need (BEGIN; Herrera et al, 2022). BEGIN is a five-session structured psychoeducation intervention that educates CHR individuals on the CHR condition and treatment options in order to inform future decision making about treatment.…”