Contribution of Group Therapeutic Factors to the Outcome of Cognitive–Behavioral Therapy for Patients with Panic Disorder

Abstract

BackgroundInvestigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive–behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce. ObjectivesTo identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT. DesignNon-controlled clinical trial. MethodsA 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors. ResultsThe sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors. ConclusionsTherapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.