Examining group members’ interpersonal style discrepancies on treatment outcomes in focused brief group therapy: A test of interpersonal group composition.

Studies investigating effectiveness of group psychotherapy intervention in depression in persons with HIV have showed varying results with differing effect sizes. A systematic review of randomized controlled trials of group psychotherapy in depression in persons with HIV has been conducted to present the best available evidence in relation to its effect on depressive symptomatology. Electronic databases were searched to identify randomized controlled trials. Selected studies were quality assessed and data extracted by two reviewers. If feasible, it was planned to conduct a meta-analysis to obtain a pooled effect size of group psychotherapeutic interventions on depressive symptoms. Odds ratio for drop out from group was calculated. The studies were assessed for their quality using the Quality Rating Scale and other parameters for quality assessment set out by COCHRANE. The quality of reporting of the trials was compared against the Consolidated Standards of Reporting Trials (CONSORT) checklist for non-pharmacological studies (CONSORT-NPT). Four studies met the full inclusion criteria for systematic review. The trials included in the review examined group interventions based on the Cognitive behavioral therapy model against other therapeutic interventions or waiting list controls. In all four studies, group psychotherapy was an effective intervention for reducing depressive symptoms in persons with HIV in comparison to waiting list controls. The reported benefits from the group psychotherapy in comparison to active controls were less impressive. There were no statistically significant differences in drop outs at post treatments across group psychotherapy, wait list control, and other active interventions. The methodological quality of the studies varied. The quality of reporting of the studies was sub-optimal. The results of this systematic review support that group psychological interventions for depression in persons with HIV have a significant effect on depressive symptomatology. This review also indicates that group cognitive behavioral therapies are an acceptable psychological intervention for persons with HIV and comorbid depression.

Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy. In general, treatment outcome studies did not demonstrate differences between group and individual modalities, and no single type of group therapy reliably demonstrated greater efficacy than others. Unique methodological and logistical hurdles encountered in research on group therapy for substance use disorders, as well as considerations for future research, are also discussed.

Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes

To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful. Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities. Prospective cohort study. Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session. Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors. Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame. Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Group Therapy Use and Its Impact on the Outcomes of Inpatient Rehabilitation After Traumatic Brain Injury: Data From Traumatic Brain Injury–Practice Based Evidence Project

This study examined the long-term outcomes of mental health treatment, specifically individual therapy, group therapy, and pharmacotherapy, in a population-based study. Using a prospective cohort design, the effectiveness of mental health treatment was analyzed on the basis of data from an epidemiological catchment area follow-up study, which assessed health care use and mental health status at 2 times, 15 years apart, in a random sample of Baltimore residents. A cohort of 771 men and women with at least 1 diagnosable Diagnostic and Statistical Manual of Mental Disorders disorder was selected from the 1,920 individuals randomly sampled in 1980 who were followed in 1994-1996. The results are consistent with clinical trials on the efficacy of pharmacotherapy and psychotherapy. After controlling for baseline psychopathology, sociodemographic characteristics, and service providers, participants who received group and individual therapy had lower distress at follow-up than those who either received medication or did not seek or receive any treatment. No concomitant reductions in the number of disorders were found, except for a dose-response association between the number of therapy sessions and the number of disorders at follow-up, as well as distress at follow-up.

This study examined the long-term outcomes of mental health treatment, specifically individual therapy, group therapy, and pharmacotherapy, in a population-based study. Using a prospective cohort design, the effectiveness of mental health treatment was analyzed on the basis of data from an epidemiological catchment area follow-up study, which assessed health care use and mental health status at 2 times, 15 years apart, in a random sample of Baltimore residents. A cohort of 771 men and women with at least 1 diagnosable Diagnostic and Statistical Manual of Mental Disorders disorder was selected from the 1,920 individuals randomly sampled in 1980 who were followed in 1994-1996. The results are consistent with clinical trials on the efficacy of pharmacotherapy and psychotherapy. After controlling for baseline psychopathology, sociodemographic characteristics, and service providers, participants who received group and individual therapy had lower distress at follow-up than those who either received medication or did not seek or receive any treatment. No concomitant reductions in the number of disorders were found, except for a dose-response association between the number of therapy sessions and the number of disorders at follow-up, as well as distress at follow-up.

To compare outcome and dropout rates of an individual nutritional counselling (IT) and a cognitive behavioural group therapy (GT) after 6 months of treatment. One hundred and twenty-nine women (72 in the IT and 57 in the GT group) aged 18-65 years, with body mass index (BMI) > or =25 kg/m(2). Body weight, height and waist circumference were measured. Obesity Related Well Being 97 questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometrical variables. After 6 months, 37.2% (54.2% of initial IT sample and 15.8% of initial GT sample) of subjects abandoned the treatment programme. Completers were older (p<0.03) and had a worse BUTa General Severity Index score (p<0.04) than non-completers. IT had a higher dropout rate than GT. After 6 months of treatment completers lost 6.39% of initial weight and obtained improvements in all studied variables, except scores of SCL 90 and BUTb Positive Symptom Distress Index questionnaires. IT and GT groups did not differ significantly. Outcomes of IT and GT were comparable in all studied variables, whereas dropout rate of IT was higher than that of GT, suggesting that some characteristics of GT can contribute to the reduction of attrition. Younger age and better body image (measured by BUT) were associated to dropout. After weight loss we observed improvements in almost all variables in both groups without differences.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale-24 items, HDRS24; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients' evaluation improved significantly from t1 to t2 with a medium effect size (d=0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were 'optimal' and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 ('good'). Therapists' evaluation was positive throughout, except for size of the group. Outcome scores of HDRS24, BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d=1.48; d=1.11; d=0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.

Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members

This study had three objectives concerning patients' dissatisfaction with their psychotherapist. The first was to compare patient dissatisfaction with the therapist in interpretive and supportive group therapies. The second was to investigate the relationship between dissatisfaction and treatment outcome. The third was to examine the quality of object relations (QOR) as a moderator of the effect of dissatisfaction on treatment outcome. The study utilized data from 107 patients with complicated grief who participated in a randomized trial of interpretive and supportive group therapies. Patients reported a greater dissatisfaction in interpretive therapy than in supportive therapy. Dissatisfaction was inversely related to improvement in supportive therapy, but not in interpretive therapy. Further, QOR moderated the effect of dissatisfaction on treatment outcome in supportive therapy. The findings suggest that, for certain patients, dissatisfaction with one's therapist may have an adverse effect on one's ability to benefit from group therapy. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Recovery from addiction requires motivation to change, understanding of the process of addiction, and the ability to form new, stable patterns of behavior. Cognitive behavior therapy is currently a mainstay of treatment for cocaine dependence. Its aim is to change behavior and affective responses by teaching coping skills and by addressing and modifying dysfunctional thought patterns. Through learning and practice, a patient can gain increasing control over urges and behaviors that were previously considered to be unmanageable and immutable. In most substance abuse treatment programs, counseling also includes disease-model education, anger management, and motivational enhancement in both individual and group settings to provide alternative responses when an addict is faced with unmanageable feelings, urges, or circumstances. The capacity to respond to such “psychosocial” intervention is largely dependent on a patient’s cognitive flexibility. Intellect, in the conventional sense, varies as a function of education and socioeconomic background. Educational history is relevant in cognitive therapy only as regards intellect in the intrinsic sense: the ability to learn and reason and abstract. The case reports presented here were chosen to illustrate the premise that intellect, in this less colloquial sense, changes over the period of early recovery from heavy drug exposure. We propose that this change in complex cognitive function is multidetermined, a product of effects of drug abuse at many levels of regulation of cerebral function, but focus on cerebral perfusion in these two cases. Cocaine induces constriction of coronary and cerebral vessels in both humans and in animal models (1, 2). Over the last 10 years, several groups of investigators using positron emission tomography and single photon emission computed tomography to measure brain perfusion have found that chronic cocaine use (usually in the context of polysubstance abuse) is associated with multiple focal decreases in cerebral blood flow (CBF) (3, 4). Magnetic resonance angiography has provided the first direct demonstration of acute, cocaine-induced cerebral vasospasm in humans (5). Previous investigations have demonstrated both deficits in neuropsychological performance and abnormalities in brain perfusion or metabolism in chronic cocaine abusers and that both of these deficits can improve during abstinence (4, 6, 7). Although prior studies have indicated that the severity of these flow deficits is related to the degree and duration of drug abuse, their pathophysiology is unknown, and their consequences on brain function are unclear. One corollary of these findings is that the degree of change in CBF during abstinence correlates with the degree of abnormality at the beginning of treatment. Figure 1 presents the baseline image of the patient in case 2, Ms. B, in relation to that of a typical comparison subject. These images have been scaled and colorcoded to show the same relative activity. Note that in addition to several cortical regions with markedly decreased perfusion, e.g., orbital and dorsal prefrontal, parieto-occipital and frontoparietal, CBF in the patient’s cortex is generally lower than that of a comparison subject. We have hypothesized that a measure of the change from baseline perfusion will correlate with a measure of the capacity to learn new behavior. The cases were chosen to highlight the role of cognitive function and its relation to cerebral perfusion in recovery from cocaine abuse and to demonstrate an association between the response to behavioral therapy and improvement in cerebral perfusion. Both patients were in drug-free residential care during the two neuroimaging and neuropsychological testing sessions. We suggest that this correlation provides a hypothesis for further clinical study of the relationship between cerebral perfusion and the response to cognitive behavior therapy in recovery from cocaine dependence.

The Effectiveness of Group Voice Therapy: A Group Climate Perspective

Despite much attention in the clinical literature, research on alexithymia in the treatment setting has only recently gained traction. While several reports indicate limited benefit from therapy amongst patients with high alexithymia, this seems to be less so in the context of group therapy. This study considers a specific aspect of the group therapy process - family re-enactment - in facilitating improvement in overall quality of life for patients with high levels of alexithymia. Family re-enactment was examined as a potential mediator of the relationship between alexithymia and change in quality of life among 50 patients who completed treatment in an intensive, integrative group therapy programme. Patients completed three self-report measures: Toronto Alexithymia Scale-20 (baseline), Quality of Life Inventory (baseline, post-therapy), and Therapeutic Factors Inventory-Short Form (week 8). Regression with mediation analysis was employed using the change score for the QOLI as the dependent variable, alexithymia scores as the independent variable, and the family re-enactment score as the mediator; baseline quality of life was included in the model as a control variable. Family re-enactment emerged as a significant mediator of the relationship between alexithymia and treatment outcome, implicating it as a contributing mechanism of change for alexithymic patients who participate in group therapy. Patients with higher levels of alexithymia (in particular, difficulty identifying and describing feelings) were more likely to positively endorse aspects of family re-enactment during group therapy, which in turn were significantly associated with greater improvement in patients' overall quality of life.

The Challenge Project: A treatment program evaluation for perpetrators of child sexual abuse