Cognitive-behavioral Group Treatment Research Articles

Group cognitive behavioural treatment of youth anxiety in community based clinical practice: Clinical significance and benchmarking against efficacy

The efficacy of a group cognitive behavioural therapy (CBT) programme (Cool Kids) of youth anxiety has been demonstrated at university clinics in Australia and Denmark and similar CBT programmes have been found effective within community settings in other countries. However, most effectiveness studies of CBT for youth anxiety have either used a mixture of CBT guidelines, or translated protocols not previous tested in an efficacy trial. This study used a benchmarking strategy to compare outcomes from the same CBT programme used at a university research clinic (N=87) and community centres (N=82). There was a significant reduction on both clinical and self-report measures of youth anxiety over time with medium to large effect sizes within both samples. Treatment effects on self-report measures of youth anxiety were significantly larger within the university sample, while changes in clinical measures of youth anxiety were similar in the two samples. Overall these findings suggest that an efficacious CBT group treatment programme developed within research contexts is transportable to community centres. Despite being effective within the community, the results indicate that the treatment may lose some of its efficacy when disseminated to the community.

Systematic review and meta-analysis of group cognitive behavioural psychotherapy treatment for sub-clinical depression.

Studies investigating effectiveness of group psychotherapy intervention in sub-threshold depression have shown varying results with differing effect sizes. A systematic review of randomised controlled trials of group psychotherapy in adults with sub-threshold depression has been conducted to present the best available evidence in relation to its effect on depressive symptomatology and prevention of incident major depression. Electronic search for RCTs and a meta-analysis using random effects models to obtain a pooled estimate. Eight studies from six clinical trials met the inclusion criteria. Group psychotherapy is an effective intervention for reducing depressive symptoms in adults with sub-threshold depression in comparison to waiting list controls (MD=-3.48, 95% CI: -5.02, -1.93). The reported benefits for group intervention in reducing depressive symptoms in comparison to other active interventions did not reach statistical significance (MD=0.37 95% CI: -1.29, 2.04). The benefit of group psychotherapy at follow-up is not maintained. Group psychotherapies do not appear to reduce the risk of incident depressive disorder during the follow up (RR=1.15 95% CI: 0.85, 1.54). Dutch studies had bigger effect sizes than studies from other countries. The quality of reporting of all the studies was suboptimal. The results of this meta-analysis show that group CBT interventions for patients with sub-threshold depression have a significant effect on depressive symptomatology at post treatment in both working age and older adult population. However it does not appear to reduce the incidence of major depressive disorders and has minimal or no effect on depressive symptomatology during follow-up.

Efficacy and moderators of a family group cognitive-behavioral preventive intervention for children of parents with depression.

Building on an earlier study (Compas, Forehand, Thigpen, et al., 2011), tests of main effects and potential moderators of a family group cognitive-behavioral (FGCB) preventive intervention for children of parents with a history of depression are reported. Assessed a sample of 180 families (242 children ages 9-15 years) in a randomized controlled trial assessed at 2, 6, 12, 18 and 24 months after baseline. Significant effects favoring the FGCB intervention over a written information comparison condition were found on measures of children's symptoms of depression, mixed anxiety/depression, internalizing problems, and externalizing problems, with multiple effects maintained at 18 and 24 months, and on incidence of child episodes of major depressive disorder over the 24 months. Effects were stronger for child self-reports than for parent reports. Minimal evidence was found for child age, child gender, parental education, parental depressive symptoms, or presence of a current parental depressive episode at baseline as moderators of the FGCB intervention. The findings provide support for sustained and robust effects of this preventive intervention.

There’s no ‘I’ in GCBT: Identifying predictors of group-level outcome in transdiagnostic group cognitive-behavioral therapy for anxiety.

Anxiety disorders represent a prevalent and impairing class of disorders. While individual and group cognitive-behavioral interventions have been efficacious in treating anxiety, this research typically looks at individuals or study condition as the unit(s) of analysis. Thus, an understudied area in group therapy is in the investigation of outcome with therapy group as the unit of analysis. Using data from 43 transdiagnostic CBT groups representing a heterogeneous composition of anxiety disorders, this study analyzed data at the level of therapy group to investigate predictors of group-level change associated with this treatment. Results demonstrated that gender heterogeneity and group cohesion positively predict group outcome while racial/ethnic heterogeneity negatively predicts outcome. However, results suggest that negative effects of racial/ethnic heterogeneity were limited to only the most diverse groups, which may need to integrate more multicultural perspectives in order to better integrate the different cultural identities. Results and implications are discussed in terms of CBT group composition and the implementation of culturally sensitive strategies into evidencebased treatments.

Clinical Change in Cognitive Distortions and Core Schemas After a Cognitive–Behavioral Group Intervention: Preliminary Findings from a Randomized Trial with Male Prison Inmates

The goal of this pilot study was to assess the efficacy of a cognitive–behavioral program in reducing cognitive distortions and schemas in prison inmates. The Angry Cognitions Scale and the Young Schema Questionnaire was answered by a treatment and control group, and the treatment effects were tested using ANCOVA with baseline as covariate and condition as fixed factor. In order to assess clinical change, the Reliable Change Index was computed. At baseline, no differences were found between groups, except for one subscale of the Angry Cognitions Scale (Maladaptive Processes), where controls scored higher than treatment subjects. ANCOVA showed significant differences between groups at post-treatment, with treatment subjects presenting lower scores on the studied variables. Concerning clinical change, differences between groups were observed in the distributions by change categories in the majority of the variables. These outcomes offer preliminary evidence of the program’s ability to change cognitive variables underlying antisocial behavior.

Does a preoperative cognitive-behavioral intervention affect disability, pain behavior, pain, and return to work the first year after lumbar spinal fusion surgery?

A randomized clinical trial including 90 patients. To examine the effect of a preoperative cognitive-behavioral intervention (CBT) for patients undergoing lumbar spinal fusion (LSF) surgery. Few published studies have looked at the potential of rehabilitation to improve outcomes after LSF. Rehabilitation programs using CBT are recommended. Furthermore, initiating interventions preoperatively seems beneficial, but only limited data exist in the field of spine surgery. Patients with degenerative disc disease or spondylolisthesis undergoing LSF were randomized to usual care (control group) or preoperative CBT and usual care (CBT group). Primary outcome was change in Oswestry Disability Index from baseline to 1-year follow-up. Secondary outcomes were catastrophizing, fear avoidance belief, work status, and back and leg pain. At 1-year follow-up, there was no statistically significant difference between the CBT group and the control group in Oswestry Disability Index score (P = 0.082). However, the CBT group had achieved a significant reduction of -15 points (-26; -4) already at 3 months (between group difference P = 0.003), and this reduction was maintained throughout the year. There were no differences between groups at 1-year follow-up with regard to any of the secondary outcomes. Participating in a preoperative CBT intervention in addition to usual care did not produce better outcomes at 1-year follow-up for patients undergoing LSF. Although the reduction in disability was achieved much faster in the CBT group, resulting in a significant difference between groups already 3 months after surgery, it did not translate into a faster return to work. Our findings support the need for further research into the use of targeted rehabilitation interventions among patients with elevated levels of catastrophizing and fear avoidance beliefs. 2.

Managing Neuropsychological Impairment in Multiple Sclerosis: Pilot Study on a Standardized Metacognitive Intervention.

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of potential autoimmune origin that is frequently associated with psychological disorders and cognitive deficits, as well as with fatigue, stress, and psychosocial burden. These factors often cause decreased quality of life, social withdrawal, and unemployment. We describe the development of a cognitive-behavioral group intervention based on the concept of metacognition and evaluation of the feasibility and acceptance of the program as a rehabilitation tool. Metacognitive Training in MS (MaTiMS) consists of six modules, each 90 minutes in duration. We tested acceptance and design of the program in six focus groups (entire sample, n = 27). Framework analysis of transcripts was used to identify key topics and categories. Program modules were revised in accordance with appropriate recommendations of focus group members. We subsequently evaluated MaTiMS in two groups (n = 5, n = 6) in a rehabilitation center. Neuropsychological functioning as well as coping self-efficacy, depression, stress, perceived cognitive deficit, fatigue, and quality of life were assessed. Acceptance of MaTiMS from the patient perspective was also studied. The modules were highly accepted by patients. Pre-post assessments showed significant improvements in the Coping Self Efficacy Scale (P = .007), the Würzburger Fatigue Inventory for MS Score (P = .028), and the Hamburg Quality of Life Questionnaire in Multiple Sclerosis Mood subscale (P = .046). These preliminary results suggest that MaTiMS represents a feasible psychological group training program that may foster improvements in self-efficacy, fatigue, and mood. The next step will be an evaluation of the program in a randomized controlled trial.

The Effectiveness of Cognitive Behavioral Group Intervention on the Stress Levels of New Graduate Nurses

Background & Aim: New graduate nurses bear high levels of stress which could lead to unpleasant personal and professional outcomes. This study aimed to determine the effectiveness of cognitive behavioral group intervention on the stress levels of new graduate nurses. Material & Methods: It was a quasi-experimental pretest-posttest study with control group. A total of 80 new graduate nurses were first recruited by purposeful sampling and then were randomly assigned into two experimental and control groups (n=40). Eight, 90 minutes sessions of cognitive behavioral group intervention was performed for the experimental group two times a week. Control group received no intervention. The data was collected before and after the intervention by ―Expanded Nursing Stress Scale‖ and analyzed by inferential statistics such as chi-square and independent T test using SPSS- PC (v. 20). Results: The findings showed that the mean score of stress level has reduced significantly after the intervention (from 44/44 to 29/44) (p<0/001). No significant reduction was found in the stress levels of control group (p=0/276). There was also a significant difference between the mean score of stress levels of the two groups after intervention (p<0/001). Conclusion: According to the findings cognitive behavioral group intervention can reduce the stress levels of new graduate nurses. Therefore, using this intervention in the beginning of new graduate nurses’ work is suggested.

The German Version of the Behavioral Activation for Depression Scale (BADS): A Psychometric and Clinical Investigation.

The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students (N = 312) and depressed outpatients in partial remission undergoing cognitive-behavioural group treatment for depressive rumination (N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd. Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression. The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment. The BADS is available in different languages and has shown to possess good psychometric properties.

Cognitive behavioral therapy in breast cancer patients--a feasibility study of an 8 week intervention for tumor associated fatigue treatment.

Tumor associated fatigue (TAF) or cancer related fatigue (CRF) is not a new concept. Nonetheless, no real headway has been made in the quantitative analysis of its successful treatment via cognitive behavioral therapy. Since 20 to 30% of all breast cancer patients suffer from anxiety and/or depression within the first year of their diagnosis, this issue needs to be addressed and a standard treatment protocol has to be developed. This study focused on developing a simple, reproducible and short (8 weeks) protocol for the cognitive behavioral therapy support of tumor associated fatigue patients. Between the year 2011 and 2012, 23 breast cancer patients fulfilled the diagnosis TAF requirements and were introduced into this study. Our method focused on a psycho-oncological support group using a predetermined, highly structured and reproducible, cognitive behavioral therapy treatment manual. Eight weekly, 90 minute sessions were conducted and patients were evaluated before and after this eight session block. Tumor fatigue specific questionnaires such as the multidimensional fatigue inventory (MFI) as well as the hospital anxiety and depression scale (HADS) were used in order to quantitatively evaluate patient TAF. Of the 23 patients enrolled in the study, only 7 patients fulfilled the TAF diagnostic criteria after the psycho-oncological group treatment. This represents a 70% reduction in diagnosable tumor associated fatigue. The HADS analysis showed a 33% reduction in patient anxiety as well as a 57% reduction in patient depression levels. The MFI scores showed a significant reduction in 4 of the 5 evaluate categories. With the exception of the "mental fatigue" MFI category all results were statistically significant. This study showed that a highly structured, cognitive behavioral therapy group intervention will produce significant improvements in breast cancer patient tumor associated fatigue levels after only 8 weeks.

Effectiveness of Group Cognitive Behavioral Intervention to Increase Perceived Social Support in Patients with Substance Abuse (a Treatment Model in Prevention of Substance Abuse)

Introduction The people who seem to have less social support And suffer lack of multiple social supports are more likely at risk to drug abuse. Materials and Methods This research was an experimental with pre-test post-test design with randomly assigned 30 patients referred to drug addiction treatment centers in experimental and control groups. present aim at testing the effect of eight, 2- hour sessions of stress management training based on cognitive behavioral techniques. Subjects were tested at the beginning and at the end of the project with (SSQ). Results Study findings showed that the subjects of experimental group that were under the intervention(training)compared with control group showed significantly better scores and test effectiveness. Discussion Interventions based on cognitive – behavioral approaches, is effective treatment that it can alters behavioral and cognitive factors associated with substance abuse and be as an efficient model for the prevention of drug abuse and also after treatment.

The indirect effect of the therapeutic alliance and alcohol abstinence self-efficacy on alcohol use and alcohol-related problems in Project MATCH.

Empirical literature indicates that the therapeutic alliance explains a modest but reliable proportion of variance in predicting alcohol-related outcomes among individuals in treatment for alcohol use disorders (AUDs). Hartzler and colleagues (2011) showed in the COMBINE data set that alcohol abstinence self-efficacy is a potentially important statistical mediator of the relationship between the alliance and client outcomes. The purpose of this study was to replicate this finding in the Project MATCH data set. We used total alliance ratings on the Working Alliance Inventory and tested both client and therapist ratings in mediation analyses. We found that posttreatment self-efficacy accounted for the effect of therapist and client ratings of alliance (measured at session 2) on posttreatment drinking outcomes (drinks per drinking day and alcohol-related problems). In addition, we found a moderation effect of treatment, such that the association between the client's rating of the alliance and self-efficacy changes was positive for individuals in the cognitive behavioral treatment group but negative for those receiving motivation enhancement or Twelve-Step Facilitation. This study reaffirms the importance of the therapeutic alliance and self-efficacy in predicting AUD outcomes. Future research should examine changes in the therapeutic alliance throughout treatment and how these changes are related to self-efficacy and AUD treatment outcomes over time.

Cognitive-behavioral group treatment for perinatal anxiety: a pilot study.

Along with physical and biological changes, a tremendous amount of upheaval and adjustment accompany the pregnancy and postpartum period of a woman's life that together can often result in what is commonly known as postpartum depression. However, anxiety disorders have been found to be more frequent than depression during pregnancy and at least as common, if not more so, during the postpartum period, e.g., Brockington et al., (Archieves Women's Ment Health 9:253-263, 2006; Wenzel et al. (J Anxiety Disord, 19:295-311, 2005). Cognitive-behavioral therapy (CBT) is a well-established psychological treatment of choice for anxiety; however, few studies have specifically examined a cognitive-behavioral intervention targeting perinatal anxiety. This pilot study examined the effectiveness of a cognitive-behavioral group treatment (CBGT) program specifically tailored to address perinatal anxiety in 10 women who were either pregnant or within 12months postpartum. Participants were recruited from a women's clinic at an academic hospital setting, with anxiety identified as their principal focus of distress. Following a diagnostic interview confirming a primary anxiety disorder and completion of assessment measures, participants completed a 6-week CBGT program. There was a statistically significant reduction in anxiety and depressive symptoms following the CBGT program (all p < 0.05). Participants also reported high acceptability and satisfaction with this treatment for addressing their perinatal anxiety. These findings suggest that CBGT for perinatal anxiety is a promising treatment for both anxiety and depressive symptoms experienced during the perinatal period. Further studies are needed to evaluate the treatment efficacy through larger controlled trials.

Effectiveness trial of an indicated cognitive-behavioral group adolescent depression prevention program versus bibliotherapy and brochure control at 1- and 2-year follow-up.

The main goal of this study was to evaluate the long-term effects of a brief group cognitive-behavioral (CB) adolescent depression indicated prevention program through 2-year follow-up, relative to CB bibliotherapy and brochure control, when high school personnel recruited students and delivered the program. Three hundred seventy-eight adolescents (M age = 15.5, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms who were randomized to CB group, CB bibliotherapy, or educational brochure control were assessed at pretest, posttest, and 6-, 12-, 18-, and 24-month follow-up. By 2 years postintervention, CB group participants showed significantly lower major depressive disorder (MDD) onset versus CB bibliotherapy (10% vs. 25%, respectively; hazard ratio = 2.48, p = .006), but the incidence difference relative to brochure controls (17%) was nonsignificant; MDD incidence for bibliotherapy and brochure controls did not differ. Although CB group participants showed lower depressive symptoms at posttest versus brochure controls, there were no effects for this outcome or for social adjustment or substance use over 2-year follow-up. Moderator analyses suggested that participants with higher baseline depressive symptoms showed greater long-term symptom reductions in the CB group intervention versus bibliotherapy. The evidence that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset versus CB bibliotherapy is potentially encouraging. However, the lack of MDD prevention effects relative to brochure control and lack of long-term symptom effects (though consistent with results from other depression prevention trials), suggest that the delivery of the CB group should be refined to strengthen its effectiveness.

Cognitive-Behavioral Group Treatment for Men Voluntarily Seeking Help for Violence towards Their Intimate Partners: The Impact of Treatment Components 4 - 7 Years after Therapy

Background: Even though domestic violence is a major problem, only a few studies have examined the long term sustainability of treatment for men who voluntarily seek help to stop their violent behavior towards intimate partners. Women are exposed to a much greater degree of serious violence and sexual abuse compared to men. Objective: The aim of this study was to identify which elements of the treatment program batterers found most useful four to seven years after program completion. Design: The participants consisted of a sample of men who had gone through anger management therapy four to seven years previously. Data on violence were collected through self-report before and four to seven years after treatment, using a modified version of the Conflict Tactics Scales. Results: The decrease in physical violence was statistically significant: t (36) = 8.43, p < 0.001 with a large effect size (eta squared = 0.66). Psychological violence also decreased significantly: t (36) = 9.21, p < 0.001 with a large effect size (eta squared = 0.7). The results indicate that the most important anger management techniques were extensively applied in former patients of the anger management treatment program. In total, about two out of three patients still used the techniques after ending treatment four to seven years earlier.

Effectiveness of a cognitive–behavioural group intervention for knee osteoarthritis pain: a randomized controlled trial

Objective: To assess the effectiveness of a six week cognitive–behavioural group intervention in patients with knee osteoarthritis pain. Design: Single-blinded randomized controlled trial. Study setting: Primary care providers in a medium-sized city in Finland. Patients: A total of 111 participants aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2–4) of knee osteoarthritis were included. Interventions: In the intervention group, 55 participants attended a cognitive–behavioural training programme for pain management with six weekly group sessions supervised by a psychologist and a physiotherapist. Concurrently, they and the 56 participants of the control group continued in ordinary GP care that was not altered by the study. Main measures: The primary outcome on three-month and 12-month follow-up was the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index pain subscale. Secondary outcome measures included self-reports of pain and physical function, health-related quality of life, and a comprehensive set of psychological questionnaires. Results: Mixed model results showed no significant differences between the intervention and control group for any measures of pain or function. A significant difference between the groups was found in the Pain Self-Efficacy Questionnaire (Pr = 0.022) in favour of the control group, and in the RAND-36 emotional well-being subscale in favour of the intervention group (Pr = 0.038). Conventional group comparisons of mean follow-up values showed no significant differences in any of the outcome variables. Conclusion: This trial could not confirm the hypothesized advantage of a cognitive–behavioural training programme over ordinary GP care in knee osteoarthritis pain patients. Trial registration: Current Controlled Trials ISRCTN64794760

Heterogeneous Symptom Patterns of Sexually Abused Children in Treatment: Understanding the Complexity of the Problem

A major challenge for clinicians and researchers is the heterogeneity of the severity and type of symptoms presented by sexually abused youth, including those who are subclinical on traditional clinical measures but still present to treatment. Most research continues to treat sexually abused youth as a single population and has not assessed the outcomes or symptom trajectories of various groups of sexually abused youth. Participants included 107 sexually abused children and their nonoffending parents presenting to a cognitive-behavioral group treatment. A cluster analysis using child- and parent-report measures revealed four profiles, including Subclinical, Highly Distressed, Problem Behaviors, and Self-Reported Distress clusters. Hierarchical linear modeling was used to create separate child- and parent-report models of weekly symptomatology to examine differential change over the course of treatment. Contrary to expectation, there was little variation in the weekly rates of change for the different symptom groups; however, all groups evidenced a decrease in symptoms over the course of treatment, including the Subclinical cluster.

"Strength at Home" Intervention for Male Veterans Perpetrating Intimate Partner Aggression: Perceived Needs Survey of Therapists and Pilot Effectiveness Study.

Veteran and active duty populations evidence higher rates of intimate partner aggression (IPA) than comparable civilian groups, perhaps due in part to their unique service-related experiences. IPA offender treatment programs that take military background into consideration are not widely available, and it is unclear to what extent there is a perceived need for them among clinicians who serve service members and Veterans. Strength at Home (SAH) is a promising 12-session cognitive-behavioral group intervention designed to address IPA perpetration in military populations. While clinical support for SAH is emerging, the extent to which service members and Veterans find it appropriate and helpful is not yet known. Goals of the current study were threefold: (a) assess the perceived need for a military-specific IPA program among Veterans Administration and community domestic violence (DV) program providers; (b) conduct a pilot study to examine the feasibility and preliminary effectiveness of SAH in a sample drawn from a diverse, multicultural community; and (c) conduct focus groups to obtain participant feedback on the SAH protocol. Findings from the provider survey suggested a need for specialty programs to treat military personnel who perpetrate IPA of mildtomoderate severity. Results of the SAH pilot study (n = 6) indicated decreased psychological aggression and increased anger control from baseline to 6-month follow-up. Focus group feedback indicated participants found the program to be helpful and appropriate across a wide variety of ethno-cultural variables. As more service members and Veterans of the Iraq/Afghanistan war era reintegrate into our communities, it will become increasingly important for providers in both private and public sectors of care to understand the unique needs of this treatment population, and to have access to effective IPA treatment programs.

Efficacy of a burn-specific cognitive-behavioral group training

ObjectiveThe aim of the present study was to evaluate the efficacy of a newly developed cognitive-behavioral group training, specifically designed for burn patients. MethodIn a multicenter-study data pre- and post treatment and at 6-month follow-up were obtained from participants of the group program (Intervention group, IG; n=86) and a control group who received treatment as usual (TAU; n=128). Outcome variables of psychological distress, resources and health-related quality of life of both groups were compared using linear mixed models. ResultsUp to 6 months after group treatment, the IG reported a substantial decline of general symptom severity as well as posttraumatic stress, whereas the TAU group showed no significant change over time. Optimism increased in the IG after group treatment, but not in the TAU group. Regarding overall quality of life both groups showed a gradual improvement over the three assessment points. ConclusionThe newly developed burn-specific cognitive-behavioral group intervention had positive effects on psychological well-being and resources of burn participants. As a consequence, the group intervention has been implemented as inherent part of the regular burn treatment in two rehabilitation centers in Germany.

Targeting perfectionism in anorexia nervosa using a group-based cognitive behavioural approach: a pilot study.

This study aimed to explore whether a six session cognitive behavioural group intervention targeting perfectionism is efficacious in reducing perfectionism in adults with anorexia nervosa in an inpatient setting. Adults with anorexia nervosa received a group perfectionism intervention in an inpatient setting. Self-report and patient satisfaction questionnaires were completed at the beginning of the first session and end of the last session. Significant changes of moderate effect size were observed for overall perfectionism, concern over mistakes and personal standards dimensions of perfectionism following participation in the group. These changes were found to be independent of change in body mass index. A group cognitive behavioural approach appears to be efficacious in reducing perfectionism in adults with anorexia nervosa.