Cognitive Behavioral Group Training Research Articles

Evaluation of a Life Functioning Goal Attainment Psychosocial Treatment Program for Adults with Psychotic Disorders

Purpose: To determine if the use of an integrated goal attainment cognitive behavioral social skill training program can impact serious mental illness related treatment and life functioning avolition. Methods: The attendance and goal attainment progress of thirty-eight serious mental ill diagnosed adults admitted to psychiatric clinic’s integrated goal attainment cognitive behavioral social skills group training program were studied. Demographic (age, gender, race, education), clinical (psychiatric diagnosis, trauma history), and life experience (work, income, housing, relational status, friendship support, incarceration and drug arrest histories) variables were compared to identify possible program attendance and goal attainment level associations and differences. Results: Participants attended a mean of 8 program days of the 6 to 8-week program with younger and unmarried attending significantly more days than older and married participants. Greater attendance and participation rates were positively correlated with higher levels of assessed goal attainment. Conclusions: Individuals with serious mental illness conditions are likely to voluntarily attend and participate in psychosocial intervention programs focused on major area life functioning goal attainment. Higher levels of attendance and participation were associated with higher levels of short-term goal attainment. Functioning focused psychosocial interventions may be effective in reducing serious mental illness related avolition.

Effectiveness of Cognitive-Behavioral Group Training on Mother’s Child Abuse and Quality of Life of Preschool Children

Background: Child abuse and neglect are global problems with negative outcomes in the quality of life among children. This study aimed to investigate the effectiveness of cognitive-behavioral group training on child-abuser mothers and the quality of life of children. Materials and Methods: This interventional study was conducted based on a pretest-posttest design and a control group. The statistical population of this study included all preschool children in kindergartens in Khorramabad, Iran. Using the cluster sampling method, 23 children who gained the abuse score were selected, along with their mothers were selected and randomly divided into an experimental (n=10) and a control (n=13) group. The mothers in the experimental group received cognitive-behavioral training for eight 90-minute sessions. The tools used to collect data consisted of the Child Abuse Scale (Mohammadkhani, 2011) and the Quality of Life Questionnaire (Fakkes, 2000). The gathered data were analyzed in SPSS software (version 22) using descriptive statistics, the Chi-square test, and the Mann-Whitney U test at a significance level of <0.05. Results: The data analysis of this study showed that group cognitive-behavioral training had a significant effect on the reduction of all dimensions of mother’s child abuse (P<0.05) and a positive effect on evaluating the quality of life of children from their mother's point of view (P<0.05). Conclusion: In general, the results of the study indicated that cognitive-behavioral training was effective in reducing mothers’ child abuse and improvement of the quality of life of preschool children.

The effect of cognitive-behavioral group training of self-care skills on self-care in patients with schizophrenia

Background & Aim: Self-care is one of the challenges of the health care system in patients with schizophrenia. It has been less studied due to these patients have no insight into the symptoms. This study aimed to determine the effect of cognitive-behavioral group training on self-care skills in patients with schizophrenia. Methods & Materials: This single-blind randomized controlled clinical trial (blinding of data analysts) was performed on 50 hospitalized schizophrenia patients by convenience sampling method and random block allocation to the intervention (n=26) and control (n=24) groups in Ebn-Sina Psychiatric Hospital of Mashhad, Iran from late July 2020 to mid-January 2021. The intervention group received cognitive-behavioral group training of self-care skills based on Kashani Lotfabadi et al. (2020) protocol in 10 sessions (two sessions per week). The control group was placed on a waiting list. Data collection tools included the Self-Care Requisites Scale (SCRS-H) and the Positive and Negative Syndrome Scale (PANSS). The data were analyzed by SPSS 25 version, repeated measures of ANOVA test. Results: 60 % (n=30) of participants were female, and 40% (n=20) were male with a mean age of 32.98±8.35 years. The results of repeated measures of ANOVA indicated a significant difference between the intervention and control groups in terms of descending mean score of total self-care during the test stages (p=0.001). Conclusion: Cognitive-behavioral group training of self-care skills could promote self-care behaviors in patients with schizophrenia. Therefore, we suggest using this intervention to strengthen self-care skills in patients with schizophrenia.

Effect of cognitive behaviour therapy on the improvement of psychological stress.

College freshmen, as a special group who are far away from their parents and begin to study and live independently, will face psychological stress in adaption to the college life, which may affect their working and living conditions in the university and even after entering the society if not solved reasonably. Hence, it is necessary to explore how to relieve the psychological stress of freshmen. The study aimed to analyze the intervention effects of cognitive behavioral therapy on social psychological stress of freshmen under different demographic variables. 108 freshmen of Northeast Agricultural University were divided into the experimental group and control group. The correlation between psychological stress and impulse, self-esteem, and loneliness was analyzed using structural equation model and multiple regression. The experimental group received group training for one month, while the control group did not accept any intervention. The Fear of Negative Evaluation (FNE) Scale, Interaction Anxiousness Scale (IAS), and Interpersonal Efficacy Scale (IES) were used to score students before and after activities and three months after activities. The relevant information was collected for students' self-evaluation and the evaluation results from group teachers. The subjects' social psychological stress was positively correlated with loneliness and unplanned impulse, and negatively correlated with self-esteem (P < 0.001); the IAS and FNE scores of the experimental group after test were greatly lower than those of the control group, while the scores of affinity efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05); the tracking IAS and FNE scores of the experimental group were greatly lower than those of the control group, while the scores of affinity efficacy, self-impression efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05). All students in the experimental group were satisfied with the cognitive behavioral group training. Under the positive guidance of the team teacher, the students' psychological stress was released. The cognitive behavior group training based on impulse, self-esteem, and loneliness can effectively improve the affinity efficacy, self-impression efficacy, communication efficacy, and negative evaluation fear of freshmen, which is instrumental in easing the psychological stress of students and can maintain long-term effects.

Interventions to reduce stress, anxiety and depression symptoms in teenagers – a systematic review

Abstract Introduction Stress, anxiety and depression symptoms are frequent in teenagers. Objectives: To identify the interventions effectively able to prevent or reduce anxiety, depression and psychological stress in adolescents; to assess the effectiveness, feasibility and transferability of the interventions. Methods Comprehensive systematic review was performed. Three steps searching strategy using the databases: PsycINFO, PubMed, SCOPUS, Cochrane Library, and Google Scholar identified 679 studies and reviews. Critical appraisal was performed by 2 reviewers, data extraction performed on finally selected 59 reviews, RCT, cohort studies focused on sample size, geographical context, setting, description of intervention, measures of primary and secondary outcomes. Results The considered interventions are: Internet-based multifaceted cognitive bias modification training (CBM), Internet (iCBT) or school-based cognitive behavioral group training (CBT), Social skills training (SST), Metacognitive therapy, Psychosocial Support Intervention, organized sports participation and voluntary outdoor play, school-based resilience-focused intervention, assertiveness group training, short-term psychoanalytic psychotherapy (STPP), brief psychosocial intervention (BPI), Guided Parent-Delivered Cognitive Behaviour Therapy (GPD-CBT), Internet-based self-support method. Conclusions Interventions for promoting mental health in adolescents have to combine parenting programs with leisure activities and balanced curriculum; various approaches (physical activity, music, sports participation) should be tailored into the national, community and school contexts. Resilience factors (relationship with parents, communications with peers), development of help-seeking behaviours and available self-help programs could support early detection and assistance. Most interventions showed positive effects on short and medium term and potential transferability. Key messages Regular screening for childhood adversities and traumas and screening of symptoms as feeling sad, hopeless, worried should be performed in adolescents as they get older. Besides mental health risk factors, interventions should target developmental risk factors in transitional stages from childhood to adolescence and from adolescence to young adulthood.

Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: Two-year follow-up of a randomized controlled trial

Background and ObjectivesThis two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. MethodsIn this RCT, moderately socially anxious adolescents (N=240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design. ResultsPrimary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire. LimitationsThere was a substantial (50%) though seemingly non-selective attrition at follow-up. ConclusionsThis RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years.

Development and Feasibility of an Evidence-Based Patient Education Program for Managing Fatigue in Multiple Sclerosis: The "Fatigue Management in MS" Program (FatiMa).

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. Fatigue is a common and disabling symptom, often causing decreased quality of life, social withdrawal, and unemployment. We developed and studied the feasibility of a cognitive-behavioral group intervention to manage fatigue in MS. We aimed to integrate the concepts of cognitive-behavioral therapy and evidence-based patient information. We conducted patient interviews and a focus group to assess patients' interest in and need for fatigue self-management training and developed the program accordingly. The program consists of six 90-minute modules, which were structured with the use of moderation cards, helping to guarantee treatment fidelity. The program was tested on three pilot groups (N = 16) in a rehabilitation center. Fatigue, depression, and coping self-efficacy were assessed at baseline and after the intervention. Acceptance and general satisfaction with the program were also evaluated. Patient interviews elicited different characteristics of fatigue, suggesting that patients had different requirements. The program was very acceptable to patients. Pre-post assessments of the pilot study showed significantly improved scores on the Coping Self-Efficacy Scale (P = .013) but not on the Fatigue Scale for Motor and Cognitive Functions and the 30-item Inventory of Depressive Symptomatology. These preliminary results suggest that this program is a feasible cognitive-behavioral group training program that may improve coping self-efficacy and has the potential to subsequently reduce fatigue. The next step is evaluation of the program in a randomized controlled trial.

Assessment of Effectiveness of Cognitive-Behavioral Group Training on Self-Esteem and Achievement Motivation of High School Students

Background: Based on researches done in recent decades, there are several therapeutic approaches to increase self-esteem and achievement motivation of students. Among these methods, we can refer to cognitive-behavioral therapy. The purpose of this research is assessment of effectiveness of cognitive-behavioral group training on self-esteem andachievement motivation of students. Methods: The research method was experimental with two- grouped pre-test and post- test design, experimental group and control group. The statistical population includes all students of high schools in Sarakhs (educational year 2012-2013). (N=85). Participants were chosen by available sampling method and randomly assigned to an experimental (15 boys) and a control group (15 boys). The experimental group received cognitive-behavioral group training through 8 sessions of 1 hour, while the control group received no training at all. For assessing the research variables, Alis Pop self- esteem questionnaire and Edwards’s achievement motivation questionnaire were done before and after completion of the trainings. The collected data were analyzed using independent and dependent T test by SPSS statistical software. Results: The study demonstrated that cognitive-behavioral training had positive effects on students’ self-esteem (P<0.001) and achievement motivation (P<0.001) in comparison to control group. Conclusions: In general, it can be concluded that cognitive- behavioral training were found effective in increasing self-esteem and achievement motivation.

The Cost-Effectiveness of Cognitive-Behavioral Group Training for Patients with Unexplained Physical Symptoms

ObjectiveThe aim of the study was to evaluate the cost-effectiveness of a cognitive-behavioral group training compared with a wait-list control for patients with unexplained physical symptoms (UPS). MethodsA probabilistic decision-analytic Markov model was developed with three health states (poor health, average health, and death) based on a cutoff score of the Physical Component Summary of the short-form 36 health survey. To assess the cost-effectiveness in terms of cost per quality-adjusted life-year (QALY), a societal perspective was adopted. The model consisted of cycles of 3 months and a time horizon of 4 years. Data for the model were derived from a randomized controlled trial, in which 162 patients with UPS were randomized either to cognitive-behavioral group training or to the wait-list control. Data were assessed at baseline and after the training of 3 months or after a wait-list period of 3 months. In addition, the training group was followed in an uncontrolled phase and assessed at 3 months and 1 year after the training. ResultsAfter 4 years, the group training was in terms of cost-effectiveness “dominant” compared with the wait-list control; there was a positive effect of 0.06 QALYs and a €828 reduction in costs. The cost-effectiveness improved with a longer time horizon. A threshold of €30,000/QALY was passed after 18 months. The group training was cost saving after 33 months. ConclusionsCognitive-behavioral group training is a cost-effective treatment compared with the wait-list control for patients with UPS.

Cognitive Behavioral Group Training for Welfare Recipients: A Psychoeducational Approach to Improving Employment Outcomes

Cognitive Behavioral Group Training for Welfare Recipients: A Psychoeducational Approach to Improving Employment Outcomes

The Effectiveness of Cognitive Behavioral Group Training on Stress Management Style Resiliency and Glycemic Hemoglobin Levels in Diabetic Patients

The purpose of this study was to determine the effectiveness of Cognitive Behavioral Group Training on Stress Management Style Resiliency and Hemoglobin Levels in diabetic patients of Shiraz city has been done. Research method was experimental and the design of pretest-posttest-with-control group kind been. Statistical population consisted of nearly nine hundred and fifty diabetic patients from the Diabetic Center of the City of Shiraz one year before and filling the case. The research community consisted of 60 people was randomly selected from the member patients of Shiraz diabetic association who were available from the sample. They were randomly bringing in two groups of experimental and control. At first pre-tests were performed by both groups and then the experiment group were trained stress management, cognitive - behavioral therapy with relaxation in 10 sessions of two hours and a half every week and during this term control group was under training other unrelated stress management programs such as drug educations. After the end of the term, both groups completed the questionnaires again. Also glycemic control index (HbA1c) test was repeated after 3 months from the first test. The research tools include resiliency questionnaires and glycemic control index (HbA1c) testing. Also, data obtained from research using descriptive statistics (mean, standard deviation, frequency, maximum and minimum) and the covariance method Manova inferential statistics and independent T-test and analysis software SPSS-18 case. The findings indicate that cognitive style group training, stress management - treated diabetic patients by increasing resiliency and decrease of the glycemic hemoglobin in the blood of diabetic patients.

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.

Cognitive Bias Modification versus CBT in Reducing Adolescent Social Anxiety: A Randomized Controlled Trial

Social anxiety is a common mental disorder among adolescents and is associated with detrimental long term outcomes. Therefore, this study investigated the efficacy of two possible early interventions for adolescent social anxiety and test anxiety. An internet-based cognitive bias modification (CBM; n = 86) was compared to a school-based cognitive behavioral group training (CBT; n = 84) and a control group (n = 70) in reducing symptoms of social and test anxiety in high socially and/or test anxious adolescents aged 13–15 years. Participants (n = 240) were randomized at school level over the three conditions. CBM consisted of a 20-session at home internet-delivered training; CBT was a 10-session at school group training with homework assignments; the control group received no training. Participants were assessed before and after the intervention and at 6 and 12 month follow-up. At 6 month follow-up CBT resulted in lower social anxiety than the control condition, while for CBM, this effect was only trend-significant. At 12 month follow-up this initial benefit was no longer present. Test anxiety decreased more in the CBT condition relative to the control condition in both short and long term. Interestingly, in the long term, participants in the CBM condition improved more with regard to automatic threat-related associations than both other conditions. The results indicate that the interventions resulted in a faster decline of social anxiety symptoms, whereas the eventual end point of social anxiety was not affected. Test anxiety was influenced in the long term by the CBT intervention, and CBM lead to increased positive automatic threat-related associations.Trial RegistrationTrialRegister.nl NTR965

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

BackgroundAlthough Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments.MethodsPatients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome).CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment.ResultsThe predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain.ConclusionsAs the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.Trial registrationNederlands Trial Register, NTR1609

Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up.

BackgroundAlthough cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care.Methodology/Principal FindingsThe effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d = 0.38;p = .002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d = 0.43;p = 0.01), emotional (Cohen's d = 0.44;p = .0.01), and social (Cohen's d = 0.36;p = 0.01) functioning, less pain and better functioning despite pain (Cohen's d = 0.51;p = <0.001), less physical symptoms (Cohen's d = −.23;p = 0.05) and less sleep difficulties (Cohen's d = −0.25;p = 0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses.Conclusions/SignificanceThe cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS.Trial RegistrationTrialRegister.nl NTR1609 <rctview.asp?TC = 1609>

A pilot study of social competence group training for adolescents with borderline intellectual functioning and emotional and behavioural problems (SCT‐ABI)

Emotional and behavioural problems as well as a lack of social competence are common in adolescents with borderline intellectual functioning and impair their social and vocational integration. Group interventions specifically developed for this target group are scarce and controlled evaluation studies are absent. A cognitive-behavioural group training (Social Competence Training for Adolescents with Borderline Intelligence) was developed and its effectiveness was examined in students attending special vocational schools. A total of 77 adolescents with borderline intelligence were randomised either to the intervention (n=40) or to the control group (n=37). Outcome measures at post-treatment and at a 6-month follow-up comprised self-reports, caregiver reports and behavioural observations. The adolescents in the intervention group showed temporally stable improvement in their social competence, especially in social problem solving (F=17.6, P<0.001) and attainment of individual behavioural goals in everyday life (self-reports: F=15.9, P<0.001; caregiver reports: F=87.9, P<0.001). Effects of the intervention on other outcomes such as problem-solving competence and skills performed in standardised role plays were weak or absent. Social Competence Training for Adolescents with Borderline Intelligence is a promising treatment for adolescents with borderline intellectual functioning and associated emotional/behavioural symptoms. Further studies examining long-term effects on the participants' social and vocational integration are needed.

Studying The Effect of Cognitive Behavioral Group Training on Depression in Hemodialysis Patients

This study aimed to investigate the effect of cognitive behavioral training on depression in Hemodialysis patients selected hospitals in Mashhad was. For this purpose the number of cases in 1210 haemodialysis patients in 12hospitals in Mashhad dialysis with random (cluster) from 12 hospitals, four hospitals selected from among 40 cases of patients selected for the study and random assignment in the two groups…. (20 patients) and control (n= 20) groups. Training patterns of cognitive behavior therapy for experimental group and control group were not given training in this study significant amount of pre-test and post test results from t-test Msql criteria. Results indicate the experimental group had reduced depression and cognitive behavior training effect on haemodialysis patients was felt depressed.Recent research results highly consistent with results Sylvyra Priscilla Dvarth et al (2009) has a total of this study indicate Asrgzary cognitive behavioral patterns in hemodialysis patients is to reduce depression.

The effectiveness of motivational interviewing in improving health outcomes in adults with type 2 diabetes

Diabetes is one of the most serious, threatening, developing, and costly health problems. This disease can influence the psychological and especially physical dimensions of people. The aim of current study was investigation of the effects of group Motivational Interviewing (MI) and Cognitive Behavioral Group Training (CBGT) in improving physical health outcomes among adults with diabetes type 2. Ninety- three Patients with type 2 diabetes were selected from Iranian Diabetes Society and Institute of Endocrinology and Metabolism. The participants were randomly allocated to the MI group, CBGT group, and the control group and were tested before and after intervention. Each of interventions consisted of four 90minutes group sessions. The findings showed that in the MI and CBGT groups, mean of BMI was significantly lower than control group. Also, it was found that, in the MI, the mean of HbA1c was significantly lower than CBGT intervention group. The results indicated that in helping adults with type 2 diabetes, CBGT and MI in group format may be useful interventions to improve their weight loss, and MI may be a useful intervention to improve their glycemic control than CBGT. Theoretical and practical implications of results are discussed.

The effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial

BackgroundIn primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training.Methods and designA randomized controlled trial is designed. One hundred patients are randomized to either the group training or the waiting list.Physicians in general practices and outpatients clinics of general hospitals refer patients. Referral leads to inclusion if patients are between 18 and 65 years old, understand Dutch, have no handicaps impeding participation and the principal DSM-IV-TR classification is undifferentiated somatoform disorder or chronic pain disorder. In contrast to other treatment effect studies, the co-morbidity of a personality disorder does not lead to exclusion. By this, we optimize the comparability between the study population and patients in daily practice enlarging the generalization possibilities.Also in contrast to other effect studies, we chose quality of life (SF-36) instead of physical symptoms as the primary outcome measure. The SF-6D is used to estimate Quality Adjusted Life Years (QALYs). Costs are measured with the Trimbos/iMTA Questionnaire for Costs associated with Psychiatric Illness. Measurements are scheduled at baseline, after the training or waiting list, three and twelve months after the training. The differences between measurements are analyzed according to the intention-to-treat principle. The cost-effectiveness is expressed as costs per QALY, using multiple sensitivity analyses on the basis of a probabilistic model of the trial.DiscussionIf we show that our group training is (cost-)effective, more patients could be served, their quality of life could be improved while costs might be reduced. As the training is investigated in a heterogeneous patient group in the daily practice of a mental healthcare institution, its transfer to practice should be relatively easy.Trial registrationNederlands Trial Register, NTR1609

The impact of cognitive behavioral group training on event-free survival in patients with myocardial infarction: The ENRICHD experience

Objective Although the Enhancing Recovery in Coronary Heart Disease (ENRICHD) treatment was designed to include individual therapy and cognitive behavioral group training for patients with depression and/or low perceived social support, only 31% of treated participants received group training. Secondary analyses classified intervention participants into two subgroups, (1) individual therapy only or (2) group training (i.e., coping skills training) plus individual therapy, to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care. Methods Secondary analyses of 1243 usual care, 781 individual therapy only, and 356 group plus individual therapy myocardial infarction (MI) patients were performed. Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; low perceived social support was determined by the ENRICHD Social Support Instrument. Psychosocial treatment followed MI, and for participants with severe or unremitting depression, was supplemented with a selective serotonin reuptake inhibitor. Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI. To control for confounding of group participation with survival (because individual sessions preceded group), we used risk set sampling to match minimal survival time of those receiving or not receiving group training. Results Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33% reduction (hazard ratio=0.67; 95% confidence interval, 0.49–0.92, P=.01) in medical outcome compared to usual care. No significant effect on event-free survival was associated with individual therapy alone. The group training benefit was reduced to 23% (hazard ratio=0.77; 95% confidence interval: 0.56–1.07, P=.11) in the multivariate-adjusted model. Conclusions Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point. A randomized controlled trial is warranted to definitively resolve this issue.