Group Cognitive Behavior Therapy Program Research Articles

Group cognitive behavioural therapy for stroke survivors with depression and their carers

Background: Depression in stroke survivors is common, leads to poorer outcomes and often not treated. A group cognitive behavioural therapy (CBT) program (Brainstorm) for stroke survivors with depression, and their carers has been running as part of usual care since 2007.Objective: To evaluate the implementation and acceptability of Brainstorm, a closed group intervention consisting of up to 10 sessions of education, activity planning, problem solving and thought challenging.Methods: Participating stroke survivors and their carers complete assessment measures at baseline, post-treatment and 1-month and 6-months follow-up. A mixed models for repeated measures data was conducted with depression and anxiety scores for stroke survivors (Beck Depression Inventory-II; Hospital Anxiety and Depression Scale) and the assessment of depression, anxiety and carer burden for carers. Acceptability was assessed by session attendance and written and open participant feedback upon completion of the program.Results: Forty-eight community dwelling stroke survivors and 34 carers attended Brainstorm, with a median attendance of 88% of sessions. Follow-up assessments were completed by 77% (post-treatment), 46% (1-month) and 38% (6-month) of stroke survivors. Stroke survivors’ depression scores decreased from baseline to post-treatment (p<.001); maintained at 1-month (p<.001) but not at 6-month (p=.056). Anxiety scores decreased between baseline and 1-month (p=.013). Carer burden, depression and anxiety scores at 1-month and 6-month follow-up, for carers, were all reduced when compared with baseline (p<.05).Conclusion: The Brainstorm group intervention for depression in stroke survivors appears to have been effectively implemented and is acceptable to stroke survivors and carers.

Effects of Cognitive Behavioral Group Therapy (CBT) on Employment Stress, Dysfunctional Attitude, and Depression of College Students

The purpose of this study was to examine the effects of cognitive behavioral group therapy (CBT) on employment stress, dysfunctional attitude, and depression of college students. Three hundred ninety six four-year-course college students completed the Job-seeking Stress Scale and Dysfunctional Attitude Scale-Korean Version(DAS-K). Sixteen patients were selected for those scales using the Beck Depression Inventory-Korean version(K-BDI) and randomly assigned to a CBT group and a waiting list control group (eight each). The CBT program was administered for eight sessions. All participants completed the Job-seeking Stress Scale, Dysfunctional Attitude Scale-Korean Version (DAS-K), and Beck Depression Inventory-Korean version (K-BDI) at pre-test, post-test, and at 4 weeks follow-up periods. The results of this study were as follows: Job-seeking stress, dysfunctional attitude, and depression of the therapy group decreased more than those of the control group at pre-post, pre-follow up test. Last, the implications and limitations of this study, and suggestions for future study were also discussed.

Quality of life measured by PDQ39 and SEIQoL during anti-stress training for Parkinson's disease (PD) patients

program. Both groups underwent weekly sessions of 2 hours for 9 weeks. The “Fragebogen zur krankheitsbezogenen Kommunikation” (FKK) and the “Belastungsfragebogen” (BELA) were primary outcome variables. Ratings were completed at baseline, after 9 weeks (right after the treatment) and after 6 months. Results: Both, FKK and BELA, showed a significant difference in favor of the patients receiving the CBT program right after the training (FKK p<0.05; BELA p¼<0.01). There were also significant improvements in the subscales of BELA (Emotional p<0.01; Somatic-Motoric p<0.05; Cognitive p<0.01). Conclusions: Cognitive Behavioral Group Therapy (CBT) for Patients with PD is a helpful and efficient approach for stress reduction and therefore might have beneficial influences on the patients' quality of life. Follow-up examinations after completion of the trainings are warranted to investigate sustainability of the effect.

Motivational Interviewing as an Adjunct to Cognitive Behavioral Therapy for Anxiety.

This study examined the effect of a single session motivational interviewing (MI) intervention on engagement in a 12-week transdiagnostic group cognitive behavioral therapy (CBT) treatment for anxiety. Participants were randomized to MI (N = 20) or non-MI (N = 19) conditions before enrolling in a 12-week group CBT program. Participants in the MI condition received an individual 50-minute MI session adapted from the longer MI pretreatment protocol, developed by Westra and Dozois () and Westra (). Rates of treatment initiation and treatment expectancies were significantly higher among participants who received the MI pretreatment intervention. Results indicate substantial reduction in clinician-rated anxiety severity after transdiagnostic group CBT, with no significant differences between MI and non-MI conditions. These findings suggest that a single MI pretreatment session may have positive effects on proximal measures of treatment engagement, but that these effects may not affect the severity of anxiety symptoms over the course of CBT.

Randomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults.

Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults. A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale. Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder. Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.

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.

Immediate help through group therapy for patients with somatic diseases and depressive or adjustment disorders in outpatient care: study protocol for a randomized controlled trial.

BackgroundOne in three people with a chronic somatic disease suffer from a comorbid mental disorder. Most common comorbidities are depressive, anxiety and adjustment disorders. These lead to an increase in morbidity and mortality, and a deterioration of quality of life and healthcare costs. Treatment of mental disorders is of great importance, but the waiting time for outpatient individual psychotherapy can be up to six months in Germany. Group therapy has comparable treatment effects and is considerably more economic than individual therapy; however, it is still almost unused in the outpatient care system. The introduction of a stepped care approach, such as attending a group program before individual therapy, could improve this issue. For this purpose we developed a group program (STEpS), and its efficacy will be evaluated in this study.Methods/DesignA randomized controlled trial will be conducted to evaluate the efficacy of a cognitive behavioral therapy (CBT) group program for patients with somatic diseases and depressive or adjustment disorders, compared to a wait-list control group. A total of 128 adults with any chronic somatic disease and comorbid depression or adjustment disorder will be recruited in our outpatient clinic, and will be randomly assigned to participate in the group program immediately after contacting the clinic (intervention group) or after a waiting period of four months (wait-list control group). Primary outcomes will be self-reported depressive and anxiety symptoms. Secondary outcomes will be self-reported psychological distress, changes in experience and behavior, health-related quality of life, state of self-esteem and subjective need for therapy. Assessments will take place at baseline, 10 weeks (post-treatment) and 18 weeks (follow-up) after randomization. Additionally, treatment acceptance and psychotherapeutic process will be assessed after each session.DiscussionThis study investigates whether the CBT group program is an effective treatment to reduce depressive and anxiety symptoms and psychological distress in these patients. If the group program is effective, it could be implemented as a treatment option prior to individual outpatient therapy. These results will contribute to improving outpatient care for mental disorders in patients with somatic diseases.Trial registrationGerman Clinical Trials Register DRKS00005140 (27 August 2013).

Effectiveness of an Individualized Case Formulation-Based CBT for Non-responding Youths with Anxiety Disorders

The study examined the effectiveness of an individualized case formulation-based cognitive behavior therapy (CBT) for youths (9–17 years) with anxiety disorders and their parents after unsuccessful treatment with a manualized group CBT program (the Cool Kids). Out of 106 participant youths assessed at a 3-month follow-up after manualized CBT, 24 were classified as non-responders on the Clinical Global Impression-Improvement scale (CGI-I), and 14 of 16 non-responders with anxiety as their primary complaint accepted an offer for additional individual family CBT. The treatment was short-term (M sessions = 11.14) and based on a revised case formulation that was presented to and agreed upon by the families. At post-treatment, nine youths (64.3 %) were classified as responders on the CGI-I and six (42.9 %) were free of all anxiety diagnoses, while at the 3-month follow-up 11 (78.6 %) had responded to treatment and nine (64.3 %) had remitted from all anxiety diagnoses. Large effect sizes from pre- to post-individualized treatment were found on youths’ anxiety symptoms, self-reported (d = 1.05) as well as mother-reported (d = .81). There was further progress at the 3-month follow-up, while treatment gains remained stable from post-treatment to the 1-year follow-up. Results indicate that non-responders to manualized group CBT for youth anxiety disorders can be helped by additional CBT targeting each family’s specific needs.

A Pilot Study of Group Cognitive Behavioural Therapy for Depression in a Japanese Community

Aims: This pilot study investigated the effect and feasibility of a group cognitive behavioural therapy program in a Japanese community setting. Methodology: Participants were five patients with major depression. Ten weekly 1-hour sessions of group cognitive behavioural therapy was conducted in a Japanese community setting. Outcomes were assessed using the Beck Depression Inventory-II (BDI-II). Statistical comparison of means was performed using nonparametric Wilcoxon signed-rank test using normal approximation, and effect sizes (d) was used to compare depression scores before and after the Short Communication Asano et al.; BJMMR, 10(4): 1-6, 2015; Article no.BJMMR.19447 2 intervention. Results: Group cognitive behavioural therapy appears to be significantly efficacious in a Japanese community setting, with an effect size of .85. The present results are similar to those found in clinical settings. Discussion: Adapting group cognitive behaviour programs to Japanese community settings can contribute to improved mental health in this country. The limitations of this study are the sample size was very small, measurement is self-reported questionnaire and conducted in a community setting as an uncontrolled, naturalistic pilot study. Controlled studies are needed and would provide a more convincing demonstration of the program’s efficacy in Japanese community settings.

Effect of Group Cognitive Behavioural Therapy with Compassion Training on Depression: A Study Protocol

Aims: Cognitive behavioural therapy (CBT) is one of the evidence-based treatments for depression. However, some patients high in self-criticism do not respond to CBT. Compassionfocused therapy (CFT) is featured in treating self-criticism and shame, and some trials have reported its effectiveness on depression in individual and group settings. The aim of this study is to adapt an established combined manual of group CBT and CFT, evaluate its efficacy as a pilot study, and discuss the advantages of group CBT (GCBT) program using compassion as a depression therapy in a Japanese community setting. Study Protocol Article Asano et al.; BJMMR, 9(10): 1-5, 2015; Article no.BJMMR.19206 2 Design and Methods: In this single group study, participants will receive 10 sessions of GCBT with compassion training that was provided through the CFT. All sessions will last for 1 hour and be provided weekly. The outcome measure is the Beck Depression Inventory II, and the secondary outcome is the Self-Compassion Scale in Japanese. Both outcomes will be measured preand post-program. The sample size will be 15 participants due to the limited capacity for intervention within the community. Discussion: It is expected that the program will show a larger effect size than that of GCBT reported in previous studies on depression and self-compassion. The results will show an effect size that justifies the introduction of a randomized controlled study to improve the program. Trial Registration: UMIN Clinical Trials Registry 000015007 https://upload.umin.ac.jp/cgi-openbin/ctr/ctr.cgi?function=brows&action=brows&type=summary&language=J&recptno=16862. Conclusion: CFT or compassion training can augment the treatment of major depression using CBT. Despite several limitations, this clinical trial may help estimate the effectiveness of CFT, which will aid in the design of a further controlled study.

Improving the mental health of adolescents with epilepsy through a group cognitive behavioral therapy program

The threat of unpredictable seizures makes epilepsy unique among childhood chronic illnesses. One consequence is that people who have childhood-onset epilepsy often have poor social adjustment and competence in adulthood. Better emotional and social functioning could improve long-term outcomes. Thirty-four adolescents with epilepsy participated in a group cognitive behavioral therapy program designed to enhance their level of psychosocial functioning. Baseline Strength and Difficulty Questionnaire scores suggested that many participants had difficulties with emotions, concentration, and social functioning, with parent-reported Impact scores significantly worse than adolescent-reported scores (p=0.005). Four months after the intervention, adolescent-reported Prosocial Behavior scores significantly improved (p=0.03). Parent-reported scores improved significantly at follow-up, compared with baseline, in Peer Problems (p=0.04), Impact (p=0.001), and Prosocial Behavior (p=0.004) scores. Adolescents with lower socioeconomic status reported the greatest improvements (p=0.01). A brief CBT intervention was effective and resulted in improved mental health indices and social functioning for adolescents with epilepsy.

Exploring mechanisms of change: The relationships between cognitions, symptoms, and quality of life over the course of group cognitive-behaviour therapy

BackgroundThis study aimed to explain how quality of life changes during psychotherapy, using a cognitive-behavioural theoretical framework, and examined whether changes in symptoms or changes in cognitions were more influential with regard to quality of life change. Three different hypotheses were tested that might explain the mechanisms by which quality of life changes during group cognitive-behaviour therapy (CBT) for anxiety and depression. Methods127 outpatients with anxiety and/or depression enrolled in a four-week group CBT programme participated. Measures of anxiety and depression symptoms, cognitive change, and quality of life were administered at baseline and post-treatment. Baseline to post-treatment change scores were calculated and entered into multiple regression analyses. ResultsReductions in anxiety and depression symptoms were related to increases in quality of life, whereas cognitive changes were not consistently related to changes in quality of life. LimitationsThe main limitation was that the study׳s design was not able to assess whether changes in cognitions or symptoms preceded changes in quality of life, as all variables were measured at the same two points in time. ConclusionsThese results provided evidence that quality of life changes as a result of or, simultaneously with, symptom change. It appears that group CBT does not improve quality of life through strategies designed to change patients׳ cognitions.

Patient and family factors associated with family accommodation in obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) impacts family functioning as family members modify their personal and family routines, participate in rituals, and provide reassurance. These behaviors have been identified as family accommodation (FA), a phenomenon that, if ignored, may facilitate OCD symptoms and lead to poorer prognosis. Because FA has been recognized as a predictor of treatment outcome, we examined the prevalence of FA and identified patient and family sociodemographic and clinical variables associated with FA in an outpatient sample. The study comprised 228 subjects, namely, 114 patients with OCD and 114 family members, assessed before the patients entered a 12-session cognitive behavioral group therapy program. A multivariate linear regression model was used to control for confounding factors and to evaluate variables independently associated with FA. FA was evaluated using the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer Rated. FA was found to be highly prevalent among family members. Two patient factors positively associated with FA were OCD severity as measured by the Clinical Global Impressions Scale and higher scores on the Obsessions dimension of the Obsessive-Compulsive Inventory-Revised. Family members' characteristics that were positively associated with FA were higher scores on the Obsessive-Compulsive Inventory - Revised hoarding subscale and being the patient's spouse. Our findings suggest that the early identification of patients and family members who could benefit from interventions aimed at reducing FA could improve treatment outcomes.

Group Cognitive Behavioural Therapy Program Shows Potential in Reducing Symptoms of Depression and Stress Among Young People with ASD

We examined the efficacy of cognitive behavioural therapy (CBT) delivered in groups on the reduction of symptoms of depression, anxiety and stress in young people on the autism spectrum. Utilising a quasi-experimental design, comparisons were made between individuals allocated to a group intervention program and individuals allocated to a waitlist. Following the intervention program, participants who were initially symptomatic reported significantly lower depression and stress scores on the Depression Anxiety Stress Scales in comparison to individuals on the waitlist. There was no significant change in anxiety related symptoms. The benefits were maintained at 3 and 9month follow-up. Our findings demonstrate the potential of CBT in a small group setting for assisting young people with ASD who have symptoms of depression and stress.

Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients

ObjectiveThere is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. MethodsWe administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest–posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation–Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. ResultsParticipants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. ConclusionsGroup CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.

A Multiyear Follow-Up Study Examining the Effectiveness of a Cognitive Behavioral Group Therapy Program on the Recidivism of Juveniles on Probation

The present study evaluated the long-term effectiveness of a cognitive behavioral group therapy program titled Community Opportunity Growth. This study monitored juvenile delinquents' recidivism across a 7-year time period, with the average length to follow-up being 39 months. It was hypothesized that program graduates (N = 178) would have a significantly lower recidivism rate than a control group (program nonstarters; N = 66) and program dropouts (whose predisposing factors may have influenced their program participation; N = 150). Analyses controlled for sex, ethnicity, age, prior petitions, highest class of prior petition, and months to follow-up. Results show a general trend indicating the long-term effectiveness of the program as graduates had a lower incidence of petitions at follow-up compared with dropouts and fewer petitions compared with the other two groups.

The influence of individual, group, and relative self-esteem on outcome for patients undergoing group cognitive-behavioural therapy treatment

Despite a strong association between individual self-esteem and treatment outcome in group cognitive-behavioural therapy (GCBT), no study has investigated how patient outcomes might be influenced by an individual's self-esteem relative to other group members. The study comprised a retrospective examination of patients' data and used a multiple regression analysis to identify predictors of treatment outcome. Patients' pre-treatment self-esteem scores were assessed on a continuum and assigned to be low, medium, or high. Therapy groups were assigned to be either low, balanced or high self-esteem groups based on averaged self-esteem scores of participants. In this study, 3,878 patients who had completed a 10-day intensive cognitive behavioural group therapy programme at a private psychiatric facility were included in the study. The Rosenberg Self-Esteem measure was chosen to assess self-esteem. The three subscales of the Depression Anxiety Stress Scales were used as the outcome measures. Patient outcomes were influenced by pre-treatment self-esteem scores, such that higher initial self-esteem was associated with better treatment outcomes. Low group self-esteem was predictive of significantly better outcomes for depression, relative to higher self-esteem groups. Additionally, the combined influence of high individual self-esteem and low group self-esteem was associated with significantly enhanced depression improvement. High self-esteem patients perform better on outcome measures following completion of GCBT. Low self-esteem groups show greater improvement in depression symptoms. Similar results for depression are achieved when patients with high self-esteem complete treatment in low self-esteem groups.

The Anxiety Disorders Clinic for Children and Adolescents (TADCCA) at Aarhus University in Denmark

This article serves as an introduction to the two case studies in this issue of PCSP. The first is the single case of "Erik," a 12-year-old boy with cognitive difficulties and multiple anxiety disorders who was seen with his family in a cognitive behavioral therapy group program designed for children with anxiety problems. The second case study is one of the total group of six families in which Erik was participating; as such it includes a summary of Erik's case in the context of the other five who participated. The group was conducted by a combination of a senior doctoral clinical psychologist and eight students. They were part of a training clinic, called The Anxiety Disorder Clinic for Children and Adolescents (TADCCA), in the Educational and Research Clinic of the Department of Psychology at Aarhus University in Aarhus, Denmark. This article describes the background and context of the TADCAA in which the two case studies took place.

The efficacy of a brief group cbt program in treating patients diagnosed with bulimia nervosa: A brief report

The aim of the study was to evaluate the efficacy of a brief group cognitive behavior therapy (CBT) program in treating a large cohort of patients diagnosed with bulimia nervosa. Treatment outcome defined as reductions in bulimia related behavioral symptoms and bulimia related distress was examined in 205 consecutive new patients enrolled in an eight-session group CBT program. Significant reductions in eating disorder pathology were found on all measures of bulimia related behavioral symptoms, as well as on all measures of bulimia related distress. There is strong evidence for the efficacy of brief group CBT in treating patients with bulimia nervosa.

Forecasting Success: Patients' Expectations for Improvement and Their Relations to Baseline, Process and Outcome Variables in Group Cognitive–Behavioural Therapy for Depression

There is growing evidence for the important role of patients' outcome expectations to the process and outcome of psychotherapy, yet its relevance to group cognitive-behavioural therapy (CBT) for depression has not been examined. In an effort to fill this void, the present study investigated expectations for improvement among 80 psychiatric outpatients attending a group CBT program for depression. The study addressed the following four questions: (1) Which baseline patient characteristics might be associated with patients' expectations for improvement? (2) Does providing a rationale and outline for treatment affect patients' expectations? (3) Are patients' expectations related to the quality of therapeutic alliance? and (4) Are patients' expectations associated with the outcome of treatment? The main findings of the study are as follows: (a) baseline symptoms of depression, quality of life and current suicidal ideations were consistently associated with outcome expectancies; (b) outcome expectancies were unrelated to treatment completion status; (c) although expectancy ratings did not change significantly for the group as a whole, there was some variability in how individual patient's expectancy ratings changed; (d) baseline expectancies were related to early-treatment alliance quality, but not to mid-treatment alliance, whereas early-treatment expectancies were significantly associated with mid-treatment alliance; and (e) baseline expectations of favourable outcome had a negative association with improvement in anxiety symptoms, yet expectancy ratings from session 3 had a positive association with improvement in quality of life and interpersonal problems. Increases in expectancy ratings were significantly related to improvement in anxiety, quality of life and interpersonal problems. Patients who present in a particularly hopeless and demoralized state are likely to have low expectations for a positive outcome of treatment. Efforts should be made in the first few sessions of therapy to mobilize patients' hope and expectation of success, for increases in one's expectations may facilitate a favourable treatment outcome. An optimistic outlook on the probability of success in treatment may contribute to the development of a strong working relationship between the patient and the therapist.