Group Cognitive Behavior Therapy Program Research Articles

Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Three-Month Follow-Up Investigation

This study examined the efficacy of a game-based cognitive-behavioral group therapy program for addressing problems typically found among elementary school-aged victims of child sexual abuse immediately after treatment and at three months following treatment. It was hypothesized that positive gains would be observed among the following domains: (a) internalizing symptoms (e.g., anxiety, depression, and trauma); (b) externalizing behaviors (e.g., oppositional behavior, disobedience, and conduct disordered behavior); and (c) sexually inappropriate behaviors. Improved knowledge of abuse and personal safety skills was also predicted. Results indicated that game-based cognitive-behavioral group therapy resulted in improvements in internalizing symptoms, externalizing behavioral problems, total behavioral problems, and personal safety skills both immediately after treatment and at three-month follow-up.

Randomised controlled trial of group cognitive behaviour therapy versus brief intervention for depression in cardiac patients

To determine whether a six-session group cognitive behaviour therapy (CBT) programme results in a greater reduction in depression symptoms than a brief intervention alone in cardiac patients with clinically significant symptoms of depression. Fifty-seven community dwelling cardiac patients scoring >13 on the Beck Depression Inventory-II (BDI-II) received a single-session brief intervention. They were then block randomised to either six sessions of group CBT (n = 25) or no further intervention (BI; n = 32). All were re-assessed at 2, 6 and 12 months. Differences between treatment groups in the primary (BDI-II) and secondary [rates of depression; anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale-Anxiety (HADS-A)] outcomes were examined using generalised linear mixed models with a random intercept term for the individual. Significant improvements were seen for the total group from baseline to 12 months on BDI-II and HADS-A scores. However, no differences were found between the CBT and BI conditions on change in BDI-II score, rates of major depressive episode or HADS-A score. Post hoc analysis on the total group found 12-month symptom non-remission was associated with higher baseline BDI-II score (p = 0.03), more visits to health professionals 12 months prior to baseline (p = 0.05) and a greater likelihood of either drinking alcohol over recommended levels or smoking at baseline (p = 0.01). Group CBT of up to six sessions did not result in greater reductions in depression or anxiety symptoms compared with a single-session brief intervention. Further work should focus on the efficacy and role of brief interventions, and addressing smoking and alcohol misuse in cardiac patients with depression.

Intervention for aggressive victims of school bullying in Hong Kong: A longitudinal mixed‐methods study

The distinction between aggressive and passive victims of school bullying is well documented. Aggressive victims exhibit restlessness and hot-temperedness, are easily provoked, and take revenge when irritated, whereas passive victims are quiet and timid when attacked or insulted and withdraw rather than retaliate. To date, there has been no evidence-based evaluative study examining interventions designed specifically to reduce aggressive victimization, and neither has there been an inclusive assessment screening of high-risk aggressive victims prior to intervention. This study addressed these research gaps by employing multi-stage assessment procedures and a mixed-mode methodology in a one-year longitudinal design. Data were collected from student self-reports, parent and teacher rating scales, and individual structured interviews with students, parents and teachers. A total of 269 potential high-risk aggressive victims were identified from among 5,089 schoolchildren, 68 of whom were screened out and randomly assigned to 10 treatment groups, with 39 completing a one-year follow-up study. Multivariate analysis of variance identified significant improvements in physical and verbal victimization (F(2,47, 93.99) = 10.73, p < 0.01), verbal victimization (F(2.74, 104.14) = 12.80, p < 0.01) and social exclusion scores at the three follow-up assessments compared to the pre-treatment scores, and the qualitative results were consistent, showing participants' cognition, emotion, and behavior to have been positively reconstructed by the group intervention. The consistent quantitative and qualitative results confirm that the cognitive-behavioral group therapy program reported herein is effective in reducing aggressive victims' anxious and depressed emotions and reactive cognition.

“They didn't tell us, they made us work it out ourselves”: Patient perspectives of a cognitive–behavioral program for rheumatoid arthritis fatigue

Fatigue is an overwhelming rheumatoid arthritis (RA) symptom caused by interacting clinical and psychosocial factors. Cognitive-behavioral therapy (CBT) addresses links between thoughts, feelings, and behaviors and uses cognitive restructuring to facilitate behavior changes. In a randomized controlled trial, a group CBT program for RA fatigue improved fatigue impact, severity, and perceived coping, as well as mood and quality of life. The aim of this study was to explore the patient perspective of the program and the impact of behavior changes. Ten exit focus groups were held (38 patients). Transcripts were analyzed by an independent researcher using a hybrid thematic approach, with a subset analyzed by a team member and patient partner. Three overarching themes were identified. In "they made us work it out ourselves" (program factors facilitating changes), patients spontaneously identified elements of group CBT as pivotal, including guided discovery, the impact of metaphors, and working as a group. In "feeling much better about yourself and coping much better" (the nature of changes), patients described cognitive changes, including enhanced self-efficacy and problem solving, and emotional changes, including being less volatile and fearful of fatigue. In "my life has changed so much it's unbelievable" (benefits beyond fatigue), patients reengaged in previously abandoned activities, were more active, and enjoyed greater social participation. Patients highlighted that CBT elements were key to making behavior changes and that these had far-reaching impacts on their lives. This suggests it could be beneficial in clinical practice to incorporate cognitive-behavioral approaches into patient education programs that aim to enhance self-management.

The Acceptability and Efficacy of a Group Cognitive Behavioural Therapy Programme in a Community Mental Health Setting

This paper presents data on a patient evaluation of a group cognitive behavioural therapy programme in an applied setting and its efficacy for reducing generalised anxiety and or depression, and distress. Patients (n=14) participated in one of two 8-week group cognitive behavioural therapy programmes for generalised anxiety or depression, within a mental health service. Patients’ perceptions of the programme were collected via an evaluation questionnaire, and data on clinical outcomes were sourced from patients’ case notes. Most patients who were invited to participate in the programme (n=14 of 17), and their evaluations were generally favourable. Almost all participants (93%) indicated that the programme either met or exceeded their expectations. The clinical outcomes of the intervention were similar to those found in efficacy studies reported in the published literature (approximately half to threequarters of one standard deviation improvement in anxiety, depression, and distress scores).

When Cognitive-Behavioral Group Therapy Works and When It Doesn't: Clinical Data Mining on Good and Poor CBGT Outcomes for Depression and Anxiety Among Hong Kong Chinese

The present study is a review of 672 participants who joined a cognitive-behavioral group therapy program in the community. In addition to the overall positive outcome, the researcher goes further to investigate two negative outcomes of the program as well as their predictors. The absence of using individual counseling and social worker's scoring of low energy were identified as predictors of dropout. Some cognitive and interpersonal pretreatment symptoms are found to be poor treatment outcome. Implications to social work practice and research are discussed.

Suicide Prevention After Traumatic Brain Injury

To evaluate the efficacy of a psychological treatment to reduce moderate to severe hopelessness after severe traumatic brain injury (TBI). Randomized controlled trial. Participants were aged between 18 and 65 years, experienced posttraumatic amnesia more than 1day and moderate to severe hopelessness (Beck Hopelessness Scale [BHS]) and/or suicide ideation. Intervention comprised a 20-hour manualized group cognitive behavior therapy program. Participants were randomly allocated using concealed allocation (treatment n = 8; wait-list n = 9); all remained in their allocated group. Outcome variables were collected by assessors blind to group allocation. No between-groups differences were observed on demographic, injury, cognitive, and psychosocial variables at baseline (time 1). A significant group-by-time interaction was found for BHS in the treatment group (F1,15 = 13.20, P = .002), reflecting a reduction in mean BHS scores between time 1 and time 2 (posttreatment) with no main effects for group or time. At 3-month follow-up (time 3), the treatment gains were maintained or improved for 75% (6/8) of participants. Secondary outcome variables (suicide ideation, depression, social problem solving, self-esteem, hopefulness) displayed no significant group-by-time interactions or main effects. This trial provides initial evidence for the efficacy of a psychological intervention in reducing hopelessness among long-term survivors with severe TBI.

A Pilot Group Cognitive Behavioural Therapy Program for Problem Gamblers in a Rural Australian Setting

An innovative pilot treatment program was developed for problem gamblers living in rural areas of Australia using cognitive behaviour therapy (CBT) modified from an established specialist therapy service. The standard 12 weekly group program was delivered on site by adapting it to two 1 week blocks with daily group sessions and 1 week of patient practice between the face to face group sessions. The median SOGS score (8) met the cut off for probable pathological gambling at assessment. All 7 who were assessed as suitable for the program completed the treatment with the median SOGS score of 0 at the end of treatment indicating these clients were no longer pathological gamblers. This was maintained at 12 months for 5 clients who provided follow up measures. Participants experienced a clinically significant change in the severity of their gambling and its impacts. This pilot program proved to be acceptable to rural participants and provides preliminary evidence that this intervention can reduce gambling and improved life functioning. Randomised controlled designs are needed to confirm the efficacy of this treatment approach. This program may provide a model for the treatment of gambling clients with complex co-morbidities in other rural settings.

P03-520 - Efficacy of cognitive behaviour group therapy with Portuguese breast cancer survivors

IntroductionBreast Cancer is the most frequent cause of death by cancer in Women. Therefore Breast Cancer is a priority of the Portuguese Health Ministry. Mental illness, as Depression, is also a priority of that Ministry and breast cancer presents higher psychopathology comorbidity than general population. These both facts emphasize the relevance of the studies about interventions to promote mental health of Portuguese breast cancer women. Simultaneously, there are little studies about the applicability and efficiency of Cognitive Behavior Group Therapy in the European context and in Portugal in particular.ObjectivesWe purpose to develop a group cognitive behavior therapy (CBT) program to breast cancer survivors and implement it in a Portuguese group.MethodsAfter a proper review of cognitive behavior group therapy programs to oncologic patients, we will adapt them to the Portuguese population. Then, a study will be made with a group of breast cancer survivors. We intent to assess them before and after the therapy in respect to the following psychological variables: self-concept, optimism, coping, quality of life and psychopathology.ResultsWe expect to improve the knowledge about the applicability of Cognitive Behavior Group Therapy in Portuguese (and European) context.ConclusionsIn sum, we expect to contribute with efficient psychological interventions to Breast Cancer Women survivors, in respect to self-concept, optimism, coping, quality of life and psychopathology.

Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Preliminary Investigation

This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem problems, and (f) knowledge of healthy sexuality and self-protection skills. Results indicate that game-based cognitive-behavioral therapy was effective for improving internalizing and externalizing symptoms, reducing sexually inappropriate behaviors, and improving children's knowledge of abuse and self-protection skills. Although results pointed in a positive direction for social skills and self-perception, these findings were not statistically significant. Clinical significance was also evaluated to assess the clinical utility of treatment effects. Treatment implications of the findings and future research directions are discussed.

Mechanisms of change in negative thinking and urinary monoamines in depressed patients during acute treatment with group cognitive behavior therapy and antidepressant medication

This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms.

BraveHeart Begins: Pilot Results of Group Cognitive Behaviour Therapy for Depression and Anxiety in Cardiac Patients

In a general medical hospital with limited mental health resources, a clinical need arose for an effective treatment for depression and anxiety symptoms in cardiac rehabilitation patients. A total of 628 cardiac rehabilitation outpatients at a tertiary care centre were screened with the Hospital Anxiety and Depression Scale at week 4 of their programme, and 182 of 558 responders (33%) scored > or =8 on the Depression and/or Anxiety subscales. A 6 week group cognitive behaviour therapy programme was developed to assist these identified patients. The resulting programme, BraveHeart, was piloted on 39 patients still experiencing significant symptoms of depression or anxiety at the end of rehabilitation. Patients were assessed at baseline, after treatment, 1 and 6 months after treatment using the Hospital Anxiety and Depression Scale and the Beck Depression Inventory-II. Significant improvement in levels of depression and anxiety symptoms occurred from baseline to post-treatment assessment, and this change was maintained at 6 months, with moderate-strong effect sizes. Feedback from the group members was positive. A specialized group treatment programme for cardiac patients with existing depression and anxiety was created that resulted in significant reductions in symptoms.

Brief cognitive-behavioral therapy with fibromyalgia patients in routine care

Objective The purpose of the present study was to evaluate the effectiveness of a brief cognitive-behavioral therapy (CBT) group intervention for fibromyalgia syndrome in routine care. Method Thirty-four female outpatients who participated in a 5- to 6-week group CBT program were assessed for depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), coping strategies (Coping Questionnaire for Chronic Pain), physical functioning (Fibromyalgia Impact Questionnaire), and somatization (Health Attitude Survey) at 3 time points (baseline, pretreatment, and posttreatment) using a pre-post, quasi-experimental design. Results Twenty-three female outpatients (68% of the initial sample) for which data were available in all 3 time points were included in the analyses. No changes were found during the waiting period. During the treatment period, there were significant reductions in depression ( P = .001) and anxiety ( P = .006) symptoms and an increased use of distraction skills ( P < .001). The analysis of rate of change showed a significant correlation between anxiety and depression ( P = .004), but not between these variables and the use of distraction as a coping strategy. Conclusion Brief group CBT is effective in reducing emotional distress in female patients with long-standing fibromyalgia syndrome in the context of routine care. Attention-distraction skills appear to be amenable to change by means of brief CBT, but further research is needed to clarify their contribution to short-term clinical improvement.

Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study

Cognitive Behavioral Therapy (CBT) has demonstrated benefits for anxious school-aged children and adolescents; however, treatment programs have not been developed to teach CBT strategies to children under the age of eight. This pilot study examined a novel treatment program for children aged 5-7 years with anxiety disorders. Thirty-two children (19 females) aged 5-7 years (mean age=6.51 years) with DSM-IV anxiety disorders and their families completed a 12-week, manualized CBT group program. Parent and child groups (5-8 children per group) were held separately but concurrently. Multiple measures of anxiety (Screen for Child Anxiety Related Emotional Disorders, Anxiety Disorders Interview Schedule for DSM-IV-Parent Version, and clinician Children's Global Assessment Scale ratings) were completed pre and post each treatment series. A subset of participants (n=11; 8 females; mean age=6.34 years) completed an initial assessment followed by a wait period of approximately 3.5 months (range 2.5-5 months) with a second assessment just before treatment start. No treatment was received during this wait time. With treatment, 43.8% of children no longer met criteria for any Axis 1 anxiety disorders whereas 71.9% had at least one anxiety disorder resolve. A series of paired, two-tailed t-tests revealed significant reduction in anxiety symptoms on standardized measures. Children who waited for treatment showed no significant change in anxiety symptoms during nontreatment but demonstrated improvement after program attendance. This pilot study suggests that CBT can be used effectively to treat anxious children as young as 5 years of age. Further research is warranted.

Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder

Purpose To identify the presence of factors associated with treatment outcome in patients under group cognitive-behavioral therapy (GCBT) for obsessive-compulsive disorder (OCD). Subjects and methods This study evaluated 181 patients with OCD that attended a 12-session weekly GCBT program. Response criteria were: ≥35% reduction in Y-BOCS scores and global improvement score of the Clinical Global Impression (CGI) ≤ 2 at post-treatment evaluation. Sociodemographic data, OCD characteristics, and treatment data were studied. Results In the bivariate analysis, the following variables showed statistical significance ( p < 0.20) to enter the regression model: being woman ( p = 0.074), greater insight ( p = 0.017) and better quality of life (QOL) in all domains before treatment ( p = 0.053), overall severity of disease according to the CGI ( p = 0.007), number of associated comorbidities ( p = 0.063), social phobia ( p = 0.044), and dysthymia ( p = 0.072). In the final regression model, these variables were associated with response to GCBT: female gender ( p = 0.021); WHOQOL-BREF psychological domain ( p = 0.011); insight ( p = 0.042); and global improvement score of the CGI severity-scale before therapy ( p = 0.045). Conclusion Special attention should be paid to patients with poor insight, increasing the cognitive aspects of the therapy in an attempt to modify the rigidity and fixity of their beliefs. In addition, male patients should be more observed, since they showed lower chance of response to GCBT when compared to women. Patients with more severe global symptoms (CGI) are poorer responders to GCBT, which indicates that not only obsessive-compulsive symptoms (OCS) should be evaluated, since other symptoms, such as depression and anxiety, may affect the treatment; therefore, an attempt to reduce these symptoms, prior to the treatment of OCD, should be considered as an option in some cases.

P01-201 Group cognitive behaviour therapy for depression - does it help bipolar patients too?

Aims:To compare the effectiveness of a manualised group cognitive behaviour therapy (CBT) programme for people with bipolar disorder (BPD) and major depressive disorder (MDD).Method:In addition to treatment as usual (TAU), 17 people with BPD and 17 matched controls with MDD completed 8 or 12 sessions of twice weekly group CBT, followed by 6 booster sessions, held at monthly intervals. Participants completed the Structured Clinical Interview for DSM-IV Axis 1 Disorders, Clinician Version (SCID-1) and the University of Rhode Island Change Assessment (URICA) prior to therapy. They completed the Beck Depression Inventory - II (BDI), the Beck Anxiety Inventory (BAI), the Clinical Outcomes in Routine Evaluation (CORE), the World Health Organisation Quality of Life Brief Version (WHOQoL - BREF) and the Dysfunctional Attitudes Scale (DAS) before and after therapy and at the final follow-up session. The BDI and BAI were also completed at each group session.Results:Both groups showed statistically and clinically significant improvement on the BDI and BAI after treatment and at follow-up. Both groups showed a significant improvement on the psychological health sub-scale on the WHOQoL-BREF.Conclusions:Manualised group CBT leads to a reduction in the symptoms of depression and anxiety in people with both BPD and MDD and helps improve their perceived quality of life.Declaration of interest:None.

A controlled study of the effect of cognitive–behavioural group therapy for pathological gamblers

As the number of pathological gamblers has increased recently, the need for effective treatment has become more evident. The aim of this study was to evaluate the effectiveness of a short-term cognitive–behavioural group therapy programme for pathological gamblers. Fourteen subjects (three females and 11 males), who met the criteria for pathological gambling in accordance with the Diagnostic and Statistical Manual of Mental Disorders IV, were randomly assigned to a Treatment Group (n=7) or a waiting list Control Group (n=7). An experimental design with three repeated measures was used (pre-treatment, post-treatment/post-waiting list and follow-up). The dependent variables were DSM-IV Criteria for Pathological Gambling, Money Spent on Gambling During the Last Week and Gamblers Inventory of Negative Consequences. The Treatment Group improved on the DSM-IV Criteria for Pathological Gambling, but did not show a significant improvement on Money Spent on Gambling During the Last week from pre-treatment to post-treatment. Combining both groups at 3-months follow-up, there was a significant improvement on all three variables from pre-treatment to follow-up. The results of this controlled study indicate that a short-term cognitive–behavioural group treatment for pathological gamblers had an effect.

A Nonrandomized Effectiveness Comparison of Broad-Spectrum Group CBT to Individual CBT for Depressed Outpatients in a Community Mental Health Setting

Controlled trials have established the efficacy of cognitive-behavior therapy (CBT) for depression. However, the relative effectiveness of individual versus group treatment formats in real-world settings is less well established. The current study evaluated the effectiveness of group CBT ( n = 157) compared to individual CBT ( n = 77) for depressed outpatients in a naturalistic setting. Symptom improvements for depression, anxiety, and quality of life were compared between treatment formats in intent-to-treat and completer analyses. Effect sizes and rates of recovery were examined. Results showed that both individual and group CBT were effective, even in the presence of high levels of comorbidity. Whereas individual CBT was associated with larger effect sizes and significantly higher rates of recovery, group CBT compared favorably to outcomes established by past research. A broad-spectrum group CBT program may be a viable treatment option when depression symptoms are less severe and when this format of treatment delivery is desirable.

Efficacy of a cognitive-behavioral group therapy program on Taiwanese school-age children with Asperger's disorder

Efficacy of a cognitive-behavioral group therapy program on Taiwanese school-age children with Asperger's disorder

Sensitization of catastrophic cognition in cognitive-behavioral therapy for panic disorder

BackgroundCognitive model of panic disorder have proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations. Cognitive-Behavioral Therapy (CBT) for panic disorder aims to change these catastrophic cognitions. CBT intervention successfully caused reduction of catastrophic cognitions and symptomatic improvement in the majority of cases. However there are some patients who fail to modify their catastrophic cognitions or rather experience an increase in them during CBT treatment. It is clinically and theoretically important to understand about cognitive sensitization of panic disorder during CBT sessions. The purpose of the present study is 1) to clarify the baseline characteristics of panic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment, and 2) to examine the course of symptomatic changes for them.MethodsOf ninety-five outpatients with panic disorder started the group CBT program for treatment of panic disorder, seventy-nine completer were classified as "cognitively sensitized (CS)" or "cognitive responding (CR)" or "no-responder" according to the difference of the Agoraphobic Cognitions Questionnaire score across treatment. We compared the CS and CR patients in terms of their baseline clinical characteristics. Then we assessed the symptomatic and functional changes for both groups.ResultsAt the start of the CBT program, despite of the same degree of panic disorder severity, CS scored significantly lower on ACQ score than CR. CS also showed significantly lower score on anticipatory anxiety compared to CR. At the end of treatment CS showed significant improvement in severity of panic disorder, although the degree of improvement was smaller than that for CR. Then CS would progressively reduce their agoraphobic fear and avoidance, and would improve their functional impairment up to three month of follow-up.ConclusionPanic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment could nonetheless gradually improve. They showed a relatively low level of catastrophic cognition and anticipatory anxiety before starting the CBT program. We might conclude that temporary sensitization of catastrophic cognition may be necessary before improvement especially among those with initially low catastrophic body sensation fears and that we need not be concerned too much with temporary increase in catastrophic cognition in the process of CBT for panic disorder.