Group Cognitive Behavior Therapy Program Research Articles

Kognitiv-verhaltenstherapeutische Gruppentherapie für Jugendliche mit angstbedingter Schulverweigerung. Eine Beobachtungsstudie

School refusal is a multicausal disorder with an estimatedprevalence of about 5%. Patients are at risk for developingeducational, social, and behavioral problems. Studies evaluatingtherapeutic interventions are, however, rare. Objectives: Weprospectively investigated adolescents with prolonged school refusalwho took part in a standardized group treatment program tofind out if the program was suited for this group and if comorbidproblems influenced the therapeutic progress. Patients and Methods:We investigated 18 adolescents admitted for prolonged schoolrefusal. They were 10-14 years old and met ICD-10 criteria for socialphobia (F40.1). All attended 16 sessions of manual-based, cognitivebehavioral group therapy (CBT) [Joormann und Unnewehr, 2002]and were psychologically tested before, during and at the end ofCBT. Results: 14 patients completed the study and the pre- andposttherapeutic assessment. Social phobia, clinical, and depressionscores improved but not significantly. Temperamental factors ‘persistence’,‘self-directedness’, and ‘cooperativeness’ were associatedwith better therapeutic success, ‘harm avoidance’ with higher socialphobia scores and a less substantial clinical improvement. All patientshad at least one comorbid axis-1 diagnosis, most frequentlyseparation anxiety. Nearly all patients had impaired executive functions,and nearly all parents had psychiatric problems. Conclusions:The Joormann and Unnewehr CBT program was somewhat effective.Considering the high number of comorbidities, longer durationof treatment, additional treatment components and parentalpsychotherapy are recommended.

The use of a manual-driven group cognitive behavior therapy in a Brazilian sample of obese individuals with binge-eating disorder

To assess the effectiveness of a manual-based cognitive behavior therapy adapted to a group format in a sample of Brazilian obese subjects with binge-eating disorder. In an open trial, 21 obese subjects with binge-eating disorder received a group cognitive-behavioral therapy program. Changes in binge-eating frequency, weight, body shape concerns, and depressive symptoms were compared between baseline and the end of the study. The mean frequency of binge-eating episodes significantly decreased from baseline to post-treatment (p < 0.001), with a binge eating remission rate of 76.1% at the end of the trial. Depressive symptoms and body shape concern also improved (p < 0.001). In addition, weight loss was statistically and clinically significant. The use of this adapted manual-based cognitive behavior therapy in this sample resulted in a marked improvement in binge-eating, weight, body shape concern, and depressive symptoms related to binge-eating disorder.

Music therapy and emotional exploration: Exposing substance abuse clients to the experiences of non-drug-induced emotions

Recent cognitive behavioral therapy (CBT) approaches to treatment of substance use disorder (SUD) have emphasized the need for clients to explore emotional regulation and experiential avoidance. This study aimed to determine whether music therapy programs situated within a CBT framework facilitated the exploration of emotions in 24 adults with SUD attending a hospital open group CBT program. In a 7-week trial, the impact of a single music therapy session on participants’ emotional experience was assessed using a self-report questionnaire at the end of each participant's first session. Results indicated that music therapy sessions facilitate the experiencing of predominantly positive emotions, and that these were experienced to a moderate or high degree. Participants reported that music therapy was beneficial in allowing them to experience emotions without the need for substance use. It is recommended that clinicians include interventions that encourage the exploration of negative emotions so that clients can experience these in a safe environment.

‘I've lost my husband, my house and I need a new knee … why should I smile?’: Action research evaluation of a group cognitive behavioural therapy program for older adults with depression

The current paper details an action research approach to developing and evaluating a group cognitive-behavioural therapy (CBT) program for older adults (65+ years) experiencing depression. This approach allowed the development of a novel program and for each component of the program to be evaluated and modified in an iterative, developmental fashion – a particularly important, ethically responsive feature when working with vulnerable populations. Formative and summative evaluations allowed the identification of beneficial, cohort-specific elements of an intervention without compromising individual wellbeing. A mixed methods data design was used to triangulate multiple and repeated quantitative and qualitative measures; in essence, a formalisation of usual clinical practice. The outcomes from the pilot study will be discussed in the context of a methodology that uniquely facilitates microanalytic research while maintaining therapeutic accountability, making replication and program accountability available to all clinicians.

Cognitive change process during group cognitive behaviour therapy for depression

Background This study extended that of Kwon and Oei [Kwon, S.M., Oei, T.P.S., 2003. Cognitive change processes in a group cognitive behavior therapy of depression. J. Behav. Ther. Exp. Psychiatry, 3, 73–85], which outlined a number of testable models based on Beck's cognitive theory of depression. Specifically, the current study tested the following four competing models: the causal, consequential, fully and partially interactive cognitive models in patients with major depressive disorder. Methods A total of 168 clinically depressed outpatients were recruited into a 12-week group cognitive behaviour therapy program. Data was collected at three time points: baseline, mid- and at termination of therapy using the ATQ, DAS and BDI. The data were analysed with Amos 4.01 ( Arbuckle, J.L., 1999. Amos 4.1. Smallwaters, Chicago.) structural equation modelling. Results Results indicated that dysfunctional attitudes, negative automatic thoughts and symptoms of depression reduced significantly during treatment. Both the causal and consequential models equally provided an adequate fit to the data. The fully interactive model provided the best fit. However, after removing non-significant pathways, it was found that reduced depressive symptom contributed to reduced depressogenic automatic thoughts and dysfunctional attitudes, not the reverse. Conclusion These findings did not fully support Beck's cognitive theory of depression that cognitions are primary in the reduction of depressed mood.

Identifying and targeting predictors of drop-out from group cognitive behaviour therapy

The predictors of drop-out from a group cognitive behaviour therapy (CBT) program were examined. In Study 1, 6 years of archival data of Perth Clinic's group CBT program were examined to determine the predictors of treatment drop-out. The predictors identified were low self-esteem at admission and a poor relationship status. These predictors were used to generate an algorithm for use by clinicians in identifying patients who may be likely to drop out. In Study 2, a controlled trial was conducted to determine if a brief self-esteem module delivered prior to a group CBT program might enhance outcomes and reduce drop-out rates. Day-patients who received the self-esteem module reported small additional reductions in depression scores but there were no noticeable effects upon drop-out rates. Suggestions are made for other ways to reduce drop-outs in CBT programs.

Components of Group Processes: Have They Contributed to the Outcome of Mood and Anxiety Disorder Patients in a Group Cognitive-Behaviour Therapy Program?

The present study assessed the influence of group processes on clinical outcomes of patients with anxiety and depression following group Cognitive Behavior Therapy (CBT). Five group environment variables were measured: cohesion, leader support, expressiveness, independence, and self-discovery. One hundred and sixty two patients attended a group CBT program and were assessed at pre and post-treatment. Results provided evidence for the effectiveness of group therapy as patients reported significantly lower depression and anxiety at the conclusion of treatment. Expressiveness was the only predictor of post-treatment anxiety, whereas leader support, expressiveness, and independence were significant predictors of post-treatment depression. Overall, findings suggest that the patients benefited from high levels of expressiveness and independence within their therapy group. In contrast, they failed to benefit from high levels of leader support, whereas both group cohesion and self-discovery appeared to be unrelated to outcome.

Group cognitive behavior therapy for breast cancer patients: A qualitative evaluation

Twenty-five patients who had attended a group cognitive behavior therapy program for breast cancer patients were interviewed by telephone about their experience. Responses were categorized independently and indicated that participants enjoyed the interpersonal and social environment of the group, but also acknowledged the benefits provided by the cognitive behavior therapy modality of the group. While the majority of groups that are currently run for cancer patients are supportive, it is possible that adding a psycho-educational component may meet the needs of greater number of patients.

Pilot Study of Community-Based Cognitive Behavioral Group Therapy for Adolescents With Social Phobia

A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric setting. Twelve adolescents with social phobia (ages 13-18), diagnosed by DSM-IV criteria and confirmed with Anxiety Disorders Interview Schedule for Children assessment, were randomly assigned to treatment (n=6) and waitlist (n=6) groups. The waitlist group was subsequently treated, and results were included in the data analysis. Assessments, including Anxiety Disorders Interview Schedule for Children interviews and self-report Social Phobia and Anxiety Inventory and Beck Depression Inventory II questionnaires, were performed at baseline and immediately after treatment or waitlist. All subjects completed the treatment program. Compared with the waitlist group, treated subjects showed significantly greater improvement in both examiner-evaluated (Anxiety Disorders Interview Schedule for Children) and self-reported (Social Phobia and Anxiety Inventory) symptoms of social anxiety (effect sizes [d], 1.63 and 0.85, respectively). No significant change was seen in Beck Depression Inventory II scores for treatment or waitlist groups. This study provides support for the use of simplified cognitive-behavioral interventions for adolescents with social phobia that are practical for community psychiatric settings.

Post-surgery group therapy for gastric bypass patients.

The prevalence of both compulsive eating patterns (bingeing and "grazing") and psychosocial distress and/or psychiatric co-morbidity in patients seeking bariatric surgery has been documented. While surgery is often seen as the solution, research has shown that these problems can persist postoperatively and may adversely affect outcome. This paper will describe a postoperative psychotherapy group process designed specifically for gastric bypass patients. A semi-structured cognitive-behavioral group therapy program adapted from a treatment program for compulsive eaters was designed for patients who had been identified (by questionnaire and clinical interview) as having compulsive eating problems before surgery. Therapy addresses eating patterns as well as the emotional adjustments following surgery. 16 12-week therapy groups have been conducted to date. The groups are small and designed to help patients understand the stages of postoperative adjustment and the tasks, both eating-related and psychological, associated with each stage. Feedback from participants has been very positive with patients reporting the need for a therapy group in addition to the traditional support group. Since both disturbed eating patterns and psychological difficulties are seen following surgery, it is imperative that treatment programs be developed to address these issues. The group process is a highly effective intervention but must be designed for the special needs of these patients. Measures of success need to take psycho-social factors into account as well as eating behaviors and weight loss. Outcome studies are needed to compare those receiving treatment vs those who do not.

A group therapy programme for eating disorders with preventive goal

Eating disorders tend to take a prolonged course because of high rates of comorbid psychiatric disorders and medical complications. We developed a cognitive behavioural group therapy programme, divided in 4 consecutively phases in a special unit. Included in the programme are therapeutic residence groups. Current and former patients are regular involved in preventive activities.

Cognitive change processes in a group cognitive behavior therapy of depression

The present study attempted to examine the causal relationships among changes in automatic thoughts, dysfunctional attitudes, and depressive symptoms in a 12-week group cognitive behavior therapy (GCBT) program for depression. In all, 35 depressed patients attending the GCBT program were monitored with the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale, and Beck Depression Inventory at the pre-treatment, 4th and 8th sessions, and post-treatment. The results were as follows: (1) GCBT reduces negative cognitions; (2) changes in automatic thoughts and dysfunctional attitudes lead to change in depressive symptoms; and (3) automatic thoughts play a mediating role between dysfunctional attitudes and depression. The findings taken as a whole support the Causal Cognition Model of depression.

Predicting outcomes of group cognitive behavior therapy for patients with affective and neurotic disorders.

An attempt was made to predict outcomes following group Cognitive Behavior Therapy (CBT) for patients with affective and neurotic disorders. A group of 348 patients at a private psychiatric clinic, treated in a group CBT program, completed the Depression, Anxiety, and Stress Scale (DASS) before and after treatment. Prior to treatment, data from the Locus of Control of Behavior (LCB), a Global Assessment of Function (GAF), the Health of the Nation Outcome Scales (HoNOS), and the Rosenberg Self Esteem Scale (RSE) were also collected. Results indicated that posttreatment stress scores of all patients were predicted by pretreatment stress and self-esteem. Among patients with neurotic disorders, posttreatment anxiety was predicted by initial anxiety and self-esteem whereas among patients with affective disorders, posttreatment anxiety scores were predicted by initial anxiety and GAF. For patients with neurotic disorders, self-esteem did not predict variance in posttreatment depression in addition to that explained by pretreatment depression. In contrast, for patients with affective disorders, pretreatment depression and Locus of Control predicted posttreatment depression.

CHANGES TO AUTOMATIC THOUGHTS AND DYSFUNCTIONAL ATTITUDES IN GROUP CBT FOR DEPRESSION

The present study sought to clarify the role of cognitive change in Cognitive Behavioural Therapy (CBT) by examining the relationship between depression outcome and changes to automatic thoughts and dysfunctional attitudes at different points of therapy. Thirty patients suffering from Major Depression (MDD) or Dysthymia attended the 12 sessions of a group CBT program. Multiple regressions found total scores on the Automatic Thoughts Questionnaire (ATQ) and cumulative change scores on the Dysfunctional Attitudes Scale (DAS) to predict scores on the Beck Depression Inventory (BDI) at later stages of therapy, though neither form of cognition was predictive from earlier stages of therapy. Only scores on the ATQ were significantly related to both cognitive and somatic subscales of the BDI, indicating that automatic thoughts are more directly related to cognitive change than dysfunctional attitudes. Overall findings suggest that significant reductions in both automatic thoughts and dysfunctional attitudes are related to non-clinical levels of depressive symptoms at the end of the treatment.

Group Cognitive-Behavioral Treatment for Depressed Adolescent Offspring of Depressed Parents in a Health Maintenance Organization

A randomized, controlled effectiveness trial of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO) was conducted. Potential adult cases were found by reviewing antidepressant medication prescriptions, mental health appointments, and medical charts. Introductory study letters signed by each parent's treating physician were mailed to the appropriate adults. Eligible offspring aged 13 to 18 who met current DSM-III-R criteria for major depression and/or dysthymia were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session group CBT program (n = 41). Assessments were conducted at baseline, after treatment, and at 12- and 24-month follow-up. Using intent-to-treat analyses, the authors were unable to detect any significant advantage of the CBT program over usual care, either for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. Group CBT does not appear to be incrementally beneficial for depressed offspring of depressed parents who are receiving other mental health care. However, given that many other studies have found positive effects of CBT for youth depression, this single study should not be viewed as evidence that CBT is ineffective overall.

Group Cognitive Behaviour Therapy for Residual Depression: Effectiveness and Predictors of Response

To date, there is a lack of evidence on the effectiveness of cognitive behaviour therapy for residual depression in naturalistic treatment settings. Previous reports have indicated that perfectionism and self-criticism may be predictive of poor response to individual cognitive behaviour therapy for acute depression. However, no studies of the impact of these cognitive variables on the outcome of treatment for residual depression have been reported. Accordingly, we sought to evaluate the effectiveness of a group cognitive behaviour therapy program for residual depression and to assess the impact of self-criticism, self-oriented perfectionism and socially prescribed perfectionism on the outcome of this treatment. Sixty-five patients (44 women) with residual symptoms (Beck Depression Inventory score >8) following medication treatment for major depression completed measures of depression, functional status, self-criticism, self-oriented perfectionism and socially prescribed perfectionism before and after 12 sessions of group cognitive behaviour therapy. Depression symptoms and functional status both showed significant change over the course of treatment (Cohen's d = 0.62 and 0.39, respectively). Pre-treatment self-criticism scores and change scores (pre- to post-treatment) for self-criticism and socially prescribed perfectionism were associated with the symptomatic and functional outcome of treatment. The results suggest that group cognitive behaviour therapy may be a useful and cost-effective treatment for residual depression in a tertiary care setting that uses predominantly prescriptive treatment.

Changes in eating self-efficacy and body image following cognitive–behavioral group therapy for binge eating disorder: A clinical study

Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among individuals seeking treatment for obesity. Cognitive–behavioral therapy (CBT) is frequently recommended for the treatment of obese individuals with BED. However, there is limited investigation into the effectiveness of the specific components of CBT. In this study, we examine the impact of CBT for BED in obese women on self-efficacy for eating behavior and body image issues. Participants were 12 obese women who participated in a 15-week CBT group program. As predicted, results indicated a reduction in binge episode frequency and significant improvements in self-efficacy and body image pre- and posttreatment. These findings support the premise that a structured cognitive–behavioral group treatment program for obese individuals with BED will promote changes in self-efficacy and body image.

A group cognitive behaviour therapy programme with metastatic breast cancer patients

A group cognitive behaviour therapy programme with metastatic breast cancer patients

Description of a group Cognitive Behaviour Therapy programme with cancer patients.

Cognitive Behaviour Therapy (CBT) has already been shown to be highly effective in the treatment of various psychological disorders within mental health populations; however, it has not been widely tested in the treatment of cancer patients. In the last decade there has been growing interest in the application of CBT interventions within psycho-oncology, and some studies have reported on its efficacy, both with individuals and in group-therapy contexts. To date there have been few descriptions of how a CBT programme for cancer patient groups can be structured and delivered. We present a description of a 12-session CBT programme that has been developed by our centre, for delivery to cancer patient groups.

Cognitive changes following recovery from depression in a group cognitive-behaviour therapy program.

We report on the changes in cognitions as a result of cognitive-behaviour therapy (CBT), in 35 recovered and 32 non-recovered mood disordered patients who had undergone a 12-week group CBT program for depression. An end-of-therapy cut-off score of 10 on the BDI was used to define recovered and non-recovered patients. ANOVA analyses were conducted to explore possible main effects of recovery status and time on various clinical measures, including cognitions and activity levels. Mean mood and activity self-rating measures were significantly higher for the recovered as compared to the non-recovered patients over the course of the program. Similarly, scores on the Automatic Thoughts Questionnaire (ATQ) for recovered patients were within the non-clinical range, in contrast to their non-recovered counterparts. In addition, recovered patients improved significantly in their Hopelessness scores, and there was a change in the expected direction in their Dysfunctional Attitudes Scale scores, although this was not significant. These results are consistent with the proposition of cognitive theory (i.e. the remediation of negative cognition plays a significant role in recovery from depression during CBT).