Group Therapy Protocol Research Articles

Intensive cognitive behavioral group therapy for the treatment of panic disorder

Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

\u201cI\u2019m not alone, my story matters\u201d: Incarcerated women\u2019s perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories

BackgroundAlthough it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments – exposure therapy – should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others’ trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; SurvivorsHealing fromAbuse:Recovery throughExposure) while incarcerated. We assessed women’s reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability.ResultsTreatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting “it depends”). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others’ trauma narratives (i.e., exposures) in the SHARE group context as helpful—making them feel less alone and normalizing their experiences. Sharing one’s own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function).ConclusionsOur findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae—those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)—should be offered to incarcerated women as part of standard of care.

Cognitive behavioral therapy for perinatal anxiety: A randomized controlled trial.

Up to one in five women meet diagnostic criteria for an anxiety disorder during the perinatal period (i.e. pregnancy and up to 1 year postpartum). While psychotropic medications are effective, they are associated with risks for mothers and babies. There is a growing demand for evidence-based non-pharmacological treatments for perinatal anxiety. To evaluate the effectiveness of a cognitive behavioral group therapy protocol for perinatal anxiety. In total, 96 women were randomized to cognitive behavioral group therapy or waitlist at a clinic specializing in women's mental health. Participants were 22-41 years of age, pregnant or up to 6 months postpartum and had an anxiety disorder with or without comorbid depression. Compared to waitlist, participants in cognitive behavioral group therapy reported significantly greater reductions in the primary outcome of anxiety (State-Trait Inventory of Cognitive and Somatic Anxiety, η2p = .19; Hamilton Anxiety Rating Scale, η2p = .16), as well as in secondary outcomes including worry (Penn State Worry Questionnaire, η2p = .29), perceived stress (Perceived Stress Scale, η2p = .33) and depressive symptoms (Edinburgh Postnatal Depression Scale, η2p = .27; Montgomery-Åsberg Depression Rating Scale, η2p = .11). Maternal status (pregnant, postpartum) and medication use were unrelated to treatment outcomes. All gains were maintained, or continued to improve, at 3-month follow-up. Cognitive behavioral group therapy was effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.

Abstract 5831: Activated Wnt signaling for the treatment of recurrent medulloblastoma

Abstract Brain tumors represent the leading cause of childhood cancer mortality, of which medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current molecular subgroups of MB recognize distinct disease entities of which activated Wnt signaling (monosomy 6, exon 3 mutations in CTNNB1, and Wnt gene signature) is associated with a distinct subgroup and the best overall outcome. In contrast, only non-Wnt MBs are characterized by metastatic disease, increased rate of recurrence, and poor overall survivorship. Given the excellent clinical outcome in patients with Wnt-driven MB, we aimed to convert treatment-resistant MB subgroups into an ostensibly benign tumor through selective targeting by small molecules and transgenic patient-derived lines containing a stabilized beta-catenin mutant. Activated Wnt signaling by way of Wnt agonists in treatment-refractory MBs resulted in decreased in vitro self-renewal and promoted differentiation. Comparative gene expression profiling of control and transgenic lines containing a stabilized beta-catenin mutant demonstrated a reduction in stem cell self-renewal genes following beta-catenin overexpression, including Sox2 and Bmi1. In order to validate the therapy-sensitive nature of Wnt-activated cells, we developed stable patient-derived lines containing a 7XTOPFlash reporter for endogenous Wnt signaling. Rare subclonal Wnt-active cells demonstrated a reduced self-renewal and tumor-initiating capacity through in vivo limiting dilution assays when compared to bulk Wnt-inactive cells. The therapeutic relevance of these findings were demonstrated with an in vivo survival advantage in mice with orthotopic injections of cells containing a stabilized beta-catenin mutant representative of constitutively active Wnt signaling or endogenous Wnt-active cells. Xenografts generated from Wnt-activated tumors were smaller in size, maintained a lower rate of proliferation, and reduction in MB self-renewal genes. To further illustrate the clinical utility of activated Wnt signaling, we modified the Children’s Oncology Group therapy protocol for childhood MB so that xenografts may receive chemo/radiotherapy. Tumors generated from Wnt-active xenografts were much more radiosensitive and displayed a significant reduction in spinal metastasis when compared to mice receiving standard therapy without Wnt activation. To develop a rationale clinical therapeutic, we developed unique agonist antibodies that target the Wnt co-receptor LRP5. Treatment with LRP5 antibodies showed a significant reduction in tumor burden and increase in survival of patient-derived tumors that were otherwise treatment-resistant. Our work establishes for the first time activated Wnt signaling as a novel treatment paradigm in childhood MB, identifies a rationale therapeutic approach for recurrent MB, and provides evidence for the context-specific tumor suppressive function of the canonical Wnt pathway. Note: This abstract was not presented at the meeting. Citation Format: Branavan Manoranjan, Chitra Venugopal, Zvezdan Pavlovic, David Bakhshinyan, Michelle Kameda-Smith, Minomi Subapanditha, Sujeivan Mahendram, Jason Moffat, Bradley W. Doble, Sheila Singh. Activated Wnt signaling for the treatment of recurrent medulloblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5831. doi:10.1158/1538-7445.AM2017-5831

Replication of a cognitive behavioral therapy for chronic pain group protocol by therapists in training

According to the American Psychological Association (Division 12), there is strong, long-standing research support for cognitive behavioral therapy (CBT) to treat chronic pain. Furthermore, meta-analytic comparisons have shown CBT to be highly efficacious. However, not all researchers agree with this conclusion. The purpose of the current pilot study was to determine whether a CBT outpatient, group-based treatment facilitated by junior therapists benefited veterans who suffer from mixed idiopathic, chronic, noncancer pain, thus replicating results from effective CBT programs from the past. A sample of 46 veterans aged 33 to 81 years with chronic, noncancer pain who participated in an outpatient CBT pain group therapy protocol at a Midwestern Veterans Affairs Medical Center between November 3, 2009, and September 2, 2010 was evaluated. All participants completed a pre- and postintervention assessment. Paired-samples t tests were conducted to evaluate the impact of the program on veterans’ scores on assessment measures. No significant difference was found between the pre- and posttest primary outcome measures of pain intensity. A significant difference was established between the pre- and posttest secondary outcome measure of catastrophizing. However, there were no other significant differences found among the remaining pre- and posttest secondary outcome measures of pain interference, disability, and psychological distress. Training junior therapists on how to use CBT protocols may be enhanced by paying greater attention to what mechanisms are responsible for the desired outcomes among veterans with chronic pain.

Brief Therapy for PTSD Symptoms in Maltreated Youth in a Shelter Care Facility

Therapy to address PTSD symptoms in maltreated youth has received increased research attention in recent years. However, little data are available regarding the treatment of youth temporarily housed in shelter care facilities whose parents are unavailable or inaccessible. The present study examined a brief group therapy protocol for such youth in a county-operated shelter. Participants received 1-6 sessions of treatment depending on their length of stay at the shelter. Treatment components included psychoeducation, anxiety management, cognitive restructuring and coping skills, emotional expression, mindfulness, brief exposure, boundary setting, and journaling. Results revealed a significant reduction in PTSD symptoms overall and that number of group therapy sessions mediated pre-treatment and post-treatment scores on various dependent measures. In addition, level of pre-treatment dissociation predicted reduction in PTSD levels. These preliminary results indicate that brief treatment for youth temporarily housed in a shelter care facility can provide some amelioration of PTSD-related symptoms.

Brief Therapy for PTSD Symptoms in Maltreated Youth in a Shelter Care Facility

Therapy to address PTSD symptoms in maltreated youth has received increased research attention in recent years. However, little data are available regarding the treatment of youth temporarily housed in shelter care facilities whose parents are unavailable or inaccessible. The present study examined a brief group therapy protocol for such youth in a county-operated shelter. Participants received 1-6 sessions of treatment depending on their length of stay at the shelter. Treatment components included psychoeducation, anxiety management, cognitive restructuring and coping skills, emotional expression, mindfulness, brief exposure, boundary setting, and journaling. Results revealed a significant reduction in PTSD symptoms overall and that number of group therapy sessions mediated pre-treatment and post-treatment scores on various dependent measures. In addition, level of pre-treatment dissociation predicted reduction in PTSD levels. These preliminary results indicate that brief treatment for youth temporarily housed in a shelter care facility can provide some amelioration of PTSD-related symptoms.

The Men's Stress Workshop: A Gender-Sensitive Treatment for Depressed Men

Over 10% of men will meet lifetime criteria for major depressive disorder, yet men often are unwilling to enter treatment, and have more negative attitudes toward therapy than do depressed women. The Men's Stress Workshop was developed as a gender-sensitive group therapy protocol for men that explicitly addresses the role of masculine norms in the treatment of depressive symptoms. In this article we: (a) provide an overview of the model that serves as the conceptual foundation for the workshop; (b) outline the major treatment components and hypothesized change mechanisms for the workshop; and (c) describe the research design and treatment development. Case material is presented to illustrate the treatment content and format.

Hope Therapy in a Community Sample: A Pilot Investigation

We report findings from an initial empirical test of a hope-based, group therapy protocol. In this context, hope is defined as a cognitive process through which individuals pursue their goals [Snyder, C. R.: 1994, Free Press, New York]. As such, the eight-session group treatment emphasized building goal-pursuit skills. Findings from a randomized, wait-list control trial using a community sample (n=32 completers) are reported. Participants underwent structured diagnostic interviews (SCID-I) and completed assessment packets. Post-participation assessment results indicate the intervention was associated with statistically significant (p<0.05) improvements in the agency component of hope, life meaning, and self-esteem as well as reductions in symptoms of depression and anxiety. These results suggest that a brief hope intervention can increase some psychological strengths and reduce some symptoms of psychopathology.

Protocolo de tratamiento psicológico grupal para abordar sintomatología deansiedad

This work present a psychological group therapy protocol to manage symptoms instead of mental disorders aimed at reducing assistance demand in Mental Health Units. The protocol consists of a group therapy program to manage anxiety symptoms from a cognitive-behavioural perspective. It includes a detailed description of the content of each session, as well as an explanatory model of anxiety and a complete checklist that considers the psychopathology and the anxiety coping strategies.

Group Cognitive Behavioral Therapy for Obsessive‐Compulsive Disorder: A Review

Behavioral therapy utilizing exposure and response prevention (ERP) is considered the psychosocial treatment of choice for obsessive-compulsive disorder (OCD). Individual ERP treatment is the most common therapy format, and much of the empirical support for ERP is based upon studies of OCD subjects treated individually. However, there are numerous advantages of delivering this effective intervention in a group format, including cost savings to patients and time-efficiency for ERP therapists. This review summarizes the 12 adult trials and 4 adolescent trials of group behavioral therapy for OCD conducted to date. The paper also describes a typical group therapy protocol in detail and describes the costs and benefits of delivering ERP for OCD in a group format. [Brief Treatment and Crisis Intervention 3:217–229 (2003)]

Cognitive-behavioral group therapy in obsessive-compulsive disorder: a clinical trial

Objective: To develop a cognitive-behavioral group therapy protocol and to verify its efficacy to reduce obsessive-compulsive symptoms. Methods: An open clinical trial with 32 obsessive-compulsive patients was performed, in which a cognitive-behavioral group therapy protocol of 12 weekly sessions of two hours, in 5 consecutive groups, was applied. The severity of symptoms was rated with the Yale-Brown Obsessive-Compulsive (Y-BOCS), Hamilton Anxiety (HAM A) and Hamilton Depression (HAM D) scales. The patients were followed up for 3 months after the end of the treatment. Results: There was a significant reduction in the scores of Y-BOCS, HAM A and HAM D scales with the treatment regardless the use of anti-obsessive medications. The rate of improved patients (decrease of &gt; or = 35% in Y-BOCS) was 78.1%. Two patients (6.25%) dropped out from the study. The effect size calculated for the Y-BOCS scale was 1.75. Conclusions: This study suggests that cognitive-behavioral group therapy reduces obsessive-compulsive symptoms. In addition, patients presented good compliance.

Cognitive behavioral group therapy for residents in assisted-living facilities.

Geriatric depression is a disabling illness that is associated with increased morbidity and mortality and deserves aggressive and early intervention. Cognitive-behavioral group therapy is an effective intervention for the treatment of geriatric depression and can be used with residents in an assisted living facility to manage and prevent depression. Cognitive-behavioral group therapy protocol modifications for residents in assisted-living facilities aids their participation and learning.

"Seeking safety": outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence.

Women with current posttraumatic stress disorder (PTSD) comprise 30-59% of substance abuse treatment samples and experience a more severe course than women with either disorder alone. As yet, no effective treatment for this population has been identified. This paper reports outcome results on 17 women who completed a new manual-based 24-session cognitive behavioral group therapy protocol treatment, based on assessments at pretreatment, during treatment, posttreatment, and at 3-month follow-up. Results showed significant improvements in substance use, trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. Patients' treatment attendance, alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Overall, our data suggest that women with PTSD and substance abuse can be helped when provided with a treatment designed for them. All results are clearly tentative, however, due to the lack of a control group, multiple comparisons, and absence of assessment of dropouts.

The “new family” model: The evolution of group treatment for adult survivors of childhood sexual abuse

Abstract The evolution of a group therapy protocol for adult survivors of incest and the theoretical model on which it is based are discussed in this article.