Group Therapy Outcome Research Articles

Терапия расстройств пищевого поведения: от исследований к практике

<p>This digest reviews recent significant changes that can play a role in the treatment of eating disorders. It also contains proposals on improving the efficacy of treatment in general and investigation of the outcome of intensive treatment and psychodynamic group therapy for patients with eating disorders.</p>

Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial

AbstractBackgroundFor the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost‐ and time‐intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.MethodsWe conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5‐week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.ResultsIn contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.DiscussionThis trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.Significance StatementThe study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

A person-centered, transdiagnostic schema and mode profile approach to predict outcome in time-limited schema group therapy

Objective This study employs a person-centered transdiagnostic approach to examine how schema and mode profiles predict symptom severity reduction in schema group therapy for patients with personality disorders and enduring clinical syndromes. Method We analyzed symptom reduction in 248 patients across three formats of manualized, time-limited schema group therapy. Latent profile analysis and mixed multilevel modeling were used to determine the extent to which schema/mode classes predict symptom reduction, and whether the inclusion of individual schemas and modes enhances these predictions. Results No significant differences in treatment outcomes were found across the group modalities. A three latent profile solution for schemas and modes showed external validity with clinical variables and demonstrated that declines in symptom severity varied by schema and mode class, even after adjusting for baseline symptom severity. Adding the Vulnerability to Harm schema and Vulnerable Child mode to the model increased the explained variance. Conclusion Patients with more severe personality problems show more substantial symptom reduction. Both schema and mode profiles significantly contribute to predicting post-treatment symptom levels. Understanding these profiles may help therapists tailor interventions more effectively, consistent with Young’s theoretical model. Trial registration: ISRCTN.org identifier: ISRCTN17262253.

Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes

Objective An individual’s attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member’s attachment on the dynamic relationships between that group member’s (actor) and other group members’ (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. Results Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner’s alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. Conclusion Group members’ attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

New horizons in group psychotherapy research and practice from third wave positive psychology: a practice-friendly review.

Group psychotherapy has been shown to be equivalent to individual therapy for many disorders, including anxiety, depression, grief, eating disorders, and schizophrenia (Burlingame & Strauss, 2021). In addition to effectiveness in reducing symptoms, group offers members a sense of belonging, purpose, hope, altruism, and meaning throughout treatment (Yalom & Leszcz, 2020). These additional outcomes are especially important considering the COVID-19 pandemic and national/international conflicts, given the trauma, disruptions, and losses people have experienced. Applying recent developments in positive psychology to group therapy can enhance treatment. A practice-friendly review examined recent advances in the positive psychology literature, demonstrating how group therapy offers members unique growth opportunities in addition to reducing symptoms. Key findings from studies applying positive psychological constructs to group therapy outcomes are synthesized. Our review sheds light on the relevance of third wave positive psychology to enrich group therapy (Lomas et al., 2021). Specifically, group therapy can facilitate the development of vitalizing psychological virtues, and these can be used to assess treatment outcome: humanity, wisdom, transcendence, courage, temperance, and justice. Interrelatedly, we present support for including attachment theory and mentalization within a positive psychological group framework. Implications are explored for group therapy research, clinical work, and training.

The relationship of alliance, cohesion, and climate with outcome among college counseling populations.

It is not yet fully understood how alliance, cohesion, and climate differentially correlate with client outcome in group therapy, especially when assessed simultaneously. This study aims to elucidate these relationships through an archival analysis of continuous Group Questionnaire (GQ) and Outcome Questionnaire-45 (OQ-45) data from 412 group therapy clients at college counseling centers, which were originally collected by Burlingame, Whitcomb, et al. (2018). We predicted that alliance, cohesion, and climate would each correlate with improvements in outcome and, further, that they would have similar relationships with change in outcome. Results indicate that greater alliance, cohesion, and climate are individually associated with lower distress. This relationship was significant regarding session-to-session fluctuations on individual client scores (p < .01), as well as regarding differences between clients in their personal averages across sessions (p < .01). However, when linear growth trajectories were considered, only alliance was significantly associated with improvement (p < .05). In other words, alliance, climate, and cohesion all correlate with outcome when time is ignored; however, alliance alone significantly correlates with outcome when change over time is taken into account. This study highlights the importance of the client-therapist relationship, emphasizing how alliance is significantly related to change in group therapy. Thus, therapists should prioritize a strong bond with clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The influence of attachment style on interpersonal learning in substance use psychotherapy groups

Substance Use Disorders (SUDs) are prevalent, long-term conditions, commonly treated via group intervention. Additionally, interpersonal learning (IL) is a therapeutic factor unique to group treatment programs, which has been associated with successful group therapy outcomes. While previous research has suggested attachment styles may predict experiences of IL within groups, research in this area is limited. Therefore, this study aims to investigate if attachment style impacts IL, within SUD group treatment programs and specifically, if anxious and avoidant attachment styles influence IL. Participants (N = 38) were recruited voluntarily from an outpatient SUD open group therapy program at a private mental health hospital in Sydney. All participants completed paper-based self-report questionnaires to assess attachment style and IL. Two separate Multiple Linear Regressions (MLRs) revealed anxious attachment was not a significant predictor of IL and avoidant attachment was a significant, negative predictor of IL. Additionally, thematic analysis of qualitative data revealed themes and behaviours which may improve IL. Thus, future directions and implications of the study’s findings indicate the need to conduct additional research into members attachment-based needs to enhance SUD group treatment outcomes.

Group climate in online group cognitive behaviour therapy predicts treatment outcomes

ABSTRACT Objectives Although group processes impact significantly on face-to-face group therapy outcomes, it is unclear whether online cognitive behaviour therapy (CBT) group processes mimic face-to-face group processes, and whether these processes predict positive therapeutic change. This study explores the development of group climate in an online group therapy format and investigates the relationship between group climate dimensions and therapeutic outcomes. Method Participants were 24 individuals with a depressive disorder who participated in an online group CBT intervention. The development of group climate and their relationship to treatment outcomes post-group and at six-month follow-up were examined. Results Findings showed that online group processes developed in a similar manner to those observed in successful face-to-face group CBT interventions and that group climate variables in the online setting played an important role in predicting therapeutic outcomes. Conclusions Our results underscore the importance of a positive working atmosphere and low levels of interpersonal conflict among participants in online group CBT, given their associations with treatment outcomes. KEY POINTSWhat is already known about this topic (1) Group climate is the extent to which a therapy group has a positive working atmosphere, where conflicts are handled constructively, and individuals take responsibility for their own change. (2) Group climate is a predictor of positive outcomes in face-to-face groups. (3) Although online group cognitive behaviour therapy (CBT) is an efficient, and effective treatment for depression, there is very little research examining group climate in online group CBT and its association with treatment outcomes. What this study adds (1) Group climate in online group CBT develops in a similar pattern as face-to-face group CBT. (2) A positive working atmosphere and lower levels of perceived conflict at the latter stages of the online group predicted positive outcomes at the end of treatment. (3) A positive working atmosphere, lower levels of conflict, and lower avoidance of personal responsibility for change at the end of treatment predicted positive outcomes at the six-month follow-up.

Mindfulness-based group therapy for in-patients with schizophrenia spectrum disorders – Feasibility, acceptability, and preliminary outcomes of a rater-blinded randomized controlled trial

BackgroundA Growing body of literature indicates therapeutic effectiveness of mindfulness for mental disorders. Only few trials have been conducted with schizophrenia spectrum disorders (SSD), mostly in outpatient settings. Primary objective was to assess feasibility, acceptability, and preliminary outcomes of mindfulness-based group therapy (MBGT) for in-patients with SSD. MethodsA pre-registered randomized controlled trial was conducted to assess feasibility and acceptability of the MBGT. The primary outcome was mindfulness measured with the Southampton Mindfulness Questionnaire (SMQ). Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, and self-reported mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime at baseline, post-intervention, and follow-up (Clinical Trails NCT03671005). Results40 participants received either treatment-as-usual (TAU; n=19) or (MBGT+TAU; n = 21) for four weeks. At post-intervention, protocol adherence was 95.2%, and retention rate was 95%. ANCOVA revealed significant improvements in the MBGT+TAU for the primary outcome SMQ as well as negative symptoms at post-intervention between groups. In exploratory analyses, secondary outcomes showed medium-to-large pre-to-post-intervention effects on mindfulness, positive-, negative-, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-to-moderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported. ConclusionsMBGT appears feasible and acceptable for in-patient settings, with high protocol adherence and retention rates. Preliminary findings highlight a proof of concept of MBGT and various improvements in clinical- and process dimensions. A fully powered trial is warranted to determine efficacy, cost-efficiency, and longitudinal changes based on these promising outcomes.

Is there an optimal level of positive and negative feedback in group therapy? A response surface analysis.

Interpersonal feedback is an important process in group therapy. Feedback can be both positive and negative, and group researchers have noted the importance of both positive and negative feedback in fostering cohesive groups and evoking behavioral change (Yalom & Leszcz, 2005). However, there is a paucity of research examining the amount and valence (i.e., positive and negative) of interpersonal feedback on group therapy process and outcomes. Therefore, this study tested the proposition that congruent and high levels of members' perceptions of positive and negative feedback was optimal for member's perceptions of cohesion and improvement in group therapy. Data for this study consisted of 168 members across 43 interpersonal process therapy groups. Polynomial regression and response surface analysis revealed that members' perceptions of congruent and high levels of positive and negative interpersonal feedback were positively associated with members' perceptions of group cohesion and improvement. In addition, members' perceptions of discrepant high positive feedback and low negative feedback were positively associated with members' perceptions of group cohesion and improvement. These findings suggest that members' perceptions of balanced and high amounts of positive and negative feedback, as well as discrepant high positive feedback and low negative feedback, are optimal in group therapy. Group leaders should attend to the amount and proportion of positive and negative member-member feedback in therapy groups to enhance the clinical benefit of these services. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Predictors of Treatment Outcome in Group or Individual Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Active Duty Military.

The purpose of this study was to examine demographic, psychological, military, and deployment variables that might predict posttraumatic stress disorder (PTSD) symptom improvement in a sample of active duty service members who received either group or individual cognitive processing therapy (CPT). Data were analyzed from 165 active duty service members with pre- and posttreatment data participating in a randomized controlled trial comparing group with individual CPT. Pretreatment variables were examined as predictors of change in PTSD severity from baseline to posttreatment, assessed using the PTSD Symptom Scale-Interview Version (PSS-I). Predictors of PSS-I change were first evaluated using Pearson correlations, followed by partial and multiple correlations to clarify which associations remained when effects of other predictors were controlled. Multiple regression analyses were used to test for interactions between pretreatment variables and treatment format. Only age was a significant predictor of PTSD symptom change after controlling for other variables and statisitically correcting for testing multiple variables. There was also an interaction between age and treatment format. Younger participants had greater symptom improvement, particularly if they received individual treatment. Other pretreatment variables did not predict outcome. CPT appears to be robust across most pretreatment variables, such that comorbid disorders, baseline symptom severity, and suicidal ideation do not interfere with application of CPT. However, individual CPT may be a better option particularly for younger service members.

Comparative study of excessive oxygen therapy effects on critically ill patients’ outcome

Introduction The use of oxygen in medicine became common around 1917 and is believed to be the most common treatment given in hospitals in the developed world. Aim of the work This study was aimed to compare and evaluate the effects of excessive oxygen therapy on severely ill patients’ prognosis and outcome. Patients and methods This study was conducted on 70 adult severely ill patients admitted to Department of Critical Care, Alexandria Main University Hospital. The selected cases were divided into two groups: control group I included 35 patients who will receive conservative oxygen therapy, and study group II included 35 patients, who will receive liberal oxygen therapy. Statistical analysis The collected data were coded, tabulated, and statistically analyzed using IBM statistical package for the social sciences statistics. Results There was no significant difference between the two groups regarding demographic data, the incidence of shock, clinical data, the vital signs and hemodynamic data, laboratory data, the ICU mortality, the sequential organ failure assessment (SOFA) score, and ICU stay. Discussion In our study, it was found that there was no significant difference between the outcome in the conservative oxygen therapy group and liberal oxygen therapy. This results may be owing to the small number of patients and the short duration of treatment. Conclusion These results can be a starting point for further research studies assessing the potential beneficial effects of normoxia in critically ill patients.

Adolescents and Music Therapy: Contextualized Recommendations for Research and Practice

Abstract Music therapists have been working with, writing about, and researching their work with adolescents for many decades. This paper provides a reflective review of the research literature in the field that is categorized in three contexts: education, mental health, and community. Grouping knowledge in this way affords a new perspective on how music therapists describe adolescents, including the terms we use to describe them, the types of programs we offer, the approaches to research that are most popular, and the way we talk about the focus of therapy. Distinctions between research in these fields are highlighted, with reference to the beliefs and values that are most congruent with each of these contexts. Following this reflective review on the literature, I provide five recommendations for consideration by researchers and practitioners. These include: determining if and when evidence is an appropriate focus; continuing to seek understanding; not underestimating the value of positive experiences; avoiding an exclusive focus on the music therapist’s perspective; and being realistic about the outcomes of group versus individual therapy. The paper concludes with an illustrative example to emphasize how one adolescent might be “seen” differently in each context.

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants’ randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.

Alexithymia stability and therapeutic outcome in an Australian psychiatric outpatient sample

BackgroundThe aim was to examine the role of alexithymia on therapeutic outcome in a naturalistic group therapy setting, as well as the effectiveness of cognitive‐behavioural group therapy in reducing alexithymia.MethodsA pre‐test/post‐test research design was used to examine alexithymia before and after treatment. Pre‐ and post‐alexithymia and psychological distress scores from routinely administered measures were retrieved for 61 psychiatric outpatients referred for group therapy at a mental health facility. Correlation, repeated measures t‐test, and regression analyses were conducted to explore the data.ResultsBaseline alexithymia was not a significant predictor of group therapy outcome (change in psychological distress) once baseline psychological distress was controlled for. There was a small but significant reduction in mean‐level alexithymia scores over the course of therapy. A high level of relative stability was observed in alexithymia scores, independent of change in psychological distress severity. A reduction in alexithymia during treatment was a significant predictor of a reduction in psychological distress over the course of therapy.ConclusionsHigh baseline alexithymia does not present a therapeutic disadvantage for patients receiving cognitive‐behavioural group therapy. However, cognitive‐behavioural group therapy is somewhat effective at improving alexithymic features, and this improvement can provide symptom relief by the end of treatment. Thus, it may advantageous for clinicians to treat alexithymia in order to enhance therapeutic intervention.

P.4.d.007 - The effect of early maladaptive schema on the treatment outcomes of cognitive-behavioural group therapy for panic disorder

P.4.d.007 - The effect of early maladaptive schema on the treatment outcomes of cognitive-behavioural group therapy for panic disorder

Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia

Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia

Group therapy processes and treatment outcomes in 2 couple-focused group interventions for breast cancer patients.

There has been little attention paid to the role of therapeutic processes in group therapy outcomes for cancer patients participating in group. The goal was to evaluate the contribution of 3 group processes-group climate (conflict, engagement, and avoidance) working alliance and therapeutic realizations-to the outcomes of 2 couple-focused approaches to group treatment. Three hundred and two women with early stage breast cancer and their partners were randomized to one of 2 conditions: an 8-session enhanced couple-focused group (ECG) intervention or a couples' support group participated. Couples completed measures of depressive symptoms and well-being before and 6months after group. Group process measures were completed after sessions 4 and 8. Support group participants (both patients and partners) perceived higher engagement and less avoidance than ECG participants. Conflict, working alliance, and therapeutic realizations did not differ. Group engagement, working alliance, and therapeutic realizations increased, and group conflict decreased over the course of both treatments. Greater conflict was associated with more posttreatment anxiety and lower well-being, and engagement was associated with higher posttreatment well-being. Patients whose partners reported higher conflict reported greater posttreatment anxiety. Working alliance was associated with posttreatment anxiety for ECG patients and with well-being among participants whose partners reported higher working alliance. Fostering a positive group environment bolsters treatment efficacy for women with early stage breast cancer and their partners attending couple-focused groups. Facilitating the leader-member alliance bolsters treatment efficacy. Improving engagement with one member of a couple impacts the other member.

Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial.

The goal of this study was to investigate treatment outcome and mediators of cognitive-behavioral group therapy (CBGT) versus mindfulness-based stress reduction (MBSR) versus waitlist (WL) in patients with generalized social anxiety disorder (SAD). One hundred eight unmedicated patients (55.6% female; mean age = 32.7 years, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT versus MBSR versus WL and completed assessments at baseline, posttreatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale-Self-Report (primary outcome; Liebowitz, 1987) as well as measures of treatment-related processes. Linear mixed model analysis showed that CBGT and MBSR both produced greater improvements on most measures compared with WL. Both treatments yielded similar improvements in social anxiety symptoms, cognitive reappraisal frequency and self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination. There were greater decreases in subtle avoidance behaviors following CBGT than MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, and attention shifting, and decreases in subtle avoidance behaviors and cognitive distortions, mediated the impact of both CBGT and MBSR on social anxiety symptoms. However, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms. CBGT and MBSR both appear to be efficacious for SAD. However, their effects may be a result of both shared and unique changes in underlying psychological processes.

You’re Not Alone: Mental Health Outcomes in Therapy Groups for Abused Women

Few evaluations have assessed the outcomes of group therapy for women abused by intimate partners. Most group programs emphasize support rather than offering therapy, although women abused by partners often present with significant clinical mental health issues. This paper describes, "You're Not Alone," a 14-week therapy group model for women abused by intimate partners informed by a narrative approach Jenkins (The Australian and New Zealand Journal of Family Therapy, 12 (4), 186-195 1991). The results present the demographic characteristics of the 379 women who began group, and a comparison of those who completed treatment (N = 214) versus those who dropped out (N = 165). Women with less income and a psychiatric history were less likely to complete group, as were women with higher depression, clinical stress, and mental health symptoms. The pretest/posttest outcome evaluation for the completers used measures of mental health symptoms, self-esteem, depression, and clinical stress, finding statistically significant improvements on most measures with moderate effect sizes. Practice implications and suggestions are presented. Language: en