Group CBT for early psychosis--are there still benefits one year later?

Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.     

Patient Perspectives on Co-Therapists’ Behaviors in Group CBT

Journal of Contemporary Psychotherapy - Therapist behaviour influences group cohesion and the outcome of group psychotherapy. The group members make first hand observations of the therapists in...     

Can CBT Be Effective for Aboriginal Australians? Perspectives of Aboriginal Practitioners Trained in CBT

The objective of the study was to investigate whether high and low intensity versions of cognitive behaviour therapy (CBT) might be an effective therapeutic approach for enhancing the mental health of Aboriginal Australians. Five university‐educated Aboriginal counsellors received in‐depth training in CBT. Over the following year, they used CBT strategies with their clients, and met 10 times as a participatory action research group. The group addressed three key questions: (a) Does CBT appear to be useful for Aboriginal Australians? (b) If so, what elements of CBT are perceived to be effective? (c) What adaptations might be made to CBT to enhance its effectiveness with Aboriginal Australians? The resulting qualitative data were transcribed and analysed. Counsellors perceived CBT to be very useful for their Aboriginal clients and for themselves. They reported that it enhanced their clients' well‐being, their own clinical skills, and their own well‐being, and it reduced burnout. The qualities of CBT that were perceived to be effective were its adaptability, pragmatic here‐and‐now approach, capacity for low‐intensity interventions, safe containing structure, promotion of self‐agency, and valuable techniques. It was suggested that the prime requirement for adaptations to CBT were that they would need to fit different social and cultural contexts.     

Group intervention for medical patients—A treatment for damaged self-esteem

There is a need to integrate our knowledge of psychoanalytic theory, group therapy and medical care delivery systems. Understanding the importance of selfesteem, based upon the study of psychoanalytic theory, can help to determine appropriate technique in medical groups as well as to add to our understanding of the profound importance of such groups in the delivery of medical care. Groups in hospitals help patients to get in touch with their strengths, feel less isolated, and be more active—all of which enhance selfesteem. As patients participate in groups, narcissistic defenses can be enhanced and the quality of life improved. When interdisciplinary teams participate in patient groups, delivery of medical care can be more comprehensive: The totality of the patient emerges more clearly and staff becomes more aware and sensitive to his/her emotional and physical needs.This paper was presented at Thirty-Sixth Annual Conference, American Group Psychotherapy Association, 1978. The author would like to acknowledge Hazel M. Halloran and Susanne A. Kohut, Director and Associate Director, Department of Social Work, who conceived of and supported the expansion of the group work program in the General Hospital Division of St. Vincent's Hospital and Medical Center of New York. The following professionals contributed clinical material used in this paper: Sara Bookbinder, M.S.W., Carol Coven, M.S.W., Linda Haselman, R.N., Barbara Horn, M.S.W., Kathleen McQuade, R.N., Ellen McGuire, M.S.W., Sister Marita Rose O'Brien, R.N., and Emile Powe, M.D.     

Should We Have Children? A Decision-Making Group for Couples

The authors designed and conducted a group for couples deciding whether to have children or remain childfree. Four couples participated in various group exercises and activities. The group experience was positive for most members; in relation to this decision they gained an understanding of their own needs and attitudes, of their spouses' positions, and of the issues involved. Outcomes varied: One couple decided to wait to make the decision, two decided to have children later, and one decided to probably remain childfree.     

Now for Me,Later for Us? Effects of Group Context on Temporal Discounting

Delayed rewards are less valuable than immediate rewards. This well‐established finding has focused almost entirely on individual outcomes. However, are delayed rewards similarly discounted if they are shared by a group? The current article reports on three experiments exploring the effect of group context on delay discounting. Results indicate that discount rates of individual and group rewards were highly correlated, but that respondents were more willing to wait (decreased discounting) for shared outcomes than for individual outcomes. An explanatory model is proposed suggesting that decreased discount rates in group contexts may be due to the way the effects of both delay and social discounting are combined. That is, in a group context, a person values both a future reward (discounted by delay) and a present reward to another person (discounted by the social distance between them). The results are explained by a combined discount function containing a delay factor and a factor representing the social distance between the decision maker and group members. Practical implications of the fact that shared consequences can increase individual self‐control are also discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Modifying CBT for Perinatal Depression: What Do Women Want?: A Qualitative Study

The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences of pregnancy and the postpartum period and its relationship to mood, and perspectives on ideal treatment content. Thematic analysis revealed a number of perinatal-specific themes that were relevant to CBT in three key domains: self, motherhood, and interpersonal. Mothers particularly struggled with: internalization of “motherhood myths,” self-sacrifice, and managing social support during this period. Shifts in women's themes across the perinatal period, and between racial and socioeconomic groups are discussed as are implications for modification of CBT to improve relevance for perinatal depression.     

Examining Parents’ Preferences for Group Parent Training for ADHD When Individual Parent Training is Unavailable

Parent training programs are considered well-established interventions for attention deficit hyperactivity disorder in children as they reduce behavioral impairment, but limited parent engagement decreases service effectiveness. We used a discrete choice experiment to examine how parent preferences for group vs. individual format might influence their participation in Parent training. Parents (N?=?260) seeking mental health services for children with elevated symptoms of attention deficit hyperactivity disorder in Ontario, Canada were participants. They preferred Individual parent training in another study and completed a discrete choice experiment composed of 30 choice tasks measuring Parent training format preference. In this paper, parents’ preferences for alternatives to Individual Parent training, specifically Group Parent training and Minimal Information options, were estimated. Specifically, this study asked “if first choice is unavailable, what is the second choice?” This question is important as many clinics may not be able to offer both group and individual therapy given state funding cuts for youth mental health services. Simulations predicted that 85.8?% of parents who initially preferred Individual Parent training would switch to Group Parent training that included step-by-step solutions to children’s emotional and behavior problems, and the possibility of feeling informed and confident. The remaining 14.2?% of parents preferred Minimal Information; these parents preferred internet services offered conveniently and timely. Findings highlight consideration of less appealing factors that families might trade for more desirable service elements in a cost-restrictive environment.     

Intrusiveness of Minorities: Growing Pains for the Majority Group?1

In this paper, we examined the impact of the numerical representation and the intrusiveness of immigrants on feelings of group threat voiced by the majority. The present evaluation of group threat differs from previous studies in its inclusion of temporal comparisons. The relationship between feelings of threat and attitudes toward immigration was also evaluated. In all, 221 college students completed a questionnaire. As predicted, results obtained show that numerical representation was positively associated with feelings of group threat resulting from invidious social comparisons. Intrusiveness was positively related to feelings of group threat resulting from temporal comparisons. Contrary to hypotheses, the final model confirms that only feelings of temporal group threat were associated with negative attitudes toward immigration. Practical implications and the important role of temporal comparisons are discussed.     

Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive–Compulsive Disorder?

Clinical studies in adults and children with obsessive–compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.     

A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.     

What Does the Alliance Predict in Group Interventions for Early Psychosis?

The therapeutic alliance is considered an essential component of any clinical or psychological intervention. The therapeutic alliance can however change over time, and therefore it is relevant to determine if the alliance and its variations are related to clinical outcomes. The present study had three objectives: (1) determine the impact of the alliance measured by the client and the therapist, on clinical and psychosocial outcomes of individuals with early psychosis receiving group interventions; (2) measure the concordance between the client and the therapists’ ratings of the alliance; and (3) determine the best predictor of the client’s alliance in our sample. A total of 36 individuals with early psychosis who participated in group interventions for symptom management answered the WAI three times, and so did the group therapists. Outcomes included measures of insight, symptoms (total, positive and negative), and self-esteem. Attendance and group participation were also measured. Results suggest that the overall client’s alliance predicted total symptoms and self-esteem at post-therapy, whereas both clients’ and therapists’ ratings predicted group attendance and participation. Greater variations in the alliance overtime for the clients were somewhat linked to worse negative symptoms at post-therapy. Alliance ratings were generally high and fairly concordant between therapists and clients. Only the baseline measure of capacity for attachment, predicted the client’s overall alliance scores. Clinical implications are discussed.     

The Iatrogenic Effects of Group Intervention for Antisocial Youth: Premature Extrapolations?

Group intervention for antisocial youth has received harsh criticism in recent years. This paper reviews relevant research focused on the influence of contact with delinquent peers on the development of antisocial activity. Also reviewed are studies reporting outcomes of group intervention for antisocial youth. Although a few studies have found iatrogenic effects for group intervention with antisocial youth, the majority have not. Well-developed models of group intervention have produced substantial reductions in youth antisocial activity. We describe one such program, a family-style residential program based on behavioral learning principles, and review outcomes of this program. We conclude that treatment of antisocial youth in groups is feasible and can be effective in reducing delinquent behavior.     

Group support interventions for women with breast cancer: who benefits from what?

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n = 230). The authors administered the SF-36 (S.E. Ware, K.K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed.