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Wirksamkeit von Gruppenpsychotherapie und ihre Bedeutung in Behandlungsleitlinien am Beispiel der Gruppenpsychotherapie von Angststörungen

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Abstract

In Germany, group psychotherapy is a very common treatment in inpatient settings whereas outpatient group psychotherapy is less provided. This article gives an overview of the current status of group psychotherapy in the health care service and its importance in current treatment guidelines. Additionally, guideline recommendations were compared to current meta-analytic evidence on the efficacy of group psychotherapy. In doing so we focus on different anxiety disorders such as social phobia, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder. There is still a discrepancy between empirical evidence, guideline recommendations, and the provision of group psychotherapy in outpatient treatments settings. Although empirical findings on the efficacy of group psychotherapy are promising, treatment guidelines still give preference to individual psychotherapy. To improve the provision of group psychotherapy in the outpatient service treatment guidelines need to be updated and barriers for implementing group psychotherapy should be reduced.

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... Strauß BM. Evidenz der Gruppenpsychotherapie -aktuelle ... PiD -Psychotherapie im Dialog 2020; 21:[17][18][19][20][21][22][23] Eine Fülle von Studien zu Prädiktoren und Prozessfaktoren zeigt, dass Beziehungsmerkmale (Bindungscharakteristika) und Beziehungsgestaltung im Prozess (Allianz und Kohäsion) relevante Prädiktoren für den Therapieerfolg darstellen. Dies gilt für Gruppen, die sich an einem großen Spektrum formaler Veränderungstheorien orientieren, so dass eine Reflexion dieser Faktoren in der Praxis zu empfehlen ist. ...
... Insgesamt gesehen hat sich der Standard in der Wirksamkeitsforschung zur Gruppenpsychotherapie und deren Vielfalt deutlich erhöht. Trotz der guten Behandlungsergebnisse nach Gruppentherapien werden diese allerdings noch eher selten empfohlen, was vermutlich auch mit der Latenz zu tun hat, mit der neue Ergebnisse in Leitlinienkontexten rezipiert werden (vgl.[18]). Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht. ...
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In den letzten Jahren wurde die gesundheitspolitische Zielsetzung, ambulante Gruppenpsychotherapie zu fördern 1, mit einer Reihe von Maßnahmen unterstützt: bessere Vergütung, Kombination von Einzel- und Gruppenpsychotherapie 2, Reduktion der Gruppengröße und jüngst der angekündigte Wegfall der Gutachterpflicht. Dies stellt naturgemäß auch die Frage nach der Evidenzbasierung von Gruppenpsychotherapie, nicht zuletzt im Kontrast zur Einzeltherapie, die subjektiv nach wie vor von PatientInnen bevorzugt und auch für effektiver erachtet wird.
... Auffällig ist, dass die existierenden Leitlinien -sowohl im deutschsprachigen Raum die der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) als auch internationale wie beispielsweise der APA oder des National Institute for Health and Care Excellence (NICE) -Gruppentherapien nur im Ausnahmefall empfehlen (Schwartze et al. 2016b). Diese Tatsache ist verwunderlich und erklärungsbedürftig und könnte darauf hindeuten, dass Gruppen tatsächlich nach wie vor nicht oder viel zu wenig im Bewusstsein von Forschern sind, die die Evidenz bezüglich der Wirkung von Psychotherapie systematisch zusammenfassen. ...
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This review ties in with earlier summaries of studies on group therapy research, predominantly focusing on the outcome of group therapy for various disorders. Meanwhile, an increasing number of meta-analyses dealing with this question have been published that are summarized together with results related to group treatment for patients with cancer and pain. The results are clearly in favor of group treatment indicating outcome equivalence of the effectiveness with individual psychotherapy. Besides general outcome studies, recent publications dealt with the effect of feedback on therapy outcome in groups as well as meta-analyses about the roles of alliance and cohesion for the effects of group treatment. Other promising developments in the field of group therapy research are described.
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Zusammenfassung Basierend auf einigen Uberlegungen zu Veranderungen des Stellenwerts von Gruppenpsychotherapien in der Offentlichkeit und in der klinischen Versorgung, die mit Sicherheit auch die psychodynamische Gruppenpsychotherapie tangieren werden, wird in diesem Beitrag zunachst der aktuelle Stand zur Effektivitat und Wirksamkeit von Gruppenpsychotherapien zusammengefasst. Es wird deutlich, dass fur eine ganze Reihe von klinischen Bildern gute Evidenz fur Gruppenbehandlungen vorliegt, die unter anderem auch eine weitgehende Gleichwertigkeit von Gruppen- und Einzelpsychotherapie nahelegt. Die grose Mehrzahl der Studien, die in den letzten Jahrzehnten vorgelegt wurden, stammen aus dem Bereich der kognitiv-verhaltenstherapeutischen Forschung, wohingegen Untersuchungen rar sind, die sich auf psychodynamische Ansatze beziehen. Die wenigen vorliegenden Studien zur psychodynamischen Gruppenpsychotherapien werden kurz zusammengefasst, verbunden mit der Frage, wie psychodynamische Gruppenpsychotherapien in Zu...
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In diesem Kapitel wird ausgehend von verschiedenen Strategien der Wirksamkeitsbeurteilung von (Gruppen-)Psychotherapien die Evidenz für die Wirksamkeit von Gruppentherapien im Vergleich zu Einzeltherapien in Abhängigkeit von der formalen Veränderungstheorie, dem Setting und den behandelten Störungen beschrieben. Behandlungsökonomische Aspekte, mögliche Einflussfaktoren im Hinblick auf den Effekt von Gruppentherapien und Überlegungen zu negativen Wirkungen von Gruppen schließen sich an.
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Das Kapitel beschreibt die soziale Phobie als eine weitverbreitete Angststörung und skizziert die in den letzten Jahren entwickelten (manualisierten) Gruppenbehandlungen anhand von Kurzzusammenfassungen, welche durch empirische Wirksamkeitsbefunde sowie Literaturempfehlungen zur Vorbereitung auf die Durchführung ergänzt werden. Die wissenschaftliche Literatur belegt, dass speziell die kognitiv-behavioralen Gruppentherapien evidenzbasiert sind. Das Kapitel schließt mit der Diskussion um Vor- und Nachteile der gruppentherapeutischen Behandlung bei Patienten mit sozialer Phobie sowie einigen Anregungen für die effektive Nutzung dieses Feldes.
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Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g = 0.84, 95% CI [0.72; 0.97] and general psychopathology: g = 0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats.
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This article gives an historical review of the 48 years of development of the psychotherapy guidelines for outpatient treatment by the statutory health insurance (GKV). Furthermore, some plans for further developments of psychotherapy are discussed.
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Der Einsatz von Gruppenpsychotherapie in der Behandlung von Patienten mit einer Posttraumatischen Belastungsstörung (PTBS) wird im Überblick besprochen. Nach einleitenden allgemeinen Anmerkungen zu den sozialen Folgen der PTBS werden die folgenden drei gruppenpsychotherapeutischen Ansätze in der PTBS-Behandlung erläutert: (1) traumafokussierte kognitiv-verhaltenstherapeutische Gruppentherapien, (2) Kognitive Verarbeitungstherapie (Cognitive Reprocessing Therapy (CPT)), (3) psychoedukative Gruppenansätze. Der verstärkte Einsatz gruppenpsychotherapeutischer Ansätze sowohl im klinisch-stationären als auch im ambulanten Bereich wird empfohlen.
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This chapter describes how cognitive–behavioral therapy (CBT) can be delivered in a group setting, the advantages and disadvantages of this treatment modality, and presents some data regarding the change in symptoms and cognition following group treatment for obsessive compulsive disorder (OCD). In cognitive behavioral approaches, exposure plays a significant role. However, the function of the exposure is not habituation to the feared stimulus, but rather a behavioral experiment to test the validity of alternate appraisals developed during treatment. Behavioral experiments are one of several tools at the disposal of the cognitive–behavioral therapist. The obsessional belief questionnaire (OBQ) and the interpretations of intrusions inventory (III) are administered during the assessment phase to identify the cognitive domains that are relevant for each patient. Cognitive challenging begins with the appraisal domain that appears to be the most common among the group members. Group treatment provides an immediate opportunity to conduct a survey regarding the importance of the appraisal process. Although all group members have OCD and thus share many similar features, the heterogeneity of their symptoms often provides the opportunity to compare and contrast appraisals.
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To our knowledge, no previous meta-analysis has attempted to compare the efficacy of pharmacological, psychological and combined treatments for the three main anxiety disorders (panic disorder, generalized anxiety disorder and social phobia). Pre-post and treated versus control effect sizes (ES) were calculated for all evaluable randomized-controlled studies (n=234), involving 37 333 patients. Medications were associated with a significantly higher average pre-post ES [Cohen's d=2.02 (1.90-2.15); 28 051 patients] than psychotherapies [1.22 (1.14-1.30); 6992 patients; P<0.0001]. ES were 2.25 for serotonin-noradrenaline reuptake inhibitors (n=23 study arms), 2.15 for benzodiazepines (n=42), 2.09 for selective serotonin reuptake inhibitors (n=62) and 1.83 for tricyclic antidepressants (n=15). ES for psychotherapies were mindfulness therapies, 1.56 (n=4); relaxation, 1.36 (n=17); individual cognitive behavioural/exposure therapy (CBT), 1.30 (n=93); group CBT, 1.22 (n=18); psychodynamic therapy 1.17 (n=5); therapies without face-to-face contact (e.g. Internet therapies), 1.11 (n=34); eye movement desensitization reprocessing, 1.03 (n=3); and interpersonal therapy 0.78 (n=4). The ES was 2.12 (n=16) for CBT/drug combinations. Exercise had an ES of 1.23 (n=3). For control groups, ES were 1.29 for placebo pills (n=111), 0.83 for psychological placebos (n=16) and 0.20 for waitlists (n=50). In direct comparisons with control groups, all investigated drugs, except for citalopram, opipramol and moclobemide, were significantly more effective than placebo. Individual CBT was more effective than waiting list, psychological placebo and pill placebo. When looking at the average pre-post ES, medications were more effective than psychotherapies. Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects. However, the decision on whether to choose psychotherapy, medications or a combination of the two should be left to the patient as drugs may have side effects, interactions and contraindications.
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
Article
Abstract Based upon observations indicating decreasing attractiveness of groups within and outside the clinical field, the present study aimed to determine attitudes toward, and expectations of, groups in a representative sample of 2512 German citizens. The survey also included questions specifically related to group psychotherapy and its acceptance. In addition, psychological characteristics of respondents (measures of narcissism, psychological impairment, and emotion regulation) and socio-demographic variables were assessed to examine their potential association with group-related attitudes. In total, the survey revealed a relatively positive picture of attitudes and expectations toward groups in general and psychotherapy groups in particular. Those with more open attitudes towards groups were comparatively less distressed, anxious, and depressed; they favored emotional reappraisal instead of suppression as the dominant strategy to regulate their emotions. Contrary to prediction, narcissism did not influence attitudes towards groups. The results are related to current discussions of the attractiveness of groups and to implications for the practice of group psychotherapy.
Article
Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for Generalized Anxiety Disorders (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative metaanalysis. A total of 41 studies (with 2,132 patients meeting diagnostic criteria for GAD) were identified through systematic searches in bibliographical databases, and were included in the meta-analysis. Most studies examined the effects of cognitive behavior therapy (CBT). The majority of studies used waiting lists as control condition. The pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control group was large (g = 0.84; 95% CI: 0.71~0.97) with low to moderate heterogeneity. The effects based on self-report measures were somewhat lower than those based on clinician-rated instruments. The effects on depression were also large (g = 0.71; 95% CI: 0.59~0.82). There were some indications for publication bias. The number of studies comparing CBT with other psychotherapies (e.g., applied relaxation) or pharmacotherapy, was too small to draw conclusions about comparative effectiveness or the long-term effects. There were some indications that CBT was also effective at follow-up and that CBT was more effective than applied relaxation in the longer term.
Article
Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion ber die wissenschaftlichen Standards und deren Praxisrelevanz gefhrt. Dabei nehmen Fragen der Qualittssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die bertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis. In the field of psychotherapy, similarly to other areas of medicine, there is currently an intensive and controversial discussion about the scientific foundation and standards of research and their relevance for clinical practice. Very important in this context is the concept of evidence based medicine and its methodological standards, which primarily include experimental treatment studies. This paper addresses the concept of evidence based medicine in the area of psychotherapy (evidence based psychotherapy) with regard to methodology and content. A core question in this context is to what extend scientific results can be transferred into clinical practice.
Conference Paper
Video-based media spaces are designed to support casual interaction between intimate collaborators. Yet transmitting video is fraught with privacy concerns. Some researchers suggest that the video stream be filtered to mask out potentially sensitive ...
Article
Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive-compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta-analysis of the effectiveness of group CBT/ERP for OCD. A systematic literature search was conducted and studies were meta-analysed by means of the Cochrane Review Manager Program with measures of i) pre- to post-effect sizes (ES) and ii) between-group ES in comparison with different control conditions. Outcome was primarily measured on the Y-BOCS and ES was calculated in the form of Cohens d. Thirteen trials were included in the meta-analysis. The overall pre-post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT. Group CBT is an effective treatment for OCD, but more studies are needed to compare the effectiveness of group and individual treatment formats.
Article
Given the evidence for the efficacy, applicability, and efficiency of the group therapies, they appear to be underutilized by clinicians, therapists, and researchers. This article considers reasons for their underutilization. The article also considers procedures for lessening patient and therapist tendencies to resist participating in the group therapies relative to individual therapies. Underutilization not only deprives patients of effective treatment for a wide range of problems but deprives therapists from experiencing fascinating and rewarding therapeutic processes. That has been the experience of the author after more than 35 years of conducting and studying group therapies.
Article
Generalised anxiety disorder (GAD) is a very common condition, in which people suffer from excessive worry or anxiety about everyday events and problems. Psychological therapies are a popular form of treatment for anxiety disorders. This review aimed to find out whether psychological therapies are effective for GAD, and whether cognitive behavioural therapy (CBT) is more effective than other psychological therapy approaches, including psychodynamic and supportive therapies. The review included 25 studies, with a total of 1305 participants. All the studies used a CBT approach, and compared CBT against treatment as usual or waiting list (13 studies), or against another psychological therapy (12 studies). The review showed that people attending for psychological therapy based on a CBT approach were more likely to have reduced anxiety at the end of treatment than people who received treatment as usual or were on a waiting list for therapy. CBT was also very effective in reducing secondary symptoms of worry and depression. People who attended for group CBT and older people were more likely to drop out of therapy. None of the studies comparing CBT with treatment as usual or waiting list looked at the long-term effectiveness of CBT. It is not clear whether people attending for CBT sessions were more likely to have reduced anxiety than people attending for psychodynamic therapy or supportive therapy, because only one study compared CBT with psychodynamic therapy, and the six studies that compared CBT with supportive therapy showed differing results. None of the studies included in the review reported on the possible side effects or acceptability of psychological therapies. More studies should be carried out to establish whether psychodynamic and supportive therapies are effective for GAD, and whether CBT is more helpful than other psychological therapy approaches in treating GAD.
Article
Background: Obsessive compulsive disorder (OCD) is a chronic anxiety disorder associated with significant morbidity, social impairment and lower quality of life. Psychological treatments are a frequently used approach for OCD. Objectives: To perform a systematic review of randomised trials of psychological treatments for obsessive compulsive disorder in comparison with treatment as usual. Search strategy: We conducted an electronic search of CCDANCTR-Studies (31/10/2006), and other databases. We searched reference lists, and contacted experts in the field. Selection criteria: Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD DATA COLLECTION AND ANALYSIS: Two review authors worked independently throughout the selection of trials and data extraction. Findings were compared and disagreements were discussed with a third review author. Full data extraction, using a standardised data extraction sheet, was performed on all studies included in the review. Results were synthesised using Review Manager software. For dichotomous data, odds ratios were calculated. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated. Fixed and random effects models were used to pool the data. Reasons for heterogeneity in studies were explored and sensitivity analyses were performed by excluding trials of lower quality. Main results: Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95% CI -1.61 to -0.87, I(2) test for heterogeneity 33.4%). Different types of cognitive and/or behavioural treatments showed similar differences in effect when compared with treatment as usual. The overall treatment effect appeared to be influenced by differences in baseline severity. Authors' conclusions: The findings of this review suggest that psychological treatments derived from cognitive behavioural models are an effective treatment for adult patients with obsessive compulsive disorder. Larger high quality randomised controlled trials involving longer follow up periods are needed, to further test cognitive behavioural treatments, and other psychological approaches, in comparison to each other and control conditions. Future trials should examine the predictors of response to each treatment, and also conduct cost-effectiveness evaluations.
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