Article

Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective.

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Abstract

There are mixed findings regarding the differential efficacy of the group and individual format. One explanation of these mixed findings is that nearly all-recent meta-analyses use between-study effect sizes to test format equivalence introducing uncontrolled differences in patients, treatments, and outcome measures. Only 3 meta-analyses were located from the past 20 years that directly tested format differences in the same study using within-study effect sizes; mixed findings were reported with a primary limitation being the small number of studies. However, we located 67 studies that compared both formats in the same study. Format equivalence (g = −0.01) with low effect size heterogeneity (variability) was found in 46 studies that compared identical treatments, patients, and doses on primary outcome measures. Format equivalence (g = −0.06) with moderate effect size heterogeneity was found for 21 studies that compared nonidentical treatments; however, allegiance to a specific format moderated differences in effect sizes. There were no differences between formats for rates of treatment acceptance, dropout, remission, and improvement. Additionally, there were no differences in outcome between formats by patient diagnosis; however, differences in pre-to-post improvement were explained by diagnosis with depression, anxiety, and substance disorder posting the highest outcomes and medical and childhood disorders the lowest. Findings are discussed with reference to the practical challenges of implementing groups in clinical practice from an agency, clinician, and reimbursement perspective.

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... For example, a meta-analysis that explored individual and group delivery in psychotherapy practice found that when identical doses and treatments were compared, there was no difference in outcomes between the two formats. 26 Similarly, a further meta-analysis comparing group-and individual-based physiotherapy in people with musculoskeletal conditions reported equally effective outcomes. 27 Thus, for these specific disciplines, it appears there is little difference in treatment efficacy between the two delivery formats. ...
... This finding supports previous meta-analyses and systematic reviews in physiotherapy and psychotherapy programs that have found there is little difference in terms of patient outcomes between individual or group delivery styles. 26,27 We extend this for the first time to show that this is also the case for MPMPs delivered to people with chronic pain. ...
... This supports previous research indicating that group psychological treatments are just as effective as one-toone psychological treatments. 26 In addition, individual physiotherapy and massage sessions were halved in the new program. Although the exact content of the individual physiotherapy sessions at QE Health varied, they commonly involved individual exercise prescription, manual therapy and further massage. ...
Article
Objective There is little information on how multidisciplinary pain management programs (MPMPs), the gold-standard treatment for people with chronic non-cancer pain, should be structured or delivered. This study compared outcomes from a 3-week in-patient MPMP between those who attended a group-based program that included 8 h of individual therapy each week and those who attended when the amount of individual therapy had been halved.Methods Participants were patients attending an MPMP with a large component of individual sessions (n = 112; Standard) and patients attending the same MPMP after it switched to predominantly group-based sessions (n = 117; Revised). The Hospital Anxiety and Depression Scale (HADS) and Queen Elizabeth (QE) Health Scale were administered to participants at baseline and discharge. Regression analysis was used to compare outcomes between the two delivery formats.ResultsThere were no significant differences in any outcome measures between the two delivery formats overall. The QE Health Scale (P < 0.001) and HADS depression (P < 0.05) scores were significantly better for patients with rheumatoid arthritis or osteoarthritis who had undertaken the Revised program compared with the Standard program.Conclusions This study provides support that changing the amount of individual therapy within in-patient MPMPs does not change patient outcomes. However, there is evidence that those with rheumatoid arthritis and osteoarthritis respond better to a more group-based approach, suggesting that different populations may be suited to different delivery formats.What is known about the topic?Studies have shown mixed results as to whether group- or individual-based rehabilitation programs are more effective. Previous systematic reviews on physiotherapy- or psychological-based interventions have concluded that individual and group approaches are generally equivalent in terms of patient outcomes. MPMPs are trending towards more group-based delivery of content; however, it is unknown whether the equivalence of efficacy between group and individual formats extends to a chronic pain population receiving multidisciplinary care.What does this paper add?This research specifically adds to the knowledge that almost exclusive group delivery of therapy is just as effective as a program with more individual components in a population of patients participating in an MPMP. There is some evidence that those with rheumatoid arthritis and osteoarthritis in the almost exclusive group delivery program had better outcomes than those in the program with more individual components, indicating that specific conditions may benefit more from a group approach.What are the implications for practitioners?Practitioners can be confident that group delivery is just as effective as individual delivery of program components in an MPMP. Thus, decisions regarding the delivery format can be based on factors such as practical considerations, cost or patient and clinician preference.
... So, what does the present meta-analysis contribute? First, metaanalyses of format are often based upon betweenstudy comparisons where estimates of group or individual come from different studies Burlingame, Seebeck, et al., 2016). When format estimates come from different studies (indirect comparisons) rather than the same study (direct comparisons), a host of confounds are present (e.g., differences in protocols, patients, settings, etc.). ...
... A repeating theme in the group versus individual format literature is the finding from single studies that more people dropout of group than individual therapy (Burlingame et al., 2013). Rates of attrition, reliable improvement, recovery, and treatment acceptance were tested in a large format comparison meta-analysis (Burlingame, Seebeck, et al., 2016) and no format differences were found. The present study found the same pattern, increasing our confidence that the samples were not biased by the threat of differential attrition. ...
... A common argument for group treatment referral is its cost-efficiency over individually delivered Psychotherapy Research 355 treatments (Burlingame, Seebeck, et al., 2016). While empirical studies support this fiscal advantage, a growing body of evidence provides a more compelling reason for group referral-effectiveness. ...
Article
The addition of group psychotherapy as a specialty by the APA in 2018 creates a need for rigorous empirical reviews of group treatments for specific disorders. We conducted a meta-analysis of randomized controlled trials (RCTs) that tested the effect of group psychotherapy for mood disorders, including depression and bipolar disorder, at posttreatment and follow-up time-points, as well as rates of recovery and attrition. Major databases were searched for RCTs of group treatment for depression and bipolar disorder published from 1990 to 2018, which identified 42 studies across both disorders. Random effects meta-analyses indicated that group therapy for depression produced superior outcomes compared to waitlist control (WLC) and treatment as usual (TAU) and equivalent outcomes to medication. Similarly, group therapy for bipolar disorder produced superior outcomes to TAU. Analyses of recovery rates were conducted for depression, producing similar results to the main outcome analyses. Rates of attrition did not differ between group and comparison conditions for either disorder. These findings support group therapy for treating depression and bipolar disorder, although further research is needed comparing group treatment for bipolar disorder to medication.
... In comparison to notreatment control groups we found large betweengroup effect sizes similar to within-group (pre-post) effects reported by Bandelow et al. (2015). Moreover, our head-to-head comparisons of individual and group treatment revealed non-significant differences as found by Burlingame et al. (2016) and Gould et al. (2012), but contradicting findings from the study by Carpenter et al. (2018). Additionally, our study pool shows substantial overlap with disorderspecific reviews on the efficacy of group therapy (SAD: Acarturk et al., 2009;Barkowski et al., 2016;Mayo-Wilson et al., 2014;Powers et al., 2008;Wersebe et al., 2013;GAD: Cuijpers et al., 2014;Hunot et al., 2007;PD: Schwartze et al., 2017). ...
... So far, larger study pools with direct head-to-head comparisons were obtained by aggregating across disorders (e.g. Burlingame et al., 2016). ...
... Another limitation is dependency among observations and has been noted already in previous research (e.g., Burlingame et al., 2016;Schwartze et al., 2017). When patients are treated in groups, they share a common environment (e.g., having the same therapist, interacting with the same group members). ...
Article
Objective: This meta-analysis evaluates the efficacy of group psychotherapy in the treatment of anxiety disorders. Method: A comprehensive literature search using PubMed, PsychInfo, Web of Science, CENTRAL, and manual searches was conducted to locate randomized controlled trials. We found 57 eligible studies (k = 76 comparisons) including 3656 participants receiving group psychotherapy or an alternative treatment for generalized anxiety disorder, social anxiety disorder, and panic disorder. Results: Effect size estimates show that group psychotherapy reduces specific symptoms of anxiety disorders more effectively than no-treatment control groups (g = 0.92, [0.81; 1.03], k = 43) and treatments providing common unspecific treatment factors (g = 0.29 [0.10; 0.48], k = 12). No significant differences were found compared to individual psychotherapy (g = 0.24 [−0.09; 0.57], k = 7) or pharmacotherapy (g = −0.05 [−0.33; 0.23], k = 6). The effects were unrelated to factors of the group treatment. Within head-to-head studies, a significant moderating effect emerged for researcher allegiance. Conclusions: Our results support the efficacy of group psychotherapy for anxiety disorders. They indicate that mixed-diagnoses groups are equally effective as diagnosis-specific groups, although further evidence is required. Future primary studies should address differential effectiveness, include a wider range of therapeutic approaches as well as active comparison groups.
... Meta-analyses indicate that low-intensity treatment forms such as guided self-help based on CBT principles (Cuijpers et al. , 2013, CBT delivered in groups (Huntley et al., 2012;Cuijpers et al., 2013;Barkowski et al., 2016;Burlingame et al., 2016) and computerized CBT (cCBT) (Andrews et al., 2010) are effective treatment forms for anxiety and depression disorders. Some studies even indicate that these treatment forms can give treatment outcomes comparable to that of individual treatment (Andrews et al., 2010;Cuijpers et al., 2010Cuijpers et al., , 2013Barkowski et al., 2016;Burlingame et al., 2016). ...
... Meta-analyses indicate that low-intensity treatment forms such as guided self-help based on CBT principles (Cuijpers et al. , 2013, CBT delivered in groups (Huntley et al., 2012;Cuijpers et al., 2013;Barkowski et al., 2016;Burlingame et al., 2016) and computerized CBT (cCBT) (Andrews et al., 2010) are effective treatment forms for anxiety and depression disorders. Some studies even indicate that these treatment forms can give treatment outcomes comparable to that of individual treatment (Andrews et al., 2010;Cuijpers et al., 2010Cuijpers et al., , 2013Barkowski et al., 2016;Burlingame et al., 2016). Psycho-education for anxiety and depression seems to give promising results, although the evidence for group-based forms is scarce (Brown and Lewinsohn, 1984;Donker et al., 2009). ...
... Previous research has shown that low-intensity treatment forms can be effective for anxiety and depression (McDermut et al., 2001;Andrews et al., 2010;Cuijpers et al., 2010;Huntley et al., 2012;Cuijpers et al., 2013;Barkowski et al., 2016;Burlingame et al., 2016), though the evidence for group-based psycho-education is scarce (Brown and Lewinsohn, 1984;Donker et al., 2009). Our results showed that all treatment forms (guided self-help, group-based psycho-education, individual CBT and a mix of treatment forms) were associated with a large symptom reduction from baseline to 12 months posttreatment, although the low-intensity treatments were associated with a somewhat smaller reduction in symptom levels. ...
Article
Full-text available
Objectives Prompt Mental Health Care (PMHC) is the Norwegian version of the England’s Improving Access to Psychological Therapies (IAPT). Both programs have been associated with substantial symptom reductions from pre- to post-treatment. The present study extends these findings by investigating symptom levels at 12 months post-treatment, as well as treatment outcome in relation to low- vs. high-intensity treatment forms.Design and Outcome MeasuresA prospective cohort design was used. All participants (n = 1530) were asked to complete the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 questionnaire (GAD-7) at baseline, before each session during treatment, at final treatment, and at 12 months post-treatment. Cohen’s d was used as effect size measure. Sensitivity analyses were conducted to examine the impact of the high missing data rates at post-treatment (≈44%) and 12 months post-treatment (≈58%).ResultsA large symptom reduction was seen from baseline to 12 months post-treatment for both PHQ (d = −0.98) and GAD (d = −0.94). Improvements observed at post-treatment were largely maintained at 12 months post-treatment (PHQ (Δd = 0.10) and GAD (Δd = 0.09). Recovery rates decreased only slightly from 49.5% at post-treatment to 45.0% at follow-up. Both low- and high-intensity treatment forms were associated with substantial and lasting symptoms reductions (−1.26 ≤ d ≤ −0.73). Sensitivity analyses did not substantially alter the main results.Conclusion The findings suggest long-lasting effects of the PMHC program and encourage the use of low-intensity treatment forms in PMHC like settings.
... We selected and coded 38 variables stemming from four main categories: study characteristics, leader characteristics, member characteristics, and group characteristics. Some of these variables have been found to moderate outcome in previous group therapy metaanalyses (Burlingame et al., 2016). More specifically, we used the same moderator variables reported in a recent study that tested the relationship between cohesion and outcome . ...
... and confidence interval (.26 -.30) that does not overlap with findings from our study. While there are obvious limitations in directly comparing these two meta-analyses due to confounds inherent in between-study comparisons (Burlingame et al., 2016;Shadish & Sweeney, 1991), it is important to note that both meta-analyses used identical alliance measures and overlapping outcome instruments. One might expect alliance to be more predictive in individual therapy compared to group therapy because it is essentially the only relationship possible for that format. ...
... As such, the current study provides a bridge from research to understanding recovery in clinical practice. The results support the existing limited literature on format efficacy, provided by RCTs (Burlingame et al., 2016a;Manassis et al., 2002;Sharp et al., 2004). Results replicate findings of the RCT in Manassis et al. (2002), where significant post-intervention reductions in anxiety and improvements of global functioning were cited in pre-adolescent children with GAD and social anxiety, regardless of treatment format. ...
... Results from our exploration of treatment formats for GAD did not support the notion that gCBT yields higher rates of attrition (Fernandez et al., 2015), as suggested by previous research replicating a CBT intervention for GAD, where drop-out rates were significantly higher in group than individual format (Ladouceur et al., 2000). Our findings are supported by a recent large meta-analysis, which concluded no differences in attrition between individual and gCBT (Burlingame et al., 2016a). RCTs yield significantly lower attrition rates than that of clinical practice (Richards and Borglin, 2011;Swift and Greenburg, 2012). ...
Article
Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group ( n = 44) and individual ( n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.
... Group psychotherapy is an effective treatment for patients with a variety of psychiatric disorders, often with comparable results to individual psychotherapy (Burlingame et al., 2016). Despite equal levels of efficacy, group psychotherapy is a distinct treatment modality with unique therapeutic factors, such as vicarious learning (learning from each other), universality (observing others struggling with similar issues) and altruism (offering support to each other) (Fuhriman & Burlingame, 1990). ...
Article
Full-text available
Monitoring treatment progress by the use of standardized measures in individual therapy, also called feedback-informed treatment (FIT), has a small but significant effect on improving outcomes. Results of FIT in group therapy settings are mixed, possibly due to contextual factors. The goals of this study were to investigate the feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool, based on the principles of the Contextual Feedback Theory and earlier FIGT research. Patients with anxiety or depressive disorders following interpersonal or cognitive behavioral group psychotherapy (IPT-G or CBT-G) were randomized to either feedback (n = 104) or Treatment As Usual (TAU; n = 93). In the feedback condition, patients filled out the Outcome-Questionnaire 45 (OQ-45) weekly in a FIGT tool and therapists were instructed to discuss the results in each session. Dropout, attendance and outcomes were measured. Additionally, in the feedback condition, OQ-45 response, feedback discussions and acceptability by patients and therapists were assessed. Results showed no differences on dropout, but lower attendance rates in the feedback condition. Although therapists reported high rates of feedback use and helpfulness, patients experienced that results were discussed with them only half of the time and they were also less optimistic about its usefulness. The findings indicate that the FIGT instrument was partially feasible, more acceptable to therapists than patients, and was not effective as intended. Future research is needed to discover how feedback can be beneficial for both therapists and patients in group therapy.
... A lthough psychotherapy is effective for most patients, approximately 20% of patients drop out (Swift & Greenberg, 2012) and 5-10% experience a decrease in functioning (Lambert & Ogles, 2004). In general, effects of group psychotherapy are comparable to individual therapy for the treatment of mental disorders (Burlingame et al., 2016) and rates of deterioration at the end of treatment are also similar (Schuman et al., 2015;Slone et al., 2015). Unfortunately, therapists are poor at predicting these negative treatment outcomes and tend to overlook worsening during treatment (Chapman et al., 2012;Hannan et al., 2005;Hatfield et al., 2010;Walfish et al., 2012). ...
Article
Full-text available
Therapists, including group therapists, can systematically gather feedback from patients about how their group members are responding to treatment. However, results of research on using feedback-informed group treatment (FIGT) are mixed, and the underlying mechanisms responsible for positive patient changes remain unclear. Therefore, the present qualitative study examined the perceptions and experiences of both (a) group therapists and (b) group members regarding using feedback in their therapy groups to gauge treatment progress, across five different therapy groups. Specifically, three interpersonal psychotherapy groups and two cognitive-behavioral therapy groups used a FIGT tool in which treatment progress updates were provided to patients and therapists. Observational data were collected in the form of feedback discussions in these therapy groups, as well as during interviews conducted with patients and therapists. Data were analyzed using thematic analysis and a grounded theory approach. Overall, patients were mostly positive about their experiences with FIGT, but therapists also expressed concerns about FIGT. Results indicated that FIGT is useful for gaining insight and strengthening the working alliance. In addition, specific group processes were also found to be important, especially interpersonal learning, cohesion, and social comparison. Practical implications are discussed.
... During COVID-19, Forsyth (2020) applied group theory to the group behaviors influencing people to shed light on groupthink and ways we can try and address it. Applied group researchers have published many meta-analyses and summaries of the evidence base for group therapy being effective, equivalent to individual treatment, and efficient (Burlingame et al., 2016;Rosendahl et al., 2021;Whittingham et al., 2021). Although researchers and those reading the literature are aware of the benefits of group therapy, most of the population is not. ...
... These meta-analytic findings demonstrate that group therapy had the same positive effects on various outcomes for many specific mental disorders compared to other treatments (Burlingame & Strauss, 2021). For example, Burlingame et al. (2016) included 67 studies that compared individual and group treatment and found indistinguishable outcomes on treatment acceptance, symptom improvement, and dropout. However, almost all included studies had a CBT approach, and the efficacy of group analytic and psychodynamic group psychotherapy has been investigated only in a few RCTs. ...
Article
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The present study investigated the treatment effects of focused short-term group analytic psychotherapy and examined whether outcomes were predicted by the client’s psychological mindedness and personality structure as measured by the Operationalized Psychodynamic Diagnosis (OPD). Treatment foci were formulated according to the OPD for 66 student counseling clients across nine groups. Two observers independently rated client psychological mindedness and personality structure. The pre-post Cohen’s d effect sizes were large on the Global Severity Index (GSI) and the Inventory of Interpersonal Problems (IIP-64) and moderate on the Social Adjustment Scale Self Report, including all 66 clients starting treatment. Psychological mindedness significantly predicted two outcomes (GSI, IIP), and personality structure predicted one outcome (GSI). These measures could be helpful when selecting clients for short-term group analytic psychotherapy. We discuss study limitations and implications for future research and practice.
... Research indicates that individual and group psychotherapy are equally effective (e.g., see Burlingame et al., 2016). ...
Article
Research has repeatedly demonstrated that individual and group psychotherapy are equally effective. Compassion‐focused therapy (CFT) has been shown to be an effective approach to treating individuals with a wide range of presenting mental health concerns. In this study, we discuss the basic tenets of CFT and introduce a 12‐module CFT group psychotherapy approach for college counseling centers. We use a clinical vignette to provide an example of how psychotherapists may implement this approach. We then discuss clinical applications, including strengths and limitations of this approach.
... Research has demonstrated that both individual (1, 2) and group therapy (3) can help patients live more fulfilling and happier lives, although studies have also suggested that whichever modality the therapist prefers shows more efficacy. In examining 67 studies that compared formats, Burlingame et al. (4) found no difference between formats for "rates of treatment acceptance, dropout, remission, and improvement." ...
... As there is no literature to date on the use of digital health for MI, ensuring that an online delivery would not be problematic to participants was central to our study. Our results indicate that participants did not find it to be problematic or an impediment to MI treatment, thus supporting a growing body of literature which shows that online means may be useful for a number of serious mental health conditions including psychosis (57), PTSD (58), major depressive disorder (59), and anxiety disorders (60) along with vulnerable populations such as indigenous (61) Group therapy has been shown to be equally effective compared to individual treatment (65). Group therapy has also been noted to bring unique components to the therapeutic process not found in one-on-one. ...
Article
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Introduction In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)–a trauma syndrome related to transgressing personal morals and values–in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy. Purpose This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called “Accepting Moral Pain and Suffering for Healthcare Providers” (AMPS-HCP). Method This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing. Results Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI. Discussion This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.
... La terapia grupal ha demostrado repetidamente serlo (Tucker y Oei, 2007;van der Spek et al., 2018). Vale la pena recordar que, a pesar de la cantidad de evidencia generada sobre que los grupos de pacientes hospitalizados son muy diferentes de las modalidades ambulatorias (Burlingame et al., 2016), también se ha demostrado su eficacia (Kösters et al., 2006). ...
... Both efficacy and effectiveness of group psychotherapy are generally well established for a variety of mental disorders Burlingame & Strauss, 2021). Research has indicated that individual and group formats are equally effective in promoting change (Burlingame, Seebeck, et al., 2016). Within specialist mental health services, group psychotherapy is a frequent treatment approach (Lorentzen & Ruud, 2014) and in specialized PD treatments, groups often represent core components (Storebø et al., 2020). ...
... In addition to this individual therapeutic format, we developed a version of the Switch intervention for group settings to meet the increased service demands that are being placed upon mental health systems (Burlingame et al., 2016). Providing interventions in a group setting might indeed be more cost-effective than in individual settings (e.g., Neufeld et al., 2020). ...
Article
Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of “Switch,” an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants’ smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants’ activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.
... Gruppenpsychotherapie ist wirksam. Gruppenpsychotherapie wirkt genauso gut wie Einzeltherapie und setzt dabei die zur Verfügung stehenden Ressourcen für Behandlungsangebote effizient ein (Burlingame et al., 2016;Burlingame u. Strauß, 2021;Yalom u. ...
Article
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Several legal initiatives to promote group psychotherapy have led to the creation of new „brief“ psychotherapeutic group interventions and the possibility of co-therapy pairs in outpatient group psychotherapies. The German Federal Joint Committee (G-BA) included into the federal psychotherapy directive trial sessions and the „primary psychotherapeutic care“ in a group setting as an element of primary care. Through „primary psychotherapeutic care“, patients can access up to eight group therapy sessions of 50 minutes each. This approach should explicitly take patients’ needs into account and contribute to better pre-group preparation for group psychotherapy. The new treatment options improve prognosis and effectiveness of the subsequent group psychotherapy. In the long term, a wide range of therapy groups could be created in outpatient care. This article presents the new treatments options included in the new regulations, points to promising approaches regarding short-term group therapy in current scientific literature and provides suggestions for implemen-tation in professional practice. The new treatment options could expand the supply with evidence-based group psychotherapy.
... Rosendahl et al.'s review of research in this special issue (41) sheds light on the empirical inquiry taking place nationally and internationally. Group psychotherapy has been shown to be as effective as individual therapy for most patients and disorders (42,43). Moreover, an increasing body of meta-analyses have supported the efficacy of group psychotherapy for particular disorders, such as anxiety (44) and depression (45), and research on therapeutic factors, such as the impact of group cohesion on outcome (46), is ongoing. ...
Article
Group psychology and group psychotherapy (GPGP) are distinctive, effective practices that meet an important need. In 2018, the American Psychological Association recognized GPGP as a specialty, thus setting standards for education and training in the field. Although there is a need for high-quality group psychotherapy, practitioners often lack standardized training, thus posing a risk to patients. Adoption of these standards by practice settings and training programs is essential for expanding the availability of quality group therapy. An understanding of how the specialty became recognized and of the specific criteria for its practice (i.e., public need, diversity, distinctiveness, advanced scientific and theoretical preparation, structures and models of education and training, effectiveness, quality improvement, guidelines for delivery, and provider identification and evaluation) are essential for expanding the availability of high-quality group psychotherapy. Such understanding also informs how training programs can align with standards. This article provides a foundation of understanding and details implications of group psychotherapy's establishment as a specialty. The benefits of high-quality group psychotherapy are far-reaching, whereas the risks of inadequate practice loom large.
... Diese Wirksamkeit lässt sich sowohl im Vergleich mit "inaktiven" Kontrollgruppen, wie Wartelisten etc., nachweisen, aber auch im Vergleich zu anderen aktiven Behandlungsmaßnahmen (einschließlich der Einzeltherapie), bei denen sich keine bedeutsamen Unterschiede zwischen Gruppen und anderen Behandlungssettings finden lassen (z. B. Burlingame et al. 2016). ...
... This RCT-study compared MGAB with TAU for adolescents with BPD (for details see Ref. [30]). The design of the MGAB program was inspired by research suggesting that group psychotherapy generally is as effective as individual psychotherapy [31], and that group therapy for adolescents seems to be efficient [32]. For example, in a meta-analytic study including 56 studies on child and adolescent group treatment for different diagnoses and behavioural problems, results indicated that group treatment was more effective than both placebo control groups or waitlist, with an effect size of 0.61, suggesting that those adolescents were better off than 73% of the adolescents in the two control groups [33]. ...
Article
Background: In this paper, we outline our approach to dealing with complex social isolation by presenting a network treatment approach named Adaptive Mentalization-Based Integrative Treatment (AMBIT). Method: We describe the AMBIT approach, what elements it consists of, and we explain how we employed this method in the case of a 17-year-old boy referred to our child and adolescent psychiatric clinic, who isolated himself from the world. Results: We emphasize in which ways the specific network approach pertinent to the AMBIT approach was helpful in this complex case. Furthermore, we describe and reveal our insecurities and doubts related to our interventions and the general treatment process and point to why the AMBIT network approach and the interventions were crucial in this case. Discussion: We argue that the boy could not have been helped out of his social isolation within the conventional child and adolescent psychiatric system without engaging and establishing an integrated professional network from many sectors.
... Diese Wirksamkeit lässt sich sowohl im Vergleich mit "inaktiven" Kontrollgruppen, wie Wartelisten etc., nachweisen, aber auch im Vergleich zu anderen aktiven Behandlungsmaßnahmen (einschließlich der Einzeltherapie), bei denen sich keine bedeutsamen Unterschiede zwischen Gruppen und anderen Behandlungssettings finden lassen (z. B. Burlingame et al. 2016). ...
Article
Based upon the findings related to the impact of the coronavirus disease 2019 (COVID-19) pandemic on human living conditions and psychological health, in the first part of this review the authors discuss the consequences of the pandemic for public health. It is surprising to see that related to public health but also psychological factors and sequelae of the pandemic, a broad knowledge was already available based upon former pandemics and disasters long before the outbreak of COVID-19. This knowledge has been used very sparsely, if at all, for health political decisions. In view of the social significance of the pandemic and its social impact, findings from group psychology and group dynamics seem to be specifically important for a better understanding of behavior within the population as well as the conceptualization of public health interventions. An increase in psychological disorders was described related to the pandemic. For the treatment of these disorders, a range of psychotherapeutic approaches including evidence-based group psychotherapy are available. Whereas the use of telemedical and digital techniques is increasingly more common within individual psychotherapy, many questions are still open related to online group treatment.
... To date, 11 different meta-analytic summaries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) have been based on RCTs examining the efficacy of group psychotherapy for patients with mental disorders. In comparison to untreated control groups (e.g., waitlist control groups, minimal contact conditions), group psychotherapy has demonstrated large effects on the reduction of disorder-specific symptoms associated with anxiety, obsessivecompulsive disorders, and depression. ...
Article
This article reviews group psychotherapy research published within the past 30 years, predominantly focusing on outcomes of group treatments for patients with various mental disorders. Additionally, meta-analyses on the efficacy of group treatments for patients with cancer or chronic pain are summarized. Results strongly support the use of group therapy and demonstrate outcomes equivalent to those of individual psychotherapy. The research also appears to emphasize the effect of feedback on outcomes in group treatments and an association between treatment outcomes and group cohesion and alliance. Other promising developments in the field of group therapy are discussed.
... (2) Further, group formats have been found to produce statistically equivalent outcomes to individual formats when comparing identical treatments, patients and doses. (3) In major depressive disorder, psychosocial interventions delivered in a group format are efficacious in acute treatment as well as in reducing the rates of relapse and/or recurrence of depression in pharmacologically treated individuals. (4,5) Specifically, group-based psychotherapy, (6,7) psychoeducation, (8) peer support, (9) music therapy (10) and art psychotherapy have been shown to have positive effects on depressive symptoms, quality of life and overall mental well-being. ...
... The design of the MGAB program was inspired by research suggesting that group psychotherapy J o u r n a l P r e -p r o o f generally is as effective as individual psychotherapy [31], and that group therapy for adolescents seems to be efficient [32]. For example, in a meta-analytic study including 56 studies on child and adolescent group treatment for different diagnoses and behavioural problems, results indicated that group treatment was more effective than both placebo control groups or waitlist, with an effect size of .61, ...
Article
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The efficacy of treatment of borderline personality disorder in adolescents is an underresearched area. Although increasing research in borderline personality disorder in adolescents has emerged over the last decade there is a paucity of knowledge about how treatment is adequately designed for this group of patients. As a consequence, it is currently difficult to provide evidence-based guidelines and firm recommendations for how to design and implement borderline treatment in adolescence. In this selective review we summarize the most important research findings concerning treatment for adolescents with borderline personality disorder, including a recent mentalisation-based group treatment program. We highlight pivotal developmental obstacles for psychotherapy in adolescence and integrate these into a framework for the understanding and designing of effective treatment of borderline in adolescence.
... Es gibt auch im Gruppenkontext mittlerweile reichliche Erfahrungen mit internetbasierten Therapien [9]. Auch Sicherheitsaspekte und die Erfassung von Nebenwirkungen in der Gruppentherapie spielen eine zunehmende Rolle [27]. ...
Article
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.
... Most subgroup analyses use results from different studies that tested either group or individual treatments and these betweenstudy comparisons are highly susceptible to a host of confounds (e.g., differences in the treatment protocol, type of patients included, and setting of care; Shadish & Sweeney, 1991). Withinstudy comparisons, where the two formats are compared in the same study, are preferred for comparing individual and group treatment effects because they lead to stronger inferences Burlingame et al., 2016). A second limitation arise when effects from active treatment (e.g., TAU) and control group (e.g., WLC) are combined which occurred in nearly all the above meta-analyses. ...
Article
The effectiveness of group treatments for people with schizophrenia has not been examined on symptom-specific (positive and negative symptoms) outcomes, and the differential effects of the most popular group treatments remain unknown. We conducted a meta-analysis of randomized controlled trials that tested (a) the effectiveness of 7 frequently used group treatments on positive and negative symptoms and (b) if treatment-specific outcome improvement was associated with improvement on schizophrenia symptoms. Major databases were searched from 1990 to 2018 for randomized controlled trials of group treatment for people with schizophrenia, including first-episode psychosis. A random effects meta-analysis and meta-regression was conducted on 52 studies representing 4,156 individuals that produced a significant, small effect on symptom-specific outcomes (g = 0.30), with 4 group treatments (cognitive remediation, multifamily, psychoeducational, and social skills training) posting significant improvement. In addition, change on treatment-specific outcomes explained 16% of schizophrenia symptom and 44% of general functioning improvement. Results are discussed with respect to how they replicate past meta-analytic findings and possible revision of practice guidelines to incorporate evidence-based group treatments for schizophrenia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... As a result, these normalised shared experiences led to a perceived reduction in distress for several participants. Burlingame et al (2004Burlingame et al ( , 2016 asserted that these factors can lead to positive therapeutic outcomes but suggested that it remains unclear which factors are important in attitudinal and behavioural changes. ...
Article
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Background: Chronic obstructive pulmonary disease (COPD) is a chronic and life-threatening inflammatory lung disorder that results in progressive symptoms and significant disability. Co-morbid depression and/or anxiety are highly prevalent in people with COPD and are linked with higher mortality and symptom burden. Aim: To explore if a psychoeducation session on depression and anxiety is a useful addition to a pulmonary rehabilitation programme. Method: In total, 74 psychoeducation sessions, attended by 214 patients with COPD, took place. The sessions involved providing information on the symptoms and potential triggers for depression and anxiety, as well as basic cognitive behavioural therapy strategies on how to cope with these experiences. A total of 163 patients completed session evaluation forms and 12 patients participated in focus group discussions. Thematic analysis was used to analyse the data. Findings: The evaluation forms indicated that 95% of respondents found the psychoeducation session useful. Six themes were identified from the focus group data: education on depression and anxiety; normalising; the benefits of being in a group; learning skills to manage symptoms; knowing that support is available; and barriers to accessing the group and making referrals to an improving access to psychological therapies (IAPT) service. Conclusion: The addition of a psychoeducation session may be a useful adjunct to pulmonary rehabilitation programmes. Participants reported that they learned about the signs and symptoms of depression and anxiety, and most of them felt more confident in recognising these after the session. However, only a few participants were referred to the IAPT service, potentially because of several barriers to accessing this service.
... In order to treat individuals who report SIM and fear to (re-)offend or want to stop watching online abuse material, group therapy is an important element in the network mentioned. Generally, there is substantial evidence that group psychotherapy is an effective type of treatment [3,4]. As group therapy is also often considered to be more economic than individual therapy, it is offered in many clinical settings. ...
Article
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In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.
... In general, group-based therapies are found to be as efficacious as individually delivered therapies. [2][3][4][5] However, research has found that individual outcomes of group CBT-based programmes for chronic pain are influenced, to some degree, by features of the group to which they are allocated. For example, Williams and Potts 6 reported that patient outcomes were worse during periods of high staff turnover, pointing to an impact of group allocation and staff competence. ...
Article
This study explored whether the psychological composition of a group, with respect to mood, catastrophising, fear of movement and pain self-efficacy characteristics at baseline, is associated with individuals’ treatment outcomes following group cognitive behavioural therapy (CBT)-based programmes for chronic pain. Retrospective analyses of outcomes from two independently run CBT-based pain management programmes (Programme A: N = 317 and Programme B: N = 693) were conducted. Mixed modelling analyses did not consistently support the presence of associations between group median scores of depression, catastrophising or fear avoidance with outcomes for individuals in either programme. These results suggest that the psychological profiles of groups are not robust predictors of individual outcomes in CBT groups for chronic pain. By implication, efforts made to consider group composition with respect to psychological attributes may be unnecessary.
... The former is the most common approach to SAD (Antón, Olivares, & Amorós-Boix, 2012) and presents consistent efficacy indicators in both the short and long term (Fogarty, Hevey, & McCarthy, 2019;Hofmann & Otto, 2008). Group intervention is effective due to the continuous exposure to a social situation inherent in being part of a group ( Burlingame et al., 2016;Principe, Vincelli, & Capoderose, 2019). ...
Article
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To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions-an individual and a group intervention-in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms. © 2019 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Psicología Conductual.
... Relevant to the current study, a recent meta-analysis suggested that individual and group formats do not differ in outcome in the short-and long-term, including for anxiety disorders (Burlingame et al., 2016). However, studies directly comparing the individual and group administration forms of the UP are still needed and might help shed light on the relative efficacy of each administration form and their long-term effects. ...
Article
We describe a transdiagnostic treatment for anxiety disorders in community mental health centers (CMHCs), based on the Unified Protocol (Barlow et al. 2011), and adapted to a group format (UP-G). Participants were 13 CMHC patients in an intensive measurement design. Participants were interviewed for anxiety severity at pre- and post-treatment and completed weekly self-reports of distress, emotion dysregulation, valued living, fear of bodily sensations, and therapeutic alliance. We observed significant improvements in all measures except for valued living. Improvements in emotion regulation preceded and predicted subsequent reductions in distress as well as the other way around. Improvements in alliance co-occurred with reductions in distress. The UP-G is a flexible intervention that is suitable for CMHCs and may assist in reducing the burden of anxiety disorders and improving dissemination. These preliminary findings suggest that improvements in emotion regulation may play an important role in facilitating change in the UP-G.
... The group setting offers an opportunity to explore and work with these in vivo (Karterud, 2012). In a meta-analysis, Burlingame et al. (2016) found similar outcomes for group versus individual therapy for mood and anxiety disorders. In an uncontrolled pilot study with no precalculated sample size (Bo et al., 2017), we tested the feasibility of a MBT-group program in 25 adolescents with BPD symptoms and found significant reductions in self-reported borderline symptoms, depression, self-harm, and general psychopathology in the 23 completers. ...
Article
Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. Method: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. Results: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval -6.3 to 7.1, p = .91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. Conclusions: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.
... The results of a meta-analysis highlight the valuability and effectiveness of group therapy in inpatient setting by comparing a patient cohort receiving group therapy with a control group receiving one-on-one therapy or being on the waitlist [45]. Other studies have shown that group therapy is also effective in outpatient settings [46]. Our results show, that by combining group therapy elements and individual therapy sessions in an outpatient eveningclinic setting, evening clinic seem especially favourablefor patients who have sufficient resources to form strong relationships and build up trust, while not being emotionally too involved. ...
Article
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Background: Over a course of 10 weeks the psychosomatic-psychotherapeutic evening clinic at the University of Heidelberg offers an intensive and multimodal 3-h treatment program on three evenings a week. The clinic aims at accommodating patients who on the one hand do not fit the criteria of partial or full-time inpatient therapy, but on the other hand requires a more intensified therapy dose than the usual German outpatient settings can cater for. In the presented monocentric, qualitative study, we wanted to examine this treatment concept with regard to the patients' specific concerns, expectations, and individual experiences. By contrasting differences in intensity of outpatient and inpatient treatment, we aimed to identify those characteristics of the evening clinic setting that were perceived as especially helpful. Method: Each of the 25 patients was interviewed twice, using semi-structured interviews. The interviews took place before (T0) and after (T1) the 10-week treatment interval. A qualitative content analysis of the transcribed interviews was performed using the software "MaxQDA". Results: We identified a total of 1609 separate codes and grouped them into 33 topics and 5 overarching categories. Here, we found some aspects independent of the therapeutic setting, and others concerning the patients' specific expectations and experiences resulting from the particularities of the evening clinic as an outpatient setting including certain inpatient characteristics. This included the possibility of patients continuing to work and being able to fulfil social obligations, i.e. childcare or caring for relatives, while at the same time undergoing intensive psychotherapeutic treatment. Conclusions: Our results show that the evening clinic concept is particularly suitable for patients with mental and psychosomatic disorders who require intensified multimodal therapy while continuing to meet their obligations in their private and working lives. However, in comparison to other therapeutic methods, this concept generated greater stress and time challenges. Patients should therefore have a reasonably good standard of functioning in everyday life and sufficient coping resources. This is especially important for patients who continue working in their jobs while undergoing treatment. So far, there is a lack of quantitative data which would be needed to evaluate the effectiveness of this novel setting.
... The group setting offers an opportunity to explore and work with these in vivo (Karterud, 2012). In a meta-analysis, Burlingame et al. (2016) found similar outcomes for group versus individual therapy for mood and anxiety disorders. In an uncontrolled pilot study with no precalculated sample size (Bo et al., 2017), we tested the feasibility of a MBT-group program in 25 adolescents with BPD symptoms and found significant reductions in self-reported borderline symptoms, depression, self-harm, and general psychopathology in the 23 completers. ...
Presentation
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RCT study comparing MBT group treatment to TAU for adolescents with BPD
Article
The American Group Psychotherapy Association (AGPA) hosts the Anne and Ramon Alonso Plenary Address each year at its annual conference. In the 2022 plenary address, AGPA’s newly elected president, Dr Gary Burlingame, discusses his identity formation as a person, therapist, and group researcher and highlights several reasons why the future of group therapy is bright. These reasons include (1) solid scientific evidence for group therapy effectiveness, (2) strong scientific evidence for format equivalence, (3) links between evidence-based group factors and client improvement, (4) evidence-based support for multicultural competence, (5) AGPA progress in supporting the clinical practice of group, and (6) increasing public and professional exposure of groups. Dr Burlingame closes the address with a call to renew AGPA’s commitment to community and the power of relationship.
Chapter
Group psychotherapy treats patients with mental disorders, ameliorates specific symptoms, teaches psychological skills, enhances mental health, and supports coping with physical illnesses or other stressors. Groups vary in size, member characteristics (e.g., age, gender, race, presenting concerns), therapist characteristics and methods, and in the frequency, duration and number of sessions. Group psychotherapy can be provided in-person or online and can be combined with individual psychotherapy and/or medications. Group psychotherapy is as effective as individual therapy for most conditions and more cost-effective. It is time to make group psychotherapy more accessible, relevant, and effective for our diverse population.
Chapter
Group CBT‐I aims at disseminating the first‐line treatment for insomnia by increasing cost‐effectiveness in comparison to individual CBT‐I. Since less therapist time is usually needed per patient in group therapy, each therapist can treat a larger number of patients per time. Meta‐analytical data clearly shows that group CBT‐I is an effective treatment. In addition, so far, no inferiority of group CBT‐I versus individual CBT‐I was found; however, only a few studies have directly compared the two formats with each other. Meeting other patients with insomnia in the context of group CBT‐I helps many patients to overcome feelings of loneliness and isolation and gives them the chance to learn from others who are in a similar situation. Moreover, the presence of a group may motivate some patients to adhere to the challenging behavioural changes of sleep restriction therapy and stimulus control therapy. A disadvantage of group CBT‐I is that therapists have less time for the interaction with each individual patient, which may complicate tailoring the intervention to the specific needs of each patient. In addition, group therapy is a logistic challenge outside of the inpatient setting.
Article
Zusammenfassung Gruppentherapien sind ausgesprochen effektiv. Vermutlich ist Mentalisieren der zentrale Wirkmechanismus für die eindrucksvollen Ergebnisse. Mentalisierungsbasierte Gruppenpsychotherapien sind in Kliniken und Tageskliniken für Patienten mit schwereren psychischen und psychosomatischen Störungen die Therapie der Wahl. Im ambulanten Bereich gibt es allerdings immer noch zu wenig Gruppentherapie-Angebote.
Chapter
Group cognitive-behavior therapy (CBT) is well-established as an effective treatment for a wide range of psychiatric disorders. In this chapter we discuss the benefits of group CBT and the unique role of group process factors. We then provide guidance on the adaptation of CBT for group settings and review the research on the effectiveness of group CBT for a number of psychiatric conditions and the role of group process factors in outcome. We end the chapter with a discussion on tips for running a CBT group and unique considerations, including diversity issues, virtual groups, and inpatient settings.
Article
Purpose The purpose of this study was to determine behavioral and clinical outcomes of the DECIDE (Decision-Making Education for Choices in Diabetes Everyday) diabetes support program trial participants with and without a mental health (MH) history by treatment arm. Methods A secondary analysis was conducted of data from the DECIDE trial sample of urban African American adults with type 2 diabetes (T2DM; N = 137) who received the DECIDE diabetes support program in 1 of 3 delivery formats: self-study (n = 46), individual (n = 45), and group (n = 46). Positive screen on the Patient Health Questionnaire-2 and/or reported MH diagnosis were coded as MH history. Self-management, knowledge, problem-solving, and A1C data at baseline and 1 week and 6 months postintervention were analyzed for participants with and without MH history. Results Prevalence of MH history was 37% in the sample. Among those with no MH history, knowledge and problem-solving improved at 6 months postintervention in all intervention arms. For those with MH history, knowledge and problem-solving improved in the self-study and individual arms but not in the group arm. Clinically but not statistically significant changes in A1C were observed at 6 months. Conclusions In an urban minority T2DM sample, those with an MH history benefited from the intervention, but delivery format mattered, with robust improvements when participants with an MH history received self-directed or one-on-one formats rather than group.
Article
Objective: ConquerFear has been found to effectively reduce fear of cancer recurrence (FCR). Group interventions may be particularly effective for the treatment of FCR and could lower overall costs. Our objectives were therefore to adapt ConquerFear into a group format (ConquerFear-Group, CF-G), and to evaluate its feasibility, acceptability, and preliminary efficacy. Methods: Eligible patients had completed treatment for breast cancer 3 months to 5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). The manual was first evaluated with seven patients (Pilot 1), adjusted in accordance with feedback from the patients, therapists, and the original ConquerFear developers. After further evaluation with eight patients (Pilot 2), and subsequent adjustments, the preliminary efficacy of the final manual was evaluated with 27 patients, randomized in blocks to CF-G (N=13) or active control (AC) (relaxation training) (N=14) (Pilot 3). The primary outcome was the FCRI total score. Secondary outcomes included general distress, quality-of-life, and process outcomes pertaining to metacognitions, decentering, and worry. All measures were completed at baseline, post-treatment, and at 3 and 6 months follow-up. Results: Adjustments of the original ConquerFear manual (Pilot 1 and 2) included changes in the order of treatment components, simplified exercises, and shortened homework. Compared with ACs, CF-G participants reported greater reductions in FCRI total scores from baseline to post-treatment (Hedges's g=0.59, p=.004), 3 months (g=0.50, p=.026), and 6 months later (g=0.93, p=.043). Differences corresponding to medium-to-large effect sizes (Pilot 3). Although non-significant, group differences concerning reductions in general distress and maladaptive metacognitions corresponded to small-to-medium effect sizes (g=0.40-0.61; ps=.40-.61). Conclusions: CF-G appears feasible and potentially efficacious in treating FCR in a breast cancer population. These preliminary results are promising but need to be confirmed in a larger randomized trial. This article is protected by copyright. All rights reserved.
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There are many psychotherapy varieties, but all are delivered through two predominant modalities-individual and group. This article outlines differences between individual and group treatment and the advantages and disadvantages of each. The author focuses on psychodynamic treatment, but the differences between the two modalities apply across all theoretical orientations. Human beings are social animals with an innate drive for relationships. With the advent of mass transit and mass communication, many historic bastions of relationships, such as the family, the neighborhood, and religious institutions, have been disrupted, and the roots of relationships have become shallow. As a result, many people seek psychotherapy to help build and sustain more intimate and healthier relationships, a goal for which group therapy is well suited. As relationships develop in group psychotherapy, group members demonstrate the assets and liabilities of their relational styles. Their defenses against intimacy become apparent. For these reasons, group therapy is the treatment of choice for many people. The interpersonal nature of group psychotherapy provides an opportunity to recognize interpersonal behavior patterns and thus may provide tools to allow for more intimate relationships. When meeting a new patient, the therapist seeks not only the theoretical treatment that might be most amenable to the patient's individual needs but also the form of therapy that might work best. The aim of this article is to examine the unique features of group therapy and of the patients this modality may especially help.
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Prompt Mental Health Care (PMHC, Norwegian adaptation of Improving Access to Psychological Therapies) is found successful in alleviating symptoms of anxiety and depression. Here, we investigate whether improvement is maintained over time. A randomized controlled trial was conducted in two PMHC sites from November 2015 to August 2017, randomly assigning 681 adults with anxiety and/or mild to moderate depression (70:30 ratio: PMHC n = 463, TAU n = 218). Main outcomes were recovery rates and changes in symptoms of depression and anxiety from baseline to 12 months. Secondary outcomes were functional status, health-related quality of life, mental wellbeing and work participation. At 12 months after baseline the reliable recovery rate was 59.4% in PMHC and 36.6% in TAU, giving a between-group effect size of 0.51 (95%CI: 0.26, 0.77, p < 0.001). Differences in symptom change gave between-group effect sizes of −0.67 (95%CI: −0.99, −0.36, p < 0.001) for depression and −0.58 (95%CI: −0.91, −0.26, p < 0.001) for anxiety. PMHC was also at 12 months found more effective in improving functional status, health-related quality of life and mental wellbeing, but not work participation. In sum, substantial treatment effects of PMHC remain at 12 months follow-up, although results should be interpreted with caution due to risk of attrition bias.
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The current research aimed to identify areas of recovery specific to Group Analytic Psychotherapy (GAT) to facilitate the development of a suitable patient reported outcome measure (PROM) for this therapeutic modality. Two focus groups comprising respectively of four group analytic therapists or four service users were asked about components of recovery that they felt were specific to receiving GAT. Thematic Analysis (as described by Braun and Clarke, 2006) was employed to explore their views. Three overarching themes emerged from these groups: improvement in intrapsychic and interpsychic relationships; improvement in quality of life; improvement in functionality and symptom reduction. A conceptual model emerged with regards to how those themes could inform the development on a GAT specific patient reported outcome measure.
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Objectives Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. Design Eleven rapid responses. Data sources Single electronic database (PubMed). Eligibility criteria Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. Results For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0–179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. Conclusions We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
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While empirically-supported treatment (EST) choices are continually expanding, choices regarding formats for delivery (individual only, group only, or conjoint [simultaneous individual & group]) are often determined by agency resources or clinician preference. Studies comparing individual and group formats have produced mixed results, while recent meta-analytic reviews support format equivalence. We employed a multilevel model to test for outcome differences using the OQ-45 on an outpatient archival data set of clients receiving individual-only (n = 11,764), group-only (n = 152) or conjoint (n = 1557). Individual and group outcomes were equivalent with some analyses showing conjoint trailing. Moderators of change included initial distress, treatment duration, intra-group dependency, and format. Results support meta-analytic findings of format equivalence in a naturalistic setting for group and individual. Referral practices and future results are discussed.
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Meta-analysis collects and synthesizes results from individual studies to estimate an overall effect size. If published studies are chosen, say through a literature review, then an inherent selection bias may arise, because, for example, studies may tend to be published more readily if they are statistically significant, or deemed to be more “interesting” in terms of the impact of their outcomes. We develop a simple rank-based data augmentation technique, formalizing the use of funnel plots, to estimate and adjust for the numbers and outcomes of missing studies. Several nonparametric estimators are proposed for the number of missing studies, and their properties are developed analytically and through simulations. We apply the method to simulated and epidemiological datasets and show that it is both effective and consistent with other criteria in the literature.
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This meta-analysis tested the Dodo bird conjecture, which states that when psychotherapies intended to be therapeutic are compared, the true differences among all such treatments are 0. Based on comparisons between treatments culled from 6 journals, it was found that the effect sizes were homogeneously distributed about 0, as was expected under the Dodo bird conjecture, and that under the most liberal assumptions, the upper bound of the true effect was about .20. Moreover, the effect sizes (a) were not related positively to publication date, indicating that improving research methods were not detecting effects, and (b) were not related to the similarity of the treatments, indicating that more dissimilar treatments did not produce larger effects, as would be expected if the Dodo bird conjecture was false. The evidence from these analyses supports the conjecture that the efficacy of bona fide treatments are roughly equivalent. In 1936, Rosenzweig proposed that common factors were responsible for the efficacy of psychotherapy and used the con- clusion of the Dodo bird from Alice in Wonderland (Carroll, 1865/1962) to emphasize this point: "At last the Dodo said, 'Everybody has won, and all must have prizes' " (p. 412). Later, Luborsky, Singer, and Luborsky (1975) reviewed the psy- chotherapy outcome literature, found that the psychotherapies reviewed were generally equivalent in terms of their outcomes, and decreed that the Dodo bird was correct. Since Luborsky et al.'s seminal review, the equivalence of outcome in psychother- apy has been called the Dodo bird effect. To many interested in the technical aspects of particular psy- chotherapies, the Dodo bird effect was distasteful and, on the face of it, unbelievable:
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This meta–analysis multiple well-controlled studies were combined to help clarify the overall impact of psychological treatments for social anxiety disorder. A comprehensive literature search produced 32 randomized controlled trials (N = 1,479) that were included in the final analyses. There was a clear overall advantage of treatment compared to waitlist (d = 0.86), psychological placebo (d = 0.34), and pill–placebo (d = 0.36) conditions at posttreatment on the primary domain specific outcome measures. The average treated participant scored better than 80% of the waitlist and 66% of the placebo participants. Treatment also faired better than control conditions across secondary outcomes including cognitive measures (d = 0.55), behavioral measures (d = 0.62), and general subjective distress measures (d = 0.47). Treatment gains were maintained at follow–up (d = 0.76). Combined exposure and cognitive therapy (vs. control: d = 0.61) was not significantly different from exposure (vs. control: d = 0.89; p = 0.33) or cognitive treatments (vs. control: d = 0.80; p = 0.70). Likewise, group treatments (vs. control: d = 0.68) were not significantly different from individual treatments (vs. control: d = 0.69; p = 0.62). Effect sizes were not associated with treatment dose (p = 0.91),samplesize(p = 0.53), or publication year (p = 0.77). The results add confidence to previous meta–analytic findings supporting the use of psychological treatments for social anxiety disorder with no significant differences in treatment type or format.
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Recent reviews of the group psychotherapy literature indicate that group is a beneficial and cost-effective treatment format. However, collective findings on the differential efficacy of group when compared with individual therapy remain problematic, incomplete, or controversial. To remedy this problem, the authors conducted a meta-analysis of 23 outcome studies that directly compared the effectiveness of the individual and group therapy formats when they were used within the same study. Results were consistent with previous reports that indicated no difference in outcome between the group and individual formats. This finding generally held true when client, therapist, methodology, treatment, and group variables were examined for possible relationship with effect sizes comparing group and individual therapy. Results bolster past findings that group therapy can be used as an efficacious cost-effective alternative to individual therapy under many different conditions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The aim of this study was to explore the long-term effects of affect-focused body psychotherapy (ABP) for patients with generalized anxiety disorder (GAD). A group of 61 consecutive patients, 21–55 years old, were randomized to ABP and psychiatric treatment as usual (TAU). The patients were assessed before treatment and followed up 1 and 2 years after inclusion. The ABP patients received one session of treatment per week during 1 year. Three self-report questionnaires were administered; Symptom Checklist—90, Beck Anxiety Inventory, and the WHO (Ten) Well-Being Index. In both groups, there was a significant improvement. On termination, the ABP group had improved significantly more on the SCL-90 Global Symptom Index than the TAU group, whereas the differences were short of significance on the other two scales. The integration of bodily techniques with a focus on affects in a psychodynamically informed treatment seems to be a viable treatment alternative for patients with GAD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Objectives: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. Design: A pragmatic multicentre randomised controlled trial, stratified by centre. Setting: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. Participants: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Interventions: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189). Main outcome measures: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. Results: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was −2.63 (95% confidence interval −4.95 to −0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was −1.50 (−4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. Conclusions: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.
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This paper reports on two studies which show that cognitive therapy effects as much individual change when presented in small group format, a swhen presented in individual format to community-based populations suffering depression
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Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30
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The purpose of this study was to compare outcomes and processes of a therapeutic intervention to reduce children's aggressive behavior, delivered in individual and group formats. Children in 15 small groups (n = 71) and 15 individual treatment children were compared in a pre–post experimental and control design. The Achenbach self-report behavior checklist and teachers' evaluations were used to measure outcomes. To assess outcome results further, the process of change was qualitatively analyzed. In addition, the therapeutic processes were compared using Hill's counselor and client verbal response modes system. Results concerning outcomes indicated reduced aggression of treated children compared with wait-list children, with no differential impact of the format of treatment. The analyses of stages of change supported the similarity in outcomes. Results concerning process variables indicated differences in both therapist and client verbal responses. In therapists' responses, directives were used more in groups and self-disclosure was used more in individual therapy. In clients' responses, most variables were more frequently used in individual therapy. Experiencing was more frequent in group therapy, and there was no difference in insight and simple responses…
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A randomized, controlled trial was conducted on 110 subjects who scored positive on the Diagnostic Interview for Borderlines to assess the merits of an experimental, time-limited group treatment for borderline personality disorder (BPD) in comparison with the control condition, individual dynamic psychotherapy. Seventy-nine subjects received treatment. Analyses at 12- and 24-month follow-ups on 84% of the treated subjects (N = 66), demonstrated no statistically significant differences in outcome on the major dependent variables. Outpatient referrals to the study complied with the treatments at twice the rate of inpatient referrals. The total study cohort showed significant improvements on all major outcomes at follow-up. The cost effectiveness of the group approach, in tandem with its potential for application in a range of community services by multidisciplinary practitioners, speaks to the promise of this treatment as an innovative service approach for BPD.
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The authors provide a primer on meta-analysis. Topics are covered at an introductory level and references are provided for readers wanting further information. Topics covered include literature search procedures, coding manuals and extracting information from studies, calculating effect sizes, combining effect sizes, fixed and random effects analysis, influence analysis, moderator analysis, multivariate meta-analysis, and publication bias. All analyses are illustrated using k = 18 behavioral marital therapy versus control studies. The authors conclude by considering criticisms of meta-analysis, introducing reporting standards in meta-analysis, and reviewing software options for meta-analysis. An appendix for the paper includes the data and annotated Stata code for replicating the results presented.
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One hundred schizophrenic patients, newly discharged from a state mental hospital, were randomly assigned to group or to individual psychotherapy. The patients in each treatment category were initially equivalent on measures of illness severity and on prognostic indices. Outcome after 12 and 24 months of treatment, based on social effectiveness and psychiatric ratings, was significantly better for group therapy, but rehospitalization rates did not differ significantly. Analysis of therapist variables failed to account for the differences in outcome. Thus, in this population, the type of treatment was able to influence the outcome.
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
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The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
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Objective: Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed. Method: We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies. Results: Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes. Discussion: Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.
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The primary aim of this study was to assess the overall effectiveness of individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary anxiety disorder in routine clinical practice. We conducted a random effects meta-analysis of 71 nonrandomized effectiveness studies on outpatient individual and group CBT for adult anxiety disorders. Standardized mean gain effect sizes pre- to posttreatment, and posttreatment to follow-up are reported for disorder-specific symptoms, depression, and general anxiety. The mean dropout from CBT is reported. Outpatient CBT was effective in reducing disorder-specific symptoms in completer (d=0.90-1.91) and intention-to-treat samples (d=0.67-1.45). Moderate to large (d=0.54-1.09) and small to large effect sizes (d=0.42-0.97) were found for depressive and general anxiety symptoms posttreatment. Across all anxiety disorders, the weighted mean dropout rate was 15.06%. Posttreatment gains for disorder-specific anxiety were maintained 12months after completion of therapy. CBT for adult anxiety disorders is very effective and widely accepted in routine practice settings. However, the methodological and reporting quality of nonrandomized effectiveness studies must be improved.
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Background and Objectives: It is well-established that psychological interventions are effective in the treatment of depression. However, it is not yet clear what the optima format is in which psychological treatments should be delivered. Although several studies have examined whether individual and group treatments are equally effective in the treatment of depression, no comprehensive meta-analysis has examined this. Methods: We searched major bibliographical databased and conducted a meta-analysis of 15 studies in which individual and group therapies were compared directly to each other. Results: The mean effect size indicating the difference between individual and group therapies in depressive symptomatology at post-test was 0.20 (95% CI: [0.05 0.35]; p < 0.01), in favor of individual therapies, with a lower drop-out rate in individual interventions (OR = 0.56; 95% CI: [0.37, 0.86]; p < 0.01). At follow-up no significant differences were found. Conclusions: Although individual therapy seems to be somewhat more effective than group therapy at the short term, it is not clear whether this is relevant from a clinical point of view. Because of the small number of studies and the limited quality, more research is needed to examine whether the difference between individual and group treatment is clinically relevant.
Article
There is growing evidence for the efficacy of anger treatment programmes, which aim to reduce inappropriate aggression in people with learning disabilities. To date they have been provided in both group and individual formats, but the differential efficacy of these approaches is yet to be assessed. Individuals with a learning disability and inappropriately expressed anger were assigned to either group or individual treatment or a waiting list control, depending on the availability of treatment options. In this way, 23 participants completed group treatment, 18 individual treatment and 21 were included in a waiting list control. Participants were assessed both before and after treatment using an anger provocation inventory. Improvements were found in the scores obtained on the anger inventory for both the group and individual treatments compared to the control using a 2 by 3 split plot ANOVA. There was no difference between group and individual treatments. These results replicate previous findings that suggest that both group and individual cognitive behavioural interventions are effective treatment options for people with learning disabilities, but do not support either method of delivery as the preferred option. Limitations of the data are discussed.
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Rosenthan's (1979) concept of fail-safeN has thus far been applied to probability levels exclusively. This note introduces a fail-safeN for effect size.
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Objective: This is the first randomized trial comparing virtual reality exposure therapy to in vivo exposure for social anxiety disorder. Method: Participants with a principal diagnosis of social anxiety disorder who identified public speaking as their primary fear (N = 97) were recruited from the community, resulting in an ethnically diverse sample (M age = 39 years) of mostly women (62%). Participants were randomly assigned to and completed 8 sessions of manualized virtual reality exposure therapy, exposure group therapy, or wait list. Standardized self-report measures were collected at pretreatment, posttreatment, and 12-month follow-up, and process measures were collected during treatment. A standardized speech task was delivered at pre- and posttreatment, and diagnostic status was reassessed at 3-month follow-up. Results: Analysis of covariance showed that, relative to wait list, people completing either active treatment significantly improved on all but one measure (length of speech for exposure group therapy and self-reported fear of negative evaluation for virtual reality exposure therapy). At 12-month follow-up, people showed significant improvement from pretreatment on all measures. There were no differences between the active treatments on any process or outcome measure at any time, nor differences on achieving partial or full remission. Conclusion: Virtual reality exposure therapy is effective for treating social fears, and improvement is maintained for 1 year. Virtual reality exposure therapy is equally effective as exposure group therapy; further research with a larger sample is needed, however, to better control and statistically test differences between the treatments.
Article
This article reports on a controlled field experiment into the effectiveness of a brief unilateral intervention for the partners of heavy drinkers. Forty-five women and 3 men whose partners were both dependent on alcohol and highly resistant to change were randomly allocated to 4 experimental conditions: (a) unilateral intervention on an individual basis, (b) unilateral intervention within a group, (c) a no-treatment waiting list, and (d) traditional Al-Anon groups. Results revealed that both forms of the umlateral intervention, which is referred to as Pressures to Change, were successful in promoting change in the drinker, whereas neither of the alternatives was. However, only when Pressures to Change was offered on an individual basis did the client her- or himself report reductions in personal problems. Similar reductions were also reported by Al-Anon participants. Individual Pressures to Change was also the only intervention to produce improvements in marital consensus. The need for longitudinal research into partner interventions is identified.
Article
Background and Objectives: It is well-established that psychological interventions are effective in the treatment of depression. However, it is not yet clear what the optima format is in which psychological treatments should be delivered. Although several studies have examined whether individual and group treatments are equally effective in the treatment of depression, no comprehensive meta-analysis has examined this. Methods: We searched major bibliographical databased and conducted a meta-analysis of 15 studies in which individual and group therapies were compared directly to each other. Results: The mean effect size indicating the difference between individual and group therapies in depressive symptomatology at post-test was 0.20 (95% CI: [0.05 0.35]; p < 0.01), in favor of individual therapies, with a lower drop-out rate in individual interventions (OR 0.56; 95% CI: [0.37, 0.86]; p < 0.01). At follow-up no significant differences were found. Conclusions: Although individual therapy seems to be somewhat more effective than group therapy at the short term, it is not clear whether this is relevant from a clinical point of view. Because of the small number of studies and the limited quality, more research is needed to examine whether the difference between individual and group treatment is clinically relevant.
Article
Client preferences have been found to influence both therapy dropout and treatment outcomes. However, little is known about whether accommodating preferences is more important for certain types of clients or in certain treatment situations. A metaregression with data from 33 studies and 6,058 clients was conducted testing 6 client and treatment variables as predictors of the preference effects. In the included studies, clients whose preferences were matched showed better outcomes and were less likely to drop out of treatment prematurely regardless of age, gender, ethnicity, educational level, or marital status. In addition, nonmatched clients were even more likely to prematurely terminate from shorter duration treatments, accounting for approximately 50% of the variance in dropout-rate differences between preference matched and nonmatched clients. The results from the included studies suggest that although preference matching may be particularly important in briefer interventions, there is no evidence that the effect of accommodating client preferences differs depending on the demographics of the client. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Article
There are 2 approaches to meta-analysis: One assumes that studies in a meta-analysis are sampled from populations with the same effect size (the fixed-effects case), the other assumes that studies are taken from populations that have varying effect sizes (the random-effects case). As such, 2 corresponding meta-analytic frameworks have been developed: fixed- and random-effects methods. Recent evidence suggests that the assumption of fixed population effect sizes is not tenable for virtually all real-world data (e.g., Hunter & Schmidt, 2000), and yet fixed-effects methods of meta-analysis are routinely applied to real-world data (see National Research Council, 1992). This article describes some of the problems in using fixed-effects models on random-effects data by presenting 2 Monte Carlo simulations. In keeping with statistical theory (e.g., Hunter & Schmidt, 2000) results show a radical inflation of the significance tests of the mean effect sizes (above and beyond theoretical predictions). These results are discussed in terms of the implications for previously published meta-analytic reviews and those yet to be done.
Article
PurposeThe purpose of this study is to evaluate the effectiveness of a nutrition-based shared medical appointment (SMA) intervention in the treatment of prediabetes compared to the individualized counseling standard of care.MethodsA randomized controlled trial design comparing health outcomes in patients with prediabetes attending either an individualized counseling (control group) or three 90-minute nutrition SMA (intervention group) sessions. Demographic, anthropometric (weight and body mass index), clinical (blood pressure), and biochemical (lipid profile, fasting blood sugar, glycated hemoglobin, albumin-to-creatinine ratio) measures were obtained from all participants at baseline, at 3 months, and at 1 year.ResultsNinety-four participants were randomized into the 2 study groups with a 69% completion rate at 1 year (n = 34 SMA, n = 31 control). The average participant was Caucasian (64%), male (54%), 58.3 ± 9.6 years, had a BMI of 30.8 ± 4.9 kg/m(2) (obese), and fasting blood glucose of 109 ± 9.5 mg/dL. The SMA and control participants lost a mean of 6.6 pounds and 3.6 pound, respectively; neither group met the 5% modest weight loss expected. The SMA and control group experienced a mean drop in fasting blood glucose of 6 mg/dL.Conclusions As demands on health care providers continue to rise, finding innovative ways to manage the patient load while providing quality health care is increasingly important. SMA health outcomes were equivalent to individual counseling outcomes, while increasing the provider's productivity by treating 6 to 8 people with prediabetes in 90 minutes compared to 1 patient in 60 minutes.
Article
Abstract Eighty-five smokers chose either a group or individual treatment using manualized hypnosis. Abstinence rates in group treatment at follow-up are 19.6% in comparison to 13.8% in individual treatment. This difference did not reach statistical significance. It is concluded that group treatment is as effective as the better established individual treatment and therefore can be seen as an alternative approach in smoking cessation using hypnosis.
Article
Objective: The primary aim of this study was to assess the overall effectiveness of and dropout from individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary diagnosis of unipolar depressive disorder in routine clinical practice. Method: We conducted a random effects meta-analysis of 34 nonrandomized effectiveness studies on outpatient individual and group CBT for adult unipolar depressive disorder. Standardized mean gain effect sizes are reported for end-of-treatment and 6-month follow-up effects for depression severity, dysfunctional cognitions, general anxiety, psychological distress, and functional impairment. The mean dropout rate from CBT is reported. We benchmarked our results against high-quality randomized controlled trials (RCTs). Results: Outpatient CBT was effective in reducing depressive severity in completer (d = 1.13) and intention-to-treat (ITT) samples (d = 1.06). Moderate to large posttreatment effect sizes (d = 0.67-0.88) were found for secondary outcomes. The weighted mean dropout rate was 24.63%. Posttreatment gains for depression were maintained at 6 months after completion of therapy. Effect sizes for depression were inferior to those of benchmark RCTs. Conclusions: Although clinical practice patients show lesser improvements in depressive symptoms than RCT patients, individual and group outpatient CBT can be effectively transported to routine clinical practice. The considerable treatment dropout rate, especially in individual CBT, must be improved. The small number of available studies and low quality of some reports stress the need for high-quality effectiveness studies.
Article
The purpose of this study was to compare outcomes and processes of a therapeutic intervention to reduce children's aggressive behavior, delivered in individual and group formats. Children in 15 small groups ( n = 71) and 15 individual treatment children were compared in a pre–post experimental and control design. The Achenbach self-report behavior checklist and teachers' evaluations were used to measure outcomes. To assess outcome results further, the process of change was qualitatively analyzed. In addition, the therapeutic processes were compared using Hill's counselor and client verbal response modes system. Results concerning outcomes indicated reduced aggression of treated children compared with wait-list children, with no differential impact of the format of treatment. The analyses of stages of change supported the similarity in outcomes. Results concerning process variables indicated differences in both therapist and client verbal responses. In therapists' responses, directives were used more in groups and self-disclosure was used more in individual therapy. In clients' responses, most variables were more frequently used in individual therapy. Experiencing was more frequent in group therapy, and there was no difference in insight and simple responses… (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The study compared outcomes and process in group and individual treatment of 102 aggressive boys. Analyses were performed in ordinal and logistic regressions (for change and therapeutic factors, respectively) within a hierarchical linear model. Results indicated reduced aggression for the treatment children compared with the control group, with no effect of treatment format. Most of the boys reached at least the preparation stage of change in both treatments. The process research revealed 1 difference in Emotional Awareness-Insight, presented more in group treatment, and growth in Emotional Awareness-Insight and Problem Identification-Change. The stepwise regression revealed that Other vs Self-Focus and Problem Identification-Change were related to outcomes in group treatment only: The 1st contributed negatively to gains, and the 2nd contributed positively. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Investigated the efficacy of individual and group cognitive-behavioral therapy for 182 elderly low-income and minority primary care patients over 60 yrs old. Demographic and treatment outcome data covering a 5-yr period were abstracted from clinical records from San Francisco General Hospital's Depression Clinic. In a naturalistic treatment setting, older adults who were initially depressed improved after 16 wks of cognitive-behavioral therapy. Although patients were not randomly assigned to treatments, patients in both individual and group therapy improved. The findings demonstrate that depression in medically ill elderly patients can be treated with a psychosocial intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Meta-analysis of 17 studies on the efficacy of nonmedical (psychological) treatments for depression in the elderly showed that treatment was more effective than placebo or no treatment. Effects were equal for mild and severe depression and proved to be maintained over time. The mean effect size indicated that the mean treated client was better off than 74% of the clients in control conditions. Behavior therapy and cognitive-behavior therapy separately produced larger effect sizes than a combination (cognitive-behavior therapy), reminiscing therapy, and anger expression. The attention-placebo factor proved to be important. Individual therapy produced better results than group therapy. A number of client characteristics, treatment characteristics, and research characteristics had an impact on the magnitude of the effect sizes. Because of the small number of studies, the interdependence of these variables could not be studied. It is concluded that psychological therapies are effective for treating depression in the elderly. However, given the small sample size of this meta-analysis, the results have to be interpreted with caution. (PsycINFO Database Record (c) 2012 APA, all rights reserved)