Search

There are currently no manualized, intensive outpatient programs (IOP), for diagnostically heterogeneous pediatric samples that simultaneously intervene with youth and parents. Such a program was developed and has been operating at Children's Hospital Colorado since January 2006. The current study was conducted to characterize the patient sample and evaluate clinical outcomes for this novel program. The study used a method of retrospective chart review to examine demographic and diagnostic information of youth and their families, who participated in IOP. Clinical outcomes were similarly assessed, using paired-samples t test comparisons of the baseline and endpoint parent-report versions of the Ohio Youth Outcome Scales. Results indicated that there were statistically significant differences in each of the Subscale scores on the Ohio Youth Scales from baseline to endpoint of IOP. Preliminary findings suggest that participation in the IOP program was associated with improved clinical outcomes, at the end of treatment.

Objective: To examine the feasibility and initial efficacy of 2 abbreviated dialectical behavior therapy (DBT) skills training groups: emotion regulation skills only and emotion regulation with mindfulness skills., Participants: Participants were 24 undergraduates (aged 18-29) with significant emotion dysregulation who participated between February and May of 2010, 2011, and 2012., Methods: Participants participated in 2-hour weekly group sessions for 8 weeks and completed outcome measures at baseline, midtreatment, posttreatment, and 4-week follow-up., Results: Participants in both conditions made significant gains, with large effect sizes, across measures of emotion regulation, affect, skills use, and functioning. There were no differences between the 2 groups, suggesting no additive benefit of mindfulness skills., Conclusions: This pilot study provides support for the acceptability and efficacy of abbreviated DBT skills training in colleges, given significant improvements, positive feedback, and low attrition. Impediments to feasibility included recruitment difficulties, particularly due to scheduling constraints.

Objective: The aim of this paper was to synthesize the findings of qualitative studies examining the experience of individuals with mental health difficulties attending mindfulness-based interventions., Method: A meta-synthesis of 15 qualitative studies was carried out, using a thematic synthesis approach., Results: The meta-synthesis identified eight analytical themes: 'prior experiences and expectations', 'normalising and supportive process of the group', 'relating differently to thoughts and feelings', 'acceptance', 'a sense of control and choice', 'relationship with self and others', 'struggles', and 'awareness'., Conclusions: A conceptual framework is presented which accounts for the participants' experiences and suggests a process through which they renegotiate their relationship with their mental health difficulties.

Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.

Group therapy can facilitate changes for members with greater attachment anxiety who tend to struggle with negative self-perceptions, difficulties regulating emotions, poor reflective functioning, and compromised interpersonal relationships. A clinical example of a therapy group with members who had elevated attachment anxiety and who were diagnosed with binge eating disorder demonstrates how attachment theory can be applied to group treatment. The clinical material from the beginning, middle, and end of group is presented to highlight how attachment anxiety influences members' emotional reactions and behaviors in the group, how group factors facilitate change, and how the leader fosters the development of a secure base within the group. Pre- to posttreatment outcomes indicate positive changes in binge eating, depressive symptoms, and attachment avoidance and anxiety. To facilitate change in individuals with greater attachment anxiety, group therapists may foster a secure base in the group through group cohesion, which will facilitate down regulation of emotions, better reflective functioning, and relationships that are less preoccupied with loss and more secure., (© 2013 Wiley Periodicals, Inc.)

The context for the present study was a cluster-randomized controlled trial of a group-based anger-management intervention, delivered by day-service staff. We aimed to develop a scale to measure the fidelity of manualized cognitive-behavioural therapy (CBT) delivered to adults with intellectual disabilities in group-based settings. A 30-item monitoring instrument (the MAnualized Group Intervention Check: MAGIC) was adapted from an existing fidelity-monitor instrument for individual CBT. Two sessions for 27 groups were observed by pairs of monitors who had no other contact with the intervention. 16 observers participated, in 15 unique pairings. Observers recorded high levels of inter-rater reliability and the scale had good internal consistency. Fidelity ratings predicted two key outcomes of the intervention, and were themselves predicted by the therapists' clinical supervisors., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: Medical students have been shown to have high levels of psychological distress, including self-stigmatization and unwillingness to seek care. The authors hypothesized that a student-led curriculum involving personal mental illness experience, given during the first-year neuroscience course, and titled "Mental Illness Among Us (MIAU)," would reduce stigma of mental illness., Method: In 2010 and 2011, students completed voluntary pre- and post-MIAU surveys measuring attitudes regarding mental illness in relation to MIAU. Also, in 2011, the authors categorized topics mentioned in student responses to an open-ended, free-response question on the course final examination., Results: Of 298 enrolled students, 250 submitted surveys that were matched pre- and post-intervention. Participants in the curriculum showed a significant difference in Social Distance, indicating an increased willingness to interact with individuals with mental illness, and a significant difference in the Mental Illness: Clinicians' Attitudes (MICA) score representing a stronger agreement with positive statements regarding mental illness. The non-participants' scores showed no changes in measures from pre- to post. Respondents most frequently reported that the neuroscience course prepared them to be a physician because it taught about compassion and the importance of treating the whole patient., Conclusion: The results indicate that participation in MIAU leads to a decrease in stigmatization of mental illness and a greater sense of compassion among UCSF medical students. This finding is consistent with previous research suggesting social and cognitive congruence among peers and peer-teachers can result in meaningful learning experiences. MIAU may represent a sustainable model to supplement current systems to promote well-being of medical trainees.

Background: The improving access to psychological therapy (IAPT) initiative aims to provide widespread evidence-based psychological treatments for common mental health problems in the UK. Individual services have implemented National Institute for Clinical Excellence guidelines in various ways; some provide group-based therapy, whilst others do not., Aims: The study investigates how patients and staff experience group-based therapy, what they find helpful and where improvements can be made., Method: Forty-five semi-structured interviews were undertaken with staff and patients in three IAPT services. Framework analysis was used to analyse comments relating to patient experience in group-based treatment., Results: The study found that patients can feel isolated with their symptoms and group-based interventions can normalise the illness, reducing stress. Individuals experience benefits and, in some cases, difficulties, in different ways. Some patients hear of the strategies that others have found useful, and observe others' progress, which may bring hope for their own recovery., Conclusions: IAPT group-based interventions appear to aid recovery in different ways to one-to-one therapy, by normalising mental illness and increasing social contact. Greater understanding of the factors operating in group-based interventions might increase attendance and recovery facilitated by IAPT group interventions.

Dementia is a challenging chronic illness that affects the patients and their families. Families often perform a full-time, specialised role, which requires expert knowledge and skills. This paper describes the evaluation of proFamilies-dementia (a programme developed to support families that care for a relative with dementia) using an innovative participatory methodology: photovoice, a qualitative method of research that uses photography and voice to access people's experiences. The programme was evaluated in order to identify the positive and negative impacts of the intervention on individuals and families; the advantages and disadvantages of photovoice as a participatory tool were also captured. The sample consisted of six people from five families. Participants identified only positive impacts of the programme, including better emotional management, normalisation of feelings and increased focus on self-care. Photovoice facilitated access to the process of change initiated by proFamilies-dementia, described by a process of going beyond illness, negativity and loneliness.

Objectives: Studies investigating the effectiveness of group psychotherapy intervention in sub-threshold depression have shown varying results with differing effect sizes. A systematic review of randomised controlled trials of group psychotherapy in older adults with sub-threshold depression was conducted to present the best available evidence in relation to its effect on depressive symptomatology and the prevention of major depression., Methods: Systematic search of electronic databases and random effects model for meta-analysis., Results: Four clinical trials met the full inclusion criteria. Group cognitive behavioural therapy (CBT) is an effective intervention for reducing depressive symptoms in older adults with sub-threshold depression in comparison to waiting list. Computerised CBT is at least as effective as group CBT in reducing depressive symptoms. The benefit of group CBT at follow-up is not maintained. Group psychotherapy does not appear to reduce the risk of depressive disorder during follow-up. There are fewer drop outs from group psychotherapy when compared with control conditions. The methodological quality of the studies and their reporting are sub-optimal., Conclusions: Group psychological interventions in older adults with sub-threshold depression have a significant effect on depressive symptomatology, which is not maintained at follow-up. Group psychotherapy does not appear to reduce the incidence of major depressive disorders., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: There are no randomised clinical trials comparing the outcomes of short- with long-term psychodynamic group psychotherapy., Aims: To compare differences in outcome during and after short- and long-term group psychotherapy., Method: In total, 167 out-patients with mood, anxiety and personality disorders were randomised to short- or long-term group therapy (20 or 80 weekly, 90 min sessions). Outcome measures were: symptoms (Symptom Checklist 90 - Revised), interpersonal problems (Inventory of Interpersonal Problems - Circumplex) and psychosocial functioning (Global Assessment of Functioning (GAF) split version: GAF-Symptom and GAF-Function). Change over the 3-year study period was assessed using linear mixed models. The study was registered in clinicalTrials.gov as NCT00521417., Results: Patients in both groups made significant gains. A significantly larger symptomatic change over time was found for long-term compared with short-term therapy, but no significant differences were detected for the three remaining outcome variables. There was a higher number of premature terminations in the long-term (33.3%) compared with the short-term group (8.6%)., Conclusions: Short- and long-term therapy seem equally effective for typical out-patients seeking group psychotherapy, except for symptomatic distress.

Background: The Living with Dysarthria group programme, devised for people with post-stroke dysarthia and family members, was piloted twice. Feedback from those who experience an intervention contributes to the evaluation of speech and language therapy programmes, giving the participant view of the intervention's value and guiding further developments., Research Question: What feedback do participants in the Living with Dysarthria programme provide, informing on its perceived usefulness and guiding its future development?, Methods & Procedures: Nine people with chronic dysarthria following stroke and four family members who completed the Living with Dysarthria programme all contributed to Focus Group (FG) discussion, transcribed and thematically analysed, and completed an Anonymous Questionnaire Evaluation (AQE), comprising closed statements and open questions. An anonymous descriptive adjective selection task (ADAST) was also used., Outcomes & Results: The varied forms of feedback provided complementary information. Thematic analysis of FG data and AQE open question responses were configured around programme benefits, programme structure and content, and programme practicalities. Benefits associated with participation included learning and insight, being supported by peers and professionals, and improved speech and confidence. These are consistent with the main programme elements of education, support and speech practice. All activities were seen as relevant and positively received. Flexibility, recognition of and catering to individual needs were valued characteristics. The community location was approved by all. Most participants thought the format of eight weekly sessions of 2 h was appropriate. Responses to AQE closed statements provided almost unanimous confirmation of the very positive feedback conveyed in FG discussions. The main response to suggested improvements in AQEs was that the number of sessions should be increased. Feedback indicated that for a few individuals there was negative reaction to some facts about stroke, home practice tasks were difficult to complete, the person with dysarthria/family member pair may not be the optimum combination for paired practice activities and pre-programme information should be extended. The ADAST showed that the programme was enjoyable, interesting, stimulating and useful., Conclusions & Implications: Participant feedback indicates that group therapy, with family member participation, is a valid form of management for chronic post-stroke dysarthria. Education, peer and professional support, and speech practice are confirmed as relevant programme components. Consistent majority opinions were communicated in different situations and via varied mediums. Some individuals expressed views relevant to their own needs, and these responses also inform future implementation of the Living with Dysarthria programme., (© 2013 Royal College of Speech and Language Therapists.)

Group therapists are in a unique position to be effective as change consultants to medical practices and hospital departments that wish to transition to patientcentered care (PCC) and patient- and family-centered care (PFCC). Medical groups are under increasing pressure to adopt PCC because it has been shown to be an important component of substantial improvements in health care delivery, including cost containment. The establishment of patient-centered care requires sensitive, repeated group-based interventions to be successful; group therapists have a deep understanding of such interventions. The paper outlines the literature on PCC and PFCC, considers the group processes underlying successful implementation, and then turns to various phases of the consulting process itself, including system-diagnostic interviewing, group meetings, resources, and tracking the consequences of the consultation.

Inveiglement is a mode of interpersonal influence and control that has particular relevance to group, organizational, and political life. In inveiglement, a person or group is diverted from knowing, believing, or thinking about an idea or a perception that exists mentally, or that could be generated. In the former situation, inveiglement may be conceived of as induced dissociation; in the latter, an impingement on the capacity to think and generate thoughts. In both situations, the individual or group becomes mentally bound by the parameters imposed by the other, constricting freedom to think and behave independently. I describe four subtypes: toxic, neurotic, communal, and presentational inveiglement, and provide clinical illustrations from group psychotherapy.

Objective(s): Treatment credibility and client satisfaction have received relatively little research attention, but extant findings indicate that some clients and therapists differ in their perceptions of what is helpful about therapy, with greater divergence related to poorer outcomes. This study examined relationships between treatment credibility, perceptions of therapy helpfulness, and treatment response., Method: Participants were 48 individuals (60.4% female; 53.2% Caucasian; mean age 32.79 years) with an anxiety disorder diagnosis. Participants completed a 12-week transdiagnostic treatment protocol; treatment credibility was rated after session 2, and treatment component helpfulness was rated posttreatment., Results: Treatment response was significantly correlated with perceived helpfulness of cognitive restructuring and exposure techniques, but not treatment credibility. Treatment responders recognized the helpfulness of factors considered to be important therapeutic processes., Conclusions: Findings emphasize the importance of client perceptions of cognitive and behavioral techniques in treatment and suggest the need to monitor client perceptions throughout the treatment process., (© 2012 Wiley Periodicals, Inc.)

Objective: Group psychotherapy research would benefit from an observational measure of group cohesion to complement existing self-report measures. This study introduces the Therapy Process Observational Coding System-Group Cohesion scale (TPOCS-GC), which observationally assesses cohesion between each member and the group., Method: In total 27 parents participated in a group parent-training social competency intervention for children with attention deficit-hyperactivity disorder. Independent coders double-coded group cohesion and the alliance in 144 client-sessions. Parents, teachers, and children completed cognitive, behavioral, and therapy participation measures., Results: The TPOCS-GC demonstrated modest to strong item-level interrater reliability and acceptable internal consistency. Group cohesion evidenced moderate stability over the course of treatment. Relations between TPOCS-GC and theoretically linked and unrelated variables provided some evidence for construct and predictive validity., Conclusions: This preliminary study suggests that the TPOCS-GC is a reliable instrument that may help fill an instrumentation gap in the field., (2012 Wiley Periodicals, Inc)

Mindfulness-Based Stress Reduction (MBSR) is an experientially based group intervention empirically supported to reduce psychological symptomology. Although MBSR has shown to be an effective intervention, little is known about which facets of the intervention are important in producing positive outcomes. This study tested several aspects of mindfulness practice (total practice duration, practice frequency and practice quality) with the primary focus being on validating (i.e., predictive and convergent validity) a new measure of mindfulness practice quality (PQ-M). The PQ-M fit a two-factor solution via a Maximum Likelihood Exploratory Factor Analysis (n=99). Using longitudinal multilevel modeling on a smaller subsample (n=19), preliminary support was found for changes in practice quality over the course of the MBSR intervention. Further, change in practice quality was associated with improvements in psychological symptoms. While this study was exploratory, these findings suggest that practice quality is a relevant factor to promote positive outcomes and may guide mindfulness instructors in providing highly tailored interventions.

The Group Questionnaire (GQ) is a recently developed self-report measure of the therapeutic relationship based on Johnson and colleagues (2005) three-factor model; Positive Bonding, Positive Working, and Negative Relationship. This study validated Johnson's model with a new and extended sample and created a shorter 40-item trial version. SEM analysis of the GQ tested whether it produced the same three-factor structure found in three earlier studies with 486 participants from three populations-outpatient university counseling center, non-patient AGPA process groups, and inpatient state hospital. Results of further SEM refinements demonstrated that a final 30-item version had good fit to the three-factor model although distinct differences in response pattern were found between the three populations. Implications for future utility and clinical relevance of the GQ are discussed.

Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimokawa, Lambert, & Smart, 2010). Although these interventions work well in outpatient settings their effects so far have not been investigated with eating-disordered patients or in inpatient care. In this study, the effect of providing feedback interventions was investigated in a randomized clinical trial involving 133 females diagnosed with anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Comparisons were made between the outcomes of patients randomly assigned to either treatment-as-usual (TAU) or an experimental condition (Fb) within therapists (the same therapists provided both treatments). Patients in the Fb condition more frequently experienced clinically significant change than those who had TAU (52.95% vs. 28.6%). Similar trends were noted within diagnostic groups. In terms of pre to post change in mental health functioning, large effect sizes favored Fb over TAU. Patients' BMI improved substantially in both TAU and the feedback condition. The effects of feedback were consistent with past research on these approaches although the effect size was smaller in this study. Suggestions for further research are delineated.

The purpose of the study was to compare the effectiveness of 4-day versus 5-day day hospital (DH) treatment and to document effectiveness based on a large sample size. Participants were 801 patients, diagnosed with an eating disorder, who participated in DH treatment from 1985 to 2009. The study followed a sequential cohort ABA design. Higher intensity DH was associated with higher rates of abstinence from bingeing and vomiting and larger improvements in depression and body dissatisfaction. Higher intensity DH provided no consistent advantage in rates of weight restoration or improvement on other indices of psychological functioning. These findings suggest that the optimal intensity of treatment may vary depending on treatment goals, but 5-day DH is recommended for eating disorders.

Background: Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients., Methods: This randomized, controlled trial was conducted at Boo Ali Sina Dialysis Center, Shiraz, Iran. A total of 48 hemodialysis patients participated in this study. After acquisition of informed consent, eligible patients were randomly divided into two groups, control and experimental. Pre-test data were obtained by using a demographic data form and two questionnaires for self-efficacy and quality of life. Blood pressure and interdialytic weight gain were measured. We extracted laboratory data from patients' charts. A six-week empowerment intervention that included four individual and two group counselling sessions was performed for the experimental group. Six weeks after intervention, post-test data were obtained from both groups in the same manner as the pre-test. Data were analyzed by ANCOVA using SPSS v11.5., Results: There were no statistically significant differences in demographic variables between the groups. Pre-test mean scores for self-efficacy, quality of life, blood pressure, interdialytic weight gain and laboratory results did not differ between the groups. There was a significant difference between the experimental and control groups in terms of pre-to post-intervention changes in overall self-efficacy scores, stress reduction, and decision making, in addition to overall quality of life and all dimensions included within quality of life based on this questionnaire. Additionally, the pre- to post-intervention changes in systolic/diastolic blood pressures, interdialytic weight gain, hemoglobin and hematocrit levels significantly differed between the groups., Conclusion: Our study demonstrates that a combination of individual and group empowerment counselling sessions improves self-efficacy, quality of life, clinical signs, and hemoglobin and hematocrit levels in hemodialysis patients. Empowerment of hemodialysis patients should be considered in hemodialysis centers to assist patients with the management of their health-related problems., Trial Registration: Irct ID: IRCT138901172621N4.

This paper reviews the efficacy and processes of change within group treatments for alcohol use disorders (AUD). Methodologically rigorous studies examining group treatment for interviewer-diagnosed AUD include evaluations of cognitive-behavioral group treatments that focus on skills for relapse prevention (i.e., coping skills training, coping and social skills training), interactional group therapy, combined pharmacological and group interventions, and group cue exposure treatment. Given the depth of research examining the efficacy of individual treatments for AUD there is a need for further development and evaluation of group treatments that include rigorous clinician-administered diagnostic assessment, implement a control group or active treatment comparison, randomly assign participants to condition, report the racial and ethnic composition of the sample, explore mediators and moderators of intervention efficacy, and implement a manualized treatment protocol. Evaluation of process variables within group treatments for AUD and well designed treatment development studies are also needed to better understand how well established individual treatments for alcohol use disorders can be adapted to function effectively in a group format.

In analogy to somatic medicine, modern psychiatry strives to measure the outcome of treatment and care. In order to warrant an effective therapy, this request is reasonable from the standpoint of both the therapist and the patient as well as hospitals or insurance companies. However, how can I measure friendliness, empathy or humanity, the "being available for somebody"? For sure, psychiatric DRGs, which connote efficacy based on periods of time, are by no means suitable. The present study analyses routine clinical data of an ergotherapeutic questionnaire, as an aid to estimating treatment quality. The naturalistic character of this data collection during daily routine may be an advantage to assessing the quality of results in psychiatry.

The Patient Feedback Survey is a performance improvement measure designed to assess the quality of outpatient substance abuse treatment. We modified and administered this measure to 500 individuals at a multisite treatment provider. Although the feedback scores were high in general, analyses of variance showed score variability in relation to type and length of treatment. Moreover, respondents who reported any use of marijuana, cravings for substances, or mutual-support group attendance (ie, Alcoholics Anonymous or Narcotics Anonymous) had lower feedback scores than respondents without these experiences. We highlight the importance of investigating treatment evaluations in the context of other recovery experiences. , (Copyright © American Academy of Addiction Psychiatry.)

Narrative exposure therapy (NET) applied by Neuner et al. on populations affected by war and natural disaster is compared to research data and intervention strategies developed by others. Questions are raised about the cultural sensitivity of Neuner's diagnostic instruments, the reductionist focus on PTSD which does not sufficiently take into account the complex after effects of trauma and the comprehensive psychosocial needs of affected populations. Currently available data do not yet provide convincing evidence that NET is effective or superior to other intervention strategies., (© Georg Thieme Verlag KG Stuttgart · New York.)

This retrospective descriptive correlational study evaluated treatment satisfaction and the quality of life (QOL) of consumers with serious mental illness participating in a community mental health program that combined illness management and recovery strategies with a group appointment model. The Wellness Enhancement and Recovery Program (WERP) was evaluated to determine satisfaction with services and QOL of consumers over 3 years. Findings from the data analyses indicated that consumers in WERP were satisfied with treatment services and had a fair to good QOL. Satisfaction and QOL were moderately correlated., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Earlier reviews and meta-analyses have consistently concluded that psychological treatment of depression is effective in older adults. We conducted a systematic review randomised controlled trials of group psychotherapy to present the best available evidence in relation to its effectiveness in older adults with depressive disorders., Methods: Electronic databases were searched to identify randomised controlled trials. Selected studies were quality assessed and data extracted by two reviewers., Results: Six trials met the inclusion criteria. The trials included in the review examined group interventions based on the cognitive behavioural therapy (CBT) model with active therapeutic interventions or waiting list controls. Group psychotherapy is an effective intervention in older adults with depression in comparison to waiting list controls, the overall effect size is very modest (MD = -3.92, 95%CI: -6.18, -1.67). The reported benefits of group intervention in comparison to other active interventions did not reach statistical significance. The benefits of group psychotherapy were maintained at follow-up. The quality of the studies varied and studies were heterogeneous., Conclusions: Although quality of many studies was not optimal, the results of this meta analysis support the results of earlier meta analyses. Group cognitive behavioural therapy is effective in older adults with depression., (Copyright © 2010 John Wiley & Sons, Ltd.)

Objective: The aim of this study was to prepare a group-based cognitive-behavioral therapy program for patients with schizophrenia and other psychotic disorders coping with auditory hallucinations, and to evaluate the effectiveness of the program., Method: The study included 12 male inpatients aged between 18 and 55 years from the Manisa Mental Health and Illnesses Hospital that were diagnosed with schizophrenia or schizoaffective disorder according to DSM-IV diagnostic criteria (SCID-I). The inclusion criteria were the diagnosis of schizophrenia or schizoaffective disorder, at least 1 hospitalization, the presence of auditory hallucinations, and the absence of alcohol/drug abuse/dependence, organic deficit, and mental/physical disability. In all, 7 patients received routine care plus group CBT and 5 patients received routine care alone. The group treatment program was conducted for 9-10 sessions twice a week. The patients were assessed using SAPS, SANS, the Problem/Symptom Checklist, and the Knowledge of Schizophrenia Questionnaire pre-treatment, post-treatment, and at the 1-year follow-up. The outcomes were analyzed using the Wilcoxon signed rank test., Results: There was a significant reduction in the severity and frequency of hallucinations, delusions, distress and occupation with auditory hallucinations, negative symptoms, and anxiety in the CBT group after treatment. Additionally, post-treatment outcome in the treatment group didn't change at 1 year follow-up. In the control group, there was no difference between pre-treatment and post-treatment outcome (P<0.05)., Conclusion: The therapy program was considered to be effective in increasing the ability to cope with auditory hallucinations and reducing their frequency for the patients with schizophrenia and schizoaffective disorder.

Previous research has established efficacy of cognitive behavioral therapy (CBT) for anxiety disorders, yet it has not been widely assessed in routine community clinic practices. Efficacy research sacrifices external validity to achieve maximum internal validity. Recently, effectiveness research has been advocated as more ecologically valid for assessing routine clinical work in community clinics. Furthermore, there is a lack of effectiveness research in group CBT. This study aims to extend existing research on the effectiveness of CBT from individual therapy into group therapy delivery. It aimed also to examine outcome using not only symptom measures, but also measures of related symptoms, cognitions, and life quality and satisfaction. Results from a cohort of patients with various anxiety disorders demonstrated that treatment was effective in reducing anxiety symptoms to an extent comparable with other effectiveness studies. Despite this, only 43% of individuals showed reliable change, and 17% were 'recovered' from their anxiety symptoms, and the post-treatment measures were still significantly different from the level of anxiety symptoms observed in the general population.

Objective: To test the effectiveness at 6 and 12 months' follow-up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression., Research Design and Methods: Adults with Type 1 diabetes (n = 86) with glycated haemoglobin (HbA(1c)) >or= 8% were randomized to CBT or BGAT. Primary outcome was HbA(1c) control. Secondary outcomes were: self-care, diabetes-related distress (Problem Areas in Diabetes scale; PAID), diabetes self-efficacy (Confidence in Diabetes Self-care scale; CIDS) and depressive symptoms (Centre for Epidemiological Studies--Depression scale; CES-D). Measurements were scheduled before CBT and BGAT, and at 3, 6 and 12 months after. Differential effects were analysed for the subgroup of patients reporting low vs. high baseline levels of depression., Results: Neither CBT nor BGAT had a significant impact on HbA(1c) at 6 and 12 months' follow-up. Both interventions resulted in lower depressive symptoms (CES-D 15.7-13.3, P = 0.01) up to 12 months, but only CBT was effective in lowering HbA(1c) in patients with high baseline depression scores (HbA(1c) 9.5-8.8%) up to 1 year of follow-up (P = 0.03)., Conclusions: Our findings suggest that group CBT can effectively help Type 1 diabetic patients with co-morbid depression achieve and maintain better glycaemic outcomes.

Introduction: Psychotherapy of depressive conditions is more and more in demand by patients. The effect of individual cognitive behavioral therapy (CBT) on depression is well-documented, and foreign studies indicate that group CBT also works well. There was no Danish manual on group CBT for the purpose of clinical implementation. The aim of the present project was to develop such a manual and complete a preliminary evaluation of the outcome., Materials and Methods: A therapy manual consisting of 12 group sessions of 2 hours duration was developed. A constituent part of the evaluation of the clinical effect was 10 group courses with a total of 51 consecutively referred patients with a non-psychotic depression requiring treatment., Results: On the basis of clinical experience, the manual has been revised and is now ready for publication. 80% of the patients completed the therapy course with a large Effect Size (ES) on psychiatric/depression symptoms (SCL-90R) and function level (GAF), as well as moderate ES on the degree of hopelessness (BHS)., Conclusion: The development and clinical implementation of a manual in cognitive behavioral group therapy has resulted in this treatment now being offered as permanent treatment for depressive patients throughout the cooperating centers. The existing manual can relatively easily be implemented in other treatment centers and clinics. The preliminary results are positive, but the design does not permit further conclusions.

This descriptive and comparative study employed a Q-sort process to describe common factors of therapy in two group therapies for inpatients with chronic mental illness. While pharmacological treatments for chronic mental illness are prominent, there is growing evidence that cognitive therapy is also efficacious. Groups examined were part of a larger study comparing the added benefits of cognitive versus supportive group therapy to the treatment milieu. In general, items described the therapist's attitudes and behaviors, the participants' attitudes and behaviors, or the group interactions. Results present items that were most and least characteristic of each therapy and items that discriminate between the two modalities. Therapists in both groups demonstrated good therapy skills. However, the cognitive group was described as being more motivated and active than the supportive group, indicating that the groups differed in terms of common as well as specific factors of treatment.

Aims: To assess the effects of cognitive behavioural group training (CBGT) on glycaemic control, diabetes self-efficacy and well-being in Type 1 diabetes patients in persistent poor glycaemic control., Methods: In a randomized controlled trial, a total of 107 patients with Type 1 diabetes in poor glycaemic control (HbA(1c) > or = 8%) were assigned to a 6-week CBGT or blood glucose awareness training (BGAT) as control condition. The intervention was preceded by a 3-month run-in period. Glycaemic control (HbA(1c)), diabetes-specific self-efficacy (CIDS), diabetes-related distress (PAID) and depressive symptoms (CES-D), were assessed at baseline (T1), directly before (T2) and 3 months after (T3) the intervention., Results: No significant changes in HbA(1c) were found after CBGT, whilst diabetes self-efficacy increased (mean CIDS score 71.6 +/- 14.0 to 74.3 +/- 12.2) and diabetes-related distress (mean PAID score 47.0 +/- 21.6 to 42.6 +/- 20.8) and depressive symptoms decreased (mean CES-D score 16.9 +/- 12.8 to 13.5 +/- 12.6). Changes in psychological outcomes were similar for both treatment groups. Diabetes self-care behaviours improved equally. Drop-out rate, which was higher among CBGT participants, was relatively low overall (total n = 15, 17.05%), and both interventions were well-appreciated by the participants., Conclusions: CBGT was successful in improving self-efficacy, diabetes-related distress and mood at 3 months' follow-up, but not in improving glycaemic control.

When treatments are administered in groups, clients interact in ways that lead to violations of a key assumption of most statistical analyses-the assumption of independence of observations. The resulting dependencies, when not properly accounted for, can increase Type I errors dramatically. Of the 33 studies of group-administered treatment on the empirically supported treatments list, none appropriately analyzed their data. The current authors provide corrections that can be applied to improper analyses. After the corrections, only 12.4% to 68.2% of tests that were originally reported as significant remained significant, depending on what assumptions were made about how large the dependencies among observations really are. Of the 33 studies, 6-19 studies no longer had any significant results after correction. The authors end by providing recommendations for researchers planning group-administered treatment research., (((c) 2005 APA, all rights reserved).)

This study examined supervisees and supervisors' view on focus and group climate in group supervision and their relationship with supervisees' attained skill. After supervision, supervisees completed a revised version of Buckley's measure of psychotherapeutic skill. Supervisees and supervisors' experience of focus and climate in the supervision was measured with a questionnaire, Topics and Climate (TAC). The results showed that supervisors' ratings of the extent to which different foci were used in the supervision were significantly higher compared to supervisees' ratings. Hierarchical regression analysis showed that differences in supervisor style were related to supervisees' experience of attained skill. Supervisees' experience of the degree to which focus in supervision was on psychodynamic processes was positively related to perceived attained skill, whereas focus on Theoretical aspects was negatively related. These findings underline the importance of research work with topics and group processes in group supervision.

Juvenile sexual offending is increasingly being recognized as a serious crime among youth. The prevalence of sexual offending and sexual reoffending suggests that many juvenile sex offenders (JSOs) may repeat their offending behaviors if not treated. However, clinical trials evaluating specific interventions are virtually nonexistent. Instead, the literature on the treatment of JSOs is marked by discussions of strategies that are hypothesized to be beneficial, as well as descriptions of treatment programs that exist across the country. Further, while existing literature suggests that treatment for JSOs may deter future sexual offending behaviors, it is unclear which, if any, aspects of these treatments promote the development of positive behaviors. A discussion of existing treatment approaches, effectiveness, and treatment considerations follows.

Unlabelled: This study investigated the experiences of adults who have completed a course of therapy for stammering. The objective was to inform clinicians about the effect of therapy by listening to the client's own account of the experience after they had been discharged from therapy. The study involved individuals discussing their experiences and their views on the effect of therapy in an in-depth, semi-structured interview. The individual transcripts were subjected to analyses and several major themes emerged. A number of the themes had implications for clinical practice and these were considered in detail. The value of having a dialogue with clients about the effect of therapy after it has formally come to an end is discussed in relation to monitoring of therapeutic effectiveness., Educational Objectives: The reader will be able to: (1) describe ways of evaluating the effect of therapy; (2) summarize qualitative methodology involving interviewing techniques; (3) utilize the client experience of therapy in monitoring therapeutic effectiveness.

Background: An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based., Aims and Objectives: The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach., Methods: A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component., Conclusions and Relevance to Clinical Practice: The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.

It was the aim of the study to investigate different factors of group experience in relation to therapy effects and to prove the predictive validity of the Group Experience Questionnaire (GEQ); for this purpose for each scale of the GEQ the values of later "Responders" and "Non Responders" were compared. The sample consisted of 50 patients with psychosomatic diseases who where treated with outpatient integrated psychodynamic group therapy. We found that the GEQ is able to differentiate between successful and less successful patients. Especially the therapeutic factors "autonomy and optimism" as well as "well-being" are of high predictive value. Contrary to former investigations the therapeutic factor "cohesion" was less important, which could hint at the fact that a medium amount of cohesion might be sufficient for an effective process of treatment.

Over the past 25 years, group analysis has been much influenced by new developments in psychoanalysis, developmental psychology, evolutionary neurobiology, and evolutionary psychology. Basic group-analytic concepts are now being validated and reinforced by new knowledge of developmental processes in infancy and childhood. The development of both our brain as the organ of sociality and our personality begins as early as in utero. A child first learns how and whether to trust others and how to manage its emotions through empathy and sensitive responsiveness of its parents. Infant mental and emotional development is indebted to good enough environmental responses. Understanding these early influences is important because, among other things, it makes us aware how difficult it may be to influence such early factors by psychotherapy.