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1.
Comparative study of group treatments for posttraumatic stress disorder.
Maxwell, K, Callahan, JL, Holtz, P, Janis, BM, Gerber, MM, Connor, DR
Psychotherapy (Chicago, Ill.). 2016;(4):433-445
Abstract
Presented herein is a comparative study of group treatments for posttraumatic stress disorder (PTSD). In this study, an emerging intervention, memory specificity training (MeST), was compared with cognitive processing therapy (CPT) using standardized outcome measures of target symptoms (i.e., anxiety and depression from client perspective; memory specificity from independent rater perspective) and global functioning (independent rater perspective), as well as a process measure of expectancy (client perspective). Clients were assessed on 3 separate occasions: at baseline, posttreatment, and 3 months posttreatment. Adherence and treatment fidelity (independent rater perspective) were monitored throughout the course of both treatment conditions. Improvement in PTSD symptoms, depressive symptoms, and global functioning were similar between MeST and CPT; an increase in ability to specify memories upon retrieval was also similar between MeST and CPT. Positive reliable change was observed in both groups on all outcome measures. With respect to the primary target of PTSD symptoms, 88% of participants in both treatment groups moved into the functional distribution by posttreatment and maintained these gains at follow-up. Notably, compared with CPT, MeST required only half the dosage (i.e., number of sessions) to accomplish these gains. Illustrative vignettes from client-therapist exchanges are provided, and results are discussed in terms of the potential mechanisms of action. Implications for both clinical practice and clinical research are also included. (PsycINFO Database Record
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2.
Randomized clinical trial comparing affect regulation and supportive group therapies for victimization-related PTSD with incarcerated women.
Ford, JD, Chang, R, Levine, J, Zhang, W
Behavior therapy. 2013;(2):262-76
Abstract
Traumatic victimization and associated problems with posttraumatic stress disorder (PTSD) and affect dysregulation are prevalent among incarcerated women, but there is limited evidence to support psychotherapeutic interventions for these problems in this underserved population. A group psychotherapy designed to enhance affect regulation without trauma memory processing-Trauma Affect Regulation: Guide for Education and Therapy (TARGET)-was compared to a supportive group therapy (SGT) in a randomized clinical trial with 72 incarcerated women with full or partial PTSD. Both interventions achieved statistically significant reductions in PTSD and associated symptom severity and increased self-efficacy. Dropout rates for both interventions were low (<5%). TARGET was more effective than SGT in increasing sense of forgiveness toward others who have caused harm in the past. Group therapy that teaches affect regulation may enhance incarcerated women's ability to achieve affective resolution (forgiveness) while also reducing their victimization-related PTSD and associated symptoms. Experiential-focused supportive group therapy also may reduce victimization-related PTSD and associated symptoms. Both group therapy approaches warrant further study with this vulnerable population.
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3.
Pains, joys, and secrets: nurse-led group therapy for older adults with depression.
Nance, DC
Issues in mental health nursing. 2012;(2):89-95
Abstract
This is the first study of nurse-led group therapy in Mexico. Forty-one depressed older adults with a median age of 71 participated in nurse-led cognitive behavioral group therapy once a week for 12 weeks. Participants' scores on the Patient Health Questionaire-9 showed mild to moderate improvement. Participants experienced positive results in personal growth, changing negative thoughts, and relationships with family. An important therapeutic factor was the support of fellow group members. The nurses experienced positive personal and professional growth. Difficulties included physician resistance and a too-rigid cognitive behavioral group therapy model. A combination of cognitive behavioral therapy and supportive group therapy is recommended.
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4.
Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial.
Nilsen, V, Bakke, PS, Gallefoss, F
BMC public health. 2011;:893
Abstract
BACKGROUND Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus. The purpose of this study was to assess the effects of a low-intensity individual lifestyle intervention by a physician and compare this to the same physician intervention combined with an interdisciplinary, group-based approach in a real-life setting. METHODS The "Finnish Diabetes Risk score" (FINDRISC) was used by GPs to identify individuals at high risk. A randomised, controlled design and an 18 month follow-up was used to assess the effect of individual lifestyle counselling by a physician (individual physician group, (IG)) every six months, with emphasis on diet and exercise, and compare this to the same individual lifestyle counselling combined with a group-based interdisciplinary program (individual and interdisciplinary group, (IIG)) provided over 16 weeks. Primary outcomes were changes in lifestyle indicated by weight reduction ≥ 5%, improvement in exercise capacity as assessed by VO2 max and diet improvements according to the Smart Diet Score (SDS). RESULTS 213 participants (104 in the IG and 109 in the IIG group, 50% women), with a mean age of 46 and mean body mass index 37, were included (inclusion rate > 91%) of whom 182 returned at follow-up (drop-out rate 15%). There were no significant differences in changes in lifestyle behaviours between the two groups. At baseline 57% (IG) and 53% (IIG) of participants had poor aerobic capacity and after intervention 35% and 33%, respectively, improved their aerobic capacity at least one metabolic equivalent. Unhealthy diets according to SDS were common in both groups at baseline, 61% (IG) and 60% (IIG), but uncommon at follow-up, 17% and 10%, respectively. At least 5% weight loss was achieved by 35% (IG) and 28% (IIG). In the combined IG and IIG group, at least one primary outcome was achieved by 93% while all primary outcomes were achieved by 6%. Most successful was the 78% reduction in the proportion of participants with unhealthy diet (almost 50% absolute reduction). CONCLUSION It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts. Group intervention yields no additional effects. The design of the study, with high inclusion and low dropout rates, should make the results applicable to ordinary clinical settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT00202748.
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Association between change in depression and change in weight among women enrolled in weight loss treatment.
Simon, GE, Rohde, P, Ludman, EJ, Jeffery, RW, Linde, JA, Operskalski, BH, Arterburn, D
General hospital psychiatry. 2010;(6):583-9
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Abstract
OBJECTIVE To examine the association between improvement in depression and loss of weight among women with depressive symptoms entering a behavioral weight loss program. METHODS Women aged 40 to 65 with body mass index (BMI) of 30 or more and co-occurring symptoms of depression were identified by a population-based survey. A total of 203 of these women were enrolled in one of two behavioral treatment programs: one focused on weight loss and another on both weight loss and depression. Both programs included up to 26 group sessions over 12 months. Assessments at baseline, 6 months, 12 months and 24 months included measurement of weight, depressive symptoms, self-reported physical activity and estimated caloric intake (via food frequency questionnaire). RESULTS Over the first 6 months, women with a decrease in depression score were more likely to lose 5 kg or more than women without a significant decrease in depression (38% vs. 22%, odds ratio=2.20, 95% CI=1.09 to 4.44). Over the same period, improvement in depression was associated with increase in physical activity but not with change in caloric intake. Change in depression and change in weight were not significantly associated over later intervals (between 6 and 12 months or between 12 and 24 months). CONCLUSIONS Among women with co-occurring obesity and depression, short-term improvement in depression is associated with weight loss.
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An open trial of group metacognitive therapy for obsessive-compulsive disorder.
Rees, CS, van Koesveld, KE
Journal of behavior therapy and experimental psychiatry. 2008;(4):451-8
Abstract
Research supporting the metacognitive model of OCD (Wells, A. (2000). Emotional disorders and metacognitions: Innovative cognitive therapy. West Sussex, UK: John Wiley & Sons; Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: John Wiley and Sons) is beginning to accumulate Metacognitive Therapy (MCT) aims to teach clients to shift to a 'metacognitive mode' and incorporates cognitive strategies and behavioural experiments, with the aim of modifying maladaptive metacognitive beliefs rather than the content of anxious beliefs themselves. The current paper reports on a preliminary study, applying MCT in a clinical group setting with eight adults suffering from a variety of OCD presentations. Promising results indicate a larger randomised controlled trial, with recovery achieved for seven of the eight participants on the Yale-Brown Obsessive-Compulsive Scale at 3-month follow-up. All participants demonstrated improvement on measures of OCD symptom severity and metacognitions.
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Effectiveness of peer-led eating disorders prevention: a replication trial.
Becker, CB, Bull, S, Schaumberg, K, Cauble, A, Franco, A
Journal of consulting and clinical psychology. 2008;(2):347-54
Abstract
The aim of this study was to replicate and extend results of a previous trial that investigated the effectiveness of 2 peer-led eating disorders prevention interventions in reducing eating disorder risk factors in undergraduate women (C. B. Becker, L. M. Smith, & A. C. Ciao, 2006). To extend findings from the previous study by allowing for investigation of differential response, the authors randomly assigned a larger sample of both higher and lower risk sorority members (N = 188; age M = 18.64 years, range = 18-21; 20% minority) to either a cognitive dissonance (CD) or a media advocacy (MA) intervention under naturalistic conditions. Interventions were delivered by trained sorority peer leaders and consisted of two 2-hr group sessions. Participants completed questionnaires that assessed eating disorder risk factors at pretreatment, posttreatment, 7-week follow-up, and 8-month follow-up. Results indicate that both interventions reduced thin-ideal internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 8 months, although higher and lower risk participants responded somewhat differently. Both CD and MA generally appeared effective for higher risk participants; only CD, however, appeared to benefit lower risk participants. Results further support the viability of using peer leaders in dissonance-based prevention.
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Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial.
Layne, CM, Saltzman, WR, Poppleton, L, Burlingame, GM, Pasalić, A, Duraković, E, Musić, M, Campara, N, Dapo, N, Arslanagić, B, et al
Journal of the American Academy of Child and Adolescent Psychiatry. 2008;(9):1048-62
Abstract
OBJECTIVE To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity. METHOD A total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or maladaptive grief and significant impairment in school or relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year. Distressed students who were excluded from the study due to acute risk for harm (n = 9) were referred for community-based mental health services (tier 3). RESULTS Program effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to posttreatment reductions in maladaptive grief reactions were found only in the treatment condition. Analyzed at the individual case level, the percentages of students in the treatment condition who reported significant (p <.05) pre- to posttreatment reductions in PTSD symptoms (58% at posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD (33% at posttreatment, 48% at follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions. CONCLUSIONS A three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier 1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at acute risk for community-based mental health services (tier 3) constitutes an effective and efficient method for promoting adolescent recovery in postwar settings.
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Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling.
Kalavainen, MP, Korppi, MO, Nuutinen, OM
International journal of obesity (2005). 2007;(10):1500-8
Abstract
OBJECTIVE The aim of the study was to compare the efficacy of group treatment stressing a health-promoting lifestyle with routine counseling in the treatment of childhood obesity. DESIGN AND SUBJECTS Seventy obese children (weight for height 115-182%) aged 7-9 years were randomized either to routine counseling (two appointments for children) or to family-based group treatment (15 separate sessions for parents and children). These sessions included nutrition education, physical activity education and behavioral therapy. OUTCOME MEASURES Children's weights and heights were measured at baseline, after the 6-month intervention and after the 6-month follow-up. The change of weight for height based on Finnish growth charts was used as the primary, and changes in body mass index (BMI) and BMI standard deviation scores (BMI-SDS) as secondary outcome measures. RESULTS Children attending the group treatment lost more weight for height (6.8%) than children receiving routine counseling (1.8%) (P=0.001). The difference was significant when the data were analyzed in four groups by the cut-off limits of 0, -5 and -10% for the change in weight for height. The respective decreases in BMI were 0.8 vs 0.0 (P=0.003) and in BMI-SDS 0.3 vs 0.2 (P=0.022). The results remained similar in adjusted analyses. Both group and routine programs were feasible with a high, 87-99%, participation rate in sessions and appointments and very low, 3% or less, attrition rate from the programs. Six months after the intervention, beneficial effects were partly lost, but for changes in weight for height and BMI, the differences between the two treatment programs still were significant, and for BMI-SDS, there was a trend. CONCLUSIONS Family-based group treatment that stresses a health-promoting lifestyle and is given separately for parents and children, offers an effective mode of therapy to treat obese school-aged children.
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Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a department of veterans affairs cooperative study.
Schnurr, PP, Friedman, MJ, Foy, DW, Shea, MT, Hsieh, FY, Lavori, PW, Glynn, SM, Wattenberg, M, Bernardy, NC
Archives of general psychiatry. 2003;(5):481-9
Abstract
BACKGROUND Department of Veterans Affairs Cooperative Study 420 is a randomized clinical trial of 2 methods of group psychotherapy for treating posttraumatic stress disorder (PTSD) in male Vietnam veterans. METHODS Vietnam veterans (360 men) were randomly assigned to receive trauma-focused group psychotherapy or a present-centered comparison treatment that avoided trauma focus. Treatment was provided weekly to groups of 6 members for 30 weeks, followed by 5 monthly booster sessions. Severity of PTSD was the primary outcome. Additional measures were other psychiatric symptoms, functional status, quality of life, physical health, and service utilization. Follow-up assessments were conducted at the end of treatment (7 months) and at the end of the booster sessions (12 months); 325 individuals participated in 1 or both assessments. Additional follow-up for PTSD severity was performed in a subset of participants at 18 and 24 months. RESULTS Although posttreatment assessments of PTSD severity and other measures were significantly improved from baseline, intention-to-treat analyses found no overall differences between therapy groups on any outcome. Analyses of data from participants who received an adequate dose of treatment suggested that trauma-focused group therapy reduced avoidance and numbing and, possibly, PTSD symptoms. Dropout from treatment was higher in trauma-focused group treatment. Average improvement was modest in both treatments, although approximately 40% of participants showed clinically significant change. CONCLUSIONS This study did not find a treatment effect for trauma-focused group therapy. The difference between the effectiveness and adequate dose findings suggests the possible value of methods to enhance the delivery of cognitive-behavioral treatments in clinical practice settings.