Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Group Therapy for Heterogeneous Anxiety and Mood Disorders in a Psychiatric Hospital Outpatient Clinic

Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Group Therapy for Heterogeneous Anxiety and Mood Disorders in a Psychiatric Hospital Outpatient Clinic

Article excerpt

Recent literature has shown that group cognitive-behavioral therapy (CBT) is effective for individuals with heterogeneous anxiety disorders. However, these studies have used a narrow range of outcome measures, and have not included global measures such as quality of life. In addition, heterogeneous mood disorders have not been well researched. The aim of this study was to replicate and extend on previous studies by assessing the effectiveness of group CBT treatment programs designed for use with heterogeneous anxiety or depressive disorders. Global outcome measures of quality of life and social functioning were assessed in addition to outcome measures of anxiety and mood symptoms. There were 173 patients who completed either group CBT for anxiety disorders or for depressive disorders. Symptom measures and quality of life measures were used to determine treatment effectiveness. Results demonstrated that the treatments were effective in reducing overall symptom severity and improving quality of life. Treatment gains were maintained to 12 month follow-up. However, the degree of change was considerably lower than that found in comparable trials with diagnostically homogenous samples. Overall, group CBT for heterogeneous diagnostic populations was effective but requires further investigation and refinement.

Keywords: group CBT; effectiveness; transdiagnostic; anxiety disorders; mood disorders

Cognitive-behavioral therapy (CBT) continues to evolve in ways that raise issues and questions beyond the general issue of efficacy. One of the most contentious issues in recent years is the extent to which results from efficacy research using randomized controlled trial (RCT) methodologies can be generalized to routine clinical practice (Nathan & Gorman, 2002; Norcross, Beutler, & Levant, 2006). Efficacy research maximizes internal validity to isolate and demonstrate treatment effects. There is growing recognition that characteristics of patients, therapists, and treatments in RCTs may not represent what is typically encountered in clinical practice and that research must evaluate whether a treatment works under conditions that better represent the real-world settings and populations for which treatment will be applied (e.g., Goldfried & Wolfe, 1998). Termed effectiveness research, these investigations have the goal of evaluating efficacious treatments from research settings to clinical service settings using realistic, real-world clinical populations (Jónsson & Hougaard, 2009; Stewart & Chambless, 2009) and benchmarking methodology (e.g., Oei & Boschen, 2009).

Stewart and Chambless (2009) conducted a meta-analytical review of 56 effectiveness studies of CBT for adult anxiety disorders. They found that overall, the studies yielded large treatment effect sizes for improvement in anxiety symptoms in the clinically representative samples (e.g., few exclusion criteria or patients who refuse randomization) ranging from 0.92 to 2.59 across the anxiety disorders. Benchmarking these studies against efficacy trials indicated that the effectiveness studies generally yielded effect sizes that fell within the range of the efficacy trials (ranging from 0.89 to 2.50). Although there was an inverse relationship between outcome and the degree of clinical representativeness of the sample, this relationship was of small magnitude. In all, CBT was transportable and effective in clinically representative populations.

Although the bulk of effectiveness research has tested the use of CBT delivered in the individual format (Addis et al., 2004; Franklin, Abramowitz, Kozak, Levitt, & Foa, 2000; García- Palacios et al., 2002; Hahlweg, Fiegenbaum, Frank, Schroder, & van Witzleben, 2001; Lincoln et al., 2003; Merrill, Tolbert, & Wade, 2003), a smaller number of studies have also investigated the effectiveness of the group version (Enns, Cox, & Pidlubny, 2002; Gaston, Abbott, Rapee, & Neary, 2006; McEvoy, 2007; Oei & Boschen, 2009; Oei, Llamas, & Devilly, 1999; Rosenberg & Hougaard, 2005). …

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