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Cognitive Behavioral Therapy in Groups

Introduction

Cognitive-behavioral therapy (CBT) is among the therapy approaches that can be applied to group work. Due to its focus on the procedures that are supported by evidence, CBT has been covered by research articles rather extensively. In this paper, a definition of CBT will be presented, and an overview of some recent studies on the topic will be summarized to make conclusions about CBT effectiveness and future research. Based on the current evidence, it can be stated that while the individual methods of CBT have not been examined or compared with each other exhaustively, there are still enough data to demonstrate the application of group CBT to various problems that therapy can help to manage.

Definition and Discussion

CBT is characterized by several key principles that are applicable to group therapy. In particular, it is a problem-focused approach that aims to change maladaptive patterns with the help of evidence-supported procedures, the outcomes of which must necessarily be assessed using a specific method (Corey, 2016). As a result, CBT presupposes careful planning with measurable and specific goals and evaluation options. It is also commonly rather brief and typically focuses on behaviors that clients want to change, although CBT also takes into account detrimental thought patterns, including, for instance, incorrect beliefs.

A CBT leader employs varied techniques; some examples consist of feedback, coaching, and cognitive restricting. They are used to reinforce positive patterns and behaviors and discourage maladaptive ones. The positive features of CBT include its focus on structure and planning, as well as evidence-based interventions. As pointed out by Corey (2016), CBT can be ineffective mostly when inappropriately applied, for example, if it is excessively structured or didactic. As an evidence-based approach, CBT is well-studied, which is why a review of the literature dedicated to its efficacy with group therapy is in order.

Literature Review

CBT is a very well-researched topic, which is why the present paper can focus on randomized controlled trials (RCTs) and meta-analyses. The evidence presented by such studies is particularly reliable, which justifies the choice. Also, this approach helps to limit the number of articles to be included in this paper without choosing a particular problem. Instead, this section will attempt to present the research that is dedicated to the application of group CBT to various concerns.

Indeed, CBT has been tested as a solution to multiple issues, many of which are specific diagnoses. For example, Pityaratstian et al. (2015) studied CBT effects on post-traumatic stress disorder in children aged 10-15 who had developed the issue after a tsunami. The results of comparing CBT to no treatment (a waitlist group) in an RCT showed significant positive effects of group CBT, which supported the authors’ hypothesis. In a similar way, Egan, Kane, and Rees (2015) conducted an RCT comparing the effectiveness of CBT to a waitlist control; the forty-two participants of the study were eligible due to elevated perfectionism which could be combined with various disorders. As the authors had anticipated, the CBT group showed significant improvements, which demonstrates the effect of CBT on problematic patterns that are not a disorder. Also, Cape, Leibowitz, Whittington, Espie, and Pilling (2016) considered CBT’s impact on insomnia in an RCT with 239 patients. The authors did not state a direct hypothesis, but they intended to contrast group CBT with treatment as usual, and their findings suggested that CBT was more effective.

Moreover, Yorke et al. (2017) considered the application of group CBT to people with asthma and anxiety disorder or depression. The premise of the study was that asthma could be exacerbated by the mentioned disorders, but the authors did not offer a hypothesis, and they generally worked on using the RCT to determine the feasibility of a future one. Still, with a total of 51 patients, the results indicated that certain aspects of CBT-modifiable patterns (such as asthma control and anxiety) showed improvements for the CBT group as compared to the patients who were receiving treatment as usual. Also, a meta-analysis on the topic of using CBT to combat particular disorders was presented by Bodryzlova, Audet, Bergeron, and O’Connor (2019). The authors focused on patients with hoarding disorder, and they managed to find only eight relevant articles which did not cover much longitudinal research. While the meta-analysis does suggest that evidence supports the use of CBT to reduce the severity of hoarding disorder, it also indicates the scarcity of related literature. Thus, group CBT has indeed been applied to rather diverse issues with positive outcomes, and both RCTs and meta-analyses can demonstrate this fact.

Attempts at comparing individual and group CBT can be encountered. For instance, Pozza and Dèttore (2017) presented a meta-analysis that focused on patients with obsessive-compulsive disorder. In the article, individual and group CBT were compared through the review of six eligible studies. The authors did not present a hypothesis while acknowledging the small amount of data on the topic. The findings suggested no statistically significant differences between the outcomes (or drop-out rates) of the two approaches to CBT, which implies that they should be roughly interchangeable. However, the insufficient number of relevant studies is a significant issue that prevents the authors from making definite statements.

Certain articles also compare different approaches to group CBT. Thus, Hvenegaard et al. (2019) contrasted the usual group CBT method with rumination-focused CBT in an RCT with 131 patients with depression. The rumination-focused version proved to be superior at post-treatment, which is what the authors had hypothesized. However, the follow-up showed no statistically significant differences. In a similar way, Hooper, Antoni, Okuyemi, Dietz, and Resnicow (2017) compared regular group CBT aimed at smoking cessation to a culturally specific one. 342 African Americans participated in the RCT, and the findings showed that the culturally specific version was more effective after the treatment and during the first follow-up, which occurred three months after the treatment. These findings were in line with the authors’ hypothesis. The effects were similar for the subsequent follow-ups for both groups, though; they did not show statistically significant differences. Still, these studies demonstrate that CBT proceeds to develop as new approaches to it are tested.

Certain CBT studies show limited or no improvements, which should also be mentioned. Berk et al. (2018) considered the impact of group CBT on weight control in adults. The RCT compared treatment as usual and CBT for 158 people diagnosed with obesity and type 2 diabetes who attempted to lose weight using diets. The authors did not propose a hypothesis, but the study was supposed to check if CBT could assist patients in preventing weight gain. However, after two years, there were no statistically significant differences, which meant that CBT did not succeed in achieving the desired outcomes. Similarly, an RCT by Langdon et al. (2016) focused on patients with Asperger syndrome and tested a modified group CBT aimed specifically at this population. Its target outcome was the reduction in comorbid anxiety. With the sample of 52 people, the RCT compared CBT to no treatment and found no statistically significant differences between the groups. It is noteworthy that the latter study had a rather small sample; one with more people could result in different findings. Still, these examples demonstrate that individual approaches to CBT might have different effects, which highlights the importance of investigating the topic and conducting more research on it.

Conclusions

As an approach to group therapy that prioritizes evidence-based solutions, CBT has received substantial coverage in recent studies, including RCTs and meta-analyses. The effectiveness of CBT has been reviewed, among other things, for issues like post-traumatic stress disorder, perfectionism, insomnia, and asthma. The populations that were considered included children and adults with a variety of disorders. Some of the RCTs demonstrate significant improvements, which suggests that CBT can be an effective intervention for multiple issues. Other studies may demonstrate no improvements or suggest that group CBT is equivalent in effectiveness to other approaches. Furthermore, the research shows that new and improved versions of CBT are also being developed and tested. As was shown by the meta-analyses included in this paper, more research might be needed on CBT effectiveness for particular issues and populations, and individual approaches and methods of CBT should also be studied in greater detail. Still, the literature demonstrates that CBT is a well-investigated and feasible therapy option that is applicable to groups.

References

Berk, K. A., Buijks, H. I., Verhoeven, A. J., Mulder, M. T., Özcan, B., van’t Spijker, A.,… Sijbrands, E. J. (2018). Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: Results from the randomised controlled POWER trial. Diabetologia, 61(4), 790-799.

Bodryzlova, Y., Audet, J., Bergeron, K., & O’Connor, K. (2019). Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis. Health & Social Care in the Community, 27(3), 517-530.

Cape, J., Leibowitz, J., Whittington, C., Espie, C., & Pilling, S. (2016). Group cognitive behavioural treatment for insomnia in primary care: A randomized controlled trial. Psychological Medicine, 46(5), 1015-1025.

Corey, G. (2016). Theory and practice of group counseling (9th ed.). Boston, MA: Cengage Learning.

Handley, A., Egan, S., Kane, R., & Rees, C. (2015). A randomised controlled trial of group cognitive behavioural therapy for perfectionism. Behaviour Research and Therapy, 68, 37-47.

Hooper, M., Antoni, M., Okuyemi, K., Dietz, N., & Resnicow, K. (2017). Randomized controlled trial of group-based culturally specific cognitive behavioral therapy among African American smokers. Nicotine & Tobacco Research, 19(1), 333–341.

Hvenegaard, M., Moeller, S. B., Poulsen, S., Gondan, M., Grafton, B., Austin, S. F.,… Watkins, E. R. (2019). Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: Phase II trial. Psychological Medicine, 1-9.

Langdon, P. E., Murphy, G. H., Shepstone, L., Wilson, E. C., Fowler, D., Heavens, D.,… Mullineaux, L. (2016). The People with Asperger syndrome and anxiety disorders (PAsSA) trial: A pilot multicentre, single-blind randomised trial of group cognitive–behavioural therapy. Bjpsych Open, 2(2), 179-186.

Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., & Pariwatcharakul, P. (2015). Randomized controlled trial of group cognitive behavioural therapy for post-traumatic stress disorder in children and adolescents exposed to tsunami in Thailand. Behavioural and Cognitive Psychotherapy, 43(5), 549-561.

Pozza, A., & Dèttore, D. (2017). Drop-out and efficacy of group versus individual cognitive behavioural therapy: What works best for Obsessive-Compulsive Disorder? A systematic review and meta-analysis of direct comparisons. Psychiatry Research, 258, 24-36.

Yorke, J., Adair, P., Doyle, A. M., Dubrow-Marshall, L., Fleming, S., Holmes, L.,…Shuldham, C. (2017). A randomised controlled feasibility trial of group cognitive behavioural therapy for people with severe asthma. Journal of Asthma, 54(5), 543-554.

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OctoStudy. (2022, July 14). Cognitive Behavioral Therapy in Groups. Retrieved from https://octostudy.com/cognitive-behavioral-therapy-in-groups/

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OctoStudy. 2022. "Cognitive Behavioral Therapy in Groups." July 14, 2022. https://octostudy.com/cognitive-behavioral-therapy-in-groups/.

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