Artificial Intelligence-Based Co-Facilitator (AICF) for Detecting and Monitoring Group Cohesion Outcomes in Web-Based Cancer Support Groups: Single-Arm Trial Study

BACKGROUND

Commonly offered as supportive care, therapist-led online support groups (OSGs) are a cost-effective way to provide support to individuals affected by cancer. One important indicator of a successful OSG session is group cohesion; however, monitoring group cohesion can be challenging due to the lack of nonverbal cues and in-person interactions in text-based OSGs. The Artificial Intelligence-based Co-Facilitator (AICF) was designed to contextually identify therapeutic outcomes from conversations and produce real-time analytics.

OBJECTIVE

The aim of this study was to develop a method to train and evaluate AICF's capacity to monitor group cohesion.

METHODS

AICF used a text classification approach to extract the mentions of group cohesion within conversations. A sample of data was annotated by human scorers, which was used as the training data to build the classification model. The annotations were further supported by finding contextually similar group cohesion expressions using word embedding models as well. AICF performance was also compared against the natural language processing software Linguistic Inquiry Word Count (LIWC).

RESULTS

AICF was trained on 80,000 messages obtained from Cancer Chat Canada. We tested AICF on 34,048 messages. Human experts scored 6797 (20%) of the messages to evaluate the ability of AICF to classify group cohesion. Results showed that machine learning algorithms combined with human input could detect group cohesion, a clinically meaningful indicator of effective OSGs. After retraining with human input, AICF reached an F1-score of 0.82. AICF performed slightly better at identifying group cohesion compared to LIWC.

CONCLUSIONS

AICF has the potential to assist therapists by detecting discord in the group amenable to real-time intervention. Overall, AICF presents a unique opportunity to strengthen patient-centered care in web-based settings by attending to individual needs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/21453.

Group Cohesion in Experiential Growth Groups: A Multilevel Growth Analysis

Group cohesion is considered a key group therapeutic factor; however, limited knowledge exists on the session-to-session development of group cohesion in the context of training groups or on the factors that may predict such developments. We utilized multilevel growth modeling to examine the longitudinal changes in 44 counselor trainees' ratings of group cohesion in seven experiential growth groups across four semesters. We found significant between-person variability in the growth trajectory of group cohesion and identified trainee self-disclosure and gender as significant predictors of group cohesion. The results indicated the complexity of within- and between-person changes in group cohesion in training groups and the need for further research to identify potential predictors of these changes. We also discussed ways for group facilitators to attend to self-disclosure as an important marker of group cohesion.

Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times

The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an evidence-based group treatment that is particularly appropriate for the current global climate.

Therapeutic Alliance and Group Cohesion Across Telehealth Delivery of Mentalizing-focused Parenting Groups

This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children's outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE.

Virtual group psychotherapy for chronic pain: exploring the impact of the virtual medium on participants' experiences

BACKGROUND

Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management.

METHODS

This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit.

RESULTS

Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants.

CONCLUSIONS

Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.

The mediator role of communication skill in the relationship between empathy, team cohesion, and competition performance in curlers

Understanding the psycho-social factors such as communication, empathy, cohesion, etc., that affect successful athletic performance is a high priority and primary focus for applied sports psychology. Detailed examination of the athletes' psycho-social characteristics is essential in revealing which processes play an active role in achieving optimum performance. Developing these features of the athlete can contribute to coordinating the team, sharing tasks, increasing motivation, preparing team members for a change, and improving performance. For this purpose, the mediating role of communication skills in the relationship between empathy, team cohesion, and competition performance was examined in a sample of 241 curlers competing in 69 teams in the Turkish Curling League in the 2021-2022 season. During the data collection process, Personal Information Form, Empathic Tendency Scale, Scale for Effective Communication in Team Sport, and Group Environment Questionnaire were used. Competition performance was calculated by giving 1 point for each match won by the teams in the competitions in which the single-circuit round-robin system is applied. Structural equation modeling was used in data analysis to determine the direct and indirect predictive effects between variables. The study showed that empathy and team cohesion predict competition performance through communication skills, and communication skills fully mediate this relationship. Based on the research results, it was evaluated that communication skills have a substantial effect on the competitive performance of athletes, and this finding was discussed in the context of the literature.

The influence of members’ attachment style on group cohesion in substance use therapy groups

Group cohesion is an important factor in group therapy as it influences treatment outcomes and group processes. One’s attachment style has been found to impact experiences of group cohesion, however research into this relationship in substance use disorder (SUD) group treatment is lacking. This is of particular concern as insecure attachment presentations are more prevalent in this clinical population and group therapy is often treatment of choice. The current study sought to determine whether attachment style significantly predicted group cohesion. It also provided a qualitative exploration of factors that promote group cohesion in SUD group treatment. Participants (N = 38) attending a SUD therapy program completed self-report measures. Attachment avoidance was a significant negative predictor of positive bonding and positive working, and a significant positive predictor of negative relationships. Attachment anxiety was a significant negative predictor of negative relationships, however, unexpectedly did not significantly predict positive bonding or positive working. The current findings highlight the importance of group therapists tailoring group treatment to meet the attachment needs of individuals to promote a group therapy environment conducive to recovery.

Harmony in intelligent hybrid teams: the influence of the intellectual ability of artificial intelligence on human members’ reactions

Purpose

The purpose of this paper was to investigate the relationships among the intellectual ability of artificial intelligence (AI), cognitive emotional processes and the positive and negative reactions of human members. The authors also examined the moderating role of AI status in teams.

Design/methodology/approach

The authors designed an experiment and recruited 120 subjects who were randomly distributed into one of three groups classified by the upper, middle and lower organization levels of AI in the team. The findings in this study were derived from subjects’ self-reports and their performance in the experiment.

Findings

Regardless of the position held by AI, human members believed that its intelligence level is positively correlated with dependence behavior. However, when the AI and human members are at the same level, the higher the intelligence of AI, the more likely it is that its direct interaction with team members will lead to conflicts.

Research limitations/implications

This paper only focuses on human–AI harmony in transactional work in hybrid teams in enterprises. As AI applications permeate, it should be considered whether the findings can be extended to a broader range of AI usage scenarios.

Practical implications

These results are helpful for understanding how to improve team performance in light of the fact that team members have introduced AI into their enterprises in large quantities.

Originality/value

This study contributes to the literature on how the intelligence level of AI affects the positive and negative behaviors of human members in hybrid teams. The study also innovatively introduces “status” into hybrid organizations.

'Isolated together': online group treatments during the COVID-19 pandemic. A systematic review

Considering the emerging need to face the negative impact of the pandemic on mental health, social support, and access to health services, it became a critical issue to adapt to online group settings and create new group interventions to face the developing distress during this time. The aim of the current study is to investigate the main findings on OPGI conducted during the COVID-19 pandemic from March 2020 until March 2022, with a particular focus on: i) the therapeutic group factors; ii) what kind of OPGI works and for whom; iii) settings and emerging dimensions. In accordance with PRISMA guidelines, we performed a systematic review on scientific databases (PsychINFO, PubMed, Web of Science and EBSCO) searching for studies published between March 2020 and March 2022. 'Group intervention' or 'group therapy' or 'group treatment' crossed with 'COVID-19' and synonymous, were used as keywords. Internet based intervention was used as an eligibility criteria during the full-text screening. A total of 1326 articles were identified, of which 24 met the inclusion criteria. Among all studies, with different participants and different orientations, data extracted supported psychological online group interventions as an effective approach to reducing psychological distress and increasing psychological resources in the interpersonal field. Our findings also showed that COVID-19 has led to new needs and issues, that require the investigation of new dimensions for online psychological interventions. Methodological and clinical implications will be discussed through a descriptive table related to setting characteristics. Recommendations are made for future research.

The transition to online psychotherapy during the pandemic: a qualitative study on patients' perspectives

The coronavirus disease 2019 (COVID-19) pandemic has substantially increased online psychotherapies due to the impossibility of participating in vis-a-vis settings. In the last years, research about online therapy has been quickly growing. However, until now, few studies investigated patients' perspective about the transition to online psychotherapy and, specifically, no qualitative research in group therapy has been done on this topic. This study aimed to explore the experience of 51 patients (39 group patients and 12 from individual psychotherapies) who continued psychotherapy in the online setting during the COVID-19 outbreak. A structured online questionnaire with open answers investigated the following topics: setting online, effectiveness, psychotherapy relationship, specific dynamics of online psychotherapy. Patients' answers were analysed by means of Consensual Qualitative Research, modified version (CQRM), an inductive method that allows analysing a large sample and relatively brief written answers. The results show the impact of shift to online platforms on patients and explore how easy or difficult it is for them to adapt to therapeutic processes are in online therapy (vs in-person therapy), by highlighting potential barriers and resources to practice implementation. Participants' responses have been arranged into three main domains: setting online, content/effectiveness of online therapy and therapeutic relationship. A fourth domain, specific for online group therapy, collected responses referred to the changes perceived regarding the group dynamics. From the patient's perspective, online therapy is effective and satisfying. Patients perceived a positive quality of therapeutic relationship in online setting, whereas produced more controversial judgments concerned the changes due to the online setting. Finally, patients in group therapy gave more attention and importance in showing and seeing private personal spaces than the ones in individual therapy.

Beyond treatment modalities: Clinical decisions and relational dynamics that facilitate change in group treatments

This commentary on six articles comprising this Journal of Clinical Psychology: In Session issue on the therapeutic process in group psychotherapy brings together relevant clinical challenges and opportunities concerning the unique processes of change in group treatments. As illustrated by these six inspiring group therapy cases, therapy groups may vary widely in content and context. To balance the rich clinical illustrations of successful group treatments and the different theoretical formulations offered in these case studies, we highlight the processes that these treatments appear to have in common. Specifically, we describe the clinical considerations about the group format and the group members. We also reflect on the relational dynamics as they play out within the complex interplay between group leaders and group members; the facilitation of the corrective emotional experience as a change mechanism in group therapy, as well as the relational challenges and opportunities inherent in group treatments more generally. It is hoped that in this issue, clinicians will not only be inspired by the clinical description of successful change processes in group treatments but will also be reminded of the therapeutic nuances and opportunities of this multilayered treatment format.

NoiBene, a Group Intervention for Promoting Mental Health Among University Students: A Study Protocol for a Randomized Controlled Trial

University students’ mental health has become a public health issue since increasingly students report high levels of psychological distress. Mental health difficulties influence students’ lives, such as academic performance, relationships satisfaction, and quality of life. Moreover, different kinds of obstacles often hinder help-seeking behavior. Such evidence strongly suggests the need to implement prevention and promotion strategies to increase health and well-being in educational contexts. This article presents a study protocol for implementing and evaluating NoiBene, an evidence-based group intervention that aims to promote mental health and well-being, improve a series of transversal competencies (e.g., emotional awareness, commitment to values, assertiveness, goal setting), and decrease dysfunctional transdiagnostic mechanisms (i.e., perfectionism, repetitive thinking, experiential avoidance). A randomized controlled trial will be conducted to evaluate the protocol’s efficacy. Participants will be assigned to one of the three conditions: the NoiBene Group condition (NB-G), the NoiBene guided web-based condition (NB-WB), or the waiting list condition (WLC). The NB-G intervention consists of six face-to-face group meetings, each dedicated to specific issues related to well-being or vulnerabilities. Every meeting includes an explanation of the theoretical contents, individual and group exercises, and role-plays. The NB-WB intervention covers the same topic addressed in the NB-G intervention. In this case, participants carry out a series of online modules, including theoretical explanations, practical exercises, useful activities, and self-monitoring tools. Students will individually meet the Tutor once every 2 weeks. The primary outcome will include an increase in mental health and well-being. Secondary outcomes will include changes in emotional awareness, assertiveness, perfectionism, rumination, worry, self-criticism, experiential avoidance, and academic performance and satisfaction. We expect that participants in both NoiBene conditions will show these outcomes. However, we hypothesized that the NB-G conditions will be more effective than the NB-WB in improving assertiveness. Besides treatment efficacy, we expect that students can benefit from the NB-G or NB-WB differently based on their specific behavioral and motivational patterns. Outcomes will be assessed at pre-, post-intervention and 6-months follow-up. In conclusion, we believe that NoiBene is a promising tool that can improve students’ well-being, and it could have positive implications for preventing mental health disorders among students.

Do self-esteem and ethical leadership dampens Machiavellianism–effectiveness relationship: a parallel mediation approach

Purpose

The present paper intends to study the relationship between Machiavellianism and effectiveness. It investigates the parallel mediating effects of self-esteem and ethical leadership on Machiavellianism and leader effectiveness.

Design/methodology/approach

The study was administered to 260 managers from the banking sector. Statistical tools, like descriptive statistics, Pearson product moment correlation, reliability analysis, validity analysis and parallel-mediated regression analysis, were used to analyze the data. Drawing from the conservation of resource (COR) theory, a parallel mediation model was empirically tested.

Findings

The study found a negative association between Machiavellianism and leader effectiveness, and the parallel mediating impact of self-esteem and ethical leadership reduced the impact of Machiavellianism on leader effectiveness.

Practical implications

The work suggests that the banking sector leaders can adapt ethical behaviors to create positive leader–member relations contributing to increased organizational efficiency and productivity.

Originality/value

The unique contribution of the study includes determining the mediating roles of self-esteem and ethical leadership, especially in the Indian context. Despite the availability of past studies on the constructs, the studies on the parallel mediating relationship between Machiavellianism and effectiveness was limited.

The Psychometric Assessment of Empathy: Development and Validation of the Perth Empathy Scale

Empathy, the ability to infer and share others' affective states, plays a vital role in social interactions. However, no existing scale comprehensively assesses empathy's cognitive and affective components across positive and negative emotional valence domains. This article explores the latent structure of the empathy construct and attempts to remedy past measurement limitations by developing and validating a new 20-item self-report measure, the Perth Empathy Scale (PES). In Study 1 (N = 316), factor analyses revealed a coherent empathy construct comprised of cognitive and valence-specific affective components. Study 2 (N = 331) replicated this factor structure, showed measurement invariance between males and females, and highlighted the importance of assessing negative and positive emotions in empathy. The PES showed convergent and discriminant validity from comparisons with alexithymia and other empathy measures. Overall, this article empirically establishes a conceptually clear structure of the multidimensional empathy construct, which the PES reliably and validly measures.

Working together: An investigation of the impact of working alliance and cohesion on group psychotherapy attendance

OBJECTIVES

Group psychotherapy holds considerable potential for cost-effective treatment delivery. However, issues with client attendance can compromise the efficacy of such treatments. To date, client specific factors are amongst the most researched predictors of attendance in psychotherapy, with much less of a focus given to process factors, particularly in the group therapy context. This study aimed to determine which process factors influenced attendance in the context of a group therapy programme for adults with anxiety. It was hypothesized that (1) the working alliance and group cohesion would be moderately correlated, (2) both the working alliance and group cohesion would explain unique variance in session attendance, and (3) the working alliance would act as a moderator for attendance, when group cohesion was low.

DESIGN

The study utilized a within participants design.

METHODS

Participants were 91 adults (aged 18-74 years) who took part in a 9-week, transdiagnostic cognitive behavioural group therapy programme for the treatment of anxiety disorders.

RESULTS

Working alliance and group cohesion were significantly, but only moderately correlated (rs ranging .41 to .55). Together, working alliance and group cohesion significantly predicted total session attendance (17.70% variance explained). Working alliance did not moderate the relationship between group cohesion and session attendance.

CONCLUSIONS

The importance of individual and group processes in influencing group therapy engagement is highlighted, including the role of fostering bonds within the group and between clients and therapists.

PRACTITIONER POINTS

A complex array of process factors has been argued to influence treatment outcomes in group therapy The quality of the relationship between group therapy clients, as well as the relationship between a client and the therapist, predict session attendance. The quality of the relationship between the client and the therapist may be the most important predictor of session attendance. Therapists should foster positive relationships between each client and the therapist in group therapy, as well as assisting each client to foster positive relationships with other group members.

How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China

BACKGROUND

Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China.

METHODS

This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes.

RESULTS

Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach's α = .70 to .86; retest r_s = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (r_s = .465 to .574) and discriminant validity (r_s = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: "reflection of transference dynamics in the doctor-patient relationship", "emotional and cognitive learning" and "case mirroring in the dynamic of the group". Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures.

CONCLUSIONS

The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

Therapeutic alliance in vocational rehabilitation counseling: Assessing client factors and functioning

BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggested that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.

Predictors of Out-of-Class Mindfulness Practice Adherence During and After a Mindfulness-Based Intervention

OBJECTIVE

Out-of-class mindfulness meditation practice is a health behavior that is considered to be a crucial ingredient in mindfulness-based interventions (MBIs), yet participant adherence to practice recommendations is often inconsistent. Furthermore, MBIs may enhance factors that lead to greater adherence to medical regimens in other contexts. This study examined baseline factors previously found to relate to adherence to medical regimen, MBI-related changes in these baseline factors, and treatment-related factors as predictors of meditation adherence in an 8-week MBI.

METHODS

Baseline traits (personality, depressive symptoms, and executive function) were entered into regression models (n = 96) to predict intervention and postintervention out-of-class meditation adherence. Trait changes and treatment-related factors were entered into models to predict postintervention meditation adherence.

RESULTS

Baseline conscientiousness (β = 0.33, p = .002), openness (β = 0.23, p = .019), and depressive symptoms (β = 0.19, p = .042) predicted intervention meditation adherence, whereas conscientiousness (β = 0.21, p = .044) and depressive symptoms (β = 0.22, p = .020) predicted postintervention meditation adherence. Although all trait variables except for agreeableness changed significantly pre-to-post intervention, these changes did not predict postintervention meditation adherence. Retreat attendance (β = 0.38, p = .029) and instructor/group-related therapeutic factors collectively predicted postintervention meditation adherence (R2 = 0.21, p = .019).

CONCLUSIONS

The identified baseline trait factors could be used to increase adherence in these interventions as a method of increasing their effectiveness. An emphasis on the MBI retreat and social factors during the intervention may be important for participant out-of-class practice postintervention.Trial Registration:ClinicalTrials.govNCT01831362.

Randomized controlled evaluation of the psychophysiological effects of social support stress management in healthy women

Considering the high and increasing prevalence of stress, approaches to mitigate stress-related biological processes become a matter of public health. Since supportive social interactions contribute substantially to mental and physical health, we set out to develop a social support stress management intervention and examined its effects on psychophysiological stress responses as well as self-reported stress in healthy women. In a parallel-group randomized controlled trial, registered in the DSRK (DRKS00017427), 53 healthy women were randomly assigned to a social support stress management or a waitlist control condition. All participants underwent a standardized psychosocial stress test where physiological and emotional stress responses were assessed by repeated measurements of cortisol, heart rate, heart rate variability and state anxiety. Also, all participants completed self-report questionnaires of perceived stress and social support at pre-intervention, post-intervention and follow-up four weeks later. Participants in the social support stress management showed a significantly attenuated integrated state anxiety response in comparison to those in the control condition, but conditions did not differ in any of the assessed physiological stress responses. The intervention significantly reduced perceived stress in comparison to the control condition, but perceived stress levels returned to baseline at follow-up. Our results indicated that the intervention had no effect on physiological responses to acute psychosocial stress, even though anxiety responses to stress were attenuated. However, the social support stress management intervention had a significant, albeit transient impact on perceived stress.

Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C

People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.

The therapist, the group and I: how therapeutic alliance moderates the effect of group cohesion on outcomes

Purpose

This study aims to investigate whether the influence of group cohesion on the outcomes depended on the levels of the therapeutic alliance.

Design/methodology/approach

Sixteen individuals with a substance use disorder who were undergoing treatment in a therapeutic community responded to therapeutic alliance, group cohesion, craving and outcomes measures after every therapeutic small group session for a period of six weeks. Data analysis was performed using hierarchical linear modeling.

Findings

Results indicate that the effect of group cohesion is stronger when there is a high therapeutic alliance between resident and therapist.

Originality/value

Even on group interventions, to enhance group cohesion effects on outcomes, therapists must foster higher therapeutic alliance levels. The findings point out the importance of studying the effect of common factors on outcomes.

Rupture and Repair in Mentalization-Based Group Psychotherapy

The article explores ideas about the role of group mentalizing-the experience of joint attention and shared intentionality-as a process that can support the emergence of more collaborative and salutogenic social functioning. This is based on developmental and evolutionary thinking about the importance of joint attention in human social cognitive development and functioning. The importance of experiencing rupture and repair as part of the process of thinking together-while also working with the separate nature of our thoughts-is described, emphasizing that it is through an understanding of the complex and inevitably uneven and challenging nature of joint attention and social cooperation that such cooperation is itself made possible.

Alliance Rupture Detection and Repair in Group Therapy: Using the Group Questionnaire--GQ

The identification of relationship ruptures in group therapy coupled with repair efforts by the group leader are addressed from a measurement-based care (MBC) perspective. Several MBC systems are now recognized as evidence-based treatments, and these systems typically use self-report assessment of both outcome and relationship measures. After laying a brief foundation of alliance rupture and repair from an individual therapy perspective, the complexity of applying alliance and repair across the multiple therapeutic relationships and constructs found in the group treatment literature is considered. The Group Questionnaire (GQ) is an empirically derived measure designed to capture the multiple relationship structures (member-member, member-leader, and member-group) and constructs (alliance, cohesion, climate, and empathy) in group therapy. Similarities and differences between the GQ and alliance rupture and repair measures are considered, followed by algorithms used to identify rupture and repair in group therapy on the three GQ subscales-positive bond, positive work, and negative relationship. MBC clinical reports are used to illustrate how rupture is identified at both a group and individual member perspective along with information to support repair interventions. Finally, both clinical and empirical reasons for using the MBC approach are considered along with clinical observations.

The Contribution of Common and Specific Therapeutic Factors to Mindfulness-Based Intervention Outcomes

While Mindfulness-Based Interventions (MBIs) have been shown to be effective for a range of patient populations and outcomes, a question remains as to the role of common therapeutic factors, as opposed to the specific effects of mindfulness practice, in contributing to patient improvements. This project used a mixed-method design to investigate the contribution of specific (mindfulness practice-related) and common (instructor and group related) therapeutic factors to client improvements within an MBI. Participants with mild-severe depression (N = 104; 73% female, M age = 40.28) participated in an 8-week MBI. Specific therapeutic factors (formal out-of-class meditation minutes and informal mindfulness practice frequency) and social common factors (instructor and group ratings) were entered into multilevel growth curve models to predict changes in depression, anxiety, stress, and mindfulness at six timepoints from baseline to 3-month follow-up. Qualitative interviews with participants provided rich descriptions of how instructor and group related factors played a role in therapeutic trajectories. Findings indicated that instructor ratings predicted changes in depression and stress, group ratings predicted changes in stress and self-reported mindfulness, and formal meditation predicted changes in anxiety and stress, while informal mindfulness practice did not predict client improvements. Social common factors were stronger predictors of improvements in depression, stress, and self-reported mindfulness than specific mindfulness practice-related factors. Qualitative data supported the importance of relationships with instructor and group members, involving bonding, expressing feelings, and instilling hope. Our findings dispel the myth that MBI outcomes are exclusively the result of mindfulness meditation practice, and suggest that social common factors may account for much of the effects of these interventions. Further research on meditation should take into consideration the effects of social context and other common therapeutic factors.

Relationship Variables in Group Psychotherapy for Women Sexual Trauma Survivors

This study examined relational group psychotherapy processes, including group cohesion, bond with group leaders, perceptions of shame, and posttraumatic stress disorder (PTSD) symptomatology for sexual trauma survivors. Six separate treatment groups of women who were either adult sexual assault survivors (N = 24) or adult survivors of childhood sexual abuse (N = 9) participated in the study. Participants completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) pre- and posttreatment, the Group Climate Questionnaire, Bond scale of the Working Alliance Inventory Short Form (WAI-S), and Compass of Shame Scale at four intervals. Growth curve models analyzed Engagement, Bond, and Shame Reactions over time. PCL-5 scores were compared pre- and posttreatment and examined in relationship to the process variables of Engagement and Bond. Results showed increases in group cohesion and perceptions of Bond with group leaders and decreases in PTSD symptoms and attacking self-shame reactions. Clinical implications and recommendations for this population are presented.

Psychometric Evaluation of the Czech Version of Group Cohesiveness Scale (GCS) in a Clinical Sample: A Two-Dimensional Model

The Group Cohesiveness Scale (GCS, 7 items) measures patient-rated group cohesiveness. The English version of the scale has demonstrated good psychometric properties. This study describes the validation of the Czech version of the GCS. A total of 369 patients participated in the study. Unlike the original study, the ordinal confirmatory factor analysis (CFA) supported a two-dimensional solution (RMSEA = 0.075; TLI = 0.986). The analysis demonstrated the existence of two moderately to highly associated (r = 0.79) domains of group cohesiveness—affective and behavioral. The two-dimensional model was invariant across genders, age, education, and time (retest after 6 weeks) up to factor means level. Internal consistency reached satisfactory values for both domains (affective, ω = 0.86; behavioral, ω = 0.81). In terms of convergent validity, only weak association was found between the GCS domains and the group working alliance measured by the Group Outcome Rating Scale (GSRS). This is the first revision of the factor structure of the GCS in the European context. The scale showed that the Czech version of the GCS is a valid and reliable brief tool for measuring both aspects of group cohesiveness.

Italian adaptation of the Group Questionnaire: validity and factorial structure

The Group Questionnaire (GQ) is a measure recently developed by Krogel et al. (2013) for the evaluation of the therapeutic relationship in group. The GQ identifies a three-factor model of the relationship that allows to measure quality (Positive Bonding, Positive Working and Negative Relationship) and structure (member-member, member-leader and member-group), dimensions in group. This work shows the results of a first study on the Italian validation of the GQ. In this study the GQ was administered to 536 subjects from 32 non-clinical groups of undergraduate students. The cross-cultural validity of the GQ in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and scores of the Italian GQ with the original American version. Multilevel confirmatory factor analysis was used to examine both the between- and within-group structures. Data concerning reliability and validity of GQ and the results for different SEM in Multilevel CFA confirm the three factors structure of the GQ. Data from the Italian population have a good fit with the original proposed model. Finally, we discuss the importance of an instrument like GQ, short but consistent, for the evaluation of the therapeutic relationship in clinical and training group.

A Systematic Review and Quality Assessment of Therapeutic Group Process Questionnaires

The aims of this study were to systematically review the literature on questionnaire-based group process measures and assess the psychometric scale development properties of these measures. A systematic search of questionnaire-based measures of group process was conducted from four databases: PsycINFO, Medline, EMBASE and AMED. A quality assessment was undertaken using established criteria. Only studies that described the development of questionnaire-based scales were included. Seventeen studies which described thirteen measures were included in the analysis. The developed list highlights a range of questionnaires that can be used by clinicians and researchers seeking to measure either "specific therapeutic group mechanisms" or "overall group experiences." Further research should focus on developing the content validity of these scales by involving the target population during item selection and reduction.

Wechselseitige Effekte von Gruppenkohäsion und Symptomen

Kohäsion ist ein bedeutsamer Teil gruppentherapeutischer Beziehungen und stellt einen potenziell kurativen Faktor dar, der nachfolgende Symptomverbesserungen erklären kann. Trotz der häufig belegten Korrelation zwischen erlebter Kohäsion und der Symptomschwere fehlen longitudinale Studien, in denen sowohl die zeitliche Abfolge von Kohäsion und Symptomveränderungen angemessen berücksichtigt und zusätzlich zwischen dem mittleren Level der Kohäsion einzelner Gruppenteilnehmer („between-person effect“) und der individuellen Veränderung („within-person effect“) differenziert wird. Diese Studie untersucht das Kohäsionserleben zur Patientengruppe auf einer Psychotherapiestation mit integrierter Tagesklinik. Vierzig depressive Patienten wurden im Rahmen einer randomisierten kontrollierten Studie zum Vergleich tagesklinischer und stationärer Psychotherapie rekrutiert. Alle Patienten gaben wöchentlich Auskunft über die Therapiebeziehungen (einschließlich Kohäsion) und die aktuelle Symptombelastung; für die Auswertung der Multilevel Daten wurde ein autoregressives cross-lagged Modell verwendet. Die Ergebnisse deuten auf eine wechselseitige Beeinflussung hin. Ein individueller Anstieg der Kohäsion war ein signifikanter Prädiktor für verbesserte Symptome, auch wenn für die vorherige Symptombelastung kontrolliert wurde. Umgekehrt war auch eine Symptomverbesserung prädiktiv für ein höheres Kohäsionserleben im Verlauf. Damit zeigt die Studie die Bedeutung der Beziehungsqualität zur Gruppe der Mitpatienten und weist auf eine wechselseitige Beeinflussung von Kohäsion und Symptomen hin. Allerdings müssen die Ergebnisse aufgrund der kleinen Stichprobe mit Vorsicht interpretiert werden.

Treatment Satisfaction and Therapeutic Alliance in Three Different Treatment Groups for Test Anxiety

Three group treatments for university students (N = 81) with test anxiety were compared to test if treatment satisfaction and therapeutic alliance differed between groups, while taking into account the actual reduction of test anxiety and the perceived engagement of the group as possible confounding factors. Two groups offered cognitive behavioral therapy (CBT), one of them included Imagery Rescripting (CBT+ImRs; n = 30), the other relaxation techniques (CBT+R; n = 20). The third group was a therapist assisted self-help group (SH; n = 31). An covariate analysis of variance (ANCOVA) with planned contrasts, controlling for the covariates group engagement and symptom reduction, revealed that students in the CBT groups were significantly more satisfied than in the SH group (t(76) = −5.27, p = .001, r = .52). Furthermore, we could find in a second ANCOVA that the CBT+ImRs group showed higher therapeutic alliance scores compared to the CBT+R (t(78) = −2.05, p = .044, r = .23), while both CBT conditions showed higher alliance scores than the SH group (t(78) = −3.16, p = .002, r = .34).

Does group cohesion foster self-directed learning for medical students? A longitudinal study

BACKGROUND

The importance of self-directed learning (SDL) and collaborative learning has been emphasized in medical education. This study examined if there were changes in the pattern of SDL and group cohesion from the time of admission to medical school under the criterion-referenced grading system, increased group activities, and interaction of medical education curriculum. Second, it was examined whether group cohesion influences self-directed learning.

METHODS

The participants were 106 medical students (71 males, 35 females) who enrolled in Yonsei University College of Medicine in Seoul, South Korea in March 2014. They were asked to complete a Korean version of the self-directed learning readiness scale (SDLRS) and group cohesion scale (GCS) at the end of each semester for three years. A repeated measures ANOVA and a correlation and regression analysis were conducted.

RESULTS

All the participants completed the questionnaires. There were differences in the SDLRS scores over the three years. A significant increase was observed one year after admission followed by stable scores until the third year. There was a significant increase in GCS scores as students progressed through medical school years. Positive relationships were found between SDLRS and GCS scores, and the regression model predicted 32% variance.

CONCLUSIONS

SDLRS and GCS increased as medical school years progressed. In addition, GCS is a significant factor in fostering SDLRS. Medical schools should develop various curriculum activities that enhance group cohesion among medical students, which would in turn promote SDL.

Group Cohesion and Climate in Cognitive Behavioral Therapy for Individuals with a First-Time DUI

Few studies have examined group cohesion and climate in the substance use disorder treatment literature. We examined whether group cohesion and climate are associated with increased self-efficacy outcomes and reduced drinks per week, binge drinking and DUI behaviors, in a sample of individuals with a first-time DUI receiving either cognitive behavioral therapy (CBT) or usual care. Additionally, we examined whether CBT moderates these relationships. Group measures and drinking outcomes were not significantly associated. This study is the first to provide an in-depth analysis on group processes in DUI settings, and as such, provides important insights into how group processes may differ in a mandated DUI context.

More than Taking a Chair: The Perceived Group Social Dynamics of Alcoholics Anonymous Related to Changes in Spiritual Practices

Alcoholics Anonymous (AA) meeting attendance and spiritual practices are established predictors of abstinence. This study utilized longitudinal data from two studies of AA to investigate 1) how perceived within meeting social dynamics in AA meetings affect later AA attendance, and thus exposure to the emphasis of spiritual practices and 2) influence the extent that spiritual gains are mobilized, beyond AA attendance. Findings revealed that greater group cohesion was associated with lower AA attrition, and that expressiveness, or openness, of the group predicted reported practice of spiritual behaviors. Findings reveal distinct group dynamics may foster distinct mechanism of change of AA attendees.

Validation of the URICA-S in Group Therapy: Associations of Stages of Change with Therapeutic Factors and Treatment Outcome

Stages of change could be driving forces to activate the realization of therapeutic factors and symptom change. Consequently, the aims of the present study were to investigate whether the stages of change concept is valid in group therapy settings shown by factor analysis, internal consistencies, and criterion validity. A total of 377 patients completed measures of stages of change, symptom change, and therapeutic factors. A confirmatory factor analysis replicated the stages of change factors for group therapy. Related to the criterion validity, stages of change demonstrated only low, non-significant associations with symptom change, but some stages of change were significant predictors of certain therapeutic factors. Further research is needed to explore whether a stronger focus on motivational stages of change could help to intensify the realization of therapeutic factors in group therapy.

Establishing a Secure Base to Increase Exploration of Diversity in Groups

All groups can be considered multicultural, and group members often present with issues that stem from contextual factors related to cultural identities, including experiences with oppression. Therefore, group leaders must be able to effectively facilitate deep intercultural dialogues in psychotherapy groups, and we suggest that an understanding of attachment theory can help leaders engage group members in these dialogues. In order to demonstrate how attachment theory can be applied to the exploration of diversity in groups, we provide a case example from an intergroup dialogue group bringing together religious minorities, secular individuals, and Christians over the course of eight weeks. In this example, we focus on the two group members who scored the lowest (Jill) and highest (Sarah) on a measure of attachment anxiety and avoidance to illustrate the experiences of one member with more secure attachment and one with more preoccupied attachment. Specifically, we present data from their weekly reflective journals to explore their different experiences of the group over time. Finally, we discuss the case in terms of attachment theory and highlight implications for group leaders.

Attachment Anxiety and Attachment Avoidance: Members' Attachment Fit with Their Group and Group Relationships

We compared each individual group member's attachment fit with the attachment of the other group members. Participants were 201 members of 20 therapy groups who sought treatment because they were overweight or obese. Group members completed the Attachment Style Questionnaire before commencing treatment and the Group Questionnaire at three points during group treatment. Multilevel polynomial regression followed by response surface analysis was used to examine how the attachment anxiety and avoidance of the individual group member and the aggregated attachment anxiety and avoidance of the group members were related to individual group members' perceptions of the positive bonding, positive working relationships, and negative relationships in the group. The findings suggested that attachment heterogeneity in group is related to the perception of members' stronger bonding relationships and lower negative relationships. In addition, positive bonding can be increased when a patient high in attachment avoidance is added to a group whose patients are low in attachment avoidance; however, group members reported weaker negative relationships when their attachment anxiety or avoidance became increasingly higher or lower than other group members' attachment anxiety or avoidance.

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Group therapy processes and treatment outcomes in 2 couple-focused group interventions for breast cancer patients

BACKGROUND

There has been little attention paid to the role of therapeutic processes in group therapy outcomes for cancer patients participating in group. The goal was to evaluate the contribution of 3 group processes-group climate (conflict, engagement, and avoidance) working alliance and therapeutic realizations-to the outcomes of 2 couple-focused approaches to group treatment.

METHODS

Three hundred and two women with early stage breast cancer and their partners were randomized to one of 2 conditions: an 8-session enhanced couple-focused group (ECG) intervention or a couples' support group participated. Couples completed measures of depressive symptoms and well-being before and 6 months after group. Group process measures were completed after sessions 4 and 8.

RESULTS

Support group participants (both patients and partners) perceived higher engagement and less avoidance than ECG participants. Conflict, working alliance, and therapeutic realizations did not differ. Group engagement, working alliance, and therapeutic realizations increased, and group conflict decreased over the course of both treatments. Greater conflict was associated with more posttreatment anxiety and lower well-being, and engagement was associated with higher posttreatment well-being. Patients whose partners reported higher conflict reported greater posttreatment anxiety. Working alliance was associated with posttreatment anxiety for ECG patients and with well-being among participants whose partners reported higher working alliance.

CONCLUSIONS

Fostering a positive group environment bolsters treatment efficacy for women with early stage breast cancer and their partners attending couple-focused groups. Facilitating the leader-member alliance bolsters treatment efficacy. Improving engagement with one member of a couple impacts the other member.

Understanding Process in Group-Based Intervention Delivery: Social Network Analysis and Intra-entity Variability Methods as Windows into the "Black Box"

Although the majority of evidence-based programs are designed for group delivery, group process and its role in participant outcomes have received little empirical attention. Data were collected from 20 groups of participants (94 early adolescents, 120 parents) enrolled in an efficacy trial of a mindfulness-based adaptation of the Strengthening Families Program (MSFP). Following each weekly session, participants reported on their relations to group members. Social network analysis and methods sensitive to intraindividual variability were integrated to examine weekly covariation between group process and participant progress, and to predict post-intervention outcomes from levels and changes in group process. Results demonstrate hypothesized links between network indices of group process and intervention outcomes and highlight the value of this unique analytic approach to studying intervention group process.

Factor Analysis in Counseling Psychology Research, Training, and Practice

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have contributed to test development and validation in counseling psychology, but additional applications have not been fully realized. The author presents an overview of the goals, terminology, and procedures of factor analysis; reviews best practices for extracting, retaining, and rotating factors in EFA; describes issues related to CFA, including potential hypotheses, how parameters are estimated, and current guidelines regarding sample size and the use of fit indices; and reviews more sophisticated applications of CFA, including multiple-groups analysis and testing of hierarchical models. Finally, the author recommends how to increase the application of factor analysis to counseling psychologists’ work in research, training, and practice settings.