The Group Questionnaire: A clinical and empirically derived measure of group relationship

Examining within- and between-member cohesion and working alliance effects on group members' motivation: a preliminary actor-partner interdependence study

OBJECTIVE

Informed by the person-environment fit theory, this preliminary study examined if a fit between a group member's treatment experience and their working therapy context (other group members' aggregated treatment experiences) were related to their level of motivation within a group treatment for healing from internalized weight stigma.

METHOD

We examined the relationship between two types of within-member and between-member's group cohesion, working alliance, and motivation. Specifically, we utilized the Actor-Partner Interdependence Model to operationalize the impact of actor's within-member cohesion and alliance (personal changes over time) and between-member cohesion and alliance (individual differences) as well as partner's within-member cohesion and alliance (contextual changes over time) and between-member cohesion and alliance (contextual differences) on group members' motivation. This study utilized self-report data from 26 group members who participated in three online weight stigma psychotherapy groups.

RESULTS

For cohesion, results suggested that the relationship between partner within-member cohesion and motivation was larger for members who reported low cohesion across all the sessions compared to the other members of their group. Additionally, an individual group member who perceived a group session more cohesive than they did on average, reported increased motivation in that session, and this relationship was stronger for members who on average perceived their group less cohesive than other group members. Lastly, session-level alliance was more strongly associated with an individual member's motivation in that session when the other group members reported lower group alliance on average.

CONCLUSIONS

These findings underscore the significance of member-group fit in group therapy and the reciprocal impact of individual members and the group on each other's therapy outcomes.

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.

Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial

INTRODUCTION

Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55).

METHODS

Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D).

RESULTS

The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members.

CONCLUSION

Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

Originalbeiträge (Originals). Psychotherapeutic inpatient depression treatment in open versus closed group format

OBJECTIVE

Controversy exists about the comparative efficacy of different group formats, e. g., open versus closed. Most of the findings come from outpatient, closed group research. In practice, the open format is more widely used. This monocentric study aims to compare the efficacy as well as group cohesion during inpatient group psychotherapy for depression delivered in an open versus closed format.

METHODS

291 depressed inpatients (ageM= 55.7, SD = 11) of a psychosomatic-rehabilitation clinic were consecutively assigned to either open (n = 117) or closed (n = 174) cognitive-behavioral groups, further subdivided into groups based on length of the stay. Using multilevel models, we examined depression and group cohesion concerning changes in patients' random effects over time.

RESULTS

Both group formats showed a reduction in symptomatology (d = 1.8). A significant group format x time interaction in favor of the closed format was found regarding group cohesion.

CONCLUSION

While group cohesion improved in the closed format only, we did not find any significant difference between group formats regarding their efficacy. Further research should focus on randomized controlled trials comparing both formats directly.

The development of the Therapeutic Group Context Questionnaire: Reliability and validity measures based on telehealth Group-based Pain Management Programs

INTRODUCTION

In 2016, the Centers for Disease Control and Prevention analyzed the National Health Interview Survey data and found that the occurrence of chronic pain and high-impact chronic pain in the USA was 20.4% and 8%, respectively. Group-based Pain Management Programs have been viewed as significant treatments aiding patients with self-management of chronic pain. The onset of coronavirus disease 2019 (COVID-19) at the beginning of 2020, widely eliminated the in-person Group-based Pain Management Programs. The exploration of therapeutic contextual factors such as the therapeutic alliance and group dynamics in telehealth Group-based Pain Management Programs appears warranted for which reason the Therapeutic Group Context Questionnaire was developed.

METHODS

The therapeutic alliance and group dynamics items in the Therapeutic Group Context Questionnaire were developed from an extensive literature review and underwent examination of content validity, internal consistency, reliability, and validity through telehealth Group-based Pain Management Programs.

RESULTS

Content validity of the Therapeutic Group Context Questionnaire was established in five separate stages and the psychometrics of the Therapeutic Group Context Questionnaire was found to be very good with high internal consistency and reliability (r = 0.85-0.97) and the ability of the Therapeutic Group Context Questionnaire to differentiate between high and low scorers on the SF-36 emotional well-being measure.

DISCUSSION

The examination of therapeutic contextual factors via telehealth Group-based Pain Management Programs using the Therapeutic Group Context Questionnaire appears possible in view of the very good psychometric properties described above. Investigation of therapeutic contextual factors through the Therapeutic Group Context Questionnaire may provide greater insight into the role that these factors may have in telehealth programs and their impact on pain outcomes. Future investigation of the Therapeutic Group Context Questionnaire in non-telehealth Group-based Pain Management Programs, as well as, other disorders being addressed via telehealth appears warranted.

Patients' and Therapists' Experiences of Standardized Group Cognitive Behavioral Therapy: Needs for a Personalized Approach

Personalizing psychotherapy can be challenging within standardized group Cognitive Behavioral Therapy (CBT), in which sessions are structured according to a protocol and must accommodate the needs and preferences of multiple patients. In the current study, we aimed to examine patients' and therapists' experiences of standardized group CBT and identify their perceptions of different patient needs. Furthermore, we explored how these needs can inform possible content of add-on interventions for patients who are not improving as expected during group CBT.We conducted 21 individual in-depth interviews with patients with depression and their therapists about their experiences during group CBT with Routine Outcome Monitoring (ROM) and feedback. Interviews were analyzed by using a hermeneutic-phenomenological thematic analysis. Five themes, representing different patient needs, were identified: (1) Individual attention, (2) Psychological exploration, (3) A focus on the patient's life outside of therapy, (4) Extended assessment, and (5) Agreement on therapeutic tasks.The study supports that "one size does not fit all" when it comes to psychotherapy. Patients have varying needs when they are not making progress in therapy, and these needs, when unmet, can negatively impact the overall experience of group CBT. By acknowledging the unique needs of each patient and providing additional individual sessions as necessary, we can move towards a more personalized approach that maximizes the benefits of group psychotherapy.

Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study

BACKGROUND

People with mental disorders face frequent stigmatizing attitudes and behaviors from others. Importantly, they can internalize such negative attitudes and thus self-stigmatize. Self-stigma is involved in diminished coping skills leading to social avoidance and difficulties in adhering to care. Reducing self-stigma and its emotional corollary, shame, is thus crucial to attenuate the negative outcomes associated with mental illness. Compassion-focused therapy (CFT) is a third-wave cognitive behavioral therapy that targets shame reduction and hostile self-to-self relationship and allows for symptom improvement while increasing self-compassion. Although shame is a prominent part of the concept of self-stigma, the efficacy of CFT has never been evaluated in individuals with high levels of self-stigma. The purpose of this study is to evaluate the efficacy and acceptability of a group-based CFT program on self-stigma, compared to a psychoeducation program for self-stigma (Ending Self-Stigma) and to treatment as usual (TAU). We hypothesize that diminished shame and emotional dysregulation and increased self-compassion will mediate the relationship between self-stigma improvements post-therapy in the experimental group.

METHODS

This seven-center trial will involve 336 participants diagnosed with a severe mental illness and/or autism spectrum disorder and reporting high levels of self-stigma. Participants will be randomized into one of three treatment arms: 12 week-treatment of compassion-focused therapy (experimental arm), 12 week-treatment of Psychoeducation (active control arm), and TAU (treatment as usual-passive control arm). The primary outcome is the decrease of self-stigma scores on a self-report scale, i.e., ISMI, at 12 weeks. Secondary endpoints include sustainability of self-stigma scores (ISMI) and self-reported scores regarding target psychological dimensions, e.g., shame and emotional regulation, social functioning, and psychiatric symptoms. Assessments are scheduled at pretreatment, post-treatment (at 12 weeks), and at 6-month follow-up. Acceptability will be evaluated via (i) the Credibility and Expectancy Questionnaire at T0, (ii) the Consumer Satisfaction Questionnaire for Psychotherapeutic Services posttreatment and at 6-month follow-up, (iii) attendance, and (iv) dropout rates.

DISCUSSION

This study will evaluate the potential efficacy and acceptability of a group-based CFT program on the decrease of self-stigma and thereby contribute to the continuing development of evidence-based therapeutic interventions for the internalized stigma of mental and neurodevelopmental disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05698589. Registered on January 26, 2023.

G-FORCE: the effectiveness of group psychotherapy for Cluster-C personality disorders: protocol of a pragmatic RCT comparing psychodynamic and two forms of schema group therapy

BACKGROUND

Cluster-C personality disorders (PDs), characterized by a high level of fear and anxiety, are related to high levels of distress, societal dysfunctioning and chronicity of various mental health disorders. Evidence for the optimal treatment is extremely scarce. Nevertheless, the need to treat these patients is eminent. In clinical practice, group therapy is one of the frequently offered approaches, with two important frameworks: schema therapy and psychodynamic therapy. These two frameworks suggest different mechanisms of change, but until now, this has not yet been explored. The purpose of the present G-FORCE trial is to find evidence on the differential (cost)effectiveness of two forms of schema group therapy and psychodynamic group therapy in the routine clinical setting of an outpatient clinic and to investigate the underlying working mechanisms and predictors of outcome of these therapies.

METHODS

In this mono-centre pragmatic randomized clinical trial, 290 patients with Cluster-C PDs or other specified PD with predominantly Cluster-C traits, will be randomized to one of three treatment conditions: group schema therapy for Cluster-C (GST-C, 1 year), schema-focused group therapy (SFGT, 1.5 year) or psychodynamic group therapy (PG, 2 years). Randomization will be pre-stratified on the type of PD. Change in severity of PD (APD-IV) over 24 months will be the primary outcome measure. Secondary outcome measures are personality functioning, psychiatric symptoms and quality of life. Potential predictors and mediators are selected and measured repeatedly. Also, a cost-effectiveness study will be performed, primarily based on a societal perspective, using both clinical effects and quality-adjusted life years. The time-points of assessment are at baseline, start of treatment and after 1, 3, 6, 9, 12, 18, 24 and 36 months.

DISCUSSION

This study is designed to evaluate the effectiveness and cost-effectiveness of three formats of group psychotherapy for Cluster-C PDs. Additionally, predictors, procedure and process variables are analysed to investigate the working mechanisms of the therapies. This is the first large RCT on group therapy for Cluster-C PDs and will contribute improving the care of this neglected patient group. The absence of a control group can be considered as a limitation.

TRIAL REGISTRATION

CCMO, NL72826.029.20 . Registered on 31 August 2020, first participant included on 18 October 2020.

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.

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.

Integrating Collaboration and Leadership in Conversational Group Recommender Systems

Recent observational studies highlight the importance of considering the interactions between users in the group recommendation process, but to date their integration has been marginal. In this article, we propose a collaborative model based on the social interactions that take place in a web-based conversational group recommender system. The collaborative model allows the group recommender to implicitly infer the different roles within the group, namely, collaborative and leader user(s). Moreover, it serves as the basis of several novel collaboration-based consensus strategies that integrate both individual and social interactions in the group recommendation process. A live-user evaluation confirms that our approach accurately identifies the collaborative and leader users in a group and produces more effective recommendations.

Group Psychotherapy as a Specialty: An Inconvenient Truth

Group psychology and group psychotherapy (GPGP) are distinctive, effective practices that meet an important need. In 2018, the American Psychological Association recognized GPGP as a specialty, thus setting standards for education and training in the field. Although there is a need for high-quality group psychotherapy, practitioners often lack standardized training, thus posing a risk to patients. Adoption of these standards by practice settings and training programs is essential for expanding the availability of quality group therapy. An understanding of how the specialty became recognized and of the specific criteria for its practice (i.e., public need, diversity, distinctiveness, advanced scientific and theoretical preparation, structures and models of education and training, effectiveness, quality improvement, guidelines for delivery, and provider identification and evaluation) are essential for expanding the availability of high-quality group psychotherapy. Such understanding also informs how training programs can align with standards. This article provides a foundation of understanding and details implications of group psychotherapy's establishment as a specialty. The benefits of high-quality group psychotherapy are far-reaching, whereas the risks of inadequate practice loom large.

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.

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.

Oxytocin-enhanced group therapy for methamphetamine use disorder: Randomized controlled trial

BACKGROUND

Methamphetamine (METH) use is a public health crisis that disproportionately affects men who have sex with men (MSM). There are currently no FDA-approved pharmacological interventions to treat methamphetamine use disorder (MUD). MUD is associated with social impairments and extremely high treatment attrition rates. Administration of oxytocin, a neuropeptide involved in social attachment, may be a novel approach to addressing these issues. Moreover, oxytocin administration has shown promise for reducing METH-related addictive behavior in animal models, but has not yet been investigated in clinical trials for MUD. Last, oxytocin is known to modulate stress responsivity via regulation of the autonomic nervous system, which is dysregulated in METH users. We hypothesize that oxytocin, in combination with group psychotherapy, will increase treatment engagement, reduce addiction behavior, and mitigate stress hyperreactivity.

METHODS

This is a randomized, double blind trial of oxytocin 40-IU (n = 24) or placebo (n = 24) administered intranasally prior to each of six weekly motivational interviewing group therapy (MIGT) sessions for MUD in MSM.

PRIMARY OUTCOME

(a) session attendance.

SECONDARY OUTCOMES

(b) group cohesion, (c) anxiety, (d) METH craving, (e) METH use, and (f) in-session cardiac physiology.

RESULTS

Participants receiving oxytocin had significantly higher group therapy attendance than those receiving placebo, OR 3.26, 95% CI [1.27-8.41], p = .014. There was a small effect of oxytocin on group cohension, but not anxiety or craving. METH use did not change over the six-week MIGT course in either treatment arm. Participants receiving oxytocin had lower average heart rates during MIGT sessions and higher heart rate variability. There were positive main effects of MIGT over Time regardless of study drug.

CONCLUSIONS

This evidence, and the lack of any serious adverse events, suggests that oxytocin may safely increase treatment attendance. One possible mechanism by which it may do so is its modulation of the autonomic nervous system. Further investigation is warranted.

Short-term versus long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder: a protocol for a randomized clinical trial

Background

Psychotherapy for borderline personality disorder is often lengthy and resource-intensive. However, the current length of outpatient treatments is arbitrary and based on trials that never tested if the treatment intensity could be reduced. As a result, there is insufficient evidence to inform the decision between short-term and long-term psychotherapy for borderline personality disorder. Mentalization-based therapy is one treatment option for borderline personality disorder and consists traditionally of an 18-month treatment program.

Methods/design

This trial is an investigator-initiated single-center randomized clinical superiority trial of short-term (20 weeks) compared to long-term (14 months) mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. Participants will be recruited from the Outpatient Clinic for Personality Disorders at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Participants will be included if they meet a minimum of four DSM-V criteria for borderline personality disorder. Participants will be assessed before randomization, and at 8, 16, and 24 months after randomization. The primary outcome is severity of borderline symptomatology assessed with the Zanarini Rating Scale for borderline personality disorder. Secondary outcomes include self-harm incidents, functional impairment (Work and Social Adjustment Scale, Global Assessment of Functioning) and quality of life (Short-Form Health Survey 36). Severity of psychiatric symptoms (Symptom Checklist 90-R) will be included as an exploratory outcome. Measures of personality functioning, attachment, borderline symptoms, group alliance, and mentalization skills will be included to explore potential predictors and mechanisms of change.

Discussion

This trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder.

Trial registration

ClinicalTrials.gov, NCT03677037. Registered on September 19, 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3306-7) contains supplementary material, which is available to authorized users.

Psychedelic-Assisted Group Therapy: A Systematic Review

Contemporary research with classic psychedelic drugs (e.g., lysergic acid diethylamide (LSD) and psilocybin) is indebted to the twentieth-century researchers and clinicians who generated valuable clinical knowledge of these substances through experimentation. Several recent reviews that highlight the contributions of this early literature have focused on psychedelic-assisted individual psychotherapy modalities. None have attempted to systematically identify and compile experimental studies of psychedelic-assisted group therapy. In therapeutic settings, psychedelics were often used to enhance group therapy for a variety of populations and clinical indications. We report on the results of a systematic review of the published literature in English and Spanish on psychedelic-assisted group therapies. Publications are characterized by their clinical approach, experimental method, and clinical outcomes. Given the renewed interest in the clinical use of psychedelic medicines, this review aims to stimulate hypotheses to be tested in future research on psychedelic-assisted psychotherapy, group process, and interpersonal functioning.

Oxytocin-enhanced motivational interviewing group therapy for methamphetamine use disorder in men who have sex with men: study protocol for a randomized controlled trial

Background

The prevalence of methamphetamine use disorder (MUD) in the United States has risen dramatically in the past four decades and is concentrated in populations such as men who have sex with men (MSM). Despite the public health consequences of MUD, there are no FDA-approved psychopharmacological treatments. Psychosocial treatment alone has been shown to reduce methamphetamine use, but high attrition rates limit treatment efficacy. Promising findings from animal models of MUD using exogenous oxytocin, a social neuropeptide, have set the stage for translational work. Along with unique anti-addiction effects, oxytocin holds a primary role in enhancing social salience and modulating stress. In humans, oxytocin administration, combined with evidence-based psychosocial interventions, may act synergistically to improve addiction treatment outcomes and improve retention rates in current MUD treatment.

Methods/design

We are conducting a randomized, double-blind, placebo-controlled trial of oxytocin-enhanced motivational interviewing group therapy (MIGT). Oxytocin or placebo 40 IU is administered intranasally in conjunction with six, weekly MIGT sessions. We will recruit 50 MSM, initiating treatment for MUD from specialized community health programs in San Francisco, CA, USA. Individuals will be randomized (1:1) to receive six, weekly sessions of MIGT with or without oxytocin. Our primary outcome is session attendance. Other outcomes of interest include: measures of group cohesion, anxiety, psychophysiology, and stimulant craving and use.

Discussion

This will be the first study of oxytocin’s effects in humans with MUD. Findings from this novel protocol will attempt to bridge existing animal data with the need for innovative clinical treatments for MUD, inform the growing field of pharmacologically-enhanced psychotherapy, and help to elucidate mechanisms behind oxytocin’s potential anti-addiction effects.

Trial registration

ClinicalTrials.gov, ID: NCT02881177. Registered on 26 August 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3225-7) contains supplementary material, which is available to authorized users.

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.

Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial

BACKGROUND

Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the "The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders" (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT.

METHODS/DESIGN

The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence.

DISCUSSION

The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02954731 . Registered 25 October 2016.

A Mathematical Framework for the Complex System Approach to Group Dynamics: The Case of Recovery House Social Integration

The complex system conception of group social dynamics often involves not only changing individual characteristics, but also changing within-group relationships. Recent advances in stochastic dynamic network modeling allow these interdependencies to be modeled from data. This methodology is discussed within a context of other mathematical and statistical approaches that have been or could be applied to study the temporal evolution of relationships and behaviors within small- to medium-sized groups. An example model is presented, based on a pilot study of five Oxford House recovery homes, sober living environments for individuals following release from acute substance abuse treatment. This model demonstrates how dynamic network modeling can be applied to such systems, examines and discusses several options for pooling, and shows how results are interpreted in line with complex system concepts. Results suggest that this approach (a) is a credible modeling framework for studying group dynamics even with limited data, (b) improves upon the most common alternatives, and (c) is especially well-suited to complex system conceptions. Continuing improvements in stochastic models and associated software may finally lead to mainstream use of these techniques for the study of group dynamics, a shift already occurring in related fields of behavioral science.

Integrating psychotherapy research with public health and public policy goals for incarcerated women and other vulnerable populations

OBJECTIVE AND METHOD

In this article, I review my research applying interpersonal treatments and interpersonal principles from psychotherapy for major depression and substance use to broader public health goals for incarcerated women and other vulnerable populations.

RESULTS

A public health focus has led me to expand the boundaries of psychotherapy research to include partners such as prisons, parole officers, and bachelor's level providers; behaviors like risky sex; service delivery challenges; and ultimately to research with an eye toward informing policy and advocacy.

CONCLUSIONS

A public health perspective provides context and rationale for conducting sound psychotherapy research; the combination of public health and psychotherapy-specific perspectives can lead to novel research.