Predictors of social identification in group therapy

Development of a group-based behaviour change intervention for people with severe obesity informed by the social identity approach to health

INTRODUCTION

Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity.

METHODS

A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere.

RESULTS

A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity.

CONCLUSIONS

A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.

Unveiling the psychological mechanisms of mutual help groups for addiction recovery: The role of social identity factors

The effectiveness of mutual help groups (MHGs) in promoting addiction recovery has been widely acknowledged. However, the psychological mechanisms underlying the impact of MHGs remain somewhat uncertain. Drawing on a social identity perspective, this study investigated a sequential mediation model in which social support is posited as a driving factor that enhances abstinence maintenance through group identification, recovery identity, and self-efficacy. A sample of 820 smokers, participating in a 6-month collective smoking cessation programme which included access to an online help group, completed measures of social support, group identification, smoker/ex-smoker identity, and self-efficacy at the programme's outset. Smoking abstinence was assessed 6 and 9 months later. The findings supported the proposed model, indicating that social support was positively associated with MHG identification, which, in turn, was related to a stronger recovery identity. Subsequently, recovery identity was associated with increased self-efficacy, and indirectly, with smoking abstinence at both measurement times. Additional analyses testing alternative mediation models further supported the validity of the proposed model. These findings suggest that social identity factors play significant roles in accounting for the effectiveness of MHGs for addiction recovery.

Understanding and Improving Athlete Mental Health: A Social Identity Approach

Understanding and positively influencing athlete mental health have become key goals for researchers and sporting stakeholders (e.g. coaches, support staff, clubs and governing bodies). In this article, we outline a novel perspective for tackling these challenges, drawing on an influential theory of group processes. This social identity approach can, we argue, help explain when and why the characteristics and demands of sport, which is typically a collective endeavour, pose a threat to athlete mental health and provide a guiding framework for efforts to protect and enhance athlete mental health. Here, we seek to illustrate the value of a social identity analysis of athlete mental health through three key points that speak to its analytical and practical value. Specifically, we propose: (1) that social identities can act as psychological resources that support athlete mental health, (2) that social identities are critical to athlete mental health during and after sporting transitions and (3) that leadership informed by a social identity approach can facilitate athlete mental health. With a view to maximising the value of our analysis both for those working with athletes and for researchers, we also identify practical steps that relevant stakeholders could take to support athlete mental health, and key avenues for future research to further test our propositions and advance understanding. Our analysis provides a new lens through which all those invested in understanding and supporting athlete mental health can approach these challenges, and a foundation for novel solutions.

PROTOCOL: Group-based interventions for posttraumatic stress disorder: A systematic review and meta-analysis of the role of trauma type

This is the protocol for a Campbell systematic review. The primary objective is to assess the effects of group-based treatments on posttraumatic stress disorder (PTSD) symptomology in people diagnosed with PTSD (by a clinician or screening instrument) or referred to a PTSD treatment group for their symptoms by a medical professional. We will also examine a range of moderators that may affect the efficacy of group-based treatments, including the nature of the trauma (interpersonal, stigmatized) and the group fit (in terms of gender and shared vs. unshared trauma). Further, we will also explore what, if any, group-based and social identity factors are recorded and how they relate to PTSD outcomes.

The group mechanism in treatment: group identification and cohesion contributes to reducing chronic lower back pain by increasing personal control

PURPOSE

There is increasing recognition of the contribution that group processes, particularly identification and cohesion, make to outcomes of group delivered health treatments. This study examined the role that these particular group processes play in the treatment of lower back pain, and a theorised mechanism of personal control through which group treatment might enhance outcomes.

METHODS

Participants (N = 85) elected to either receive NeuroHAB^®, a defined functional movement therapy of 8 weeks duration, or continue with treatment-as-usual (TAU). Pain intensity and disability were assessed at baseline (T1) and post-intervention or 8 weeks later (T2), as well as at a 1-month follow-up (T3). Only the NeuroHAB^® participants additionally completed weekly questionnaires that measured treatment group identification, cohesion, and personal control.

RESULTS

NeuroHAB^® was significantly more effective than TAU in reducing pain intensity and disability at T2 and T3. Furthermore, among NeuroHAB^® recipients, stronger treatment group identification and cohesion early in the program predicted better pain outcomes over time, and this relationship was fully mediated by perceptions of personal control.

CONCLUSION

These data provide further support for the role of group identification and cohesion as a contributing mechanism of change in group-based treatments and extend this to the domain of pain management.Implications for RehabilitationA focus on defined functional movement therapy, as offered by the NeuroHAB^® group program, was found to improve pain outcomes in patients with lower back pain.A key ingredient in the NeuroHAB^® rehabilitation program was its group delivery.Group delivery supported treatment group identification and cohesion which, through enhancing the perception of personal control, reduced pain intensity and disability.

Aspirational leaders help us change: Ingroup prototypicality enables effective group psychotherapy leadership

OBJECTIVES

Research suggests that leaders are effective when they are ingroup prototypical (represent the identity of the group they seek to lead). However, it is unclear whether leaders should represent the group's current identity ("who we are") or aspired identity ("who we want to be"). This study investigated which of these forms of prototypicality best predicted leadership effectiveness in group psychotherapy.

DESIGN

Longitudinal study.

METHODS

519 questionnaire responses were obtained from 112 women attending a four-session body acceptance program. Focal measures included participant ratings of how often they thought their psychotherapy leaders and fellow group members would (a) engage in dieting thoughts and behaviours and (b) approve of dieting. Given the program's body acceptance focus, leader prototypicality was conceptualized as the difference between participants' perceptions of how often their leaders, versus group members, would diet at the start of therapy. Leadership effectiveness was conceptualized as reductions in perceived group approval of dieting across therapy. Two therapeutic outcomes were considered: body satisfaction and dieting intentions.

RESULTS

A mixed-effects repeated measures analysis indicated that group approval of dieting decreased more rapidly when participants perceived their leaders to be aspirational (thought that group leaders dieted less frequently than group members) than when they perceived them to be exemplary (thought that group leaders dieted as frequently as group members). Changes in group approval of dieting mediated the relationship between leader prototypicality and improved therapeutic outcomes.

CONCLUSIONS

Findings suggest that group psychotherapy leaders may increase their effectiveness by striving to embody their group's aspired identity.

Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health

Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program's wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings >7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was >5/7. Retention was >80%. Homework completion was high, with <10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.

Double jeopardy: How lower levels of support during COVID-19 exacerbated the relationship between loneliness and distress

While the relationship between loneliness and psychological distress is well documented, the mechanisms underlying this relationship are less clear. One factor known to be related to loneliness as well as psychological distress, is social support, with some studies suggesting that support-both received and provided-can serve as a mechanism to reduce the distress associated with loneliness. In this paper we examine the mediating role of both aspects of support in the relationship between loneliness and psychological distress in the COVID-19 context. We used a multi-country dataset collected at two timepoints during the pandemic; the first during the early stages (N = 6,842, 11 countries) and the second collected for a subset of countries (N = 1,299, 3 countries) 3 months later. Across all eleven countries, results revealed significant positive associations between loneliness and distress. Furthermore, using longitudinal data, we investigated the directionality of this relationship and found that increased loneliness over time was associated with increased psychological distress. The data also showed that both feeling unsupported and feeling unable to provide support to others mediated this relationship. These findings point to the need to facilitate people's ability to draw effective social support and help others-particularly at times when social connectedness is threatened-as a way of alleviating the psychological distress that commonly presents with loneliness.

Social identity makes group-based social connection possible: Implications for loneliness and mental health

This review argues that a distinctly positive form of social connection is made possible by the social identities that people derive from psychologically meaningful group memberships. These connections have important implications for mental health by virtue of their distinct capacity to furnish people with a sense of collective meaning, purpose, support, and efficacy. This analysis suggests that loneliness and its toxic effects arise in part from the challenges of achieving this distinct form of social connection in contemporary society. However, it also suggests that a good way to tackle loneliness and support mental health is by building, restoring, and sustaining social identities through meaningful group-based connections. We conclude by reflecting on the success of interventions that do precisely this - most notably Groups 4 Health.

"It's Not the Same": A Comparison of the Psychological Needs Satisfied by Musical Group Activities in Face to Face and Virtual Modes

According to the social identity approach to health, group memberships influence people’s mental health to the extent that they identify with their group. Emerging evidence suggests that music groups, such as choirs, enhance mental health via group identification and the satisfaction of various psychological needs; however, more research is required to understand these processes in other types of music groups. Furthermore, the coronavirus disease 2019 (COVID-19) social distancing restrictions in 2020 prevented music groups from meeting face to face (F2F). Some music groups adapted virtually, but the rate of adaptation of various music activities is unknown, as is the impact of such adaptations on participants’ group identification, psychological need satisfaction, and mental health. We explored these questions using a cross-sectional survey with 257 participants (M_age = 46 years, 78% female) of singing (n = 172), instrumental (n = 48), and dance groups (n = 37). Participants rated group identification and psychological needs satisfaction retrospectively for their music group in F2F mode and then for the group in adapted mode, along with mental health 12-item short form health survey (SF-12). Results showed that instrumental groups (60%) were less commonly adapted to virtual mode than singing (83%) and dance (86%) groups. Group identification and average psychological needs satisfaction (M = 4.04 and 3.50 out of 5) scores were significantly lower for groups in virtual mode than in F2F mode (M = 4.53 and 4.14, respectively). Psychological needs satisfaction did not mediate the relationship between group identification and SF-12 mental health. Despite this, values on group identification and psychological need satisfaction remained high, which suggests that virtual music groups may be beneficial during the COVID-19 pandemic and in contexts where F2F groups are less accessible.

'Oh no, not a group!' The factors that lonely or isolated people report as barriers to joining groups for health and well-being

OBJECTIVES

Belonging to groups can significantly affect people's health and well-being for the better ('the social cure') or worse ('the social curse'). Encouraging people to join groups is a central component of the Social Prescribing movement; however, not everyone who might benefit from Social Prescribing aspires to participating in groups. This study aims to identify what barriers are preventing people from experiencing the associated health and well-being benefits of group belonging.

METHOD

Semi-structured interviews analysed using reflexive thematic analysis. Participants were 11 white British people (aged 48-86), 1 male and 10 female, recruited by a charity partner of a Social Prescribing project.

RESULTS

The themes derived from the interviews are as follows: (1) 'The dread, the fear of being in a group': When groups do not meet needs; (2) 'I can remember as quite a young child backing out of things': Accumulative barriers over the lifetime, and (3) 'I'm singing away and feeling terribly miserable': the challenges of fitting in with others in groups. The themes reflect how people can feel deterred from social interaction, which interferes with their ability to derive a sense of belonging or shared identity associated with the 'social cure'.

CONCLUSIONS

A key challenge for Social Prescribing is to meet the social needs of people disinclined to join groups; groups can be detrimental to health and well-being if there are barriers to integration. Alternative ways of structuring groups or activities may be more effective and can still avail of the belonging and identity associated with 'the social cure'.

Growing into "Us": Trajectories of Social Identification with College Sport Teams Predict Subjective Well-Being

BACKGROUND

Groups are often a source of social identification that may elicit subjective well-being. When joining and maintaining membership of groups such as sport clubs, it is anticipated that members will experience varying trajectories of identification strength, but it is unclear how these trajectories may relate to well-being.

METHOD

Participants were 697 college students (64% female), nested within 35 club-level sport teams. The current study longitudinally assessed students' social identification with sport teams at three timepoints (3-month lags) across a school year to examine the extent that growth trajectories in identification strength predicted indices of well-being (i.e. life satisfaction, happiness, and subjective health) at the end of the school year.

RESULTS

Multilevel latent growth modeling revealed that end-of-year well-being was positively predicted by social identification intercepts (b = .24, p = .010) and growth trajectories (b = .75, p < .001). Accounting for baseline identification, steeper increases in social identification (upward trajectories) predicted greater well-being.

CONCLUSIONS

Findings support established theory that social identification relates to well-being, while adding novel insights that students may experience unique benefits when their social identity strengthens over the course of a school year. Considering recent declines in college student well-being, groups like sport teams represent a source for social identification that should be fostered throughout the course of one's group membership.

The recovery model in chronic mental health: A community-based investigation of social identity processes

The recovery model has been enormously influential in shaping mental health services globally over the last two decades. However, empirical research on its outcomes and psychological mechanisms is sparse. This community-based case study utilised both semi-structured qualitative interviews and quantitative survey methods to investigate perceptions of recovery, identity, and wellbeing among people with chronic and severe mental illness attending recovery-oriented support groups. Consistent with a social identity approach and the recovery model, to the extent that people identified as "in recovery", they reported better recovery outcomes (e.g., sense of purpose) and reduced psychological distress. Furthermore, recovery identity more strongly predicted recovery outcomes than it did psychological distress. Both the quantitative and qualitative data pointed to collective efficacy (i.e., group-based empowerment) as a key mediator of these outcomes. These findings are consistent with the recovery model and speak to the utility of a social identity approach for conceptualizing its efficacy. However, these findings also speak to the need for further evaluation of how and when recovery-oriented mental health services achieve their intended goal of improving quality of life for people with chronic and severe mental illness.

Social identification-building interventions to improve health: a systematic review and meta-analysis

There is growing evidence that social identity processes play an important role in a range of health outcomes. However, we know little about the nature and effectiveness of interventions that build social identification with the aim of promoting health. In the present research, we systematically review and meta-analyze interventions that build social identification to enhance health and wellbeing. A total of 27 intervention studies were identified (N = 2,230). Using a three-level meta-regression, results indicate that social identification-building interventions had a moderate-to-strong impact on health (Hedges g = 0.66; 95%CIs[0.34, 0.97]). Analyses revealed significant variation in intervention effectiveness as a function of its type: group-relevant decision making (g = 1.26), therapy programmes (g = 1.02), shared activities (g = 0.40), and reminiscence (g = -0.05). By contrast, there was much less variation across health outcomes: quality of life (g = 0.80), physical health (g = 0.76), self-esteem (g = 0.69), well-being (g = 0.66), (reduced) anxiety (g = 0.61), (reduced) depression (g = 0.58), cognitive health (g = 0.55), and (reduced) stress (g = 0.49). Finally, speaking to the mechanism of the interventions, interventions tended to be more effective to the extent that they succeeded in building participants' social identification with the intervention group. We discuss the theoretical and practical implications of social identification-building interventions to foster health and outline an agenda for future research and practical application.