Offering support to the general public by building CBT-based life skills: lessons learnt from an initial evaluation

AimsCognitive behavioural therapy (CBT) is effective for symptoms of mild to moderate depression yet access to such therapy is frequently limited. An alternative to traditional ways of delivering CBT is lower intensity methods based on self-help principles, using written CBT resources, in a group or class setting. Aware, the Irish National charity providing support to people experiencing depression, has implemented a 6-week CBT-based group programme which has been independently evaluated to demonstrate its effectiveness using quantitative and qualitative measures.

METHOD

Two outcome measures (the Patient Health Questionnaire - PHQ-9, and Generalised Anxiety Disorder - GAD-7) were completed and analysed using a matched pairs t-test in respect of all participants at three intervals across the programme. Qualitative feedback was also sought upon completion of the course and offered insight into significant change and individual impact of the programme.

RESULTS

A total of 2289 individuals nationwide registered for the programme through the Aware website with 1885 completing the 6 weeks. There was an average attendance of 67% for the 6-week programme. Statistically significant reductions in terms of scores of depression and anxiety were seen upon completion but earlier trends towards improvement were noted.

CONCLUSION

Completion of a 6-week Life Skills Programme has been associated with a reduction from moderately severe to mild scores in relation to both depressive and anxiety symptoms. Longitudinal follow-up will be required to determine if the effectiveness of the intervention is maintained but CBT-based group programmes may represent a useful alternative to traditional services to treat clinically significant depression.

Special Section: Contemporary Challenges for Research in Group Analysis

In this paper, I underline the challenges for group-analytic research by demonstrating the immense difference in the amount of research done in group psychotherapy in general as compared to group analysis. After presenting an overview of findings from empirical, quantitative outcome studies in group psychotherapy at large, I will discuss some trends in contemporary group psychotherapy research, and finally, I will give a rough sketch of group-analytic research. I will focus on quantitative research and I will see group analysis as a clinical enterprise - a theory, model, art and craft that has been developed and can be used to treat psychiatric disorders, and toameliorate psychological problems.

Group therapy in public mental health services: approaches, patients and group therapists

Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration <6 or >12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed.