Evidence on the Effectiveness of Group Therapy

Everything you ever wanted to know (and more!) about evidence-based practice in group psychotherapy is now available in the form of the authoritative chapter on the subject - Gary M. Burlingame, Bernhard Strauss and Anthony S. Joyce’s "Change Mechanisms and Effectiveness of Small Group Treatments" which appears in the Bergin and Garfield Handbook of Psychotherapy and Behavior Change edited by Michael J. Lambert, © 2013 and is reproduced here with permission of John Wiley & Sons, Inc.  This is a "must read" for all teachers, supervisors, practitioners and researchers in the field!

Change Mechanisms and Effectiveness of Small Group Treatments 

During the last 30 years, studies have shown the growing benefits of group psychotherapy in a number of areas of life challenges.  Through groups, individuals find a forum of peer support, gaining strength as they share their feelings and experiences with others who are facing the same obstacles as themselves.  Some gain strength in seeing the resourcefulness of those in the same situation, while others renew their feelings of self-worth through assisting others.

During the group process, people develop a support network through each other -- no longer feeling isolated by their condition and gaining a greater sense of normalcy.  With certain medical conditions, group psychotherapy can contribute to general improvement in one’s psychosocial functioning.  Research also has shown that survival rates have, in some cases, actually increased, with proper therapy.  Research has demonstrated that various forms of group psychotherapy are equally beneficial with positive results found across the board for a variety of disorders.  Group therapy is also cost-effective when compared to individual treatment.  When a therapist’s time is spent with an entire group instead of one person, the expense for individuals is significantly reduced while the benefits remain and, in some instances, prove to be even greater. 

WHO CAN BENEFIT FROM GROUPS:

Addictions and Substance Abuse

Support for group therapy as an essential element of substance abuse and addiction treatment is unequivocal and overwhelming. It is rare -- if not impossible -- to find any treatment program in this country that does not utilize group therapy as a crucial component of its treatment regimen. Recommendations from expert clinical practice guidelines and best research evidence all indicate that it is vital that group therapy remain a staple of substance abuse and addiction treatment. Enthusiastic collaboration from directors of training and Federal guidelines from the National Institute of Drug Abuse (NIDA) and the National Institute of Alcoholism and Alcohol Abuse (NIAAA) have resulted in the mandate that group therapy be a part of every substance abuser’s treatment. While therapeutic efficiency and cost-effectiveness play an increasingly important role in the utilization of group therapy as the treatment of choice for this population, there are other distinctive features and advantages of group treatment. Over the last twenty years, a general consensus has emerged that group treatment provides a number of unique opportunities for substance abusers to learn about themselves and alter their abuse of substances.

Some of the advantages of group therapy include:

1.   mutual identification with and acceptance from others going through similar problems as they learn they are not alone or unique as they struggle with their compulsive use of substances,

2.   positive peer support with the abstinence or reduction of substance use,

3.   role modeling for abstinence or reduction of substance use is enhanced because the substance abuser has the opportunity to better understand their own attitudes about substance use and their defenses against giving up or reducing substance use by confronting similar attitudes and defenses in others,

4.   affiliation, cohesiveness, social support while learning to identify and communicate feelings more directly,

5.   structures, discipline and limit setting while permitting experiential learning and exchange of factual information about recovery and drug use,

6.   installation of hope, inspiration for the future and the pursuit of shared goals and ideas.

Cancer Patients

Many cancer patients have witnessed positive results with group therapy.  For patients in the early stages, group therapy helps them deal with their illness in a multitude of ways.  For instance, as emotional distress decreases, a person’s social activity, coping and self-esteem has increased.  For those in more advanced stages, people have not only gained a greater sense of purpose in life but have also found pain and fatigue to become less of a problem.  When those who are unaware or in denial take part in therapy, their deterioration is often lessened, while improvements are enhanced for those already aware of their condition.  People who are limited in social and personal resources find group psychotherapy can lead to greater benefits.  More compellingly, studies support the value of long-term interactive groups for those with advanced cases of widespread disease.  In the case of breast cancer, for example, patients in a group psychotherapy test survived significantly longer than those in the control conditions.  Additionally, members of cancer support groups notice a reduction in their amount of pain and stress-related physical problems. 

HIV/AIDS Patients

HIV/AIDS patients undergoing group psychotherapy have reported lower levels of stress and burnout as well as improvements in their physical condition as well as greater self-efficiency and hardiness.  For homosexual men suffering from depression, group therapy often provides improvements in psychiatric symptoms.  With adolescents, self-esteem has increased while behavioral problems, distress and family stressors have often decreased.  Patients who participated in Cognitive Behavioral Stress Management groups noticed reductions in depression, anxiety and self-reported healthcare visits. 

Character Disorders

Intense group psychotherapy sessions have yielded significant results for people with character disorders.  As patients improve interpersonal skills, mood control and self-esteem, dysfunction levels in social and family situations, along with the severity of their disturbance can diminish, leading to an overall improvement in life satisfaction.  Group psychotherapy also has helped reduce depression and suicidal tendencies in some instances of personality disorders.  Improvement has been shown through working in a variety of different groups and situations, giving patients the opportunity to work with a large number of peers and staff.  In such circumstances, patients show improvement solely from group therapy, without having individual treatment. Further, once patients are involved in therapy they may be more apt to experience a reduction in symptoms particular to their specific disorder.

Depression & Grief

Group psychotherapy is also used to help treat people with depression.  For example, women who have suffered the loss of a child have reduced their amount of grief and post-traumatic stress syndrome through group.  Surrounding themselves with a peer group helps women heal and regain a sense of hope.  Likewise for single depressed mothers, participants can increase their self-esteem and function better within their families with the right support.

Eating Disorders

Eating disorders are also treated by group.  In the case of bulimia nervosa some group participants have been able to reduce the amount of bingeing and purging with even greater benefits resulting from earlier interventions and more intensive therapy. Overall, eating behavior has been shown to improve while simultaneously reducing anxiety and depression.

Youth Violence

Youth violence is a disturbing trend.  As violence has risen in our schools, prevention methods are being sought to prevent young people from such detrimental behavior.  By bringing versions of group therapy into the classroom, students are shown how to avoid aggressive behavior and its consequences.  In studies where youths previously involved in violence took part in group therapy, a significant reduction was seen in aggressiveness and in subsequent arrests; academic performance also was shown to improve.  With early intervention and active discussion about violence, many students can learn how to curb violent tendencies and interact more normally with others.

REFERENCES:

GROUP WORKS

1.     Leszcz. M. & Goodwin, P.J. (1998) The Rationale and Foundations of Group Psychotherapy for Women with Metastatic Breast Cancer.  In Sherman, Mosier, Burlingame et. al.Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York: American Group Psychotherapy Association, p. 3.

2.     Simonton, S. & Sherman, A. (2000) An Integrated Model of Group Treatment for Cancer Patients.  In Piper, E. & Ogrodiczuk, J.S.  Brief Group Therapy, p. 10.

3.     Spiegal, D. et. al. (1989) Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer.  In Sherman, Mosier, Burlingame et. al. Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York: American Group Psychotherapy Association, p. 70.

4.     Fuhriman, A. & Burlingame, G.M. (1994).  Group Psychotherapy: Research and Practice. Piper, E. & Ogrodiczuk, J.S., Brief Group Therapy, p. 2.

5.     McRoberts, C. et. al. (1998) Comparative Efficacy of Individual and Group Psychotherapy. In Piper, E. & Ogrodiczuk, J.S., Brief Group Therapy, p. 3.

6.     Tschuschke, V., et. al. (1999) Gruppentherapie Versus Einzeltherapie [Group Versus Individual Psychotherapy – Equally Effective?] in Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 38.

ADDICTIONS AND SUBSTANCE ABUSE

1.     Brook, D. W. (2008). Group therapy. In M. Galanter & H.D. Kleber (Eds.),  The American Psychiatric Publishing textbook of substance abuse treatment. (4th ed.; pp.1413-1427). Arlington, VA: American Psychiatric Publishing, Inc.

2.     Brook, D. W., & Spitz, H. I. (Eds.). (2002). The Group Therapy of Substance Abuse. New York: Haworth Medical Press.

3.     Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) 41. DHHS Publication No SMA (05-3991). Rockville, MD: Substance Abuse and Mental Health Services Administration.

4.     Flores, P. J. (2004). Addiction as an attachment disorder. Lanham, MD: Jason Aronson.

5.     Flores, P. J. (2007).Group psychotherapy with group populations: An integration of 12 Step and psychodynamic theory (3rd ed.). Binghamton, NY: Haworth Medical Press.

6.     Khantzian, E. J., Halliday, K. S., & McAuliffe, W. E. (1990). Addiction and the vulnerable self. New York: Guilford Press.

7.     Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 58, 7-29. 

8.     Roth, J. (2004). Group psychotherapy and recovery from addiction: Carrying the message. New York: Haworth Press.

9.     Vannicelli, M. (1992) Removing the Roadblocks: Group Psychotherapy with Substance Abusers and Family Members. New York:  Guilford Press

10.   Vannicelli, M. (1989) Group Psychotherapy with Adult Children of Alcoholics: Treatment Techniques and Counter transference Considerations.  New York: Guilford Press

11.     White, W. L. (2008). Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices. Produced under grants and contracts funded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Center for Substance Abuse Treatment, 5600 Fishers Lane, Rockwall II, Suite 618, Rockville, MD 20857, 301-443-5053 and the Philadelphia Department of Behavioral Health/Mental Retardation Services.

12.   Washton, A. M. (2004). Group therapy with outpatients. In J. H. Lowinson, P. Ruiz,  R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook(4th ed).; (pp. 671-680). Philadelphia: Lippincott Williams & Wilkens.

13.   Weiss, R. D., Jaffee, W. B., de Minil, V. P., et al. (2004). Group therapy for substance use disorders: What do we know? Harvard Review of Psychiatry; 12, 339-350.

CANCER

1.     Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 10.

2.     Evans, R.L. & Connis, R.T. (1995) Comparison of Brief Group Therapies for Depressed Cancer Patients Receiving Radiation Treatment. and Fawzy et. al (1990a) A Structured psychiatric intervention for cancer patients. I. Changes Over Time In Methods Of Coping and Affective Disturbance. In Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness. by  Sherman, A. C., Burlingame, G.M., Cleary, T. et. al. New York:  American Group Psychotherapy Association, p. 8.

3.     Helgeson, V.S. et. al (1999) Education and Peer Discussion Group Interventions and Adjustment to Breast Cancer and Samerel, N. et. al.  (1997) Effect of Support Groups with Coaching on Adaptation to Early Stage Breast Cancer in Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness. by  Sherman, A. C., Burlingame, G.M., Cleary, T. et. al. New York:  American Group Psychotherapy Association, p. 8.

4.     Fawzy et. al., 8.

5.     Edelman, S. et. al. (1999a) Group CBT Versus Supportive Therapy with Patients with Have Primary Breast Cancer. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 8.

6.     De Vries, M. J. et. al.  (1997) Phase II Study of Psychotherapeutic Intervention in Advanced Cancer.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 9.

7.     Goodwin, P.J. et. al. (2001)  The Effect of Group Psychosocial Support On Survival in Metastatic Breast Cancer.,  Spiegal, D.  & Bloom, J.R.  (1993)  Group Therapy and Hypnosis Reduce Metastatic Breast Carcinoma Pain., and Spiegal, D. et. al.  (1981)  Group Support for Patients with Metastatic Cancer. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p.  9.

8.     Forester, B. et. al. (1993)  Group Psychotherapy During Radiotherapy:  Effects on Emotional and Physical Distress. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 29.

9.     Antoni, M.H. et. al. (2001) Cognitive-Behavioral Stress Management Intervention Decreases the Prevalence of Depression and Enhances Benefit-Finding Among Women Under Treatment for Early-Stage Breast Cancer, Helgeson, V.S. et. al. (2000) Group Support Interventions for Women with Breast Cancer: Who Benefits From What?. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 35.

10.   Spiegal, D. et. al., (1981) Group Support for Patients with Metastatic Cancer.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 9.

11.   Spiegal, D. et. al. (1989) Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 70.

12.   Goodwin, et. al. , 10.

HIV/AIDS

1.     Chesney, M. et. al. (1996)  Coping Effectiveness Training for Men Living with HIV.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 17.

2.     Auerbach, J.E. et. al. (1992) A Behavioral Medicine Intervention as an Adjunctive Treatment for HIV-related illness, and Gifford et. al. (1998).  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 17.

3.     Gifford, et. al., 17.

4.     Auerbach, J.E. et. al., 17.

5.     Kelly, J.A., (1993) Outcome of Cognitive-Behavioral and Support Group Brief Therapies for Depressed, HIV-Infected Persons.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 12.

6.     Rotheram-Borus, M. J. et. al. (2001)  An Intervention for Parents with AIDS and Their Adolescent Children.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 18.

7.     Antoni, M.H. et. al. (1991) Cognitive-Behavioral Stress Management Buffers Distress Responses and Immunologic Changes Following Notification of HIV-1 Seropositivity. In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association: 72, and Lutgendork, S.K, (1997) Cognitive-Behavioral Stress Management Decreases Dysphoric Mood and Herpes Simplex Virus-Type 2 Antibody Titers in Symptomatic HIV-Seropositive Gay Men.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 75.

8.     Antoni, M.H. et. al., 72.

9.     Goodkin, K. et. al. (1998) A Bereavement Support Group Intervention Is Longitudinally Associated with Slutary Effects on the CD4 Cell Count and Number of Physician Visits.  In Sherman, A. C., Burlingame, G.M., Cleary, T. et. al.  Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York:  American Group Psychotherapy Association, p. 75.

CHARACTER DISORDERS

1.     Piper, W.E., Rozie, J.S., Azim, H. F. A.  & Joyce A.S., (1993) A Randomized Trial of Psychiatric Day Treatment for Patients with Affective and Personality Disorders.  In Piper, E. & Ogrodiczuk, J.S.  Brief Group Therapy, p. 17. 

2.     Linehan, M.M. et. al. (1991) Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients., Linehan, M. M. et. al. (1993) Naturalistic Follow-Up of a Behavioral Treatment of Chronically Parasuicidal Borderline Patients., Linehan, M. M. et. al. (1999) Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug Dependence., and Munroe-Blum, H. & Marziali, E. (1995) A Controlled Trial of Short-Term Group Treatment for Borderline Personality Disorder. In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 38. 

3.     Piper, W.E. & Rosie, J.S. (1998) Group Treatment of Personality Disorders: The Power of the Group in the Intensive Treatment of Personality Disorders.  In Piper, E. & Ogrodiczuk, J.S.  Brief Group Therapy, p. 15.

4.     Piper, W.E., Rosie, J.S., Joyce, A.S., & Azim, H.F.A. (1996) Time-Limited Day Treatment for Personality Disorders. In Piper, E. & Ogrodiczuk, J.S.  Brief Group Therapy, p. 16.

5.     Eckert, J. & Wuchner, M. (1996) Long-Term Development of Borderline Personality Disorder., McCallum, M., Piper, W.E.., & O’Kelly, J.G. (1997) Predicting Patient Benefit From a Group Oriented Evening Treatment Program., and Wilberg, T. et. al. (1998) Outpatient Group Psychotherapy: A Valuable Continuation Treatment for Patients with Borderline Personality Disorder Treated in a Day Hospital. In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p.  38. 

DEPRESSION & GRIEF

1.     Murphy, S.A., (1997)  A Bereavement Intervention for Parents Following Sudden, Violent Death of their 12-28 Year-Old Children: Description and Applications to Clinical Practice.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 14. 

2.     Yalom, I.D.,  (1995) The Theory and Practice of Group Psychotherapy. In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 14. 

 EATING DISORDERS

1.     Burlingame, G.M., Fuhriman, A., & Mosier, J. The Differential Effectiveness of Group Psychotherapy: A Meta-Analytic Perspective.  Salt Lake City, Utah: Brigham Young University, p. 13.

2.     Davis, R., Olmsted, M.P., & Rockert, W. (1990)  Brief Group Psychoeducation for Bulimia Nervosa: Assessing the Clinical Significance of Change., Peterson, C. et. al. (1998) Group Cognitive-Behavioral Treatment of Binge Eating Disorder: A Comparison of Therapist-Led Versus Self-Help Formats., and Wilfley, D.E. et. al. (1993)  Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Nonpurging Bulimic Individual: A Controlled Comparison.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change,  p. 22. 

3.     Mitchell, J.E., et. al. (1993) Cognitive-Behavioral Group Psychotherapy of Bulimia Nervosa:  Importance of Logistical Variables.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 23. 

4.     Mitchell, J.E. et. al. (1990) A Comparison Study of Antidepressants and Structured Intensive Group Psychotherapy in the Treatment of Bulimia Nervosa.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p.  23. 

YOUTH VIOLENCE

1.     Goldstein, A.P. et. al. (1989) Reducing Delinquency:  Intervention in the Community.  In Aronson, S. and Schamess, G.  The Role of Group Psychotherapeutic Interventions in Youth Violence Reduction and Primary Prevention – A White Paper.  New York:  The American Group Psychotherapy Association, p. 31.

2.     Aronson, S. and Schamess, G.  The Role of Group Psychotherapeutic Interventions in Youth Violence Reduction and Primary Prevention – A White Paper.  New York:  The American Group Psychotherapy Association, p. 33.

3.     Twemlow, Fonagy, et. al. (1999). In Aronson, S. and Schamess, G.  The Role of Group Psychotherapeutic Interventions in Youth Violence Reduction and Primary Prevention – A White Paper.  New York:  The American Group Psychotherapy Association, p. 31.

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