Background: Although skills of will (volitional competences), such as self-motivation or emotion regulation, are particularly necessary for patients with psychiatric and psychosomatic disorders, it is unknown whether volitional deficits can be reduced and thereby the efficacy of psychotherapy increased. We investigated the effect of a group therapy for improving volitional competence in an inpatient rehabilitation program. Methods: In a controlled clinical trial, patients from a rehabilitation clinic participated either in the volition group therapy in addition to the standard cognitive behavioral therapy (volition group, VG) or in the standard cognitive behavioral therapy (standard group, SG). Patients were tested for volitional competence, depressive symptoms, total psychiatric symptomatology, and physical complaints prior to, at the end of inpatient therapy and after 6 months of follow-up (n = 242). Results: At the end of inpatient therapy, better improvement in volitional competence was observed in the VG than in the SG [e.g. self-motivation: effect size (ES) 0.96 vs. 0.39; ANCOVA: F(1, 209) = 16.58; p < 0.001]. Patients with greater volitional improvements had a better rehabilitation outcome. In the VG, depressive symptoms as well as total psychiatric symptomatology decreased significantly more than in the SG [ES: 1.18 vs. 0.87, F(1, 207) = 4.68, p < 0.05, and ES 1.12 vs. 0.73, F(1, 205) = 4.68, p < 0.05, respectively], but not physical complaints [ES: 0.62 vs. 0.48, F(1, 207) = 1.08, n.s.]. Conclusions: Effect size increased in patients with initially low volitional competence and high motivation to participate in a volitional training. These results might lead to a more systematic assessment and training of volitional competence.

It is still an open question whether psychotherapists adhere to their therapeutic conceptions in routine practice (clinician's treatment adherence) and thus to what extent the two most common approaches, cognitive-behavioural (CBT) and psychodynamic therapy (PDT), differ from each other as theoretically expected (treatment differentiation). This holds true especially in case of group therapy.The study compares essential process components of CBT and PDT group treatments under clinically representative conditions using non-participating observer ratings. Results demonstrate that CBT group therapists use more cognitive, behavioural and psychoeducational strategies, foster self-efficacy to a larger extent and are more supporting and empathetic. PDT group therapists use more interpretative and confrontative interventions and focus on interactional and dynamic aspects. The results strongly support that not only in individual psychotherapy-as shown in prior research-but also in the group setting do CBT and PDT reveal very distinct profiles and that therapists primarily abide by their theoretical training also in clinical practice. They allow one to identify differential process components of the group setting and to trace back parameters of outcome to the process of CBT and PDT for clinical routines.

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