Are group size and composition associated with treatment outcomes in group cognitive behavioural therapy for chronic pain?

Wilson, Dianne; Mackintosh, Shylie; Nicholas, Michael K.; Moseley, G. Lorimer; Costa, Daniel; Ashton‐James, Claire E.

doi:10.1097/j.pain.0000000000001144

Cited by 9 publications

(22 citation statements)

References 46 publications

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“…We have previously identified features of group size, age and gender mix, as well as the mix of compensable patients that are associated with outcomes. 7 We have now identified that in two CBT-based pain management programmes that varied in intensity, duration, patient characteristics and certain content, the median baseline scores of catastrophising, depression and fear of movement for a group were not associated with pain-related outcomes. That is, our results suggest that there is no systematic difference in outcomes across the group according to their collective profile when they start.…”

Section: Limitations and Future Directionsmentioning

confidence: 95%

“…For further details of the programme, refer to Nicholas et al 20 Separate data from these participants had been used to test the effect of adherence to self-management strategies 21 and a study on group composition. 7…”

Section: Methodsmentioning

confidence: 99%

“…For example, Williams and Potts 6 reported that patient outcomes were worse during periods of high staff turnover, pointing to an impact of group allocation and staff competence. In addition, Wilson et al 7 found that the group size and the mix of gender, age and compensation status were associated with individual patients’ outcomes from CBT-based pain programmes.…”

Section: Introductionmentioning

confidence: 99%

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Is the psychological composition of the therapeutic group associated with individual outcomes in group cognitive behavioural therapy for chronic pain?

Wilson

Mackintosh

Nicholas

et al. 2019

British Journal of Pain

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This study explored whether the psychological composition of a group, with respect to mood, catastrophising, fear of movement and pain self-efficacy characteristics at baseline, is associated with individuals’ treatment outcomes following group cognitive behavioural therapy (CBT)-based programmes for chronic pain. Retrospective analyses of outcomes from two independently run CBT-based pain management programmes (Programme A: N = 317 and Programme B: N = 693) were conducted. Mixed modelling analyses did not consistently support the presence of associations between group median scores of depression, catastrophising or fear avoidance with outcomes for individuals in either programme. These results suggest that the psychological profiles of groups are not robust predictors of individual outcomes in CBT groups for chronic pain. By implication, efforts made to consider group composition with respect to psychological attributes may be unnecessary.

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Section: Limitations and Future Directionsmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the psychological composition of the therapeutic group associated with individual outcomes in group cognitive behavioural therapy for chronic pain?

Wilson

Mackintosh

Nicholas

et al. 2019

British Journal of Pain

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“…The independent variables were group size and group composition in terms of gender, ethnicity and disability benefits status, and baseline pain intensity and interference, depression, pain acceptance and stigma. The independent group composition variables were selected to replicate and extend elements of the previous work of Wilson et al, 19,20 as discussed. We hypothesised that these variables would be associated with the post-treatment individual level outcomes of pain intensity, pain interference, and depression.…”

Section: Introductionmentioning

confidence: 99%

Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy

Gilpin

Ratanachatchuchai

Novelli

et al. 2022

British Journal of Pain

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Background: Although cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments. Purpose: The aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy. Methods: This was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related, and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes. Results: The ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC=0.04) was not warranted. Group percentage of participants receiving disability 8 benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes. Conclusions: Given the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and counter-therapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.

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“…Empirically, however, there is a lack of evidence to suggest that individuals fare better in groups where other families have similar ethnic and educational backgrounds. The feeling of being similar to others provides a basis for relationship building, increasing group identification, and commitment to group goals (Wilson et al, 2018). However, grouping families based on ethnic or educational backgrounds may risk parents to feel stereotyped, and normalizing experiences may be greater when families see that families with different backgrounds experience similar problems (Mørch et al, 2004).…”

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confidence: 99%

Parenting group composition does not impact program effects on children’s conduct problems.

Leijten¹,

Meij

Weeland³

et al. 2021

Journal of Family Psychology

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Many established parenting programs for children's conduct problems are delivered in groups. Various, and at times conflicting, beliefs exist about whether families fare better in groups with parents that are more similar to them, or in groups that are more diverse. We set out to test these beliefs empirically. We integrated data from four trials of the Incredible Years parenting program in the Netherlands, including 452 families (children age 2-10 years) participating in 44 parenting groups. We used multilevel regression to test whether families benefit more (or less) when they participate in a group with parents that are more similar to them in terms of ethnic background, educational level, and children's baseline conduct problems, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, and emotional problems. In addition, we tested whether relative group position effects were stronger for some families than for others (e.g., whether especially ethnic minority families benefit from groups that are more ethnically diverse). Families with more severe conduct problems benefited more, but they did not fare better (or worse) in groups where other families were more similar to them. Regarding the other group characteristics, families' relative group position did not predict parenting program effects on children's conduct problems. Our findings held across families with different sociodemographic backgrounds and different levels of children's ADHD symptoms and emotional problems. We found no evidence that parenting group composition impacts the effectiveness of the Incredible Years parenting program for children's conduct problems.

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Are group size and composition associated with treatment outcomes in group cognitive behavioural therapy for chronic pain?

Cited by 9 publications

References 46 publications

Is the psychological composition of the therapeutic group associated with individual outcomes in group cognitive behavioural therapy for chronic pain?

Is the psychological composition of the therapeutic group associated with individual outcomes in group cognitive behavioural therapy for chronic pain?

Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy

Parenting group composition does not impact program effects on children’s conduct problems.

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