Increasing the Effectiveness of Large Group Format CBT via the Application of Practice-Based Evidence

Abstract

Within Primary Care, clients presenting with mental health problems are most likely to report the presence of an anxiety disorder. Referrals to mental health services can result in waiting lists due to the prevalence of individual models of intervention. A service delivery innovation to this organizational impasse has been White's group-based "Stresspac" approach. The current project attempted to increase the effectiveness of such service delivery via the application of practice-based evidence (PBE) guidelines. Clients completed a battery of psychometric tests prior to engaging in and on completion of a six-session group cognitivebehavioural intervention. A satisfaction survey was completed on termination of the group. Two groups were completed, the second of which was conducted using a PBE derived selection criterion. The application of the PBE selection criterion appeared to increase the effectiveness of the intervention provided, with clients in both groups being widely satisfied with the group approach. The active employment of PBE in the design and implementation of services appears to offer the opportunity for increasing the range, format and effectiveness of psychological interventions offered.

Delivering group psychoeducational CBT in Primary Care: Comparing outcomes with individual CBT and individual psychodynamic‐interpersonal psychotherapy

“…Such differences may reflect the style of G-CBT, which places a premium on symptom management and does not emphasize changing interpersonal styles/patterns. Kellett et al (2004) has previously illustrated poor outcomes regarding interpersonal change for psychoeducational group CBT. A possible flaw is the unintentional exclusion of patients from the G-CBT modality with specific or acute difficulties (e.g.…”

“…There is an acknowledged lack of satisfaction data for both the group and the individual treatments conducted. Kellett et al (2004) reported high levels of satisfaction from group psychoeducational participants, but the new White (2005) model has not yet been examined from the perspective of customer satisfaction. It is worth noting that the White (2005) G-CBT model does not emphasize allocation to differing treatments, as has been conducted in the current evaluation.…”

“…A 2‐year follow‐up (White, 1998) illustrated that the improvements noted at 6‐months had been maintained. In terms of clinical effectiveness, Kellett, Newman, Matthews, and Swift (2004) illustrated increased effectiveness in ‘stress control’ groups with clients selected using a BDI total score of less than 27. Using a therapist efficiency score devised by Scott, Straddling, and Greenfield (1995), White (2000) indicated greater clinical efficiency of ‘stress control’ in comparison with individual treatments.…”

“…Critics, such as Daley, Bloom, Deffenbacher, and Stewart (1983), have argued that larger group sizes may be unsatisfactory to clients. Both Butcher and de Clive‐Lowe (1985) and Carson, Cowan, Gill, and Titman (1988) reported that psychoeducational participants typically rate positive satisfaction, while Kellett et al (2004) indicated high levels of satisfaction for ‘stress control’ attendees. Attrition from psychoeducational group CBT can occur at a variety of points: assessment, during the group programme and at follow‐up.…”

The influence of socio-demographic similarity and difference on adequate attendance of group psychoeducational cognitive behavioural therapy

“…The current study suggests three clinical changes that could be acted upon to potentially reduce perceptions of socio-demographic difference and hence improve attendance rates. There is previous evidence that selecting stress control participants based on presenting problem severity can improve outcomes (Kellett, Newman, Matthews & Swift, 2004). The current research suggests that selecting and matching patients based on socio-demographic variables may assist in creating a greater sense of togetherness in the group.…”