Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

Abstract

Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality.Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors.Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders.Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.

A randomized trial of group therapy for resource activation for patients with affective disorder.

“…This corresponds to the results of previous studies, which also reported no direct benefit of resource-oriented interventions on depression (Bolier et al, 2013; Teismann et al, 2011). Nevertheless, other studies have demonstrated an antidepressant effect of group therapies with and without a resource-activating focus (Dinger et al, 2020; Feng et al, 2012; Guhn et al, 2021; Huntley et al, 2012; Liwowsky et al, 2014; Okumura & Ichikura, 2014; Steinert et al, 2017; Troesken & Renneberg, 2019; Victor et al, 2016; Weiner et al, 2018). However, these studies did not always examine samples consisting exclusively of patients with affective disorders or did not include control groups.…”

“…Therefore, the aim of the present study was to conduct a randomized, controlled investigation of a newly developed group therapy for resource activation (GTRA) for patients with affective disorders. The group setting was viewed as particularly suitable for resource activation because group therapies have proven to be effective for the treatment of inpatients with depression (Dinger et al, 2020; Guhn et al, 2021; Liwowsky et al, 2014; Weiner et al, 2018), achieve comparable effect sizes to individual therapies (Cuijpers et al, 2006; McDermut et al, 2001), and offer the advantage that several patients can benefit from therapeutic interventions at the same time. Moreover, group interventions for supporting interactive and pleasurable experiences should specifically contribute to the satisfaction of basic needs (especially bonding and pleasure), which promotes the activation of resources (Grawe & Grawe-Gerber, 1999).…”

The Effectiveness of Group Psychotherapy on Reducing Anxiety and Depression Symptoms in Adolescents

“…Similar findings were obtained in a previous study, which found that after receiving psychotherapy intervention, adolescents with depressive disorders reported higher psychological well-being and self-esteem than those in the control groups [12]. Research in Iran reveals group psychotherapy significantly increases the level of hope in patients with major depressive disorder [13].Qualitative research conducted by Guhn et al, showed that respondents reported five main benefits of group therapy: Gains in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality [14]. In several study, it was found that therapy in emotional adjustment and emotion regulation reduces the self-harming acts and improves the regulation of both negative and positive emotions in people, especially adolescents who are exposed to multiple negative emotions.…”

CBASP – eine evidenzbasierte und praxisorientierte Einführung

“…Misst man die Wirksamkeit von CBASP nicht an der Reduktion der depressiven Kernsymptome, sondern an der Reduktion der mit der Diagnose einhergehenden Funktionseinschränkungen, so lassen sich zum derzeitigen Stand der Forschung folgende Ergebnisse resümieren: ▪ Prälogisches Denken: Eine Verbesserung des präoperatorischen Denkens erwies sich in einer 8-wöchigen Beobachtungsstudie als der wichtigste Prädiktor für einen Erfolg von CBASP [3] Verhaltensweisen und eine Abnahme feindseligsubmissiver Verhaltensweisen im Therapieverlauf [37], die ebenfalls mit einer Reduktion der Kernsymptomatik in Verbindung gebracht werden konnte [38,39]. Darüber hinaus berichten Personen nach einer Behandlung mit CBASP über eine größere Zunahme sozialer Problemlösefertigkeiten als nach Supportiver Therapie [40] und nach Behavioral Activation [41].…”

“…In einer qualitativen Datenerhebung zur Wirksamkeit von Situationsanalysen im Gruppensetting gaben Patient*innen einen Zuwachs an Sozialkompetenz, ein vermehrtes Selbstbewusstsein, eine erhöhte Selbstreflektion und ein gestiegenes Verständnis für interpersonelle Beziehungsdynamiken an [39].…”