Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early process and dropping out from short-term group therapy for complicated grief.

Early group process variables were investigated as predictors of dropping out for patients who participated in short-term group psychotherapy for complicated grief. Constructs assessed included affect, cohesion, group climate, and therapeutic alliance. Using logistic regression analyses, the authors investigated differences between dropouts and remainers at Sessions 1 and 4. Results indicated that after the lst therapy session, imminent dropouts reported experiencing less positive feelings than remainers. In addition, therapists' ratings of cohesion to the patients were significantly lower for the dropouts than for remainers. Clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expression of affect as a mediator of the relationship between quality of object relations and group therapy outcome for patients with complicated grief.

In a recent study, the patient characteristic quality of object relations (QOR) was directly related to favorable outcome (reduction of grief symptoms) among a sample of 53 outpatients with complicated grief who completed treatment in 1 of 8 time-limited, interpretive therapy groups. Recent research literature has suggested that patient affect variables may mediate the relationship between QOR and outcome. In the present study, affect variables were investigated as potential mediating variables using the procedure developed by R. M. Baron and K. A. Kenny (1986). The balance of positive and negative affect expressed in therapy as rated by both patients and therapists emerged as a significant mediating variable. Explanations for how this variable works as a mediating variable and why it facilitates favorable outcome were offered. Clinical implications are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of group climate on outcome in two forms of short-term group therapy.

The authors investigated the association between dimensions of perceived group climate (engagement, avoidance, and conflict) and treatment outcome in 2 forms of short-term group psychotherapy. They were particularly interested in the relationship between early group climate and outcome. They also examined whether average group climate and change in group climate were associated with outcome. Both engagement after Session 4 and engagement averaged over the course of therapy were directly associated with improvement. Significant interactions among the group climate dimensions were also found. These findings support the contention that aspects of the group environment influence patient benefit from psychotherapy groups. Possible explanations and implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling.

Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity.

There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complicated grief and deficits in emotional expressive flexibility.

There is growing evidence that deficits in emotion regulation may be at the heart of maladaptive reactions after bereavement. Expressive flexibility, or the ability to flexibly enhance or suppress emotional expression, appears to be especially important for adjustment in the aftermath of highly aversive events (Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). In this study, we compared expressive flexibility in a sample of bereaved adults who lost their spouse 1.5–3 years earlier and a comparable sample of married adults. Approximately half of the bereaved adults had Complicated Grief (CG) and half were asymptomatic. Using a within-subjects design, we asked all participants to either enhance or suppress their expressions of emotion or to behave normally while viewing evocative pictures at a computer screen. Observer ratings of expressiveness made blind to condition showed no group differences in overall emotion. However, bereaved adults suffering from CG exhibited deficits in expressive flexibility. Specifically, the CG group was less able to enhance and less able to suppress emotional expression relative to asymptomatic bereaved and married adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The alliance as mediator of expectancy effects in short-term individual therapy.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce. M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors, found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification in group therapy.

"The Ss of this study were male and female adolescents (12-15 years of age) who were asked to volunteer to participate in groups that 'would discuss adolescent problems.' Those who volunteered were rated by their teachers on emotional adjustment. Ss rated as most poorly adjusted were eliminated from the study. Three therapy groups were organized, each composed of five boys and five girls, each in the charge of a different therapist. The members of the group were given a special questionnaire, designed to assess needs, and a group form of the Rorschach before therapy began. At the conclusion of therapy, all Ss again took the questionnaire… . The hypotheses that both rigidity and lability were inversely related to identification were tested by correlational methods. Results were positive in both instances." From Psyc Abstracts 36:01:1IG95B. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss.

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events Screening Questionnaire; L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), complicated grief (CG) severity (Inventory of Complicated Grief--Revised--Short Form; A. E. Latham & H. G. Prigerson, 2004; H. G. Prigerson & S. C. Jacobs, 2001), PTSD severity (PTSD Checklist; F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993), and coping style use (Brief COPE; C. S. Carver, 1997). Results demonstrated that CG and PTSD severity were both significantly positively correlated with problem-focused, and active and avoidant emotional coping styles. The authors used path analysis to control for time since the loss and trauma frequency and found that only avoidant emotional coping remained significant in predicting CG and PTSD severity. Results are discussed in terms of their clinical implications for treating individuals with traumatic losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group therapy.

Cohesion is the most popular of several relationship constructs in the clinical and empirical group therapy literature. This article reviews the most frequently cited definitions and studied measures of group cohesion. We briefly introduce a new measure, the Group Questionnaire, which elucidates group relationships by suggesting two latent factors of cohesion—relationship quality (positive bond, positive work, and negative relationship) and structure factors (member-leader and member-member). To further understand the literature, we conducted a meta-analysis examining the relationship between cohesion and treatment outcome in 40 studies. Results indicate cohesion that the weighted aggregate correlation was statistically significant with outcome r = .25, k (40), N (3,323), z = 6.54 (p     

Levels of specificity of autobiographical memories and of biographical memories of the deceased in bereaved individuals with and without complicated grief.

Traumatized individuals experiencing posttraumatic stress have difficulty retrieving specific autobiographical memories to cue words on the Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). This may represent a generalized, functional avoidance of the personal past. However, such individuals also often report specific intrusive memories of their trauma in the day-to-day. This raises the possibility that memories tied to the source of the person's distress are immune to this putative avoidance process. This was investigated in bereaved individuals with complicated grief (CG) who reported intrusive, specific memories from the life of their deceased loved one, and matched bereaved controls without CG. Participants performed the AMT and two Biographical Memory Tests (BMTs), cueing memories from the life of the deceased (BMT-Deceased) and from a living significant other (BMT-Living). To negative word cues, the CG group showed reduced specificity for the AMT and BMT-Living, relative to controls, but this effect was reversed on the BMT-Deceased. These data support the proposal that memories tied to the source of an individual's distress are immune to the processes that underlie the standard reduced specificity effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group climate development in cognitive and interpersonal group therapy for social phobia.

This study was designed as a longitudinal study of 80 participants in cognitive group therapy (RCT, n = 40) and interpersonal group therapy (RIPT, n = 40) for social phobia during 10 weeks of residential therapy. The aim was to investigate the patterns of group climate development and its impact on treatment outcome. Data were collected using MacKenzie's Group Climate Questionnaire (GCQ) 4 times during treatment, and a multilevel (mixed) model approach was used in the analyses. Engagement in RCT groups showed a linear increase during treatment in contrast to a linear decline among patients in RIPT groups. This divergence might be explained by the focus on extragroup and intragroup relationships in RCT and RIPT, respectively. Neither conflict nor avoidance followed the expected pattern, nor did their mean levels influence outcome. However, when 6 extreme values of conflict were removed, there was support for a low–high–low pattern of conflict. In general, these results do not support MacKenzie's generic model of group climate development but suggest that sample characteristics, treatment models, and setting can play major roles in determining the group climate. Of the group climate variables, only the mean level of engagement predicted a change in social anxiety over the course of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The effects of a feedback intervention on group process and outcome.

The effects of a feedback intervention directed at both members and leaders was examined in psychotherapy groups held in a university counseling center. Feedback consisted of group climate information using scores from the Group Climate Questionnaire, completed by members after each group session. The direct effects of the feedback intervention were assessed using scores on the Curative Climate Instrument as well as Group Climate Questionnaire subscales. These instruments were administered after each group session. Distal effects of the feedback intervention were examined using member symptom improvement (Outcome Questionnaire) and group attendance. Members and leaders in the experimental condition were given weekly written and graphical feedback and contrasted against comparable groups receiving no feedback. Results indicate the feedback intervention had little impact on the therapeutic factors and outcome. However, for members who reported that the group was high in conflict, the feedback intervention had a significant negative effect on outcome. Implications and directions for future research are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting attendance and expectations for group therapy.

Inconsistent membership is one of the leading problems in groups. Group therapy participants (N=310) from 2 university counseling centers were studied over a period of 7 years to examine interpersonal style, expectations, and attendance in group therapy. The Group Therapy Questionnaire (R. R. MacNair & J. Corazzini, 1994; R. R. MacNair-Semands, 1996, 1997, 2001) assessed client goals, substance use, and interpersonal problems in relation to expectations for group and attendance. A discriminant analysis demonstrated that angry hostility and social inhibition were predictive of low attendance. Additionally, clients with previous therapy reported more positive expectations about group, whereas those reporting greater substance use and more somatic symptoms had fewer positive expectations about group. Implications for treatment decisions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of therapists' training on group therapeutic outcome.

The outcome of group therapy for psychotic patients was used as the dependent variable in assessing the comparative efficacy of trained and untrained therapists. The latter were undergraduate students with no training or experience in psychotherapy. For this reason, their role in psychotherapy was viewed as analogous to that of a placebo in studies assessing drug effects. Changes in psychological test performance of 295 patients before and after 5 mo. of group therapy served as the criterion of therapeutic behavior change. By comparison to an untreated control group the lay therapists achieved slightly better results than psychiatrists and psychiatric social workers doing group therapy with similar patients. Caution is urged in extending the implications of these results beyond group therapy with schizophrenic patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the outcome of social therapy with chronic psychotics.

A group of 69 male, long-hospitalized chronic psychotics in an experimental rehabilitation unit was tested on a new device, the Hunter problem box, prior to their treatment by 1 or 3 variants of social therapy. A summary score, the Hunter Process Index, was developed to relate to patients' postprogram adjustment on completion of a social therapy program. The index reflects changes in the degree of problem solving rigidity displayed by the patient as he moves from a simple, 2-light, single alternation problem to a more complex, 4-light, double alternation problem. The Hunter Process Index was validated with a group of 71 long-hospitalized, female psychotics who also had been exposed to the social therapy approach of the rehabilitation unit, and again with a group of 48 male chronic psychotics who had received some slight variation in the program. The index scores were predictive of the outcome of patients in these groups. Clinical judgments failed to predict outcomes. A normal control group in a separate study earned better Hunter index scores than did either the released or hospitalized groups of male chronic psychotics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Videotherapy in the context of group therapy for late-latency children of divorce.

Although videotape has been used for a variety of clinical and research purposes, it is now being used in a unique fashion as a therapeutic tool in group treatment of late-latency children of divorce. The videotherapy takes the form of videotaped dramas staged by children, with the intent of making a "movie." The timing of its use is crucial, the child's stage of development is relevant, and its effectiveness is dependent on other therapeutic activities. Several differences appear to exist between videotherapy and usual role playing in therapy, chief of which is that the children invest their activity with more enthusiasm than is usually observed in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and outcome evaluation of an on-line support group for Asian American male college students.

This study examined the process, outcome, and utilization patterns of an on-line support group (OSG) for Asian American male college students. Outcome measures indicated that the group participants felt supported, perceived the discussion topics as relevant, felt comfortable and connected to other group members, and preferred using aliases instead of their real identities. The discourse contained a high proportion of self-disclosure and provision of information, and more than half of the messages (58%) were responses to messages of other group members. These findings suggest that many of the components of group process theorized to be essential for effective groups can take place in OSGs. There were no significant posttest differences between the OSG (n?=?16) and control group (n?=?16) in ethnic identity or collective self-esteem. Implications of these findings for improving mental health and counseling services for culturally diverse populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)