The research tends to provide support of the effectiveness of CBGT in the treatment of social phobias. For example, Heimberg in 1990 conducted a study comparing CBGT with a credible placebo control in the treatment for social phobias of 49 participants. Groups met weekly for twelve 2-hour sessions. The CBGT condition (n = 25) consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring between sessions. The educational supportive psychotherapy comparison group (ES) (n = 24), which acted as a control, consisted of lecture-discussion and group support. While both groups demonstrated significant pretreatment-to-posttreat-ment change, CBGT patients' phobias were rated as significantly less severe than those of ES patients at posttest assessment. Six-month follow-up data revealed a similar pattern.
In another study Mattick and Peters in 1988 conducted a study to assess the effectiveness of guided exposure in groups with and without cognitive restructuring in 51 subjects (24 male) with severe social phobia. The guided exposure model of CBGT emphasized the role of avoidance behavior in the etiology and maintenance of phobias and involved exposure to moderately difficult situations, the subjects being directed into increasingly difficult situations, and self-directed exposure homework assignments. The combined model of guided exposure and cognitive restructuring emphasized both avoidance behavior and the role of irrational thoughts in initiating and maintaining behavior and included systematic rational restructuring with elements of rationalemotive therapy as well as identifying, challenging, and altering maladaptive beliefs and attitudes. The combined methods group showed a significantly greater improvement than the exposure group from before to after treatment. Results from the self-report measures of target phobia avoidance rating indicated that the treatment resulted in greater approach to the phobic object.
Support for CBGT in the treatment of agoraphobia with panic disorder in intensive short-term CBGT (two all-day workshop) was provided by Evans, Holt, and Oei in 1991. They assigned 97 participants with the diagnosis of agoraphobia with panic attacks to either the treatment (n = 74) or the control wait-list group (n = 23). All subjects in the treatment condition attended the brief intensive CBGT, which consisted of lectures regarding agoraphobia, relaxation training, cognitive rehearsal of panic control messages, in vivo exposure, and group discussion. Waiting list participants were all consecutive re ferrals to the clinic following the treatment phase. Results revealed that patients who received the treatment program had improved significantly at posttreatment and at follow-up and that significantly more patients were symptom-free or symptom-reduced following the CBGT treatment than the control group.
Lidren and colleagues in 1994 reported the results of a study that compared the effectiveness of CBGT in treating panic disorder (PD). Thirty-six men and women who met criteria of the DSM-III-R for PD were randomly assigned to one of three conditions: biblio-therapy (BT), group therapy (CBGT), or a waiting-list control (WL) group. Both groups were compared to a no-treatment control condition, and all three conditions contained 12 subjects. Results in terms of decreased panic attacks and lessening of severity of behavioral avoidance suggested the greater effectiveness of both treatment conditions over the wait list.
A number of studies support the effectiveness of CBGT in the treatment of eating disorders. For example, Telch, Agras, Rossiter, Wilfley, and Kenardy in 1990 assessed the effectiveness of CBGT in treating binge eating disorders Forty-four female patients who binged were randomly assigned to either CBGT (n = 23) for ten sessions or a waiting list control condition (n = 21). At posttreatment assessment, between-group comparisons revealed that subjects in the intervention group reported significantly reduced binge eating episodes compared with subjects in the waiting list control group. CBGT participants continued to binge significantly less frequently than at baseline. However, bingeing was usually not eliminated entirely.
Tanco, Linden, and Earle in 1997 conducted a study evaluating the effectiveness of a cognitive group treatment program on morbidly obese women. Sixty-two obese women were randomly assigned to either the cognitive program (CBGT), a behavior therapy weight loss program (BT), or a wait-list control condition (WL). Both treatment groups consisted of eight to 2-hour weekly sessions with the wait-list control condition lasting 8 weeks. However, results revealed that scores for the CBGT group improved significantly across time, while those for the BT group and the control group did not. The CBGT group and the BT group, but not the control group subjects, lost significant amounts of weight during the course of treatment. Analysis of body mass index (BMI) revealed a decrease with time in both the CBGT group and the BT group. Finally, the proportion of subjects in the CBGT group exercising regularly increased significantly over the course of treatment. Six-month follow-up data suggested that all treatment benefits were maintained.
A number of studies lend modest support to the use of CBGT in treating patients with hypochondriacal complaints or somatization. Lidbeck in 1997 conducted a study of the effectiveness of a short cognitive-behavioral group treatment model for somatization disorder in general practice. The CBGT condition consisted of six treatment groups with three groups of six patients and three groups of five patients making a total of 33 subjects receiving cognitive-behavioral therapy The treatment included patient education to explain the psychological and physiological stress symptoms in order to enable cognitive restructuring, relaxation training, and homework consisting of one relaxation training session. CBGT consisted of eight 3-hour sessions. The control group consisted of 17 people: five groups of 3 patients and one group of 2 patients. Although no significant differences were found in dealing with social problems in either condition, reduction of illness behaviors was significantly greater in the CBGT condition than in the control condition, both at posttreatment evaluation and at the 6-month follow-up, and there was also a group difference reported for hypochondriasis at the 6-month follow-up. No significant differences were reported for anxiety, depression, or sleep disturbance, either at posttreatment or at the 6-month follow-up. Medical usage was significantly different between the CBGT and control conditions at the posttreatment evaluation and at the 6-month follow-up.
Avia and colleagues in 1996 also examined the effectiveness of CBGT with hypochondriacal patients. Seventeen participants were assigned to either the CBGT groups or the wait-list control group. The CBGT condition consisted of six weekly 1.5-hour sessions of general education covering inadequate and selective attention, muscle tension/bad breathing habits, environmental factors, stress and dysphoric mood, explanations given to the somatic signals, practical exercises implementing educational material, and homework to practice skills related to topic areas. The two CBGT groups were identical except for the assigned therapist. The waiting list control condition did not receive any form of treatment for the duration of the experiment. Results suggested a significant difference between CBGT and the control condition in the reductions of physical symptoms, bodily preoccupation, symptom interference, an overall reduction of the IAS, and also in their overall change in dysfunctional health beliefs. One year follow-up data reported that subjects maintained their reductions in their worry about illness and continued reducing symptom interference.
CBGT has found some support in the treatment of drug and alcohol abuse. Fisher and Bentley in 1996 conducted a study looking at the effectiveness of two group treatment models, CBGT, disease and recovery approach, and a usual treatment comparison group. The CBGT condition consisted of interventions to enhance self-efficacy, provide more realistic and appropriate expectations about the effects of the abused substance on symptoms of personality disorders, increase adaptive coping skills, and enhance relapse prevention capacity. The disease and recovery group approach consisted of interventions to develop an "alcoholic" or "addict" identity, acknowledge a loss of control over the substance abuse and the effects of the personality disorder, accept abstinence as a treatment goal, and included participation in support group activities such as AA. Both experimental groups met for three 45-minute weekly sessions for 4 weeks. The usual treatment comparison group did not receive experimental interventions and met three times weekly in an open-ended group format. The analysis revealed that within the outpatient setting, the CBGT was significantly more effective than the disease and recovery group and the control group in reducing alcohol use, enhancing psychological functioning, and in improving social and family relations.
Eriksen, Bjornstad, and Goetestam in 1986 evaluated the efficacy of a CBGT model that used primarily social skill training procedures with patients who abused alcohol. Social skills training as part of inpatient treatment for patients with DSM III diagnosis of alcohol dependence delivered in a group format resulted in better outcomes than a traditional discussion group. Over the 1-year period after discharge, patients who had received social skills training were abstinent 77% of days, whereas control patients were abstinent 32% of days. In 1997, Vogel, Eriksen, and Bjoernelv also found support for the greater efficacy of the treatment of alcoholics in social skill groups over those in a control condition 1 year after the end of therapy.
Roffman and colleagues in 1997 assessed the effectiveness of CBGT to prevent HIV transmission in gay and bisexual men. Approximately 159 men were matched and assigned to receive either the 17-session group counseling (n = 77) or remain in an 18-week wait-list control (n = 82) condition. The CBGT condition was based on a relapse prevention model. Early sessions emphasized building group cohesion (one of the few studies that explicitly did so), HIV education, motivational enhancement, and goal setting. Middle sessions focused on determining antecedents to risky behavior and developing appropriate coping strategies that included coping skills training in high-risk situations that involved communication, cognitive activities, and behavioral strategies. Maintenance strategies for the preservation of safer behaviors were also included. This study utilized one specific dependent measure: abstinence from AIDS-risk sexual activity over the 3-month period prior to reassessment. Data reveal men exposed to the treatment group had roughly 2.3 times the odds of success experienced by men assigned to the no-treatment control condition. Also, results indicate that the intervention appeared to be more effective with exclusively gay than with bisexual men.
Lutgendorf and co-workers in 1997 conducted a study of gay men diagnosed with HIV seropositive status to measure the psychological and immunological effects of a cognitive-behavioral stress management group (which could also be classified as CBGT) (n = 22) versus a wait-list control (n = 18). The CBGT group met for weekly 135-minute sessions that consisted of didactic components explaining physiological effects of stress, stress-immune associations, cognitive-behavioral theory of stress and emotions, identification of cognitive distortions and automatic thoughts, rational thought replacement, coping skills training, assertiveness training, anger management, identification of social supports, group discussion of personal examples, and homework.
Results of measures assessing relaxation practice and mood changes revealed a correlation between regularity of relaxation practice and changes in depression and anxiety, and in assessing immunologic effects. No changes, however, were found between groups at posttest or within groups over time in most of the im-munological measures.
Adjustment of newly diagnosed cancer patients was found in a study by Bottomley, Hunton, Roberts, Jones, and Bradley in 1996. The groups compared were a CBGT condition (n = 9), a social support group (n = 8), and a wait list control condition (n = 14). Both treatment groups met for 8 weeks with sessions lasting 90 minutes. The cognitive-behavioral intervention focused on challenging dysfunctional thinking and learning coping skills while the social support group encouraged open and honest expression of ideas and employed topic-based discussions as primary treatment modalities. No significant differences were found between treatment groups at postintervention. However, differences in groups' scores on the Fighting Spirit subscale approached significance, suggesting that patients in the CBGT group received the most significant benefit in developing coping styles such as fighting spirit. However, at 3-month follow-up data indicate that the CBGT group significantly improved in their fighting spirit as compared to the other two groups. Also, a trend toward deterioration in the scores of the nonintervention condition was statistically significant in terms of increased helplessness and depression.
In the use of CBGT in the treatment of men who batter (see review by Tolman and Edleson in 1995), the results are mixed, although the authors note that consistent findings in varying programs, using various methods, seem to result in a large number of men stopping their violent behavior. In most studies they report that CBGT was more effective than a control group but not significantly more effective than alternative treatments.
In summary, the research cited earlier lends some evidence for the effectiveness of CBGT with a wide variety of presenting problems, although more research is needed. Often the group phenomena was confounded with the cognitive-behavioral procedures. The control groups were often not randomly assigned although the authors provided evidence for similarity of experimental and control conditions. In addition, it should be noted that in many of these and other studies, the number of subjects was low, and hence the power to reject the null hypothesis extremely small. It is in fact surprising that so many studies found a significant difference between control group and treatment conditions in spite of the small number. In all cases there was at least a no-treatment control group but often in the absence of a best possible alternative permitted only the conclusion that CBGT was better than nothing. In the several studies in which contrast groups existed, differences occasionally existed. No power analysis was reported prior to the intervention of most of the studies. The individual was in all cases the unit of analysis in spite of the fact that the treatment was in groups, thus incurring both statistical as well as psychological dependency.
One of the reasons for the modest methodological quality of research on small therapy groups is the complexity of such designs for groups and difficulty in recruiting sufficient subjects to meet quality design requirements. Second, because of the need to standardize treatment packages, individualization in experiments had to be ignored in contrast with actual practice. Third, most of the studies were field experiments that required special protections for the subjects that often worked against a strong design.
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