Group Cognitive Behavioural Therapy (CBT)

Rating

Category: Allied Health Options

What is it?

Group cognitive behavior therapy (CBT) refers to a therapy delivered in a group setting, which may use either trauma focused or non-trauma focused CBT techniques.

  • Non-trauma focused group CBT mainly uses techniques which focus on the present.
  • Trauma-focused group CBT primarily uses cognitive, behavioural and cognitive-behavioural techniques which have some focus on the trauma. Techniques may include various exposure therapies, flooding, and imagery rehearsal therapy.

CBT management strategies include psycho-education, exposure, and cognitive restructuring.

How does it work?

Non-trauma focused group CBT has more of a focus on the present rather than past events and aims to provide participants with skills to help them address their PTSD symptoms, such as relaxation.

Trauma-focused group CBT works on the principle that PTSD patients must confront their past experiences before they can reduce PTSD symptoms. People with PTSD may try to avoid situations which provoke unpleasant feelings and memories, however this provides only short term relief and prevents them from coping with the problem. Trauma focused therapies work from the theory that PTSD can be reduced by exposing the person to corrective information, which reduces their fears.

Is it effective?

Trauma-focused CBT therapies delivered in one-on-one sessions have been found effective in reducing PTSD symptoms; however less evidence exists for delivery in group settings. A systematic review in 2008 examined four studies on group CBT in which two of the studies were of poor quality. The largest high quality study compared trauma-focused with non trauma-focused group CBT but found no difference in the effectiveness of the two methods. However, the results from the remaining smaller studies which compared trauma-focused group CBT with usual care or wait list controls were inconsistent as to their effects on PTSD symptoms. Further research is required to determine the effectiveness of group CBT for PTSD.

Are there any disadvantages?

No studies formally considered adverse effects of group CBT. Some individuals may not feel comfortable undertaking CBT in a group setting. Evidence from individual trauma-focused CBT suggests that there may be temporary increases in distress when unresolved memories emerge, which may continue after the session. Clients may also demonstrate high levels of emotional or physical sensation during treatment.

Where do you get it?

Group CBT should only be administered by a specifically trained registered mental health professional. The health professional should have completed basic training in trauma-focused CBT.

What are the evidence limitations?

Most studies regarding the use of group CBT in PTSD to date have been small or of poor quality. Some included in the review had individuals with traumatic stress symptoms who were diagnosed using different criteria from DSM-IV. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on current limited evidence, group CBT cannot be recommended as a first line, stand alone intervention to achieve symptom relief in clients with PTSD. It may be considered as an adjunctive intervention to other individual interventions.

Key References

Bisson, J & Andre, M 2007, ‘Psychological treatment of post traumatic stress disorder (PTSD)’, Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub3.

Classen, C, Butler, LD, Koopman, C, Miller, E, DiMiceli, S, Giese-Davis, J, et al. 2001, ‘Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial’, Archives of General Psychiatry, vol. 58, no.5, pp. 494-501.

Krakow, B, Hollifield, M, Johnston, L, Koss, M, Schrader, R, Warner, TD, et al. 2001, ‘Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder. A randomized controlled trial’, JAMA, vol. 286, pp. 537-45.

Schnurr, PP, Friedman, MJ, Foy, DW, Shea, MT, Hsieh, FY, Lavori, PW et al. 2003, ‘Randomized trial of trauma-focused group therapy for posttraumatic stress disorder’, Archives of General Psychiatry, vol. 60, pp. 481–9.

Zlotnick, C, Shea, TM, Rosen, K, Simpson, E, Mulrenin, K, Begin, A, et al. 1998, ‘An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse’, Journal of Traumatic Stress, vol. 10, no. 3, pp. 425-36.

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