PhD/PsyD EBPs appropriate for a group format?

[R. Matey]

Hi folks,

Does anyone know the current state of the literature for group treatment for EBPs in say depression and anxiety? I've been asked to provide some group treatment while doing postdoc and I'm curious what's out there and effective. I don't want to just run a support group.

Thanks!

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[cara susanna]

All I know is that there's some evidence CPT in group format is less effective than individual.

 

[beginner2011]

Hi folks,

Does anyone know the current state of the literature for group treatment for EBPs in say depression and anxiety? I've been asked to provide some group treatment while doing postdoc and I'm curious what's out there and effective. I don't want to just run a support group.

Thanks!

As far as transdiagnostic groups, if I were in your position, I'd look into the unified protocol.

Unified Protocol Transdiagnostic Treatment in Group Format - PubMed

Barlow et al. published the unified protocol (UP) for transdiagnostic treatment of emotional disorders, focusing on common pathological factors across a variety of diagnoses. The limited UP research to date suggests that this treatment may be particularly useful for anxiety disorders. However...

pubmed.ncbi.nlm.nih.gov

Unified Protocol Transdiagnostic Treatment in Group Format - PubMed

Barlow et al. published the unified protocol (UP) for transdiagnostic treatment of emotional disorders, focusing on common pathological factors across a variety of diagnoses. The limited UP research to date suggests that this treatment may be particularly useful for anxiety disorders. However...

pubmed.ncbi.nlm.nih.gov

There's also mindfulness based cognitive therapy for depression, but that requires some advanced training to deliver effectively.

 

[R. Matey]

As far as transdiagnostic groups, if I were in your position, I'd look into the unified protocol.

Unified Protocol Transdiagnostic Treatment in Group Format - PubMed

Barlow et al. published the unified protocol (UP) for transdiagnostic treatment of emotional disorders, focusing on common pathological factors across a variety of diagnoses. The limited UP research to date suggests that this treatment may be particularly useful for anxiety disorders. However...

pubmed.ncbi.nlm.nih.gov

Unified Protocol Transdiagnostic Treatment in Group Format - PubMed

Barlow et al. published the unified protocol (UP) for transdiagnostic treatment of emotional disorders, focusing on common pathological factors across a variety of diagnoses. The limited UP research to date suggests that this treatment may be particularly useful for anxiety disorders. However...

pubmed.ncbi.nlm.nih.gov

There's also mindfulness based cognitive therapy for depression, but that requires some advanced training to deliver effectively.

Thank you! This is very helpful.

 

[AbnormalPsych]

Not off the top of my head, but an option between those two choices could be providing an education and skills group, structured a bit more like a class, where you cover some theory (CBT basics, cog distortions, bx activation, etc...) and apply it. I have seen this done several times in larger hospital settings with some anecdotal success for mild-moderate sx based on PHQ-9/GAD scores dropping.

 

[DynamicDidactic]

I’m going to throw a wrench in the UP idea. I don’t believe there is a single controlled study on UP in a groups setting. Is there? I’m not up on the literature for the past few years. I also don’t think there is much for UP in general vs active treatment.

There is a decent amount on other CBT treatments but you’d have to look at individual disorders. The one I think has the most research for heterogenous groups is DBT Skills training. This requires advanced training but there are numerous RCTs ranging from treatment resistant depression to ADHD to BPD.

 

[beginner2011]

I don’t believe there is a single controlled study on UP in a groups setting. Is there?

Quick google turns this up:

Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial - PubMed

Retrospectively registered at https://clinicaltrials.gov/ . Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.

pubmed.ncbi.nlm.nih.gov

There might be more, and I'm not sure of the quality of the study, but there's at least something out there.

If there's a hierarchy I'd put DBT skills groups at the top, as far as effectiveness and flexibility for transdiagnostic groups. I'm also not up on the literature, though. I do recall there being some pretty strong evidence for the effectiveness of DBT Skills groups alone for heterogeneous presenting problems, but don't have citations on hand. The one caveat I'd add is that I'd be wary of implementing skills groups in most settings. There is so much content that if people aren't going to be in the group for at least the first full 6 months then there's going to be a lot of holes and gaps in their skill building that could be problematic.

 

[DynamicDidactic]

Quick google turns this up:

Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial - PubMed

Retrospectively registered at https://clinicaltrials.gov/ . Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.

pubmed.ncbi.nlm.nih.gov

That is just a protocol and not a completed/published study.

 

[DynamicDidactic]

It is good to check into the literature every once in a while. Glad this thread got me to check. Looking over this systematic review published in 2019:

A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention

Recent advances in clinical practice emphasise transdiagnostic interventions as an effective alternative to single disorder approaches. This current s…

www.sciencedirect.com

I count 3 RCTs. Out of those 2 are vs waitlist controls and 1 is vs TAU. Despite all the UP talk, which I am in support of, there has been little stringent RCTs. I'd like to see at least one trial of UP vs an active treatment that is not TAU (e.g., psychodynamic, DBT, CT, peer support, drum circles). Maybe something more recent out there?

 

[DynamicDidactic]

I do recall there being some pretty strong evidence for the effectiveness of DBT Skills groups alone for heterogeneous presenting problems, but don't have citations on hand. The one caveat I'd add is that I'd be wary of implementing skills groups in most settings. There is so much content that if people aren't going to be in the group for at least the first full 6 months then there's going to be a lot of holes and gaps in their skill building that could be problematic.

For those interested in DBT, this is a potentially useful resource

Core Evidence & Research - Behavioral Tech Institute

There is a wealth of evidence supporting the effectiveness of DBT. The first randomized controlled trial (RCT) of DBT was published in 1991, in which Dr.

behavioraltech.org

It is a few years old but provides a lot of citations.

For DBT skills, here are the RCTs (there are a few more since this was made)

https://behavioraltech.org/wp-content/uploads/2018/04/RCTSkills-onlyResearchtoDate2016.06.28-new-logo.pdf

As you can see most RCTs are mostly 3-4 month in length rather than 6 months (or 12 months in most RCTs of 4-mode DBT).
While each study concentrates on a single disorder/problem, there are at least 2 that are pretty heterogenous; Neacsiu et al., 2014 and Uliaszek et al., 2016.

I agree that there is a lot to learn and clinicians should apply strict policies on dropout. In DBT, 4-miss rule is commonly used (4 absences in a row means dropout) and I support a 3-miss rule for shorter group lengths.

The entire treatment is designed to be modular and the full assortment of skills has probably never been used. Even the most common skills are typically not all used in most of these RCTs. Finally, which skills to use should be driven by the problems faced by individuals receiving the treatment.

 

[DynamicDidactic]

Lookie what showed up in my email today

The Unified Protocol compared with diagnosis-specific protocols for anxiety disorders: 12-month follow-up from a randomized clinical trial

To examine whether the Unified Protocol (UP) remains equivalent to single-disorder protocols (SDPs) in the treatment of anxiety disorders at 12-month …

www.sciencedirect.com