Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis.

Objective: This meta-analysis evaluates the efficacy of group psychotherapy in the treatment of anxiety disorders. Method: A comprehensive literature search using PubMed, PsychInfo, Web of Science, CENTRAL, and manual searches was conducted to locate randomized controlled trials. We found 57 eligible studies (k = 76 comparisons) including 3656 participants receiving group psychotherapy or an alternative treatment for generalized anxiety disorder, social anxiety disorder, and panic disorder. Results: Effect size estimates show that group psychotherapy reduces specific symptoms of anxiety disorders more effectively than no-treatment control groups (g = 0.92, [0.81; 1.03], k = 43) and treatments providing common unspecific treatment factors (g = 0.29 [0.10; 0.48], k = 12). No significant differences were found compared to individual psychotherapy (g = 0.24 [-0.09; 0.57], k = 7) or pharmacotherapy (g = -0.05 [-0.33; 0.23], k = 6). The effects were unrelated to factors of the group treatment. Within head-to-head studies, a significant moderating effect emerged for researcher allegiance. Conclusions: Our results support the efficacy of group psychotherapy for anxiety disorders. They indicate that mixed-diagnoses groups are equally effective as diagnosis-specific groups, although further evidence is required. Future primary studies should address differential effectiveness, include a wider range of therapeutic approaches as well as active comparison groups.

[Unwanted Events Caused by Incorrectly Conducted Psychotherapy - A Pilot Study of the Inventory for the Assessment of Malpractice and its Consequences in Psychotherapy]. / Unerwünschte Ereignisse durch unsachgemäß durchgeführte Psychotherapie.

OBJECTIVE: A pilot study was conducted to test a newly developed inventory for the assessment of malpractice in psychotherapy and its consequences. We aimed to examine the frequency of boundary crossings and violations in the context of psychotherapy from a patient's perspective and the resulting burden as well as to identify potential predictors. METHODS: Data assessment was realized in an online-based survey. The final sample existed of N  = 165 patients who underwent prior psychotherapeutic treatment. RESULTS: Patients reported M = 16.21 events which can be interpreted in terms of malpractice resulting in a mediocre level of distress. While malpractice summarized as "inadequate use of diagnostics/techniques" was reported most frequently, sexual boundary violations were associated with the highest levels of distress. CONCLUSION: The results demonstrate the need of a differential and systematic assessment of malpractice in psychotherapy. The new inventory especially seems to be suited for research purposes.

Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials.

BACKGROUND AND AIMS: From residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods. METHODS: We included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS: Thirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias. CONCLUSIONS: The current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.

Psychotherapy for eating disorders: A meta-analysis of direct comparisons.

Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) of bona fide psychotherapy for adults with eating disorders (EDs). Method: Thirty-five RCTs with 54 direct comparisons were included. The majority of RCTs included participants with bulimia nervosa and/or binge-ED, while only two RCTs included participants with anorexia nervosa, and three RCTs included participants with an ED not otherwise specified. Results: There was a clear advantage of bona fide psychotherapy over wait-list controls. Bona fide psychotherapy was superior to non-bona fide treatment; however, the majority of results were not stable. There were no significant differences between bona fide cognitive-behavioral therapy (CBT) and bona fide non-CBT, with the exception of bona fide CBT resulting in greater reductions in ED psychopathology assessed by the ED Examination, which primarily assesses maintenance factors according to the CBT model. Conclusions: Generally, the results indicate that any bona fide psychotherapy will be equally effective. While the number of trials remains modest, we hope that as more research becomes available, treatment guidelines can be updated, and more evidence-based treatment options will be available for treating EDs.

The quality of randomized controlled trials of psychotherapy for eating disorders.

OBJECTIVE: We investigated the quality of randomized controlled trials (RCTs) that included direct comparisons of psychotherapy for adults with an eating disorder (ED). METHOD: Thirty-five direct comparison RCTs of psychotherapy for adults diagnosed with an ED were rated using the Randomized Controlled Trials Psychotherapy Quality Rating Scale (RCT-PQRS). RESULTS: The mean total RCT-PQRS score (mean = 28.26; SD = 7.04) was in line with those that were reported for RCTs of psychotherapy for depression and anxiety disorders. Several standards of quality were unfulfilled by over half of the RCTs of treatment for EDs, including therapist supervision while treatment was being provided (62.9% unfulfilled); outcome assessment performed by raters blind to treatment group/condition (54% unfulfilled); and adequate sample size (66% unfulfilled). More recent RCTs were of higher quality, and higher quality was moderately associated with lower effect sizes. CONCLUSIONS: To improve the quality of RCTs of psychotherapy of EDs, we recommend that researchers address the quality criteria listed in the RCT-PQRS. Psychotherapy trials should be registered, have a published protocol, and be reported following the Consolidated Standards of Reporting Trials guidelines. Authors should take into account the quality of the research when using that research to inform ED treatment guidelines.

Group psychotherapy for eating disorders: A meta-analysis.

OBJECTIVE: In the current meta-analysis, we review the effect of group psychotherapy compared to both wait-list controls and other active treatments for adults with eating disorders (EDs). METHOD: Twenty-seven randomized controlled trials (RCTs) that provide direct comparisons with a total of 1,853 participants were included. RESULTS: Group psychotherapy is significantly more effective than wait-list controls at achieving abstinence rates of binge eating and/or purging (RR = 5.51, 95% CI: 3.73, 8.12), decreasing the frequency of binge eating and/or purging (g = 0.70, 95% CI: 0.51, 0.90), and reducing related ED psychopathology (g = 0.49, 95% CI: 0.32, 0.66) after treatment. The effects of group psychotherapy and other active treatments (e.g., behavioral weight loss, self-help, individual psychotherapy) did not differ on any outcome at post-treatment or at follow-ups. Group cognitive behavioral therapy (CBT) and other forms of group psychotherapy did not differ significantly on outcomes at any time point. DISCUSSION: Additional research is needed to evaluate other group psychotherapy approaches, along with CBT, to provide more evidence-based treatment options for individuals with an ED. Group psychotherapy appears as effective as other common treatments and is perhaps more cost-effective than the most popular treatment, individual psychotherapy. Only 8.33% of comparisons in the current meta-analysis had at least 80% power to detect a moderate effect (d = .50) and we recommend that future RCTs be adequately powered.

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment.

INTRODUCTION: Interprofessional collaboration is crucial to the optimization of patient care. AIM: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. METHODOLOGY: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). RESULTS: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. CONCLUSION: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core.

Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials.

Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g=0.84, 95% CI [0.72; 0.97] and general psychopathology: g=0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats.

[Psychometric quality of the "Eating Attitudes Test" (German version EAT-26D) for measuring disordered eating in pre-adolescents and proposal for a 13-item short version]. / Eignung des "Eating Attitudes Test" EAT-26D zur Erfassung riskanten Essverhaltens bei 11- bis 13-Jährigen und Vorschlag für eine Kurzversion mit 13 Items.

To detect risky eating behavior questionnaires should be economic but at the same time they should fulfill the psychometric quality criteria. Available instruments are too long for the target group (e. g. EDE-Q, 28 items), restricted on primary symptoms (short version of EDI, 23 items) and with minor reliability (e. g. SCOFF and WC-Scale, 5 items each). Using the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) in a community sample of 1 331 11-13 year old girls and 906 boys from Thuringia, Germany, we measured a internal consistency of Cronbachs' Alpha=0.85 for girls and 0.78 for boys. In a principal factor analysis, we could replicate the 6-factorial structure of previous studies. A confirmatory factor analysis verified the suitability of the EAT-26D for both, girls and boys. Reducing the EAT-26D on the 3 core-factors leads to an economic 13 item short version with an internal consistency of 0.87 for girls and 0.80 for boys.

[Screening of disordered eating in 12-Year-old girls and boys: psychometric analysis of the German versions of SCOFF and EAT-26]. / Screening riskanten Essverhaltens bei 12-jährigen Mädchen und Jungen: psychometrischer Vergleich der deutschsprachigen Versionen von SCOFF und EAT-26.

To detect eating disorders and risky eating behaviour at an early stage, screening tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) and the German version of the SCOFF test (which contains only 5 Yes-no questions) in a community sample of 425 12-year-old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of r (tt)=0.73 and a maximum accuracy of 82% (area under the ROC curve). With the EAT-26D (20 point cut-off) as a reference the sensitivity of the SCOFF was 79%, specificity 74%, positive predictive value 25%, and the negative predictive value, which is more relevant for screenings, was 97%. The criterion validity reached r=0.53.