Adapting evidence-based group therapies following COVID-19 restrictions

Aim: The COVID-19 pandemic has created barriers to the running of group therapies due to the need to maintain social distance. This paper aims to describe modifications of existing therapeutic groups delivered to people diagnosed with serious and enduring mental illnesses (SMIs) to enable the therapies to continue in an online format due to the COVID-19 restrictions. Conclusions: Therapists and consumers were motivated to find a way to continue the therapies described despite the context of the restrictions imposed due to COVID-19. This paper describes what was involved in ‘pivoting’ to a new mode of practice and modifications that were required over time and as new regulations were put in place. Formal research is required to establish an evidence base if these therapies were required to be regularly delivered in an online mode.

Title: Efficacy of Psychosocial Group Treatment for Post-traumatic Stress Disorder among Genocide Survivors in Rwanda, 25 Years After 1994 Genocide Against Tutsi.

Background: Prior studies indicated that post-traumatic stress disorder is becoming a global health concern even though still poorly known and treated. In the aftermath of 1994 Genocide against Tutsi, studies found high rates of depressive and anxious symptoms along with PTSD among genocide survivors. Due to the highest cruelty in which the Genocide was committed, genocide survivors still need high special humanitarian services, of those including specialized health care services. The aim of this study was to assess the efficacy of psychosocial group therapies created by AVEGA Agahozo in reducing PTSD symptoms among Genocide survivors in Rwanda, 25 years after 1994 Genocide against Tutsi.Methods: We conducted a comparative cross-sectional study design with a sample of 98 genocide survivors who received group therapy by AVEGA Agahozo. We used a multi-stage random sampling method to select participants and 7 trained psychologists interviewed genocide survivors about their PTSD status before and after treatment using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The analysis was performed using SPSS version 17.1.Results: The results showed that women were 97.96% and men presented 2.04% of all participants because AVEGA Agahozo mainly focuses on helping women survivors who lost their husbands in Genocide and previous findings also concluded that women are very prone to suffer from PTSD than men. Paired t-test results showed significant differences between symptoms, before and after treatment (P<0.001 in all pairs). Cohen's d results also showed high effect sizes (d>0.5), only in pair 8 where the difference appears to be less significant (d=0.28). The descriptive statistics showed that the severity of PTSD symptoms dramatically reduced after treatment. But this difference of severity is only statistically significant among five (5) PTSD symptoms.: (Marked physiological reactivity after exposure to trauma-related stimuli [P=0.045, x2=38.111]; inability to recall key features of the traumatic event [P<001, x2=56.309]; persistent negative trauma-related emotions [P=0.013, x2=43.184]; self-destructive or reckless behavior [P=0.041, x2=38.535]; hypervigilance [P=0.020, x2=41.596]. Conclusion: Psychosocial group therapies created by AVEGA Agahozo effectively alleviate post-traumatic stress disorder symptoms and severity among genocide survivors.

Transfer of face-to-face group therapies into online group-chats in a psychiatric outpatient setting during the COVID-19 pandemic (Preprint)

BACKGROUND At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapies and psychoeducational sessions. The lockdown in many countries is a serious threat for mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and a disruption of daily routines are considered to be a risk factor for destabilization of mentally ill patients. OBJECTIVE The aim of the present study was to develop and to evaluate the acceptability, usability, and feasibility of a group-chat program to replace cancelled face-to-face (f2f) group sessions in an outpatient psychiatric department. METHODS Participants (n = 38) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former f2f group participants were invited to take part in a therapist-guided group-chat for four weeks (eight sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, pre-intervention), after every chat session (T1), and post-treatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former f2f groups: anxiety, depression, obsessive-compulsive disorder (OCD), and adult attention deficit hyperactivity disorder (ADHD). Sociodemographic measures, attitudes towards the COVID-19 pandemic, depressive symptoms (PHQ-9), quality of life (WHOQOL-BREF), treatment credibility/expectancy (CEQ), and participants’ satisfaction (ZUF-8) were measured. RESULTS Participants joined an average of n = 5.0 out of eight offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (78.2%) and lowest in the anxiety group (41.1%). The overall pre-intervention level of depressive symptoms was moderate and showed a slight, non-significant improvement at post-treatment (T0: M = 10.7, SD = 5.5; T2: M = 10.2, SD = 5.5). A similar result was observed regarding quality of life (T0: Median = 41.7 - 68.8; T2: Median = 50.0 - 70.3). Treatment credibility and expectancy scores were medium high (T0: Mcred = 18.1, SD = 3.8; Mexp = 11.2, SD = 5.1; T2: Mcred = 17.1, SD = 4.8; Mexp = 10.3, SD = 5.8). Further, significant correlations were detected between post-treatment expectancy score and post-treatment PHQ-9 score (r = -0.41; p = .024), post-treatment physical quality of life (r = 0.54; p = .001) and post-treatment psychological quality of life (r = 0.53; p = .002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at post-treatment (ZUF-8: M = 20.6, SD = 1.0). Of all participants, a majority (87.1%) rated the program as excellent/good and would recommend the group-chat program to a friend in need of similar help (83.9%). CONCLUSIONS A therapist-guided group-chat program to substitute outpatient group-setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Online programs, such as this one, provide an easy to implement tool to successfully stabilize participants during a difficult pandemic time. CLINICALTRIAL This study is registered in the German Clinical Trials Register: DRKS00021527.

Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms

Background:In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT.Aims:The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment.Method:The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores.Results:Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large.Conclusion:The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.