Therapeutic Alliance and Group Cohesion Across Telehealth Delivery of Mentalizing-focused Parenting Groups.

This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children's outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE.

Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care.

OBJECTIVE: To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity. DESIGN: Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. LOCATION: 7 PC teams from Catalonia. PARTICIPANTS: >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. INTERVENTION: 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training. MEASUREMENTS: Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated. RESULTS: The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY. CONCLUSIONS: Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.

Implementing and evaluating group interpersonal therapy for postnatal depression in Lebanon and Kenya-individually randomised superiority trial.

BACKGROUND: Depression ranks as the foremost mental health concern among childbearing women. Within low- and middle-income countries (LMICs), between 20 and 25% of women encounter depression during pregnancy or soon after delivery. This condition impacts not only the mothers but also their offspring. Offspring of women suffering from postnatal depression (PND) exhibit suboptimal cognitive development and increased emotional and behavioural issues throughout their growth. This scenario becomes more pronounced in LMICs, where numerous adversities further jeopardise children's developmental progress. Despite antenatal services providing a pivotal platform to address women's mental health needs, PND treatment remains inaccessible in many LMICs. The World Health Organization advocates interpersonal psychotherapy (IPT) for treating depression. While research from high-income countries has established the efficacy of IPT and group-IPT (g-IPT) for PND, its effectiveness within the LMIC context and its potential benefits for child development remain uncharted. This study seeks to gauge the potency of g-IPT for women with PND in two LMICs. METHODS: This multi-site randomised controlled trial is a continuation of two preceding phases-conceptual mapping and a feasibility study executed in Lebanon and Kenya. Insights gleaned from these phases underpin this comprehensive RCT, which contrasts the efficacy and cost-effectiveness of high-quality standard care (HQ-SC) augmented with g-IPT against HQ-SC in isolation. The trial, characterised as an individually randomised superiority assessment, targets women with postnatal depression in Beirut, Lebanon, and Nairobi, Kenya. It aims to determine if culturally tailored g-IPT, administered within community settings in both countries, outperforms HQ-SC in influencing child developmental outcomes, maternal depression, and the quality of the mother-child bond. DISCUSSION: The SUMMIT trial, designed with pragmatism, possesses the magnitude to evaluate g-IPT within two LMIC frameworks. It seeks to enlighten policymakers, service commissioners, professionals, and users about g-IPT's potential to alleviate maternal PND and bolster child developmental outcomes in LMICs. Additionally, the trial will generate valuable data on the clinical and economic merits of high-quality standard care. TRIAL REGISTRATION: ISRCTN, ISRCTN15154316. Registered on 27 September 2023, https://doi.org/10.1186/ISRCTN15154316.

Significados atribuídos por mulheres com câncer de mama ao grupo de apoio / Meanings attributed by women with breast cancer to a support group / Significados atribuidos por las mujeres con cáncer de mama al grupo de apoyo

A sobrevivência ao câncer de mama é um problema de saúde pública que demanda serviços especializados com foco na reabilitação psicossocial. Entre as necessidades identificadas nesse contexto está o incentivo à adoção de estratégias de promoção de autocuidados pelas mulheres. Uma das estratégias adotadas consiste no grupo de apoio psicológico, que auxilia as pacientes a enfrentar a longa jornada do tratamento. Assim, o objetivo deste estudo é compreender os significados produzidos por mulheres com câncer de mama sobre sua participação em um grupo de apoio. Trata-se de um estudo qualitativo, descritivo e exploratório realizado com dez mulheres com câncer de mama usuárias de um serviço de reabilitação para mastectomizadas. Como referencial metodológico foi utilizada a Teoria Fundamentada nos Dados. A coleta de dados foi realizada por meio de entrevista aberta em profundidade e os conteúdos foram transcritos e codificados. A análise indutiva e o método de comparação constante foram aplicados nos processos de codificação aberta, axial e seletiva, que permitiram identificar três categorias nucleares: percepção das atividades realizadas no grupo, identificação de benefícios e barreiras do convívio no grupo e transformações decorrentes da participação. As participantes significaram sua presença no grupo como fonte de acolhimento, apoio, desenvolvimento de recursos pessoais e amizades, contribuindo para promover sua qualidade de sobrevida. Além dos potenciais benefícios, também foram identificadas barreiras que podem dificultar a adesão e continuidade da participação no grupo, o que sugere a necessidade de incorporar no cuidado um olhar para as dimensões subjetivas da saúde da mulher.(AU)

Surviving breast cancer is a public health problem and depends on services focused on psychosocial rehabilitation. Healthcare providers must encourage women to adopt strategies to promote their self-care. The psychological support group is a resource that helps women to face the long journey of treatment. This study aimed to understand the meanings women with breast cancer produced about their participation in a support group. This exploratory cross-sectional study was carried out with 10 women with breast cancer who use a rehabilitation service for mastectomized patients. Grounded Theory was used as a methodological reference. An open in-depth interview was applied for data collection. The contents were transcribed and coded. Inductive analysis and the constant comparison method were applied in the open, axial, and selective coding processes, which enabled the identification of three core categories: perception of the activities carried out in the group, identification of benefits and barriers of living in the group, and transformations resulting from participation. Participants denote their involvement with the group as a source of shelter, support, development of personal resources and friendships that helps promoting quality of life. Besides these potential benefits, participants also evinced barriers that can hinder adherence and continuity of participation in the group, suggesting the importance of incorporating a look at the subjective dimensions of women's health into care.(AU)

Sobrevivir al cáncer de mama es un problema de salud pública que depende de los servicios centrados en la rehabilitación psicosocial. Entre las necesidades identificadas en esta materia se encuentra el uso de estrategias para promover el autocuidado. Uno de los recursos que ayuda a afrontar el largo camino del tratamiento es el grupo de apoyo psicológico. El objetivo de este estudio es conocer los significados que producen las mujeres con cáncer de mama sobre su participación en un grupo de apoyo. Se trata de un estudio cualitativo, descriptivo y exploratorio, realizado con diez mujeres con cáncer de mama usuarias de un servicio de rehabilitación para mastectomizadas. Como referencia metodológica se utilizó la teoría fundamentada en los datos. Se aplicó una entrevista abierta en profundidad para la recogida de datos, cuyos contenidos fueron transcritos y codificados. El análisis inductivo y el método de comparación constante se aplicaron en los procesos de codificación abierta, axial y selectiva, lo que permitió identificar tres categorías centrales: percepción de las actividades realizadas en el grupo, identificación de los beneficios y las barreras de vivir en el grupo y transformaciones resultantes de la participación. Las mujeres denotan su participación en el grupo como una fuente de acogida, apoyo, desarrollo de recursos personales y amistades, que ayuda a promover la calidad de vida. Además de los beneficios potenciales, también se identificaron barreras que pueden dificultar la adherencia y continuidad de la participación en el grupo, lo que sugiere la necesidad de incorporar en la atención una mirada centrada en las dimensiones subjetivas de la salud de las mujeres.(AU)

Terapia Cognitivo-Comportamental em Grupo: Estratégia de Psicoeducação com Estudantes de Enfermagem / Group Cognitive Behavioral Therapy: Strategy for Psychoeducation with Nursing Students / Terapia Cognitivo-Conductual en Grupo: Estrategia para la Psicoeducación con Estudiantes de Enfermeira

Este estudo teve por objetivo apresentar os resultados de um grupo psicoterápico psicoeducativo desenvolvido junto a estudantes de Enfermagem. Foram realizados seis encontros com cinco estudantes de uma universidade pública do Estado de São Paulo. Os encontros foram audiogravados, transcritos e submetidos à análise temático-reflexiva. Os resultados encontrados permitiram a construção de cinco categorias temáticas: (1) Desafios da adaptação ao ensino superior; (2) Concepções sobre saúde mental na universidade; (3) Autocuidado e equilíbrio entre a vida universitária e pessoal; (4) Relações interpessoais e vida universitária; (5) Perspectivas e expectativas sobre a formação. O processo de integração à universidade requer mobilização cognitiva, afetiva e social, sendo que as relações com os pares, professores e familiares foram destacadas como importantes para essa adaptação. As participantes destacaram conhecer a importância do cuidado em saúde mental, mas admitiram dificuldades de promoverem o autocuidado. O espaço grupal foi utilizado como ambiente de escuta, estabelecimento de vínculo e autocuidado. Os grupos psicoeducativos demonstraram ser importantes para a construção de estratégias de enfrentamento e um espaço para o acolhimento de demandas que emergem nessa etapa do desenvolvimento.

This study aimed to present the results of a psychoeducational psychotherapy group developed with Nursing students. Six meetings were held with five students from a public university in the state of São Paulo. The meetings were audio-recorded, transcribed and submitted to a reflexive-thematic analysis. The results found allowed the construction of five thematic categories: (1) Challenges of adapting to higher education; (2) Conceptions about mental health at the university; (3) Self-care and balance between university and personal life; (4) Interpersonal relationships and university life; (5) Perspectives and expectations about training. The process of integration into the university requires cognitive, affective and social mobilization, and relationships with peers, teachers and family members were highlighted as important for this adaptation. The participants highlighted knowing the importance of mental health care, but also admitted difficulties in promoting self-care. The group space was used as a listening environment, bonding and self-care. Psychoeducational groups proved to be important for the construction of coping strategies and a space for the reception of emerging demands.

Este estudio tiene como objetivo presentar los resultados de un grupo de psicoterapia psicoeducativa desarrollado con estudiantes de Enfermería. Se realizaron seis reuniones con cinco estudiantes de una universidad pública del Estado de São Paulo. Las reuniones fueron grabadas en audio, transcritas y sometidas a un análisis temático-reflexivo. Los resultados encontrados permitieron la construcción de cinco categorías temáticas: (1) Desafíos de la adaptación a la educación superior; (2) Concepciones sobre la salud mental en la universidad; (3) Auto cuidado y conciliación de la vida universitaria y personal; (4) Relaciones interpersonales y vida universitaria; (5) Perspectivas y expectativas sobre la formación. El proceso de integración universitaria requiere de una movilización cognitiva, afectiva y social, y las relaciones con pares, docentes y familiares son importantes para la adaptación. Los participantes destacan conocer la importancia del cuidado de la salud mental, pero admiten que tienen dificultad para promover el auto cuidado. El espacio grupal fue utilizado como ambiente de escucha, vinculación y auto cuidado. Los grupos psicoeducativos demostraron ser importantes para la construcción de estrategias de afrontamiento y un espacio de recepción de demandas emergentes.

Mental health care equity and access: A group therapy solution.

Mental health services are experiencing unprecedented levels of demand from clients during COVID resulting in longer wait lists and therapist burnout. As Nemoyer et al. (2019) point out, minorities experience a higher burden of mental illness while having less access and lower quality treatments. COVID has increased demands for mental health services even further, creating bottlenecks of care, therapist burnout, and leading to ever longer wait lists. This article will argue that inefficient supply of services is created by mental health providers being incentivized toward individual therapy. Group therapy offers a solution because it is a "triple E treatment"-efficient, effective, and equivalent to individual therapy in terms of outcomes (Burlingame & Strauss, 2021). Group interventions also address systemic racism and the needs of minorities who have been marginalized and cope with minority stress. This article will utilize a labor and financial impact analysis to demonstrate how increasing group therapy by 10% nationally, particularly in private practice and primary care integration settings, would increase treatment access for over 3.5 million people while reducing the need for 34,473 additional new therapists and simultaneously saving over $5.6 billion. It will discuss how incentivizing groups while holding therapists accountable for training, competency when working with people from diverse backgrounds, and outcomes can result in improved efficiency. This will allow therapists greater freedom to collaboratively select the most effective treatments for those from underserved and minority backgrounds and create easier access to quality treatments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stakeholder's experiences of living and caring in technology-rich supported living environments for tenants living with dementia.

BACKGROUND: Technology innovation provides an opportunity to support the rising number of people living with dementia globally. The present study examines experiences of people who have dementia and live in technology enriched supported care models. Additionally, it explores caregiver's attitudes towards technology use with the housing scheme. METHODS: A qualitative research design was adopted, and eight housing schemes consented to take part in the study. A technology audit was undertaken in addition to participant interviews and caregiver survey. Seven peer researchers conducted semi-structured interviews with 22 people living with dementia. Interviews were analysed using thematic analysis. Informal and formal caregivers were invited to complete a survey to capture their attitudes towards technology use. A total of 20 informal and 31 formal caregiver surveys were returned. All surveys were input into Survey Monkey and downloaded into excel for analysis. Closed questions were analysed using descriptive statistics and open-ended questions were organised into themes and described descriptively. RESULTS: The technology audit identified that technologies were in place from as early as 2002. Technology heterogeneity of, both passive and active devices, was found within the housing schemes. Technologies such as wearable devices were reportedly used according to need, and mobile phone use was widely adopted. The themes that developed out of the tenant interviews were: Attitudes and Engagement with Technology; Technology Enhancing Tenants Sense of Security; Seeking Support and Digital Literacy; and Technology Enabled Connection. A lack of awareness about living alongside technology was a major finding. Technologies enabled a sense of reassurance and facilitated connections with the wider community. The interaction with technology presented challenges, for example, remembering passwords, access to Wi-Fi and the identification of its use in an emergency. The caregiver survey reported a range of facilitators and barriers for the use of technology within care. Both types of caregivers held relatively similar views around the benefits of technology, however their views on issues such as privacy and consent varied. Safety was considered more important than right to privacy by family caregivers. CONCLUSIONS: The present study provides new insight into stakeholder's experiences of living, working and caregiving alongside technology in supported living environments. As the generation of people living with dementia become more tech savvy, harnessing everyday technologies to support care could enable holistic care and support the transition through the care continuum. Advance care planning and technology assessments are at the very core of future technology provision. It is evident that a paternalistic attitudes towards technology use could impact the multitude of benefits technology can play in both health and leisure for people living with dementia and their caregivers.

Sobre dias em que me senti sem ar: desassossegos do pesquisar / On days when i felt breathless: unrest of search / Sobre días que me sentí sin aliento: disurbios de investigación

Resumo Conceitos como o de alteridade, encontro de saberes, polifasia cognitiva, o princípio de familiaridade e de representações sociais operaram na complexa tarefa de compreender como os encontros entre profissionais e usuários sustentavam e/ou transformavam as práticas de acolhimento. Entretanto, a experiência da minha pesquisa de doutorado me levou a questionar os próprios conceitos utilizados da Teoria das Representações Sociais. Ao final do ensaio, após discutir aspectos teórico-metodológicos, o princípio de familiaridade e a questão da tensão e dos afetos nas representações sociais, espero evidenciar como o movimento provocado pelo encontro com usuários e profissionais de uma Rede de Atenção Psicossocial levou-me a questionar pontos essenciais da teoria: o papel domesticador das representações, a forma ainda estática de evidenciar os fenômenos, a separação entre um sujeito que representa e o objeto representado e a dificuldade em usar suas ferramentas conceituais para acompanhar processos me fazem repensar meu lugar e minha função de pesquisador.

Abstract Concepts such as alterity, encounter of knowledge, cognitive polyphasia, the principle of familiarity and the very concept of social representations operated in the complex task of understanding how the encounters between professionals and users supported and / or transformed user embracement practices. However, the experience of my doctoral research led me to question the very concepts used in the Theory of Social Representations. At the end of the essay, after discussing theoretical and methodological aspects, the principle of familiarity and the issue of tension and affects in social representations, I hope to show how the movement caused by the encounter with users and professionals of a Psychosocial Care Network, led me to question essential points of the theory: the domesticating role of representations, the still static way of showing phenomena, the separation between a subject that represents and the object represented and the difficulty in using their conceptual tools to accompany processes makes me rethink my place and role as a researcher.

Resumen Conceptos como la alteridad, el encuentro de saberes, la polifasia cognitiva, el principio de familiaridad y el concepto mismo de representaciones sociales operaron en la compleja tarea de comprender cómo los encuentros entre profesionales y usuarios apoyaron y / o transformaron las prácticas de acogimiento. Sin embargo, la experiencia de mi investigación doctoral me llevó a cuestionar los propios conceptos utilizados en la Teoría de las Representaciones Sociales. Al final del ensayo, después de discutir aspectos teóricos y metodológicos, el principio de familiaridad y el tema de tensión y afectos en las representaciones sociales, Espero mostrar cómo el movimiento provocado por el encuentro con usuarios y profesionales de una Red de Atención Psicosocial, me llevó a cuestionar puntos esenciales de la teoría: el rol domesticador de las representaciones, la forma todavía estática de mostrar los fenómenos, la separación entre un sujeto que representa y el objeto representado y la dificultad para utilizar sus herramientas conceptuales para acompañar procesos, me hace repensar mi lugar y rol como investigador.

Atendimento psicológico grupal: experiências de usuários de serviços do Sistema Único de Saúde / Group psychological care: experiences of users of the Sistema Único de Saúde services / Atención psicológica grupal: experiencias de los usuarios de los servicios del Sistema Único de Saúde

O emprego de práticas grupais tem sido descrito como um recurso útil para a atuação profissional de psicólogos e uma alternativa qualificada nos serviços em saúde. Nesse estudo, objetivou-se compreender como usuários atendidos por psicólogos, em modalidades terapêuticas grupais em serviços do Sistema Único de Saúde (SUS), experienciam e significam o uso dessa ferramenta. Vinte usuários participaram da investigação e entrevistas individuais foram estratégias utilizadas para acessar suas experiências. A participação em grupos terapêuticos, em equipamentos de Atenção Primária ou Secundária, há mais de um mês, foram critérios para inclusão dos entrevistados. Os entrevistados relataram aprendizagens quando em grupos, legitimando atendimentos grupais como facilitadores da construção de vínculos com seus pares e promotores de saúde. Eles recuperaram o modelo de atendimento individual como parâmetro de atenção psicológica e apresentaram a questão do sigilo como um desafio a ser trabalhado nas realidades grupais. Novas pesquisas sobre experiências de usuários de atendimento grupal psicológico nos equipamentos de saúde do SUS permitirão ampliação dos achados.

The use of group practices has been described as a useful resource for the professional work of psychologists and a qualified alternative in health services. In this study, the objective was to understand how users cared for by psychologists, in group psychotherapeutic interventions, offered in services of the Sistema Único de Saúde (SUS) in Brazil, experience and signify the use of these devices. Twenty users participated in the investigation and individual interviews were strategies used to access their experiences. Participation in therapeutic groups, in Primary or Secondary Care equipment, for more than a month, were criteria for the inclusion of respondents. Respondents reported learning when in groups, legitimizing group care as facilitators of building bonds with their peers and as health promoters. They recovered the individual care model as a parameter of psychological care and presented the issue of secrecy as a challenge to be worked on in group realities. New research on the experiences of users of psychological group care in SUS health equipment will allow an expansion of the findings.

El uso de prácticas grupales se ha descrito como un recurso útil para la práctica profesional de los psicólogos y una alternativa calificada en los servicios de salud. En este estudio, el objetivo fue comprender cómo los usuarios atendidos por psicólogos, en intervenciones psicoterapéuticas grupales, ofrecidas en los servicios del Sistema Único de Saúde (SUS) en Brasil, experimentan y significan el uso de estos dispositivos. Veinte usuarios participaron de la investigación y las entrevistas individuales fueron estrategias utilizadas para acceder a sus experiencias. La participación en grupos terapéuticos, en equipos de Atención Primaria o Secundaria, durante más de un mes, fueron criterios de inclusión de los encuestados. Los encuestados informaron que aprendieron cuando estaban en grupos, legitimando el cuidado grupal como facilitadores de la construcción de vínculos con sus pares y promotores de salud. Recuperaron el modelo de atención individual como parámetro de la atención psicológica y presentaron el tema del secreto como un desafío a trabajar en las realidades grupales. Una nueva investigación sobre las experiencias de los usuarios de la atención psicológica grupal en los establecimientos de salud del SUS permitirá ampliar los hallazgos.

Culturally adapted cognitive behavioural group therapy for mental disorders in refugees plus problem solving training (ReTreat): study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Since a high proportion of refugees in Germany suffer from mental disorders, culturally adapted treatments are needed that target a broad range of symptoms. There is much evidence for the efficacy of culturally adapted cognitive behavioural therapy (CA-CBT). Given the promising results of CA-CBT, the combination with problem solving training (CA-CBT+) represents a novel approach that potentially improves the refugees' ability to cope actively with psychosocial problems. This randomised controlled trial evaluates the efficacy of 12-session outpatient CA-CBT+ compared with to treatment as usual (TAU) in a sample of refugees suffering from at least one DSM-5 disorder. METHODS AND ANALYSIS: The present study will be carried out as two-group randomised trial with 1:1 individual allocation to either (1) culturally adapted cognitive behavioural therapy in a group setting (CA-CBT+) or (2) TAU. The study takes place at four sites in Germany, randomising in total 138 adult refugees with at least one primary DSM-5 diagnosis to the treatment conditions. In CA-CBT+ the patients receive 12 sessions of 120 min duration over the course of 12 weeks providing psychoeducation, meditation and other techniques of emotional regulation, stretching and problem solving training. The primary outcome is treatment response operationalised by a clinically significant change in General Health Questionnaire (GHQ-28) score. Follow-up visits will take place 3 and 9 months after the end of the intervention. Secondary outcomes include changes in psychopathological symptoms, somatic symptoms and quality of life. Intention-to-treat analysis will be performed. Adverse and serious adverse events will be analysed. Further, healthcare usage and economic outcomes will be assessed and analysed. Primary and secondary outcomes will be analysed using appropriate statistical methods. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Commission of the German Psychological Society (ref: StangierUlrich2019-1018VA). Results will be disseminated via presentations, publication in international journals, and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER: DRKS00021536.

Design of an RCT on cost-effectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder: the QUEST-CLC study protocol.

BACKGROUND: Given the high prevalence of Cluster-C Personality Disorders (PDs) in clinical populations, disease burden, high societal costs and poor prognosis of comorbid disorders, a major gain in health care can be achieved if Cluster-C PDs are adequately treated. The only controlled cost-effectiveness study published so far found Individual Schema Therapy (IST) to be superior to Treatment as Usual (TAU). Group ST (GST) might improve cost-effectiveness as larger numbers can be treated in (>50%) less time compared to IST. However, to date there is no RCT supporting its (cost-) effectiveness. The overall aim of this study is to assess the evidence for GST for Cluster-C PDs and to improve treatment allocation for individual patients. Three main questions are addressed: 1) Is GST for Cluster-C PDs (cost-)effective compared to TAU? 2) Is GST for Cluster-C PDs (cost-) effective compared to IST? 3) Which patient-characteristics predict better response to GST, IST, or TAU? METHODS: In a multicenter RCT, the treatment conditions GST, IST, and TAU are compared in 378 Cluster-C PD patients within 10 sites. GST and IST follow treatment protocols and are completed within 1 year. TAU is the optimal alternative treatment available at the site according to regular procedures. Severity of the Cluster-C PD is the primary outcome, assessed with clinical interviews by independent raters blind for treatment. Functioning and wellbeing are important secondary outcomes. Assessments take place at week 0 (baseline), 17 (mid-GST), 34 (post-GST), 51 (post-booster sessions of GST), and 2 years (FU). Patient characteristics predicting better response to a specific treatment are studied, e.g., childhood trauma, autistic features, and introversion. A tool supporting patients and clinicians in matching treatment to patient will be developed. An economic evaluation investigates the cost-effectiveness and cost-utility from a societal perspective. A process evaluation by qualitative methods explores experiences of participants, loved ones and therapists regarding recovery, quality of life, and improving treatment. DISCUSSION: This study will determine the (cost-)effectiveness of treatments for Cluster-C PDs regarding treatment type as well as optimal matching of patient to treatment and deliver insight into which aspects help Cluster-C-PD patients recover and create a fulfilling life. TRIAL REGISTRATION: Dutch Trial Register: NL9209 . Registered on 28-01-2021.

Addressing health in psychotherapy: Future directions from a community wellness lens.

Building off insight provided by authors in this special section and in the broader literature, this closing article describes future directions in health in psychotherapy. We use the community wellness model (CWM; Prilleltensky, 2005) sites of personal, relational, and collective to highlight psychotherapy constructs that offer future directions for more fully embracing a community and social justice perspective in health in psychotherapy. Within each level, we describe implications for researchers and clinicians: the personal level focuses on individual psychotherapy, including theoretical orientation, interventions, and feedback-informed treatment; the relational level covers clinician-client dynamics and group psychotherapy; the collective level addresses the scope and innovation of our interventions as well as advocacy efforts. Our hope is that these psychotherapy constructs and processes offer researchers and clinicians future directions for more fully integrating health into psychotherapy in a way that embeds a social justice perspective. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Multicultural Streaming in Group Psychotherapy Supervision: Orientation to and Preparation for Culturally Humble Practice.

How do psychotherapy supervisors most effectively integrate issues and concerns about multiculturalism and social justice (MSJ) into the supervisory experience? Concrete examples of how to best address this integration are needed, and this article provides one such example. The authors propose multicultural streaming as one approach to orient supervisees about, and prepare them for, incorporation of MSJ matters into group supervision and to foster their evolving sense of culturally humble practice. This article defines multicultural streaming, presents a plan for its implementation at the group's outset, and identifies implementation guideposts for consideration. A set of cultural humility guidelines adapted for group supervision is also proposed for group facilitation. This perspective is presented with the hope of generating further discussion about integrating MSJ issues into the group supervisory experience.

Relapse prevention group therapy via video-conferencing for substance use disorder: protocol for a multicentre randomised controlled trial in Indonesia.

BACKGROUND: Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. METHODS: A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants' usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. TRIAL REGISTRATION NUMBER: UMIN000042186.

Addressing the mental health needs of learners and nonlearners in an academic medical center during COVID-19.

The coronavirus disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.

Clinical and cost-effectiveness of nurse-led cognitive behavioral group therapy for recovery of self-esteem among individuals with mental disorders: A single-group pre-post study.

AIM: To investigate whether the addition of a nurse-led cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) program to usual care for individuals with mental disorders can improve clinical outcomes and reduce direct medical costs. METHODS: This study employed single-group pre-post design, and recruited 51 community-dwelling individuals with mental disorders. Participants received 12 weekly CBGTRS sessions by a nurse in addition to usual care. The primary outcome measure was the level of self-esteem, with other clinical outcomes and direct medical costs. The clinical outcomes were measured at pre-intervention (T0), intervention midpoint (T1), immediate post-intervention (T2), and 3 months post-intervention (T3). Direct medical costs were calculated for 3 months pre-intervention (A0), 3 months post-intervention (A1), between 4-6 months post-intervention (A2), and between 7-9 months post-intervention (A3). RESULTS: Self-esteem scores were significantly improved from T0 to T2 and T3 (p = .009 and .006, respectively); within-group effect sizes were .49 (small) for T0-T2, and .51 (medium) for T0-T3. Other secondary clinical outcomes for mood, cognitive bias, global functioning, and quality of life were also improved by T3 (all p < .05). The mean total direct medical costs were significantly reduced from A0 (49,569.51 JPY) to A2 and A3 (21,845.76 JPY and 25,981.69 JPY, respectively) (p = .003 and .017, respectively). CONCLUSIONS: The results suggest that nurse-led CBGTRS for mental disorders is a potentially effective approach in improving self-esteem and other clinical outcomes, and in reducing direct medical costs. Further controlled studies that address the limitations of this study are required.

[Qualitative Evaluation of the Implementation of Group Psychoeducation for Bipolar Disorder in Clinical Settings in Quebec]. / Évaluation qualitative de l'implantation de groupes psychoéducatifs pour le trouble bipolaire à Québec.

Objectives Bipolar disorder is a chronic condition which significantly impacts the functioning and quality of life of patients with the disorder. Recognized efficacious psychological interventions, such as group psychoeducation, can help better address some of the limitations observed when pharmacotherapy is used alone in the management of bipolar disorder. However, access to these evidence-based interventions seems to be limited for most patients. Indeed, the translation of knowledge acquired through research towards actual clinical settings poses a significant challenge. Assessing the implementation of these efficacious interventions in clinical practice is thus a priority. The objective of this study is to describe the implementation of a psychoeducative intervention, the Life Goals Program (LGP), for the treatment of bipolar disorder in community mental health settings in Quebec City. Methods The LGP was implemented in three different clinical settings located in Quebec City. Fifteen healthcare service providers chosen by their respective clinical site were trained to deliver the intervention. They delivered the treatment to 73 patients with a diagnosis of bipolar disorder. Healthcare service providers filled a log book after each group session, in order to assess whether they had properly delivered the content of the program. At the end of the study, they also participated in a group interview in order to get a better understanding of their experience delivering the intervention and their appreciation of the research process. Results Following qualitative content analysis, four main categories of factors that could influence the implementation of the intervention were identified: 1) healthcare service providers' characteristics (academic training, clinical experience, personality, knowledge of the program, and dynamic between animators); 2) participants' characteristics; 3) organizational context (physical and material environment, staff stability, administrative management and research requirements); and 4) facilitation (perception of research, research team support, and facilitation tools). These categories derived from data analysis coincide with those observed in the literature. The following factors seemed to have had the most impact in the differences observed between sites in the implementation of the LGP: the support offered by the research team; staff stability; and the academic training of healthcare services providers. Conclusion Dissemination and implantation studies can not only help determine factors that are important to consider when implementing a program, but can also help improve and adapt these programs in order to increase acceptability and effectiveness in real world clinical settings.

Grupo de adolescentes em serviços de saúde mental: uma ferramenta de reabilitação psicossocial / Group of adolescents in mental health services: a psychosocial rehabilitation tool / Grupo de adolescentes en servicios de salud mental: una herramienta de rehabilitación psicosocial

Este estudo teve como objetivo conhecer a dinâmica de funcionamento de grupos de adolescentes coordenados por enfermeiras/os em Centros de Atenção Psicossocial (CAPS). Trata-se de uma pesquisa de abordagem qualitativa. A coleta de dados foi realizada entre março e maio de 2019. Neste período foram realizadas observações sistemáticas em grupos de adolescentes realizados em dois centros de atenção psicossocial. As observações foram registradas em diário de campo, e entrevistas discursivas foram realizadas com os enfermeiros coordenadores destes grupos. A análise temática dos dados foi baseada no referencial teórico de grupos de Pichon-Rivière. Evidenciou-se que as técnicas grupais se mostraram fundamentais enquanto práticas de reabilitação psicossocial para os adolescentes nestes grupos, por este ser um período de muitas dúvidas e experimentações. Contudo, os enfermeiros nem sempre coordenam os grupos a partir de um referencial teórico. Considera-se que a orientação teórica é importante para o desenvolvimento desta terapêutica. Por fim, a teoria de Pichon-Rivière se mostrou uma abordagem possível para se pensar a prática do enfermeiro no atendimento em grupo no CAPS.

This study aimed to understand the functioning dynamics of the adolescent's groups coordinated by nurses in Psychosocial Care Centers. It is a qualitative research. Data collection was carried out between March and May 2019. During this period, systematic observations were carried out in adolescents groups of two psychosocial care centers. The observations were recorded in a field diary, and discursive interviews were conducted with the nurse coordinators of these groups. Thematic analysis of the data was based on the theoretical framework of Pichon-Rivière groups. It was evident that group techniques were fundamental as psychosocial rehabilitation practices for adolescents in these groups, as this is a period of many doubts and experiments. However, nurses do not always coordinate groups based on a theoretical framework. It is considered that theoretical guidance is important for the development of this therapy. Finally, Pichon-Rivière's theory proved to be a possible approach to think about the nurse's practice in group care at CAPS.

Este estudio tuvo como objetivo comprender la dinámica del funcionamiento de grupos de adolescentes coordinados por enfermeras en Centros de Atención Psicosocial (CAPS). Es una investigación cualitativa. La recolección de datos se realizó entre marzo y mayo de 2019. Durante este período, se realizaron observaciones sistemáticas en grupos de adolescentes en dos centros de atención psicosocial. Las observaciones se registraron en un diario de campo y se realizaron entrevistas discursivas con las enfermeras coordinadoras de estos grupos. El análisis temático de los datos se basó en el marco teórico de los grupos de Pichon-Rivière. Se evidenció que las técnicas grupales fueron fundamentales como prácticas de rehabilitación psicosocial para los adolescentes de estos grupos, ya que este es un período de muchas dudas y experimentos. Sin embargo, las enfermeras no siempre coordinan grupos en base a un marco teórico. Se considera que la orientación teórica es importante para el desarrollo de esta terapia. Finalmente, la teoría de Pichon-Rivière resultó ser un posible enfoque para pensar en la práctica de la enfermera en la atención grupal en CAPS.

Formações e transformações - o olhar de um aspirante a grupoterapeuta / Training and transformations a glance of an aspirant to group therapist / Capacitación y transform aciones la mirada de un aspirante a terapeuta de grupo

Este artigo tem como objetivo o relato de uma experiência pessoal e profissional de inserção em espaços prático-pedagógicos que oferecem o ensino da coordenação/manejo de grupos psicanalíticos em seus diferentes contextos. Este trabalho é dividido em quatro partes. Discute-se a questão do trabalho com grupos em serviços da Saúde e Saúde Mental e as dificuldades enfrentadas. Posteriormente são relatadas experiências pessoais do autor em diversos espaços grupais e sua inserção em espaços prático-pedagógicos de coordenação de grupos e suas características. Por último, nas considerações finais, é reforçada a importância destes caminhos para que uma pessoa possa se enquadrar como coordenador de grupos psicanalíticos.

This article aims to report a personal and professional experience of inclusion in practical-pedagogical spaces that offer the training of coordinating /handling of psychoanalytic groups in their different contexts. This work is divided into four parts. Firstly, the issue of working with groups in Health and Mental Health services and the difficulties faced are discussed. Afterwards, the author's personal experiences in several group spaces and his inclusion in practical-pedagogical spaces for group coordination and their characteristics are described. Finally, the conclusion reinforces the importance of these paths so that a person can fit in as a coordinator of psychoanalytic groups.

Este artículo tiene como objetivo relatar una experiencia personal y profesional de inclusión en espacios práctico-pedagógicos que ofrecen la enseñanza de la coordinación/gestión de grupos psicoanalíticos en sus diferentes contextos. Este trabajo está dividido en cuatro secciones. Primero, se discute el tema del trabajo con grupos en los servicios de Salud y Salud Mental y las dificultades que enfrentadas. Entonces, son informadas las vivencias personales del autor en varios espacios grupales y su inclusión en espacios práctico-pedagógicos para la coordinación grupal y sus características. Finalmente, en la conclusión, se refuerza la importancia de estos caminos para que una persona pueda encajarse como coordinadora de grupos psicoanalíticos.