The Effectiveness of Group Interpersonal Therapy on Burnout Among Long-Term Care Workers.

OBJECTIVE: Burnout syndrome can have a negative impact on people who work in occupations that require close interaction with others, contributing to a decline in their psychological well-being. This study aimed to examine the effectiveness of Group Interpersonal Therapy (IPT-G) in reducing burnout among care workers for older adults in a Turkish long-term care facility. METHODS: The study employed a pretest-post-test randomised experimental design. Fifty care workers scoring 27 or above on emotional exhaustion and 10 or above on depersonalisation subscales of the Maslach Burnout Inventory (MBI) were randomly assigned to the intervention or control group for 8 weeks. The study utilised the World Health Organization (WHO) Group Interpersonal Therapy for Depression manual as a guide. The post-test was conducted immediately after the last session of the intervention. RESULTS: In comparing pre- and post-test scores of the intervention group, a statistically significant difference was found in overall burnout scores (pretest M = 74.10, post-test M = 63.08, p < 0.001; d = 1.12). Additionally, emotional exhaustion scores (pretest M = 30.99, post-test M = 24.89, p < 0.001; d = 1.11) and depersonalisation scores (pretest M = 12.76, post-test M = 8.53, p < 0.001; d = 1.69) exhibited significant differences. However, no significant difference was observed in personal accomplishment scores (p > 0.05). The control group had no significant differences concerning the overall burnout scores and all three subscales (p > 0.05). CONCLUSION: The IPT-G used in this study effectively decreased burnout among care workers in a long-term care facility in Türkiye. In addition, the participants reported high satisfaction with the IPT-G program. IMPLICATIONS FOR PRACTICE: Our results support the usefulness of the IPT-G program for care workers in long-term care facilities considering adding it to their occupational health management. This research aimed to determine whether IPT-G successfully decreased care worker burnout. Future research focusing on various types of healthcare workers in long-term care facilities and examining factors such as burnout, job satisfaction and self-efficacy could provide more information on the effects of IPT-G.

Group psychoeducation for patients with bipolar disorder: a retrospective study on effectiveness in delaying relapse episodes and intensity.

INTRODUCTION: Group psychoeducation is effective in preventing relapse in bipolar disorder. It's indicated as an adjunctive intervention to pharmacotherapy for all outpatients. This retrospective, single center experience of group psychoeducation for bipolar disorder over a 6 years period, aims to assess severity of symptoms and comparative relapse episodes and intensity prior to and following psychoeducation as well as evaluating the decrease in hospitalizations and days of hospitalization. METHODS: Between 2014 and 2019 patients with a bipolar disorder were invited to attend a Colom model group psychoeducation (weekly 90 minutes sessions for 22 weeks). Depression and mania were assessed at baseline, following psychoeducation, 6 months and 12 months with the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Patient specific hospitalization admissions data for 3 years prior to and 3 years following psychoeducation course were accessed. Subgroup analyses were performed according to patient sex and age with ANOVA methodology. RESULTS: Of the 95 eligible patients, 77 completed psychoeducation: 18 (19%) patients dropped out. Mean patient age was 45 years and 33 (43%) were male. Overall and subgroup specific YMRS and HDRS improved significantly throughout follow-up (p<0.01). Hospitalization analyses (45 patients; 58.4%) revealed a significant decrease in relapse and hospital stay days after psychoeducation, p<0.01. DISCUSSION: We provide evidence of applicability and efficacy of adjunctive psychoeducation in a real-world setting. Advantages observed were independent of patient sex and age. Analysis of the optimal number of sessions provided to patients according to efficacy and retention rates is required. CONCLUSIONS: Despite inherent study design limitations, retrospective evaluation of a single-center psychoeducation program supports evidence of psychoeducation effectiveness in significantly reducing the severity of bipolar disorder and hospitalizations, despite a drop-out rate of 1 in 5.

Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial.

BACKGROUND: Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. METHODS: In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. FINDINGS: From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. INTERPRETATION: The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. FUNDING: UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. TRANSLATION: For the Urdu translation of the abstract see Supplementary Materials section.

Exploring the Efficacy of Group Music and Game Therapy on the Well-Being of Institutionalized Elderly.

This study aims to explore the efficacy of group music and game therapy in enhancing the well-being of the institutionalised elderly. The implementation of group music and game therapy have significantly improved the well-being of the participating elderly residents in Long-Term Care Facilities. These participants demonstrated increased engagement and achieved interpersonal interaction objectives during the sessions.

Efficacy of Traditional Chinese Medicine Combined Online Group Psychotherapy (TCM-eRhab) on improving quality of life and relieving psychological burden for colorectal cancer survivors: a study protocol for a phase-II randomized controlled trial.

BACKGROUND: More than 50% of colorectal cancer(CRC) patients experience cancer-related psychological burden after radical surgery, which can seriously affect their physical wellness, quality of life and even survival outcomes. Our research team developed a six-week Traditional Chinese Medicine Combined Online Group Psychotherapy (TCM-eRhab) and proved its efficacy on relieving cancer-related anxiety, depression and fear of cancer recurrence though phase I single arm clinical trial (n = 40). Large sample size randomized controlled clinical trial(RCT) is necessary to further evaluate TCM-eRhab's role on improving quality of life and survival outcomes among this population. METHODS: We design a phase II RCT study, in which 210 CRC patients who have received radical surgery (stage I-III) will be recruited. Eligible patients will be randomly assigned to TCM-eRhab group or usual care group by 2:1 ratio. Patients in the intervention group will receive the structured TCM-eRhab program for six weeks, while patients in control group will receive usual care only. The primary outcomes are quality of life, severity of anxiety, depression and fear of cancer recurrence. Cancer recurrence rate will also be calculated according to long term follow-up data. DISCUSSION: As one of the first RCTs to evaluate the impacts of TCM combined psychological therapy to improve CRC patients' quality of life after surgery, the results from this study will provide innovative knowledge and evidence on integrating TCM into CRC survivorship care and mind-body intervention model.

Psychoeducation for Pathologic Narcissism and Narcissistic Personality Disorder: A Review and Proposal for a Good Psychiatric Management-based Six-week Group Program.

Pathologic narcissism (PN) and narcissistic personality disorder (NPD) are 2 common and stigmatized clinical constructs that are known to have large consequences for patients' functioning and mental health-related outcomes. To date, no treatment for these conditions has been empirically validated, but there is a relative consensus about the importance of psychoeducation. Here we present a model for a psychoeducational intervention for patients with PN or NPD. We start with a review of the current evidence on the role of psychoeducation in different treatment models for PN, and we discuss several aspects regarding the content and format of this type of intervention. Based on this review, we outline a 6-week Good Psychiatric Management-based psychoeducation group program that we developed. We also describe how such a psychoeducational intervention can be implemented individually, with fewer resources, in general care settings. Finally, we discuss the strengths and limitations of our approach and elaborate on the rationale for our proposal. We believe that this program proposal is a first step in the development of psychoeducational programs for PN and NPD that can be further corrected and enhanced.

Members' Feedback After a Spiritual Group Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT).

Six hundred and fifty-four inpatients who participated in a spiritual group therapy intervention provided qualitative feedback regarding what helped them and what could be improved. Patients revealed that enjoying a sense of connection with other people and a sense of openness in the groups and simply talking about spirituality with other people was helpful to them. Many group members requested that groups go on for a longer amount of time than 12 sessions, to have longer sessions, and to have more frequent meetings. In addition, members described improvements that could be made to the group, including members' being better screened, leaders preventing individual members from dominating discussions or from being quiet or leaving the group early, and members' wanting more structure as well as more open discussion. The findings highlight the importance of connection, openness, and spirituality when implementing spiritual group interventions in hospital settings. Implications for future research, training, and clinical interventions are discussed.

Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial.

BACKGROUND: Behavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD). METHODS: In this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS). RESULTS: The results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up. DISCUSSION: BAGT was more effective than SBA in MDD patients. Participants' engagement with self-help treatment is discussed. TRIAL REGISTRATION: The present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/ ) (Registration Date: 04/03/2019).

Online occupational therapy group training for mothers of children with feeding problems: A randomized controlled trial.

AIM: The aim of this study was to scrutinize how online occupational therapy group training for mothers influenced their attitudes and stress levels relating to feeding their children and the eating behaviours of the children. The secondary purpose of the study is to evaluate the satisfaction of the participants of this program. Twenty-nine mothers of children aged 3-6 years, experiencing feeding issues, were randomly allocated to either an intervention or control group. BACKGROUND: Feeding problems including selective eating, loss of appetite, and mealtime behaviour problems are prevalent during childhood. Parents play a fundamental role in acquiring knowledge about feeding. Problems in the feeding process may lead to parental stress, feelings of despair, and incorrect attitudes. RESULTS: The mothers in the research group participated in the 4-week training. Results indicated positive effects on both maternal attitudes and their children's eating behaviours (p < 0.05). No significant change was found in mothers' state and trait anxiety levels (p > 0.05). Participants were asked to score their satisfaction level with the program between 1 and 10, and the average of the scores was 9.78 ± 0.42. CONCLUSION: This study shows that online group education for mothers can support existing treatments and guide clinicians working with children with feeding problems.

Kaës' Internal Groups and Actual Groups: A Relational Perspective.

Rene Kaës (2007), an influential French psychoanalyst relatively unknown to English-speaking readers, extends the field of psychoanalytic investigation and practice to groups. Building on Klein, Anzeiu, Bion, and Lacan, Kaës presents a dual-axes theory in which early oedipal and sibling complexes structure unconscious dynamics of internal groups. According to Kaës, analytic group psychotherapy provides access to the phantasies, affects, and action tendencies contained within internal groups that would be otherwise inaccessible. While a few reference articles have appeared in the English literature, Kaës' bold assertions, core concepts, and praxis have not been subject to critical evaluation. I introduce Kaës' main ideas, demonstrate their influence on my group work, and by comparing two case examples, from his practice and mine, articulate our differences, some of which arise from different conceptions of and approaches to intersubjectivity. The discussion continues in the final section which briefly considers the nature of psychoanalytic learning and how we may employ the therapeutic group to reach this goal.

Increasing the Therapeutic Dosage by Combining Cognitive Behavior Group Therapy With a Monitored Self-Help Group.

Objective: A problem in psychotherapy is the limited availability of psychotherapists. This can not only delay the start of therapy but also curtail the number of sessions and the therapeutic dosage. An option to extend the therapeutic dose without an increase in therapist time may be to combine group psychotherapy with a self-help group. The goal of the present study is to investigate how patients judge this treatment mode and to what degree the contents of a regular group treatment are pursued in a parallel self-help group.Method: Seventy-two psychosomatic inpatients participated in cognitive behavior group therapy and parallel self-help group, which was monitored by the therapist during the regular group therapy sessions. Patients in both groups filled in a questionnaire that asked for the content of the group session, how patients had experienced the interaction, and what they had taken from the group.Results: Patients reported that in the self-help group, they discussed similar topics as in the regular group therapy, like how to deal with anxiety or sadness, how to interact with other people, and how to cope with their mental disorder and problems at work, in the family, or with friends. Patients indicated that there was more relaxed chatting in the self-help group, whereas learning new behavior was reported more frequently for the regular group therapy.Conclusions: In the regular group therapy and the guided self-help group, similar topics were discussed, which suggests that a combination of both can extend the therapeutic process and increase the therapeutic dosage without costs for the therapist or the institution.

Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study.

BACKGROUND: People with MS (pwMS) commonly experience a range of hidden symptoms, including cognitive impairment, anxiety and depression, fatigue, pain, and sensory difficulties. These "invisible" symptoms can significantly impact wellbeing, relationships, employment and life goals. We developed a novel bespoke online group neuropsychological intervention combining psychoeducation and cognitive rehabilitation with an Acceptance and Commitment Therapy (ACT)-informed approach for pwMS in an acute tertiary hospital. This 'Neuropsychological Intervention for Managing Invisible Symptoms' in MS (NIMIS-MS) consisted of 6 sessions, each with a psychoeducation and ACT component. The content included psychoeducation around managing cognitive difficulties, fatigue, pain, sleep and other unpleasant sensations in MS with the general approach of understanding, monitoring, and recognising patterns and potential triggers. Specific cognitive rehabilitation and fatigue management strategies were introduced. The ACT-informed component focussed on three core ACT areas of the 'Triflex' of psychological flexibility (Harris, 2019): Being Present, Opening Up, and Doing What Matters. METHODS: 118 pwMS attended the NIMIS-MS group intervention which was delivered 14 times in six-week blocks over an 18-month period. To evaluate the effectiveness and acceptability, participants completed measures of depression and anxiety (HADS), functional impairment (WSAS), Values- Progress (VQ) and Values- Obstruction (VQ), and Acceptance of MS (MSAS) pre and post NIMIs-MS group intervention. Qualitative feedback was obtained during focus groups after the final session and via online feedback questionnaires RESULTS: Pre-post analysis showed that symptoms of depression and anxiety were significantly lower and acceptance of MS was significantly higher following completion of the NIMIS-MS group. Qualitative feedback showed that participants reported that they felt more equipped to manage the "invisible" symptoms of MS following completion of the group, and benefited from using ACT-based strategies and techniques. Participants highly valued the peer support that evolved during the NIMIS-MS groups. The online format was considered more accessible than in-person groups, due to less concerns of travel time, cost, fatigue, and comfort and infection. CONCLUSION: Evaluation suggests that our novel NIMIS-MS groups is an acceptable, beneficial and feasible approach for providing neuropsychological interventions to individuals with MS.

Virtual Group Cognitive Stimulation Therapy for Dementia: Mixed-Methods Feasibility Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Cognitive stimulation therapy (CST) is an evidence-based group intervention for people with dementia, with benefits for cognition and quality of life when delivered face-to-face. Many people are unable to attend face-to-face groups for reasons including health and transport issues. This study aimed to assess the feasibility and acceptability of online or "virtual" CST (vCST). RESEARCH DESIGN AND METHODS: Single-blind, randomized controlled feasibility design with qualitative interviews. Forty-six people with mild-to-moderate dementia were randomly allocated to attend either 14 sessions of twice-weekly vCST (n = 24) or treatment as usual (TAU, defined as usual care; n = 22) over 7 weeks. Cognition, quality of life, and depression were assessed pre- and posttreatment. Qualitative interviews (n = 16) with participants and carers were analyzed using thematic analysis. RESULTS: High levels of attendance, adherence, fidelity to the manual, and completion of outcomes were recorded. Recruitment appeared feasible although randomization may not have been acceptable to some. There were no statistical differences noted between vCST and TAU in any of the outcomes evaluated, although both quantitative and qualitative data indicated acceptability, with qualitative reports of improved outcomes including cognition. DISCUSSION AND IMPLICATIONS: vCST appeared feasible to deliver but did not result in any changes in outcomes, as expected from an underpowered feasibility trial. CST is the main psychosocial intervention delivered for dementia in UK memory services and globally, with many services moving towards virtual CST delivery. Therefore, a fully powered RCT of the effectiveness of vCST is feasible and justified.

Exploring the Experiences of Regional and Rural Revictimized Women in a Group Empowerment Program.

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed.

Enhancing emotional abilities in anorexia nervosa treatment: A rolling-group cognitive remediation and emotional skills training protocol.

INTRODUCTION: Anorexia nervosa (AN) is characterised by limited remission rates and emotional dimensions are often neglected. Cognitive remediation and emotional skills training (CREST) protocol aims to address cognitive and emotional factors. This study evaluates the feasibility and effectiveness of a modified rolling-group CREST protocol in an inpatient setting. METHODS: Quasi-experimental design evaluated CREST protocol in a rehabilitation programme. A total of 116 females diagnosed with AN were included, of whom 63 were included in the CREST protocol and 53 in the standard rehabilitation treatment. Various standardized measures were employed to assess psychopathology. Data collection occurred longitudinally, before and after CREST implementation. RESULTS: No significant differences emerged between groups regarding changes in specific eating psychopathology. CREST group exhibited significant improvements in emotion regulation (p = 0.002) and social skills (p = 0.014), besides a reduction in alexithymia (p < 0.001) and cognitive rigidity (p = 0.013). Empathic features remained stable. Participants reported positive perceptions of the CREST intervention. DISCUSSION: The study highlights the potential benefits of integrating emotional training within multidisciplinary intensive treatment for AN. Results emphasise the importance of treatment protocol with more affective and hot-cognition-related interventions, beyond weight-related psychopathology. Implementing a rolling-group CREST protocol in an inpatient setting showed promise in enhancing the emotional abilities of AN patients.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

BACKGROUND: It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. METHODS: Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. RESULTS: The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). CONCLUSION: Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

Feasibility and acceptability of an online group dialectical behavioural therapy skills training in a Transdiagnostic group with Anxiety and Depression.

Transdiagnostic approaches offers a paradigm shift in managing psychiatric disorders. Emotion regulation difficulties are a transdiagnostic prevalent across various mood and personality disorders. Dialectical Behavioural Therapy Skills Training (DBT-ST), initially designed as part of treatment for borderline personality disorder, targets emotion regulation and has shown promise in diverse psychiatric conditions. In lower middle-income countries with resource-constrained settings, online delivery of evidence-based interventions holds potential to bridge treatment gaps. This study assesses the feasibility and acceptability of online group DBT skills training for individuals with depression or anxiety disorders in India. Mental health professionals practising in India referred twenty-four eligible participants currently not engaged in psychotherapy. Of these, 18 initiated the 8-week virtual group DBT-ST program, with 12 completing it (66 % female, 18-35 years of age, 5 on concurrent medication). They provided feedback on therapy content's usefulness. Baseline, post-intervention, and one-month follow-up assessments measured changes in emotion regulation difficulties, depression, and anxiety symptoms. Treatment retained 66.7 % of participants, all participants found the intervention beneficial. Repeated measures ANOVA indicates significant reductions in self-reported difficulties in emotion regulation, depression, and anxiety symptoms post-intervention. These findings highlight the promise of transdiagnostic interventions like DBT-ST that merit further evaluations using RCTs with larger sample sizes.

Therapeutic Groups to Help People Forgive Others: A Case Study.

Most people have been harmed by another at some point in their lives. Many of these hurts linger in the lives of those who were hurt, through anger, fear, and rumination. Forgiving others, when it is safe and prudent to do so, can be one route toward healing these past hurts. Group therapy has specific strengths that might help people to effectively forgive others. One of those strengths is the creation of therapeutic factors. In the current paper we discuss how group forgiveness interventions and the development of three specific therapeutic factors (universality, cohesion, and altruism) can help to promote forgiveness. We review prior work on forgiveness interventions in group therapy, focused on effectiveness generally. We then provide an applied case study of a specific group that used Worthington's REACH Forgiveness model. In this case study we highlight the themes of universality, cohesion, and altruism to illustrate the benefit of forgiveness interventions in group therapy.

Group arts therapies for patients with schizophrenia: a protocol of systematic review and meta-analysis.

INTRODUCTION: Schizophrenia, a chronic mental problem, significantly impacts cognition, emotion and social functioning. Conventional pharmacotherapy faces challenges including numerous side effects, low adherence to medication and substantial costs. In this context, group arts therapies (GATs) emerge as a promising complementary approach for symptom alleviation in schizophrenia patients. Nonetheless, the effectiveness and safety of GATs are yet to be firmly established. This study aims to systematically assess the therapeutic impact of all group-based artistic interventions as complementary treatments for schizophrenia, focusing on their potential benefits. METHODS AND ANALYSIS: This study will search four English-language databases (PubMed, Web of Science, Cochrane Library and Embase), two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) and three Korean databases (RISS, Korean Citation Index and DBpia) from their inception until October 2023. It will include all randomised controlled trials that compare GATs for schizophrenia with standard rehabilitation methods. The primary outcome is the improvement in patients' positive and negative symptoms. Methodologies such as bias risk assessment, data synthesis, sensitivity analysis and subgroup analysis will be implemented using Review Manager V.5.4. Study results with high heterogeneity will be merged using a random-effects model (I 2>50% or p<0.1). In cases where meta-analysis is not viable due to significant clinical and methodological heterogeneity, a qualitative summary of the findings will be provided. ETHICS AND DISSEMINATION: The data used in this systematic review are anonymised, devoid of any private information, eliminating the requirement for ethical approval. Dissemination of the research findings will be conducted via peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42023471583.

Unified Protocol Versus Self-Acceptance Group Therapy for Emotional Disorders in People With Severe Shame.

BACKGROUND: Severe shame is a distressing negative emotion, accompanied by intense feelings of worthlessness that contributes to a broad panoply of psychological disorders. This study aimed to compare the effects on shame dysregulation of two transdiagnostic treatments, the Unified Protocol (UP) and Self-Acceptance Group Therapy (SAGT). We additionally addressed the question of whether borderline personality disorder (BPD) can properly be regarded as an emotional disorder. The focus was on outcome measures, primarily shame that cut across individual diagnostic categories and capture emotional dysfunction broadly conceived. METHODS: Individuals suffering from a range of emotional disorders (including BPD) and high levels of shame were randomly allocated to treatment by either UP (N = 280) or SAGT (N = 282). Outcomes were measures of emotion dysfunction-shame, loneliness, neuroticism, emotional dysregulation, positive and negative affect-measured pre-treatment, post-treatment and at 3- and 6-month follow-ups. RESULTS: UP was superior to SAGT in showing better post-treatment retention of therapeutic gains on all outcome measures over the 6-month follow-up period. Compared with those without a BPD diagnosis, those diagnosed with BPD showed significantly higher neuroticism and emotion dysregulation at baseline and a similar post-treatment reduction in almost all outcomes. CONCLUSIONS: The results support the use of both the UP and SAGT in the treatment of severe shame. The superiority of the UP over SAGT in reducing negative emotionality is interpreted in terms of the specific mechanisms targeted by the UP. The results provide support for the theoretical rationale for the UP as a treatment for dysregulated shame and for emotional dysfunction generally.