We therefore chose to look at the effect of the treatment in relation to the separate diagnostic categories.
There was a significant change in depression score for all diagnostic groups, and there was no significant difference between the groups Fig. Legend: The box designates the median and the upper and lower quartiles. Observations within the range of the 1.
Dots are outlier cases.
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Bar plots show change from pre to post measurements for the response variables. BDI; Becks depression index. The difference is not significant when the three groups are compared.
However, the greatest effect tends to be in the group of patients who meet the anxiety diagnosis criteria. BAI; Becks anxiety index. However, the greatest effect tends to be in the group of patients who meet the criteria for a personality disorder diagnosis. SES; Rosenbergs self-esteem score. Table 3 shows that the greater the pre scores of BDI and BAI, and the smaller the pre score of SES the greater the treatment response, indicating that people with severe depressive and anxiety symptoms and low self-esteem profited the most from treatment. The extend of childhood adversities did not seem to have an impact on treatment, neither did socio-economic factors.
Each group had 10 weekly sessions and a follow up session. This is short time treatment, which mirrors the demands from the Danish health service. Our results seem to indicate that there is a treatment effect in 10 sessions. The impact is, however, that there is a risk of forcing the therapeutic process.
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A transdiagnostic approach makes it possible to gather a sufficient number of participants within a manageable period to be able to initiate a group course. A big advantage is that this shortens the waiting time for patients.
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Paul Gilbert among others has accentuated that CFT is a collaborative, step by step process, agreed by patient and therapist as one proceeds, and it is important not to impose [ 10 ]. It is therefore somewhat controversial in a CFT context to use a protocol. So why use a protocol? There are several reasons: It provides therapist with guidelines and some directions in therapy.
Finally It facilitates research in various ways: It is possible to establish and compare different groups, it is possible to investigate which elements of CFT are the most powerful, and finally it will be easier to ascertain, whether CFT, according to standards, has in fact been delivered.
The group format in particular facilitates the Flow of Compassion. Given the fact that therapists act as role- models, flow of compassion between the therapists is also crucial.
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Therapists must be aware of that. It is therefore essential that they meet before and after the sessions, partly in order to allot tasks, partly to debrief and discuss the session, and plan next session. Bates, who applied compassion elements to CBT group therapy, underlines the flexibility required in applying the model CBT in order to incorporate and maximize the therapeutic benefits [ 12 ]. However, he also mentions the risk of the model becoming lost in the complexities of group dynamics. It is important to stress that this protocol demands well-trained CFT therapists.
They must have a good understanding of engagement and —alleviation psychology, they must be able to bond and create a therapeutic relationship, and finally possess specialist CFT skills and be able to teach and practice compassion task. We found it very important to provide group-members with a shared understanding of the therapeutic model, implying that the psycho-educative elements are primarily in the early sessions. This enhanced the feelings of safety and getting greater insight facilitated motivation for working with compassion and increased the strength and courage to do.
The psycho-educative framework reduced the anxiety of being in a group and gave the group-members the possibilities of step wise self-disclosure, as well as grounding exercises. The more detailed case- formulation could easily provoke a lot of grief and sorrow and was therefore placed later in the group course, giving group members the opportunity of having trained basic self-soothing skills. This would enable them to meet the pain and grief more compassionately.
Throughout the group-course there is was a natural progression in participant interaction. We had to struggle to find a balance between the amount of psychoeducation and psychotherapy. Sometimes, one could be carried away passing on the theory with the expense of the more dynamic group processes. It was important to be aware of this risk, and leave time and space for the group to reflect.
There is a demand for RCT studies. We hope that the protocol and the very promising results will both provide a framework for group treatment, using the CFT model and encourage researchers to engage in further research of the treatment effect. This is a naturalistic study, carried out in a private practice. It suffers from several methodological shortcomings. There is no control group and no randomization. The patient were screened by the psychiatrist, and the criteria for referral to the group was her judgement and therefore highly subjective.
Twelve persons were not included in the study because of missing end data, and there was no follow- up assessment. Furthermore, there are no qualitative data, no process measures and relevant compassionate measures.
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We lack mediational analysis and time series analysis. This study shows that it is possible in a private practice, to offer an effective, short-term treatment, using a protocol, which contains the central CFT elements. This clearly indicates that the treatment has transdiagnostic qualities.
Using a protocol provides therapists with a good structure for the therapeutic work under due consideration for the group process. Furthermore, the protocol ensures a greater homogeneity in the group therapeutic treatment offer. Unfortunately, after publication of this article , it was noticed that Figs.
The correct versions of Figs. Cognitive-behavioral therapy for anxiety disorders. Mastering clinical challenges. New York: The Guildford Press; Cognitive behavioural processes across psychological disorders. Oxford: Oxford University Press; Toward a unified treatment of emotional disorders. Behav Ther. Ruminative coping with depressed mood following loss. J Pers Soc Psychol.
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Cognitive behavioural processes across psychiatric diagnosis: a review of the utility and validity of the transdiagnostic approach. Int J Cogn Ther. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. Spasojevic J, Alloy LB. Rumination as a common mechanism relating depressive risk factors to depression. Papageorgiou C, Wells A. Nature, functions, and beliefs about depressive rumination. In: Papageorgiou, Wells, editors. Depressive rumination. Nature, theory and treatment; Sensitivity to putdown: its relationship to perceptions of shame, social anxiety, depression, anger, and self-other blame.
Personal Individ Differ. Gilbert, P. Clin Psychol Psychother , 13, pp. Neff KD. The development and validation of a scale to measure self- compassion.
Related The Compassionate Mind Approach to Overcoming Anxiety: Series editor, Paul Gilbert (Overcoming Books)
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