Curative factors in two types of inpatient psychotherapy groups

Circadian rhythm as a therapeutic target

The circadian clock evolved in diverse organisms to integrate external environmental changes and internal physiology. The clock endows the host with temporal precision and robust adaptation to the surrounding environment. When circadian rhythms are perturbed or misaligned, as a result of jet lag, shiftwork or other lifestyle factors, adverse health consequences arise, and the risks of diseases such as cancer, cardiovascular diseases or metabolic disorders increase. Although the negative impact of circadian rhythm disruption is now well established, it remains underappreciated how to take advantage of biological timing, or correct it, for health benefits. In this Review, we provide an updated account of the circadian system and highlight several key disease areas with altered circadian signalling. We discuss environmental and lifestyle modifications of circadian rhythm and clock-based therapeutic strategies, including chronotherapy, in which dosing time is deliberately optimized for maximum therapeutic index, and pharmacological agents that target core clock components and proximal regulators. Promising progress in research, disease models and clinical applications should encourage a concerted effort towards a new era of circadian medicine.

Exploration of experiences in therapeutic groups for patients with severe mental illness: development of the Ferrara group experiences scale (FE- GES)

BACKGROUND

Group therapies are routinely provided for patients with severe mental illness. The factors important to the group experience of patients are still poorly understood and are rarely measured. To support further research and practice, we aimed to develop a questionnaire that captures how patients experience groups within a community mental health context.

METHODS

An initial pool of 39 items was conceptually generated to assess different aspects of group experiences. Items were completed by 166 patients with severe mental illness attending group therapies in community mental health services in Italy. Patients with different psychiatric diagnoses who attended at least 5 group sessions were included. An exploratory factor analysis was used to identify different dimensions of group experiences and to reduce the number of items for each dimension.

RESULTS

The resulting questionnaire has five subscales: 1) sharing of emotions and experiences, 2) cognitive improvement, 3) group learning, 4) difficulties in open expression and 5) relationships. Each subscale has 4 items. The scale and sub-scales have good internal consistency.

CONCLUSIONS

The Ferrara Group Experiences Scale is conceptually derived and assesses dimensions of group experience that are theoretically and practically relevant. It is brief, easy to use and has good psychometric properties. After further validation, the scale may be used for research into patient experiences across different group therapy modalities and for evaluation in routine care.

Therapeutic Factors in Patient Groups with Psychosis

Therapeutic factors in group therapy are a series of action mechanisms that contribute to change in therapeutic processes. They are inherent to group dynamics and interaction, yet are not necessarily associated with a therapist’s intervention. These factors are elemental components of a therapeutic change phenomenon derived from the group matrix.

We present five studies that thoroughly evaluate these therapy factors within groups of patients diagnosed with psychosis. All factors are measured with the Yalom Q-sort questionnaire that defines factors based on their value given by the patients. We evaluate and report these value differences between group context, patient diagnosis, and therapeutic orientation.

Therapeutic factors act independently of diagnoses, theoretical framework, and classification; they are intrinsic components of unique group dynamics. In general, the factor claimed to be most important in patients with severe mental disorders was the instillation of hope.

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.

Chinese inpatients' subjective experiences of the helping process as viewed through examination of a nurses' focused, structured therapy group

AIMS AND OBJECTIVES

This study examined Chinese inpatients' views on what aspects of a nurses' focused, structured therapy group worked to help their psychological and interpersonal problems and what traditional Chinese cultural values influenced their viewpoints.

METHODS

Nine Chinese inpatients with mental illness participated in the four-session nurses' focused, structured therapy group. After they completed the last session of therapy, they were invited to participate in a structured interview and a semi-structured interview regarding their perceptions of the change mechanisms in nurses' focused, structured group therapy. The semi-structured interviews were recorded and transcribed to be further analysed according to the principal of content analysis.

RESULTS

The results indicate that (i) all patients believed that a nurses' focused, structured group psychotherapy enhanced their interpersonal learning and improved the quality of their lives, (ii) traditional Chinese cultural values--those emphasizing the importance of maintaining harmonious interpersonal relationships--influenced the Chinese inpatients' expression of negative emotions in the group and their motivation on interpersonal learning.

CONCLUSION

In conclusion, we found that transcultural modification for applying Western group psychotherapy in Chinese culture was needed. The modification included establishing a 'pseudo-kin' or 'own people' relationship among group members and the therapists, organizing warm-up exercises and structured activities, applying projective methods and focusing on the issues of interpersonal relationships and interpersonal problems.

RELEVANCE TO CLINICAL PRACTICE

The small sample size of the present study raises questions regarding how representative the views of the sample are with respect to the majority of Chinese inpatients. Nevertheless, this preliminary study revealed a cultural aspect in nursing training that requires significant consideration in order to work effectively with Chinese patients.

Helping processes in a mutual aid organization for persons with emotional disturbance

To date, the notion of helpfulness of group processes has been equivocal in research on self-help groups. This article argues that findings drawn from the participants' subjective appraisals of helpfulness carry meanings different from those drawn from the correlational approach. In a mutual aid organization serving adults with mental health problems, the study found that, whereas universality, self-disclosure, and instillation of hope were the most valued processes, support and catharsis were the strongest correlates of benefits of participation. The authors propose a two-level hierarchy that distinguishes sustaining and beneficial factors. Different sets of factors should constitute the focus of facilitation at different stages of group development.

A comparison of curative factors in different types of group psychotherapy

The authors have constructed a Dutch version of Yalom's "Questionnaire for Curative Factors." This Dutch version has been administered to 134 participants of 22 psychotherapy groups in various psychiatric services in the Netherlands. Results concerning validity and reliability of the instrument are presented, as well as concerning the homogeneity of the hypothesized "factors." Differences between types of groups and categories of group members were tested by means of techniques of analysis of variance (ANOVA). Multiple regression analysis was applied in order to detect variables of differential qualities on one or more factors. Only the factor identification, neglected in literature on curative factors, was highly predictable.

Darwinian evolution of social behavior: implications for group psychotherapy

Medicine typically looks to biology for guidance in examining complexity. Application of biological principles to social processes has not been easy. Still, we need not abandon biology in the study of complex social phenomena. Biologists have come to view the study of proximate form and function (revealed by disciplines such as anatomy, psychology and physiology) versus the study of how the form and function ultimately "got to be" (revealed by disciplines such as ethology and sociobiology) as distinct and complementary levels of understanding (Lorenz 1981; Mayr 1982). Though we cannot undertake in this paper explication of the value of understanding the ultimate, as well as the proximate, in studying biological phenomena, interested readers will find a comprehensive discussion in Mayr. The evolutionary principles structuring social interactions are becoming understood and hold promise as a biologically valid system for organizing and guiding the study of complex social behaviors (Essock-Vitale and Fairbanks 1979; Kofoed and MacMillan 1987). Psychological processes have evolved in varying complexities as mechanisms to enable and guide social behavior, increasing the probability that such behavior will be adaptive in a wide variety of circumstances (Trivers 1971). Dynamic and social psychologies describe the proximate internal and interactive intricacies that have resulted from this process but cannot help us understand the goals evolution has "naturally designed" (Thompson 1986) these mechanisms to achieve. The hypothesized drives or instincts underlying most psychological models, often derived from a simplistic understanding of evolutionary theory, are usually simply taken for granted in the development of these models.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic factors within in-patient and out-patient psychotherapy groups. Implications for therapeutic techniques

Therapeutic factors operative in in-patient and out-patient therapy groups were compared. These settings differ greatly, both in terms of the patient population they serve and the overall systems within which they operate. The study revealed significant differences between the therapeutic factors operative in these two settings, and suggested that clinicians should modify their techniques for running psychotherapy groups across settings, to take account of these findings.