Effect of cognitive behavioral group therapy for recovery of self-esteem on community-living individuals with mental illness: Non-randomized controlled trial

Effects of Subjective Social Status and Self-Esteem in the Association Between Childhood Abuse and Adulthood Anxiety

Background

Subjective social status influences anxiety, but at present, the mechanism is not fully understood. It has been reported that negative childhood experiences, such as abuse, can influence depressive symptoms through subjective social status and personality traits, such as self-esteem. A similar mechanism is presumed to underlie anxiety symptoms in adulthood. Therefore, we hypothesized that subjective social status and self-esteem are intermediate factors in the indirect effects of childhood abuse on state anxiety in adulthood, and analyzed the indirect effects via these factors using a path analysis.

Subjects and Methods

Child Abuse and Trauma Scale, Subjective Social Status, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y questionnaires were administered in a self-report format to 404 adult volunteers from January 2014 to August 2014. In addition, a path analysis was conducted to determine whether subjective social status and self-esteem are associated with the indirect effects of childhood abuse on anxiety symptoms in adulthood.

Results

Childhood abuse did not directly affect state anxiety in adulthood, but affected state anxiety via subjective social status and self-esteem. Subjective social status affected state anxiety via self-esteem. This model explained 25.2% of the variation in state anxiety in adult volunteers.

Conclusion

The present study demonstrated that childhood abuse affects anxiety in adulthood through subjective social status and self-esteem. Therefore, interventions that enhance subjective social status and self-esteem for adults who experienced childhood abuse may help reduce their anxiety.

Nurses' Perception of Using Cognitive Behavior Therapy for Death Anxiety and Ageism

Despite the effectiveness of cognitive behavior therapy (CBT) in relieving death anxiety and ageism among nurses, there is not a complete consensus on its acceptability, adherence, credibility, and expectancy in the literature. Therefore, this descriptive-comparative study aimed to examine Jordanian nurses' perception of using CBT in relieving death anxiety and ageism. Most participants perceived CBT as a credible and adherable treatment for death anxiety and ageism. Significant differences were found in the CBT credibility and expectancy between nurses grouped according to levels of perceived treatment adherence and acceptability of CBT. The findings provide a promising avenue for adopting CBT to target death anxiety and its associated ageism among nurses and for improving CBT adherence, acceptability, credibility, and expectancy. A better understanding of participants' perception of CBT is crucial for optimal clinical practice.

The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: experimental research

Mood disorders are one of the most common psychiatric disorders that manifest as a low mood in depressed people or a high mood in manic people. The cognitive-behavioral therapy group is one of the most effective forms of intervention available for patients with mood disorders. This research aimed to evaluate the effect of cognitive-behavioral group therapy in reducing depression and anxiety in patients with mood disorders.

CASE PRESENTATION

The study was a semi-experimental study with a pretest-post-test design with a control group. The research subjects were 60 patients hospitalized in the psychiatric department of Razi Hospital in Tehran, who were randomly divided into two experimental (N:30) and control (N:30) groups. Both groups took medicine as usual. Before the therapeutic intervention, both groups were evaluated with Beck's depression questionnaire and the Zung anxiety scale. In addition to drug therapy, the experimental group participated in ten sessions of the cognitive-behavioral therapy group, and in the control group, no psychological intervention was performed except for drug therapy. At the end of the nonpharmacological treatment intervention, both groups were evaluated again with the aforementioned tests. The obtained data were analyzed using independent and dependent t-tests.

CLINICAL DISCUSSION

The research findings showed that the cognitive-behavioral therapy group was significantly (P<0.05) effective in reducing the depression of hospitalized patients with mood disorders, but this method did not have much effect in reducing the anxiety of the patients.

CONCLUSION

Cognitive-behavioral group therapy can be effective in reducing depression in hospitalized patients with mood disorders.

College students' mental illness disclosure and self-esteem: a moderating role of self-image goals

Objective: A link between the disclosure of a concealable stigma such as mental illness and enhanced psychological well-being tends to be weak and sometimes non-significant, pointing to the importance of examining potential moderators. This study aims to examine how self-image goals moderate the effect of mental illness disclosure on self-esteem. Participants and Methods: College students who self-identified as having been diagnosed with mental illness (N = 174) completed an online survey regarding their mental illness disclosure, self-image goals, and self-esteem. Results: Self-image goals and mental illness disclosure interacted to predict self-esteem such that the positive association between disclosure and self-esteem was significant only among those who had low self-image goals (i.e., not overly focused on protecting idealized self-image). Conclusions: The relationship between mental illness disclosure and self-esteem is dependent on students' self-image goals. Goal-setting may be a promising target for future intervention programs for students living with mental illness.

The Effect of Solution Focused Group Psychoeducation Applied to Schizophrenia Patients on Self-Esteem, Perception of Subjective Recovery and Internalized Stigmatization

The study examined the effect of Solution-Focused Group Psychoeducation on self-esteem, subjective perception of recovery, and internalized stigma among patients with schizophrenia 39 patients with schizophrenia were recruited based design of the randomized control-group with pretest and posttest. The patients completed the "Rosenberg Self-Esteem Scale (RSES)", "Subjective Recovery Assessment Scale (SubRAS)", and "Internalized Stigma of Mental Illness (ISMI) Scale" in pretest and posttest. After the psychoeducation, ISMI scores decreased in the intervention group (p < 0.001) but increased in the control group (p = 0.599). The posttest RSES score was lower in the intervention group compared to the control group (p = 0.001). A statistically significant difference was found between the pretest and posttest SRAS scores of the intervention group when compared to the control group (p = 0.018). After the psychoeducation, intervention group' self-esteem and subjective perception of recovery increased, while the severity of internalized stigma decreased.

Effects of Food Art Therapy on the Self-Esteem, Self-Expression, and Social Skills of Persons with Mental Illness in Community Rehabilitation Facilities

Persons with mental illness often have low self-esteem, a lack of self-expression, and poor social skills. This study used a quasi-experimental two-group pre-test-post-test design to investigate the effects of food art therapy on the self-esteem, self-expression, and social skills of persons with mental illness attending community rehabilitation facilities. The authors recruited persons with mental illness aged 18 years or older attending three community rehabilitation facilities. Participants in two rehabilitation facilities participated in food art therapy (experimental groups 1 and 2; n = 15 for each group), and participants in the third rehabilitation facility participated in regular programs of the facility (control group, n = 30). Participants in the experimental groups attended a total of eight sessions of food art therapy twice per week for four weeks. The Korean versions of the Rosenberg self-esteem scale, self-expression scale, and social skill rating system were administered at pre- and post-test in both the experimental and control groups. The self-esteem, self-expression, and social skills of the experimental group improved significantly compared to the control group. The findings suggested that food art therapy would be an excellent psychosocial intervention to help persons with mental illness to rehabilitate in the community.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial

Background

Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses.

Methods

A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393).

Results

Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group.

Conclusions

CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Electronic supplementary material

The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.

Effect of a brief cognitive behavioral program on depressive symptoms among newly licensed registered nurses: An observational study

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDI_pre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (P_uncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDI_pre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (P_uncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.

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.

Self-esteem fully mediates positive life events and depressive symptoms in a sample of 173 patients with affective disorders

OBJECTIVES

Previous research showed that positive and negative life events influence the development of depression. However, it is less clear how life events interact with depressive symptoms and self-esteem.

DESIGN AND METHODS

The present study aimed to investigate the mediating effects of self-esteem on the relationship between life events and depressive symptoms in adulthood. The Traumatic Antecedent Questionnaire, Multidimensional Self-esteem Scale (MSWS), and Becks Depression Inventory were administered in 173 psychiatric inpatients (mean age 39.69 ± 14.56 years, ranging from 18 to 76 years). At the time of assessment, all patients suffered from depressive symptoms caused by an affective disorder (major depression, bipolar I, dysthymia).

RESULTS

Path analyses showed that the individual level of self-esteem (measured by MSWS) fully mediated the association between positive life events and depressive symptoms.

CONCLUSIONS

The current study indicates that future therapy programmes for patients with depressive symptoms could include interventions focusing on the improvement of self-esteem, as increasing self-esteem may be beneficial for recovery.

PRACTITIONER POINTS

To date, this is the first study exploring the pathways from positive/negative life events to depressive symptoms. The relationship between positive life experiences and depressive symptoms was fully mediated by self-esteem. Strengthening self-esteem in therapy might lower the vulnerability for depression.

Symptoms of depression and the discrepancy between implicit and explicit self-esteem

BACKGROUND AND OBJECTIVES

While the role of explicit self-esteem (ESE) in depression has been well established, the relationship between implicit self-esteem (ISE) and depression is more uncertain. Recently, it has been suggested that a simultaneous consideration of both ESE and ISE may provide a more comprehensive understanding of the development and maintenance of depression than considering either ESE or ISE in isolation. The present paper tested whether the absolute discrepancy between ESE and ISE and the direction of the discrepancy are important factors to consider in relation to depressive symptoms.

METHODS

87 university students from the northeastern U.S. were recruited for the present study. The Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and Implicit Association Test were used to assess participants' severity of depressive symptoms, explicit self-esteem, and implicit self-esteem, respectively.

RESULTS

Results revealed a negative association between ESE and symptoms of depression. In addition, a positive relationship was found between the degree of discrepancy between ISE and ESE and depression. However, this relationship was only found among participants with higher ISE than ESE (i.e., damaged self-esteem), but not among participants with higher ESE than ISE (i.e., defensive or fragile self-esteem).

CONCLUSIONS

While damaged self-esteem may be a meaningful marker of depressive symptoms, it should be noted that the association between symptoms of depression and the interaction of ISE and ESE may be driven primarily by the strong link between ESE and depression. As prior studies of ESE and ISE have not looked, specifically, at the relative contributions of both constructs, this issue needs further investigation in future research.

The Role of Self-Esteem in Depression: A Longitudinal Study

BACKGROUND

Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms.

AIMS

The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem.

METHOD

The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem.

RESULTS

Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4.

CONCLUSIONS

Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.