Department of Psychology, CRIUSMM, University of Montreal, Québec, Canada.
School of Nursing, University of Quebec at Trois-Rivieres, Québec, Canada.
Psychol Psychother. 2018 Mar;91(1):15-26. doi: 10.1111/papt.12139. Epub 2017 Jul 14.
Group cohesion has been linked to positive changes in self-esteem and in symptoms during group psychotherapy in people with psychosis. These changes may be linked to changes in symptoms as fluctuations in self-esteem have been linked to symptom fluctuations.
We aimed to determine the relationship between these three factors - group cohesion, self-esteem, and symptoms - during group cognitive behaviour therapy for psychosis (GCBTp). We hypothesized that group cohesion would precede changes in symptoms and self-esteem and that improvements in self-esteem would precede improvements in symptoms.
This is an uncontrolled longitudinal study recruiting from a convenience sample within two early psychosis clinics.
Sixty-six individuals from first episode of psychosis treatment programmes participated in this study and received 24 sessions of a validated GCBTp protocol. Participants answered a brief questionnaire at the end of each session, measuring their group cohesion, self-esteem, and perception of their symptoms as worse, same, or better than usual.
Orthogonal polynomial contrasts for time effects were estimated with a mixed model for repeated measures with a random cluster effect and revealed a quartic trend regarding changes in symptoms over the 24 sessions. Self-esteem, symptoms, and group cohesion were strongly linked during a given session. Also, self-esteem changes predicted changes in symptoms up to two sessions later, and symptoms changes predicted self-esteem changes at the next session. Group cohesion preceded improvements in both self-esteem and symptoms; self-esteem also predicted improvements in group cohesion.
These results suggest that self-esteem and symptoms influence each other during therapy, with improvements in one leading to improvements in the other. Group cohesion also appears to be an essential prerequisite to positive changes in self-esteem and symptoms during GCBTp.
This study emphasizes the interrelation between self-esteem improvements and symptom improvements, with improvements in one leading to improvements in the other, during group CBT for psychosis. Group cohesion, in this study, is a predictor of self-esteem and symptom improvements, suggesting that a special attention should be given to developing a strong alliance and group cohesion early on during CBT for psychosis.
群体凝聚力与精神病患者的自尊和团体心理治疗期间的症状变化呈正相关。这些变化可能与症状变化有关，因为自尊波动与症状波动有关。
我们旨在确定群体认知行为治疗精神病（GCBTp）期间这三个因素 - 群体凝聚力、自尊和症状之间的关系。我们假设群体凝聚力将先于症状和自尊变化，而自尊改善将先于症状改善。
这是一项无对照的纵向研究，从两个早期精神病诊所的便利样本中招募。
66 名首发精神病治疗计划的个体参与了这项研究，并接受了 24 节经证实的 GCBTp 方案。参与者在每次治疗结束时回答一个简短的问卷，测量他们的群体凝聚力、自尊以及他们对自己的症状的看法，即更糟、相同或比平时更好。
通过混合模型重复测量的正交多项式对比估计时间效果，对于 24 节期间的症状变化显示出四次趋势。在给定的治疗期间，自尊、症状和群体凝聚力之间存在强烈联系。此外，自尊变化预测两个治疗阶段后的症状变化，而症状变化预测下一治疗阶段的自尊变化。群体凝聚力先于自尊和症状的改善；自尊也预测了群体凝聚力的改善。
这些结果表明，在治疗期间，自尊和症状相互影响，一个的改善会导致另一个的改善。在 GCBTp 中，群体凝聚力似乎也是自尊和症状积极变化的必要前提。
这项研究强调了在团体认知行为治疗精神病期间，自尊改善与症状改善之间的相互关系，一个的改善会导致另一个的改善。在本研究中，群体凝聚力是自尊和症状改善的预测因素，这表明在认知行为治疗精神病早期应特别注意建立强大的联盟和群体凝聚力。
