Cost effectiveness of individual vs. group cognitive behavior therapy for problems of depression and anxiety in an HMO population

Abstract

Randomly assigned 44 outpatient Ss, enrollees of the George Washington University Health Plan, a Health Maintenance Organization (HMO), to one of three treatment modalities: (1) a cognitive behavior therapy group; (2) a traditional process‐oriented interpersonal group; and (3) cognitive behavior therapy in an individual format. All Ss were referred by their physicians to the HMO Mental Health Practice for treatment for anxiety and/or depression. Beck's Depression Inventory, Speilberger's State‐Trait Anxiety Inventory and Gay and Galassi's Adult Self‐Expression Scale (an assertion measure) were administered pre‐ and post‐ treatment to all Ss. A subsample of these Ss also were rated pre‐ and post‐treatment on the Hamilton Rating Scale for Depression by experienced clinicians blind to the treatment groups. All three experimental groups significantly improved on all dependent measures from pre‐ to post‐treatment, and no differential treatment effects were found.

A Randomized Trial of Cognitive Group Therapy vs. Waiting List for Patients with Co-Morbid Psychiatric Disorders: Effect of Cognitive Group Therapy after Treatment and Six and Twelve Months Follow-Up

“…It is notable that there was no symptomatic relapse for the treated patients in CGT, which is consistent with the results of Heimberg, Salzman, Holt and Blendell (1993). Our results are comparable with other studies conducted of heterogeneous samples on psychiatric disorders related to outcome (Shapiro et al, 1982;Manning et al, 1994;Kush and Fleming, 2002). Even if the effect-sizes in our study at post-treatment were smaller than these studies have reported, the results at 6 and 12-month follow-up yielded large effect-sizes, especially with respect to symptom relief.…”

“…To our knowledge, few studies have been conducted to test the effect of CGT on a more heterogeneous sample of patients with psychiatric disorders. Shapiro, Sank, Schafer and Donovan (1982) randomly assigned patients with depressive and anxiety disorders to different treatment modalities. The group in the cognitive group therapy condition received 10 sessions of treatment, and showed significant improvement from pre to post-treatment on both levels of anxiety and depression.…”

“…At post-treatment it was demonstrated a large effect size on anxiety measured by the Spielberger-State-Trait-Inventory, and a moderate effect size on depression, measured by the Beck Depression Inventory. The study of Shapiro et al (1982) had just 10 subjects enrolled in the group receiving cognitive group therapy. Manning, Hooke, Tannebaum, Blythe and Clarke (1994) evaluated the efficacy of a combined treatment of medications and a closed group, intensive (2-week) cognitive behaviour therapy program for co-morbid psychiatric disorders, in an uncontrolled study with a sample of 531 patients.…”

Is Group More Cost Effective than Individual Cognitive Behaviour Therapy? The Evidence is not Solid Yet

“…This may be misleading for several reasons. Whereas therapist hours are an important consideration (Shapiro, Sank, Shaffer and Donovan, 1982;Webster-Stratton, 1984), there are other factors that should be taken into consideration when calculating costefficiency. For example, many of these calculations appear to be neglecting to account for therapist preparation time, overhead costs and costs to patients, as well as opportunity costs (Toseland and Siporin, 1986;Wolff et al, 1997).…”

Cognitive—Behaviour Therapy with Depressed Primary School Children: A Cautionary Note

“…Although a few published studies are available which compare the relative efficacies of group and individual therapies with depressed adults, there do not appear to be any which compare such modes of therapy for children. Rush and Watkins (1981) and Wierzbicki and Bartlett (1987) both found that group cognitive therapy was less effective than individual cognitive therapy with adults while, in contrast, Shapiro, Sank, Shaffer and Donovan (1982) concluded that group cognitive therapy was as effective as individual cognitive therapy in the treatment of mild depression. Nietzel, Russell, Hemmings and Gretter (1987), used a meta-analysis to investigate the clinical significance of the effects of cognitive and behaviour therapies on symptoms of unipolar depression in adults.…”