“Despite the Differences, We Were All the Same”. Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study

Abstract

Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients’ experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.

Mentalizing the patient–Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study

“…Interestingly, ambivalent feelings related to terminating therapy may not be exclusive to BPD patients. In a recent qualitative study of patients' experience of transdiagnostic CBT for patients with anxiety disorder and depression (25), also found this. This could indicate that ambivalent feelings at termination may be more of a general phenomenon rather than a diagnosis specific or therapy specific.…”

Trait and symptom change in group cognitive behaviour therapy for anxiety and depression

“…Furthermore, a previous qualitative add‐on study to the TRACT trial showed that patients who felt safe in the group equated that with being willing to share in the group and trying out exposure exercises, which are considered key elements in the treatment (Bryde Christensen et al, 2021). Thus, the individual personality and the dynamic between personalities can influence patients' behaviours in group therapy and their participation in essential therapeutic interventions.…”

Metacognitive therapy for generalized anxiety disorders in group: A case study

“…In the group therapy literature, group cohesion is found to be an important mechanism of change and for reducing dropout rates (Burlingame et al, 2018). In addition, group cohesion is found to promote greater motivation to attend sessions and complete homework assignments in CBT group therapies for anxiety and depression (Christensen et al, 2021). Group cohesion can be understood as the sense of belonging as well as the extent to which group members coordinate their efforts to achieve goals (American Psychological Association, 2023; Bryde Christensen et al, 2021).…”