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Symptom fluctuations, self‐esteem, and cohesion during group cognitive behaviour therapy for early psychosis
Author(s) -
Lecomte Tania,
Leclerc Claude,
Wykes Til
Publication year - 2018
Publication title -
psychology and psychotherapy: theory, research and practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.102
H-Index - 62
eISSN - 2044-8341
pISSN - 1476-0835
DOI - 10.1111/papt.12139
Subject(s) - self esteem , psychosis , psychology , clinical psychology , cognition , cohesion (chemistry) , early psychosis , group cohesiveness , psychiatry , social psychology , chemistry , organic chemistry
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. Objective 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. Design This is an uncontrolled longitudinal study recruiting from a convenience sample within two early psychosis clinics. Methods 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. Results 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. Conclusion 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. Practitioner points 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.