UH EPSY 8334 - A Comparison of Cognitive and Interperson

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Journal of Counseling Psychology Copyright 1988 by the American Psychological Association, Inc. 1988, Vol. 35, No. 3, 304-310 0022-0167/88/$00.75 A Comparison of Cognitive and Interpersonal-Process Group Therapies in the Treatment of Depression Among College Students James A. Hogg Arizona State University Jerry L. Deffenbacher Colorado State University We compared cognitive (CT) and interpersonal-process (IP) group therapies in the treatment of moderate, unipolar depression in college counseling-center clients. Subjects who sought services early in the semester were randomly assigned to CT or IP groups and compared with a waiting- list group composed of subjects who requested services just prior to the Christmas recess. Multivariate analyses revealed no significant differences between treatment and waiting-list conditions. Because the control was confounded by the Christmas holiday, we compared the CT and IP groups directly. Both treatments led to significant reductions in depression and depressed thinking and to increments in self-esteem at midtreatment, posttreatment, and follow-up assess- ments but did not differ from each other at any point in time. There was no evidence of differential effectiveness or mechanisms of therapeutic change as a function of type of treatment. Depression is the common cold of mental health because of its high incidence in all segments of the population (Bellack, Hersen, & Himmelhock, 1981). Depression is particularly prevalent among college students with 17 % to 24% of students generally (Bumberry, Oliver, & McClure, 1978; Oliver & Burkham, 1979) and 45% of students seeking counseling (Ostrow, Kivlighan, Zamostny, Cornfild, & Shapiro, 1985) reporting depression. Because depression interferes with per- sonal and academic development, may lead to suicide, and appears in so many students, many counseling centers have expanded use of time-limited group therapy programs. Of these, cognitives-therapy (CT; Beck, Rush, Shaw, & Emery, 1979) and interpersonal-process (IP; Yalom, 1985) groups are two leading approaches. According to the humanistic-existential theory of IP ther- apy, depression results from poor self-concept and low self- esteem. IP groups, therefore, attempt to create an environ- ment in which clients experience themselves fully and develop positive self-esteem as they learn to trust their experience. This environment is developed through group dynamics rich in intrinsically "curative factors" (Leszcz, Yalom, & Norden, 1985), for example, interpersonal learning, catharsis, and self- understanding, which enhance self-esteem. IP groups examine the interpersonal communications and emotional transac- tions among group members and focus on here-and-now group dynamics to help clients express their feelings more directly, act more independently, and feel more connected to others. Acceptance by others is thought to promote increased self-acceptance and self-esteem, which consequently reduce depression. Thus, in IP groups improved self-esteem precedes and mediates reductions in depression. CT theory suggests that depression is more a function of distorted thinking and biased information processing (Beck et al., 1979), that is, cognitive distortions lead to depressed affect and behavior. CT therefore helps clients identify and Correspondence concerning this article should be addressed to Jerry L. Deffenbacher, Department of Psychology, Colorado State University, Fort Collins, Colorado 80523. alter depressogenic thoughts and assumptions (Beck et al., 1979). CT uses a variety of Socratic, didactic, persuasive, supportive, and homework techniques to change such dis- torted cognitive processes. CT groups tend toward being in- dividual therapy in a group but do use the group process to help disconfirm faulty interpersonal assumptions (Beck et al., 1979). Thus, in CT, changes in distorted thinking precede changes in depression. Research employing IP groups for depression is very lim- ited. The one study (Coche, Cooper, & Petermann, 1984) that explicitly evaluated IP group therapy found it effective but not significantly different from a problem-solving condition. Indirect evidence regarding IP therapy is found in studies that compare psychodynamic and supportive group therapies with CT. In two studies (Fleming & Thornton, 1980; LaPointe & Rimm, 1980) conditions were generally equivalent in effec- tiveness; whereas in a third (Steuer et al., 1984) a slight superiority for CT was shown. No study that compared IP and CT group therapies was found, however. Outcome studies of CT for depression are much more numerous. For example, individual CT was more effective than behavioral interventions (McNamara & Horan, 1986), and group CT was equally effective (Hodgson, 1981; Taylor & Marshall, 1977). Individual CT was more effective than group CT in one study (Rush & Watkins, 1981) but equally effective in two others (Beck et al., 1979; Shapiro, Shaffer, Sank, & Coghlan, 1981). In the one study (Shaw, 1977) that compared group therapies for depressed college counseling- center clients, CT was significantly more effective than behav- ioral and waiting-list conditions. Our study addresses both the practical issue of the compar- ative effectiveness of time-limited IP and CT groups for depression and the theoretical issue of their respective mech- anisms of change. The design consisted of two active treat- ments (CT and IP groups) and a nonequivalent, untreated control. CT and IP conditions were assessed on measures of self-esteem, depressed thinking, and depression on a pretreat- merit, midtreatment (4 weeks into therapy), posttreatment, and follow-up (4-6 weeks posttreatment) basis. The midtreat- 304GROUPS FOR DEPRESSION 305 ment assessment provided an early assessment of self-esteem and depressed thinking that might reflect the differential therapeutic change mechanisms. If the theoretical models are accurate, IP groups would show greater early change in self- esteem, whereas CT groups would show greater early change in distorted thinking. Posttreatment and follow-up assess- ments provided comparisons of differential effectiveness and maintenance. The comparison of pre-post data of active


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UH EPSY 8334 - A Comparison of Cognitive and Interperson

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