Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T07:05:23.898Z Has data issue: false hasContentIssue false

An evaluation of the impact of a large group psycho-education programme (Stress Control) on patient outcome: does empathy make a difference?

Published online by Cambridge University Press:  24 February 2010

Anne Joice*
Affiliation:
School of Health, Glasgow Caledonian University, Glasgow, UK
Stewart W. Mercer
Affiliation:
Division of Community-Based Sciences, University of Glasgow, Glasgow, UK
*
*Author for correspondence: Mrs A. Joice, School of Health & Social Care, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK. (email: [email protected])

Abstract

Large psycho-education groups are being increasingly used in mental-health promotion and the treatment of common mental-health problems. In individual therapy there is a well-established link between therapist empathy, therapeutic relationship and patient outcome but the role of empathy within large psycho-educational groups is unknown. This service evaluation investigated the impact of a 6-week large psycho-education group on patient outcome and the role of perceived therapist empathy on outcome. Within a before–after experimental design, 66 participants completed baseline and endpoint measures; Clinical Outcome Routine Evaluation (CORE), Patient Enablement Instrument (PEI), and the modified Consultation and Relational Empathy (CARE) measure. The results showed that the intervention had a positive impact on patient outcome; the CORE score reduced significantly over the 6 weeks by 0.63 (95% CI 0.82–1.14) (t = 9.18, d.f. = 55, p = <0.001) and attendees felt highly enabled. Attendees perceived the course leader as highly empathetic. However, the relationship between perceived empathy and attendee outcome was less clear; no significant relationship was found with the main outcome measure (the change in CORE score). Factors that influenced the main outcome included age, symptom severity at baseline, having a long-term illness or disability, and whether attendees tried the techniques at home (homework). These findings suggest that large group psycho-education is an effective treatment for mild to moderate mental-health problems, at least in the short term. The role of therapist empathy remains ambiguous but may be important for some patient outcomes.

Type
Practice article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended follow-up reading

Mercer, SW, Cawston, PG, Bikker, AP (2007). Patients'views on consultation quality in primary care in an area of high deprivation; a qualitative study. BMC Family Medicine 8, 22.Google Scholar
Mercer, SW, Howie, JGR (2006). CQI-2, a new measure of holistic, interpersonal care in primary care consultations. British Journal of General Practice 56, 262268.Google ScholarPubMed

References

Allart-Van, Dam, Hosman, CMH, Hoogduin, CAL, Schaap, CPDR (2003). The Coping with Depression course: short-term outcomes and mediating effects of a randomised controlled trial in the treatment of subclinical depression. Behavior Therapy 34, 381396.Google Scholar
Antonuccio, DO, Davis, C, Lewinsohn, PM, Breckenridge, JS (1987). Therapist variables related to cohesiveness in a group treatment for depression. Small Group Behavior 18, 557564.CrossRefGoogle Scholar
Antonuccio, DO, Lewinsohn, PM, Steinmetz, JL (1982). Identification of therapist differences in group treatment for depression. Journal of Consulting and Clinical Psychology 50, 435443.Google Scholar
Audin, K, Bekker, HL, Barkham, M, Foster, J (2003). Self-help in primary care mental health: a survey of counsellors and psychotherapists views and current practice. Primary Care Mental Health 1, 89100.Google Scholar
Barkham, M, Evans, C, Margison, F, McGrath, G, Mellor-Clarke, J, Milne, D, Connell, J (1998). The rationale for developing and implementing CORE outcome batteries for routine use in service settings and psychotherapy outcome research. Journal of Mental Health 7, 3547.Google Scholar
Bedi, RP, Davis, MD, Williams, M (2005). Critical incidents in the formation of the therapeutic alliance from the clients perspective. Psychotherapy: Theory, Research, Practice, Training 42, 311323.Google Scholar
Bikker, AP, Mercer, SW, Reilly, D (2005). A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homeopathic Hospital. Journal of Alternative and Complementary Medicine 11, 591600.CrossRefGoogle Scholar
Bohart, AC, Elliot, R, Greenberg, LS, Watson, JC (2002). Empathy. In: Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients (ed. Norcross, J. C.), pp. 89108. New York: Oxford University Press.Google Scholar
Bohart, AC, Greenberg, LS (1997 a). Empathy and psychotherapy: an introductory overview. In: Empathy Reconsidered: New Directions in Psychotherapy (ed. Bohart, A. C. and Greenberg, L. S.), pp. 331.Washington DC: American Psychological Association.Google Scholar
Bohart, AC, Greenberg, LS (1997 b). Empathy: where are we and where do we go from here? In: Empathy Reconsidered: New Directions in Psychotherapy (ed. Bohart, A. C. and Greenberg, L. S.), pp. 419449. Washington DC: American Psychological Association.Google Scholar
Bower, P, Gilbody, S (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. British Journal of Psychiatry 186, 1117.CrossRefGoogle ScholarPubMed
Brown, JSL, Cochrane, R, Cardone, D (1999). Large-scale health promotion stress workshops: promotion, programme content and client response. Journal of Mental Health 8, 391402.Google Scholar
Brown, JSL, Cochrane, R, Hancox, T (2000). Large-scale health promotion stress workshops for the general public: a controlled evaluation. Behavioural and Cognitive Psychotherapy 28, 139151.CrossRefGoogle Scholar
Brown, JSL, Elliot, SA, Boardman, J, Ferns, J, Morrison, J (2004). Meeting the unmet need for depression services with psycho-educational self-confidence workshops: preliminary report. British Journal of Psychiatry 185, 511515.CrossRefGoogle ScholarPubMed
Burns, DD, Nolen-Hoeksema, S (1992). Therapeutic empathy and recovery from depression in cognitive behavioural therapy: a structural equation model. Journal of Consulting and Clinical Psychology 60, 441449.CrossRefGoogle ScholarPubMed
Connell, J, Barkham, M, Evans, C, Margison, F, McGrath, G, Milne, D (1997). Clinical Outcomes in Routine Evaluation (CORE): Outcome Measure – Guidelines for Use (Version 1.0). PTRC Memo 333, Psychological Therapies Research Centre, University of Leeds.Google Scholar
Cuijpers, P (1998). A psycho-educational approach to the treatment of depression: a meta-analysis of Lewinsohn's ‘Coping with Depression’ course. Behavior Therapy 29, 521533.CrossRefGoogle Scholar
Den Boer, PCAM, Wiersma, D, Van Den Bosch, RJ (2004). Why is self-help neglected in the treatment of emotional disorders? A meta-analysis. Psychological Medicine 34, 959971.CrossRefGoogle ScholarPubMed
Durham, RC, Fisher, PL, Dew, MGT, Sharp, D, Power, KG, Swah, J, Morton, VR (2004). Cognitive behaviour therapy for good & poor prognosis generalized anxiety disorder; a clinical effectiveness study. Clinical Psychology & Psychotherapy 11, 145157.CrossRefGoogle Scholar
Evans, C, Connell, J, Barkham, M, Margison, F, McGrath, G, Mellor-Clarke, J, Audin, K (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. British Journal of Psychiatry 180, 5160.CrossRefGoogle ScholarPubMed
Evans, C, Mellor-Clark, J, Margison, F, Barkham, M, McGrath, G, Connell, J, Audin, K (2000). Clinical Outcomes in Routine Evaluation: the CORE-OM. Journal of Mental Health 9, 247255.CrossRefGoogle Scholar
Glasgow Centre for Population Health (2008). South East Glasgow Community Health Profile (http://www.gcph.co.uk). Accessed 12 September 2008.Google Scholar
Gilbert, N, Barkham, M, Richards, A, Cameron, I (2005). The effectiveness of a primary care mental health service delivering brief psychological interventions: a benchmarking study using the CORE system. Primary Care Mental Health 3, 241251.Google Scholar
Gray, A, White, J (1998). Can large scale management groups be regarded as true therapy? Clinical Psychology Forum 115, 3033.CrossRefGoogle Scholar
Hartley, D, Strupp, H (1986). The therapeutic alliance: its relationship to outcome in brief psychotherapy. In: Empirical Studies of Psychoanalytic Theories (ed. Masling, J.), pp. 127. Hillside, NJ: Erlbaum.Google Scholar
Horvath, AO (2001). The alliance. Psychotherapy 38, 365372.CrossRefGoogle Scholar
Horvath, AO, Symonds, BD (1991). Relation between working alliance and outcome in Psychotherapy: a meta-analysis. Journal of Counselling Psychology 38, 139149.CrossRefGoogle Scholar
Howie, JGR, Heaney, DJ, Maxwell, M, Walker, JJ (1998). A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as outcome measure of primary care consultations. Family Practice 15, 165171.CrossRefGoogle ScholarPubMed
Howie, JGR, Heaney, DJ, Maxwell, M, Walker, JJ, Freeman, GK, Rai, H (1999). Quality at general practice consultations: cross sectional survey. British Medical Journal 319, 738743.Google Scholar
Jones, EE, Poulos, SM (1993). Comparing the process in psychodynamic and cognitive-behavioural therapies. Journal of Consulting and Clinical Psychology 61, 306316.Google Scholar
Krupnick, JL, Sotsky, SM, Simmons, S, Moyer, J, Elkin, I, Watkins, J, Pilkonis, P (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology 64, 532539.CrossRefGoogle ScholarPubMed
Lovell, K, Richards, D (2000). Multiple access points and level of entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy 28, 379391.Google Scholar
MacPherson, H, Mercer, SW, Scullion, T, Thomas, KJ (2003). Empathy, enablement, and outcome: an exploratory study on acupuncture patients’ perceptions. Journal of Alternative and Complementary Medicine 9, 869876.CrossRefGoogle Scholar
Martin, DJ, Garske, JP, Davis, MK (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology 68, 438450.CrossRefGoogle ScholarPubMed
Marziali, E (1984). Three viewpoints on the therapeutic alliance scales: similarities, differences, and association with psychotherapy outcome. Journal of Nervous and Mental Disease 172, 417423.Google Scholar
Mercer, SW, Hatch, DJ, Murray, A, Murphy, DJ, Eva, KW (2008). Capturing patients’ views on communication with anaesthetists: the CARE measure. Clinical Governance: An International Journal 13, 128137.CrossRefGoogle Scholar
Mercer, SW, McConnachie, A, Maxwell, M, Heaney, D, Watt, GC (2005). Relevance and performance of the Consultation and Relational Empathy (CARE) measure in general practice. Family Practice 22, 328334.CrossRefGoogle ScholarPubMed
Mercer, SW, Murphy, DJ (2008). Validity and reliability of the CARE measure in secondary care. Clinical Governance: An International Journal 13, 261283.CrossRefGoogle Scholar
Mercer, SW, Reilly, D, Watt, GCM (2002). The importance of empathy in the enablement of patients attending the Glasgow Homoeopathic Hospital. British Journal of General Practice 52, 901905.Google Scholar
Mercer, SW, Reynolds, WJ (2002). Empathy and quality of care. British Journal of General Practice 52, S9S13.Google ScholarPubMed
Mercer, SW, Watt, GCM, Maxwell, M (2004). The development and preliminary validation of the Consultation and Relational Empathy (CARE) measure: an empathy-based consultation process measure. Family Practice 21, 699705.CrossRefGoogle ScholarPubMed
Muran, J, Gorman, B, Safran, J, Twining, L (1995). Linking in-session change to overall outcome in short-term cognitive therapy. Journal of Consulting and Clinical Psychology 63, 651657.Google Scholar
National Collaborating Centre for Mental Health (2004). Depression: the management of depression in primary and secondary care (National Clinical Practice Guideline No. 23). London: National Institute for Clinical Excellence.Google Scholar
Orlinsky, DE, Grawe, K, Parks, BK (1994). Process and outcome in psychotherapy – noch einmal. In: Handbook of Psychotherapy and Behaviour Change, 4th edn (ed. Bergin, A. E. and Garfield, S. L.), pp. 270376. New York: Wiley.Google Scholar
Persons, JB, Burns, DD (1985). Mechanism of action of cognitive therapy: relative contributions of technical and interpersonal interventions. Cognitive Therapy and Research 9, 539551CrossRefGoogle Scholar
Price, S, Mercer, SW, MacPherson, H (2006). Practitioner empathy, patient enablement and health outcomes: a prospective study of acupuncture patients. Patient Education & Counselling 63, 239245.Google Scholar
Rees, CS, Stone, S (2005). Therapeutic alliance in face-to-face versus video-conferenced psychotherapy. Professional Psychology: Research and Practice 36, 649653.Google Scholar
Safran, J, Segal, Z (1990). Interpersonal Processes in Cognitive Therapy. New York: Basic Books.Google Scholar
Scogin, F, Hanson, A, Welsh, D (2003). Self administered treatment in stepped care models of depression treatment. Journal of Clinical Psychology 59, 341349.CrossRefGoogle ScholarPubMed
Scott, MJ, Stradling, SG, Greenfield, TA (1995). The efficacy of brief group cognitive therapy programmes for anxiety and depression, and the relevance of a personality disorder diagnosis. Paper presented at the World Congress of Behavioural and Cognitive Therapies, Copenhagen, 11–15 July 1995.Google Scholar
Scottish Executive (2005). Interim report of the National Evaluation of the ‘Doing Well by People with Depression’ Project, June 2005 (http://www.cci.scot.nhs.uk/cci/files/interim_report.pdf). Accessed 4 January 2006.Google Scholar
Scottish Executive (2006). Statistics (http://www.scotland.gov.uk/Topics/Statistics/SIMD/Overview). Accessed 22 January 2006.Google Scholar
Simon, GE, Katon, WJ, Von Korff, M, Unützer, J, Lin, EHB, Walker, EA, Bush, T, Rutter, C, Ludman, E (2001). Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. American Journal of Psychiatry 158, 16381644.Google Scholar
Squier, RW (1990). A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Social Science and Medicine 30, 325339.CrossRefGoogle Scholar
Stiles, WB, Agnew-Davies, R, Hardy, GE, Barkham, M, Shapiro, DA (1998). Relations of the alliance with psychotherapy outcome: findings in the second Sheffield psychotherapy project. Journal of Consulting and Clinical Psychology 66, 791802.Google Scholar
Swan, J, Sorrell, E, MacVicar, B, Durham, R, Mathews, K (2004). ‘Coping with depression’: an open study of the efficacy of a group psycho-educational intervention in chronic, treatment- refractory depression. Journal of Affective Disorders 82, 125129.Google Scholar
Waddington, L (2002). The therapy relationship in cognitive therapy: a review. Behavioural and Cognitive Psychotherapy 30, 179191.Google Scholar
Watkins, E, Elliot, S, Stanhope, N, Button, J, Williams, R, Brown, J (2000). Meeting the needs for psychological treatment of people with common mental disorders: an exploratory study. Journal of Mental Health 9, 445456.Google Scholar
Watt, G (2002). The inverse care law today. Lancet 360, 252254.Google Scholar
White, J (1998). ‘Stress Control’ large group therapy for generalised anxiety disorder: two year follow-up. Behavioural and Cognitive Psychotherapy 26, 237245.CrossRefGoogle Scholar
White, J (2000). Treating Anxiety and Stress – A Group Psycho-educational Approach Using Brief CBT. Chichester, England: John Wiley.Google Scholar
White, J, Keenan, M, Brooks, N (1992). Stress Control: a controlled comparative investigation of large group therapy for generalised anxiety disorder. Behavioural Psychotherapy 20, 97114.Google Scholar
Zuroff, DC, Blatt, SJ (2006). The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. Journal of Consulting and Clinical Psychology 74, 130140.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.