Clinical Psychology & Psychotherapy is a European journal dedicated to clinical trials in psychiatry and psychotherapy. This journal is explicitly focused on the description of experiments, not theoretical research. The journal’s editorial staff has been working since 1993, and during this time, it has earned respect among doctors and people interested in psychiatry and psychotherapy. The journal consistently ranks among the world’s top 100 dedicated to psychiatry. The article used in the review is titled “Effectiveness of short-term dynamic group psychotherapy in primary care for patients with depressive symptoms.” It is dedicated to a clinical experiment that took place in Spain from 2011 to 2013.
Summary
The authors devoted the article to comparing standard treatment for depression (mainly medication) and short-term dynamic group therapy. The entire study took place based on several primary health care institutions. The article’s authors wanted to find out how it is possible to organize assistance quickly for patients in these institutions (rather than specialized centers). Family physicians assigned to different population groups actively participated in the study. They interviewed patients, discussed the possibility of undergoing an experiment, and eventually referred patients to researchers. The text of the article makes a significant emphasis on non-drug intervention. The authors postulate the idea that all official medical resources are in favor of the exclusive combination of medications with the benefits of therapy. However, “primary care physicians initiate and monitor treatment of depression with various pharmacological agents, but owing to time limitation, lack of knowledge or inexperience” cannot promote other types of assistance (Bros et al., 2016, p. 827). Thus, they concentrate on somatic complaints and try to stop them. They can prevent drowsiness, insomnia, tearfulness, or other bodily symptoms while ignoring the fundamental problem.
Patients receiving support in primary health care have their specifics: their illness is relatively mild. Most patients do not warn physicians when entering the hospital about their diagnosis. It further influenced the prescription of antidepressants by family physicians. The authors argue that antidepressants do not help achieve remission quickly and adequately, and non-drug intervention is needed; however, general practitioners try to control the course of depression through drugs. The proposed program of dynamic group psychotherapy was not directive but only aimed at reducing the symptoms of depression. The authors hypothesized that short-term dynamic group psychotherapy promoted by family physicians of primary care could help patients with the symptoms of depression.
122 patients aged 25 years and older participated in the study. There were 70 patients in the psychotherapy group and 45 in the control group. At the end of the study, both groups decreased (58 and 31 patients, respectively). According to the experiment’s rules, the organizers had to exclude cases of drug and alcohol addiction, bipolar disorder, and delirium. The average age of the subjects was relatively high: about 40-50 years. The Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS) were mainly used to assess their depressive state (Bros et al., 2016). Given the age of the subjects, it was essential to avoid cases of dementia; therefore, with patients over 65 years of age, the researchers conducted a mental status milestone (MMSE). The subjects formed eight (eight to nine participants) groups according to their ages (by decades), and group work would benefit them all. In parallel with participation in the experiment, only a few (21%) visited specialized centers for psychological support. The meaning of group therapy for patients is to express feelings and opportunities to listen. Experts focused on their emotions, feelings, dreams, fantasies, and desires.
The study showed significant improvements in the quality of life of treated patients and a reduction in the severity of anxiety and depressive symptoms. It confirms the hypothesis, and, in addition, the experts noted that patients were able to improve communication skills and interpersonal relationships. It allowed, in turn, them to be more adaptive in everyday life. The experts showed an individual approach to all patients and did not concentrate on treating a particular disorder. In assessing the condition of patients, in addition to the Hamilton scales (HDRS and HARS), the scales of somatic anxiety and mental anxiety participated. The experts used the Pearson product-moment (r) scale to correlate anxiety and depression.
Critique
The information provided in the article contains a deep theoretical foundation, which is its essential advantage. This foundation defends the authors’ hypothesis and demonstrates the critical importance of treating depression and helping patients with anxiety symptoms. The authors, through theoretical justification, show the prevalence of the problem and its impact on the lives of ordinary people working in various fields. The separateness of primary care from this complex problem is critical since most people receive primary care usually.
Therefore, the article’s strength is the aforementioned theoretical framework and general statistics on disability due to depression. The strengths include non-directive work during group psychotherapy; however, there are many caveats here since non-directive care would be inadequate during secondary support for patients with severe depression (Bros et al., 2016). The focus of the specialists is clearly defined, and they were aimed at helping ordinary patients who usually consult with family doctors. The most important strength of the study is the emphasis on interpersonal relationships and the adaptation of patients to everyday life. Dynamic group psychotherapy is presented in the article not just as one of the ways to help depressed patients and people with anxiety but as a way to improve their communication skills. Depression and anxiety are often associated with communication problems that spoil the patient’s life, relatives, and friends. Such patients constantly feel suspicious and suffer from loneliness and lack of attention. In addition, they often have low self-esteem, which prevents them from representing themselves in society. The experience of group psychotherapy in practice teaches them to communicate with people ready to share their feelings and emotions.
The sample size seems entirely appropriate for this study; however, the authors did not provide several questionnaires that patients completed before and during the experiments. Although the authors received approval for conducting the surveys and the investigation, in general, examples of the topics raised in the sketches would help young professionals better understand how to interact with patients. They would understand which questions to ask are appropriate and ethical and which could harm patients and reduce their potential desire to participate in the study. It is one of the study’s shortcomings, although it is challenging to state the shortcomings directly here. Instead, the authors leave moments in the text that prompt people to ask clarifying questions when reading.
The authors do not draw the line between mediated and non-drug treatment in the context of their joint work. Patients are taking “benzodiazepines (two people), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs)” throughout the experiment (Bros et al., 2016, p. 829). It was not specified whether physicians reduced the drugs’ dosages and whether new medications were prescribed to patients during the nine months. These critical aspects help find an essential balance between drug and non-drug interventions. Theoretical justifications at the beginning of the article, before the design itself, do not affect the topic of helping patients with depression with medications. It would be helpful to mention this in the amount of no more than a paragraph to understand the comparison of two types of interventions for the same depression and anxiety. Another shortcoming is the lack of direct examples of psychotherapeutic conversations and their topics. It would be helpful to introduce short games into psychotherapeutic group practices that would make the situation within the group less tense; it is beneficial for patients with chronic anxiety.
Tables in the text mention patients with major depressive disorder, but this remains confusing and inconsistent. Major depressive disorder is usually an illness that requires secondary specialist care and stable antidepressant medication (Bros et al., 2016). It is not entirely clear, therefore, how exactly this group therapy helps patients with major depressive disorder and how it reduces its manifestations in society and moments of interaction with people daily. There are some doubts about the effectiveness of dynamic group psychotherapy with such patients. For instance, it would be interesting to see how group psychotherapy helps patients whose depression is caused by body dysmorphic disorder. Examples of such situations are anorexia associated with depression, preceding or concomitant. Such patients often need peer support and as much interaction as possible to feel that everything is in order with them, both on the superficial and mental levels.
The studied article is an exciting source on modern psychiatry, which can become a topic for brainstorming among colleagues or students. There are many places in the article where you should focus on and make it look like readers are asking questions directly to the authors. The use of materials from this article will be helpful when working with patients. It should be recommended for study by specialists who wish to gain knowledge in psychotherapy. The paper will be beneficial for narrow specialists in depression and anxiety as it illustrates one of the various ways to help such patients.
Reference
Bros, I., Notó, P., & Bulbena, A. (2016). Effectiveness of short-term dynamic group psychotherapy in primary care for patients with depressive symptoms. Clinical Psychology & Psychotherapy, 24(4), 826–834. Web.