Elsevier

Behaviour Research and Therapy

Volume 77, February 2016, Pages 78-85
Behaviour Research and Therapy

Shorter communication
Group therapy for university students: A randomized control trial of dialectical behavior therapy and positive psychotherapy

https://doi.org/10.1016/j.brat.2015.12.003Get rights and content

Highlights

  • We compared the efficacy of two group therapies in a college counseling center.

  • Dialectical behavior therapy (DBT) and positive psychotherapy (PPT) were examined.

  • Both groups showed a significant improvement in all symptoms and coping measures.

  • DBT had better outcome on alliance, life satisfaction, and dysfunctional coping.

  • DBT had less dropout and higher attendance.

Abstract

The present study examined the efficacy of two evidence-based group treatments for significant psychopathology in university students. Fifty-four treatment-seeking participants were randomized to a semester-long dialectical behavior therapy (DBT) or positive psychotherapy (PPT) group treatment. Mixed modeling was used to assess improvement over time and group differences on variables related to symptomatology, adapative/maladaptive skill usage, and well-being/acceptability factors. All symptom and skill variables improved over the course of treatment. There were no statistically significant differences in rate of change between groups. The DBT group evidenced nearly all medium to large effect sizes for all measures from pre-to post-treatment, with mostly small to medium effect sizes for the PPT group. There was a significant difference in acceptability between treatments, with the DBT group demonstrating significantly lower attrition rates, higher attendance, and higher overall therapeutic alliance. While both groups demonstrated efficacy in this population, the DBT group appeared to be a more acceptable and efficacious treatment for implementation. Results may specifically apply to group therapy as an adjunctive treatment because a majority of participants had concurrent individual therapy.

Introduction

Demand for mental health services continues to evolve among college counseling centers (CCCs). Recent national surveys of university students and CCCs have found that 8.9% of students seriously considered suicide, 6.3% intentionally harmed themselves, and 34.5% reported they had felt so depressed it was difficult to function, all within the previous year (ACHA, 2015). In addition, 92% of counseling directors believe that more students were presenting with severe psychological issues in the past 5 years (CUCCA, 2006). Other researchers have noted longitudinal increases in serious psychopathology symptoms and rates of comorbidity in CCCs (Benton, Robertson, Tseng, Newton, & Benton, 2003).

Coupling high demand and increasing levels of psychopathology with limited staff and financial resources (American College Health Association, 2015, Crozier and Willihnganz, 2006, Smith et al., 2007), CCCs must adapt their services (Watson, 2013). One strategy suggested in multiple studies is to implement evidence-based group therapy (e.g., Smith et al., 2007). Group therapy can simultaneously treat multiple consumers and is particularly appropriate for the time-limited service provided in many CCCs (Coniglio, McLean, & Meuser, 2005). While this idea is not new (Kincade & Kalodner, 2004), group treatment efficacy studies in this context are limited. Few studies have examined active group treatments through a randomized design; all have focused on either social anxiety or mild depression (e.g., Bjornsson et al., 2011, Hodgson, 1981, Huang and Liu, 2011). In addition, these studies have focused on self-reported symptom reduction as the primary outcome, with few examining specific treatment targets (i.e., coping skills), comorbid symptoms, or acceptability of treatment.

Dialectical behavior therapy (DBT) was developed by Linehan (1993) as a treatment for chronically suicidal patients, specifically individuals with borderline personality disorder (BPD). DBT is derived from cognitive-behavioral therapy, but the inclusion of a dialectical philosophy, radical behaviorism, and mindfulness makes it a unique transdiagnostic treatment for emotion dysregulation. DBT typically includes a 12-month course of individual treatment that focuses on reducing life threatening, therapy-interfering, and quality of life-interfering symptoms. In addition, DBT provides concurrent group-based didactic skills training. Several studies demonstrate it as an efficacious therapy for reducing suicidal and self-harm behaviors in adult BPD samples (e.g., Kliem et al., 2010, Panos et al., 2014). DBT has only been recently adapted for a university student population. Pistorello, Fruzzetti, MacLane, Gallop, and Iverson (2012) compared adapted DBT to treatment-as-usual in a suicidal collegiate sample, with DBT treatment related to greater decreases in self-harm, suicidal behavior, depression and BPD symptom severity. Research suggests that DBT skills group as an add-on to treatment-as-usual can further reduce symptoms of psychopathology (e.g., Valentine, Bankoff, Poulin, Reidler, & Pantalone, 2015), with preliminary support for DBT skills group as a stand-alone treatment in CCCs (Chugani et al., 2013, Meaney-Tavares and Hasking, 2013).

Positive psychotherapy (PPT) is a therapeutic endeavor within positive psychology. The central premise is to assess and enhance positive resources of clients, such as positive emotions, engagement, relationships, meaning and accomplishments. PPT is based on the assumptions that clients inherently seek growth, fulfillment and happiness, positive resources are as real as symptoms, and effective therapeutic relationships can be formed through the manifestation of positive resources. These assumptions are operationalized into five scientifically measurable components: positive emotion, engagement, relationships, meaning, and accomplishment (Seligman, 2011). It has been shown that fulfillment in positive emotions, engagement, and meaning is associated with lower rates of depression and higher life satisfaction (Asebedo and Seay, 2014, Bertisch et al., 2014). Feasibility and empirical validation of PPT has been explored through 14 studies, addressing depression, anxiety, psychosis, and nicotine dependence (for review, see Rashid, 2015). Significant research have demonstrated the effectiveness of these interventions (Bolier et al., 2013, Hone et al., 2015, Sin and Lyubomirsky, 2009).

The primary objective of this study is to test two evidence-based group treatments that have yet to be examined within the context of a randomized trial in a transdiagnostic clinical university sample. Participants were treatment-seeking students in a CCC who were randomly assigned to receive 12 weeks of either treatment. Participants were not prohibited from receiving concurrent individual therapy. This study not only examines symptom change across the course of treatment, but also focuses on maladaptive and adaptive skill usage, well-being, and the acceptability of each treatment.

Section snippets

Participants

Participants were 54 treatment-seeking university students at a mid-sized university in a large metropolitan area. This CCC offers free psychological and medical services for full-time students. Seventy-five participants were referred by onsite counselors responding to flyers and presentations. Our goal was to have participants that represented a range of symptoms of psychopathology deemed relevant for group therapy targeting “severe emotion dysregulation”. It should be noted that the presence

Randomization and participant characteristics

Twenty-seven participants were assigned to each group. Thirty-eight participants completed treatment and 35 completed the post-treatment assessment (see Fig. 1). Treatment groups did not differ significantly on any demographic or psychiatric variables (see Table 1) or on any outcome variable at baseline (see Table 2). This includes those variables assessed at midtreatment: functional subscale of the WOCCL (t = .50), the dysfunctional subscale of the WOCCL (t = .58), and the SWLS (t = 1.18).

Symptom change

The

Discussion

The aim of the present study was to compare symptom reduction, skill usage, well-being, and acceptability factors between DBT and PPT group therapy. Nearly all variables of interest improved significantly from pre-to posttreatment. There were no significant differences in rate of change between groups, however the DBT group showed larger effect sizes for nearly all variables. In addition, there were significant group differences favoring DBT group in dysfunctional coping and life satisfaction.

Conflict of interest

None.

Funding source

None.

References (44)

  • S. Guney

    The positive psychotherapy inventory (PPTI): reliability and validity study in Turkish population

    Social and Behavioral Sciences

    (2011)
  • A.D. Neacsiu et al.

    Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial

    Behaviour Research and Therapy

    (2014)
  • American College Health Association

    National college health assessment II: Spring 2015 reference group executive summary

    (2015)
  • S.D. Asebedo et al.

    Positive psychological attributes and retirement satisfaction

    Journal of Financial Counseling and Planning

    (2014)
  • R.A. Baer et al.

    Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills

    Assessment

    (2004)
  • S.A. Benton et al.

    Changes in counseling center client problems across 13 years

    Professional Psychology: Research and Practice

    (2003)
  • H. Bertisch et al.

    Positive psychology in rehabilitation medicine: a brief report

    NeuroRehabilitation

    (2014)
  • A.S. Bjornsson et al.

    Cognitive–behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: a randomized controlled trial

    Depression and Anxiety

    (2011)
  • L. Bolier et al.

    Positive psychology interventions: a meta-analysis of randomized controlled studies

    BMC Public Health

    (2013)
  • C.D. Chugani et al.

    Effectiveness of short term dialectical behavior therapy skills training in college students with cluster B personality disorders

    Journal of College Student Psychotherapy

    (2013)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • C. Coniglio et al.

    Personal counselling in a Canadian post-secondary context

    (2005)
  • S. Crozier et al.

    Canadian counselling centre survey 2004/2005

    (2006)
  • L.R. Derogatis

    SCL 90-R: Administration, scoring, and procedure manual

    (1983)
  • E. Diener et al.

    The satisfaction with life scale

    Journal of Personality Assessment

    (1985)
  • M.B. First et al.

    User's guide for the structured clinical interview for DSM-IV Axis II personality disorders (SCID-II)

    (1996)
  • M.B. First et al.

    Structured clinical interview for DSM-IV axis I disorders — patient edition (SCID-I/P, 11/2002 revision)

    (2002)
  • J.W. Graham

    Missing data analysis: making it work in the real world

    Annual Review of Psychology

    (2009)
  • K.L. Gratz et al.

    Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale

    Journal of Psychopathology and Behavioral Assessment

    (2004)
  • J.W. Hodgson

    Cognitive versus behavioral–interpersonal approaches to the group treatment of depressed college students

    Journal of Counseling Psychology

    (1981)
  • L.C. Hone et al.

    An evaluation of positive psychology intervention effectiveness trials using the re-aim framework: a practice-friendly review

    The Journal of Positive Psychology

    (2015)
  • A.O. Horvath et al.

    Development and validation of the working alliance inventory

    Journal of Counseling Psychology

    (1989)
  • Cited by (54)

    • Digital mental health interventions for anxiety and depressive symptoms in university students during the COVID-19 pandemic: A systematic review of randomized controlled trials

      2023, Revista de Psiquiatria y Salud Mental
      Citation Excerpt :

      Overall, notwithstanding the small-to-medium magnitude of the effects and the average low quality of the included RCTs according to the RCT-PQRS, the available literature seems to support the promising role of different types of digital interventions and their possible benefits on crucial mental health outcomes for university students during the COVID-19 public health emergency. CBT, DBT, and mindfulness-based techniques had previously proven to be effective options to reduce depressive and anxiety symptoms in university students, even independently of the pandemic.47–49 Similarly, PPIs50 and mind-body interventions51,52 had been formerly tested in university settings, even if the existing evidence remains scarce.

    View all citing articles on Scopus
    View full text