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