Effectiveness of cognitive-behavioural group therapy for inpatients: a 4-year follow-up study

Objective Cognitive-behavioural therapies have been applied successfully in outpatient settings for schizophrenic as well as depressive, bipolar and personality disorders. However this kind of approach in acute inpatient settings is uncommon and involves highly selected cases. Also, in Italy there are more psychosocial interventions in community rather than ward settings, where inpatient treatment tends to be crisis-oriented, with the aim to stabilize the clinical conditions of patients and to control positive symptoms. We are aware that some inpatient unit in the last years have introduced "group-therapy" interventions, but without evaluating their efficacy. In Italy, the first study that explore the effectiveness of a Group Therapy has been conducted in Rome in 2001. It was a 1-year follow-up study of Cognitive-Behavioural Group Therapy. This approach has been more structured, manualized, applied and evaluated in Campobasso after two years of follow-up, obtaining good results. On the basis of this experience in Campobasso, the inpatient unit staff decided to evaluate after a longer period of observation: 1) the effectiveness of the manualized cognitive-behavioral group therapy (CBGT) incorporated into the routine care of a psychiatric inpatient unit; 2) which of the four main diagnostic categories (schizophrenia, major depression, bipolar or personality disorders) are more sensitive to this intervention. Method The description of the Cognitive-Behavioural Group Therapy, of the methodology of evaluation and of the tools (included the inter-rater reliability properties) used for the study have been extensively described in the paper that documented the effectiveness after a 2-year follow-up. Briefly, a pre-post design is used to measure the following indicators: 1) voluntary or compulsory readmissions for each of the main diagnostic categories (schizophrenia, depression, bipolar and personality disorders); 2) ward atmosphere evaluated by an ad hoc developed 5-item Likert-scale. Through this scale it is possible to code and differentiate the aggressive or violent behaviour as well as the strategies used to manage the crises; 3) patient satisfaction evaluated through a very short, 5-item questionnaire filled-in by the patient on the day of discharge. Diagnoses were made on the basis of the DSM-IV. For what concerns statistical analyses, comparisons between parametric variables were performed with analysis of variance and between non-parametric variables with the. chi(2) test. The program used was the 12.0 version of the SPSS for Windows. Results In the years 2001-2005 the percentage of readmissions declined from 38% to 24% (p < 0.02), while the compulsory admissions from 17% to 0% (p < 0.02) (Table II). The reduction of the readmissions was consistent only for schizophrenic (p < 0.001) and bipolar disorders (p < 0.04) (Table II). The ward atmosphere at the end of the study was excellent and its improvement measured on a scale has been consistent, from the average of 2.8 to 1.3 (-1.5; p < 0.001). The same results were obtained for patient satisfaction (p < 0.001) (Table III). Conclusions This is the first effectiveness study of psychosocial treatment in Italy with a long-term follow-up (4 years), strongly structured, manualized with an explicit model of intervention based on a stress-vulnerability and on problem solving models in the form of daily cognitive behavioural group therapy for an acute inpatient unit. Results of outcome indicators suggest that a wide range of benefits may be achieved. On the basis of the results we can conclude that this approach is highly effective for schizophrenic and bipolar disorders.