To “group” or not to “group”…. Have you ever found yourself asking that question as a provider? There is, of course, the general concept of group theory and what patients work best in a group and those that don’t. It can be easy to spot people who will not interact with others well, to one extreme or the other. But it can be harder as a provider to determine the more intricate question of what type of behavioral health problem can be better served in a group format instead of individual.
We all have our biases on this topic. Mine through the years has been split between personal preference and organizational need, preferring to work one-on-one with people, but being embedded in a military facility where individual appointments can be difficult to come by, making groups a much more efficient and easily accessible means for helping those in need. When it came to trauma work, I definitely fell on the side that individual treatment was preferable given the greater opportunity for patients to share details about events that they may have never spoken of before. But over the years I have also come to recognize that there is a lot of power in the group, especially with trauma survivors who have experienced similar events. More than a few patients have told me that they prefer being with a group of people who “get it” and they feel more apt to open up in these settings. So over time, I became an “on the fence” person, wishing there was more guidance in this area.
While the research is still limited, I was excited this month when Dr. Patricia Resick et. al. published their findings of a study at Fort Hood where they compared group to individual Cognitive Processing Therapy (CPT) treatment for trauma (see reference below). Finally! Instead of the different treatment protocols being compared to each other in general terms, we are seeing more individual treatment protocols looking at their variations more and determining which styles work best. This study also concluded that given the complexity of trauma, much more research is needed to determine which types of treatment best suit different types of traumas. Believe me, I am eagerly awaiting some studies in the pipeline that will begin opening these knowledge doors!
Dr. Resick and colleagues findings, in general, indicate that with the military trauma group, individual treatment was more effective than group treatment for reducing trauma symptoms. While they cite various potential explanations for this, to include the limitations of being able to catch up a group member who missed a session or not being able to spend as much time with one member who does not understand the concepts as clearly as others, I resonated strongly with their hypothesis that group work did not give providers and patients the ability to go as in-depth with the trauma, or to address multiple traumas in the treatment context. My bias seemed to be upheld. I was still gratified that my “fence-riding” position was also supported and ruling out group treatment completely is not what the study found. While there were significant differences between the two conditions, the group treatment still demonstrated a medium to large effect size overall.
Even though the findings led to more questions, like all good research should, I was left very happy with this study. It highlighted that we need to seriously look at which treatments and modalities best serve different types of trauma to achieve the best overall improvement. True, I am a strong believer that there is no “right” answer for every patient and providers need to look at each individual to determine their best treatment fit, it will be nice one day to hopefully have research to guide us on where to begin when considering the variety of treatment options.
Resick PA, Wachen JS, Dondanville KA, Pruiksma KE, Yarvis JS, Peterson AL, Mintz J, and the STRONG STAR Consortium. Effect of Group vs Individual Cognitive Processing Therapy in Active-Duty Military Seeking Treatment for Posttraumatic Stress DisorderA Randomized Clinical Trial. JAMA Psychiatry. Published online November 23, 2016. doi:10.1001/jamapsychiatry.2016.2729
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Debra Nofziger, Psy.D. is a deployment behavioral health psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Located at the Brooke Army Medical Center, she trains and supervises pre-doctoral interns and post-doctoral fellows in providing evidence-based treatment to active-duty service members and their families.