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Title: Effectiveness of Self-Distancing in Group Cognitive Behavioural Therapy for Adult Depression in two

Authors: Peter John Sabatelli

Topic: Psychology


Background: Depression is a major cause of personal, family suffering and substantial

economic burden. Group Cognitive Behavioural Therapy is effective for mild to moderate


Aims: Testing the effectiveness of self-distancing in group cognitive behavioural therapy

(Group A) for mild to depressed individuals. It was predicted that Group A will decrease low

mood and rumination more quickly and have higher reductions at post treatment compared to

group cognitive behavioural therapy (Group B) alone.

Method: Participants were recruited from the community with depression, rumination, aged

between 22-58 (n=36) then randomly allocated to either group that lasted for four sessions.

Results:  Low mood and rumination, r = .841 (Group A), r = .840 (Group B) pre-treatment, r

= .041 post treatment (Group A), r = .471 (Group B). A repeated measures ANOVA with a

Greenhouse-Geisser correction determined that mean BDI-II and Rumination scores were

statistically significant between  time points F(1.893, 64.369) = 20.832, p<.001;  means 

F(1.365, 46.401) = 11.870, p<.001.

Post hoc tests using the Bonferroni correction showed Group A  elicited a significant

reduction from pre-treatment to post-treatment which was statistically significant (p = .001)

compared to Group B but the effect size of this difference was small (Cohen, 1988).

Limitations: No checking by an independent observer to whether the manualised treatment

was being adhered to, structural clinical interview (SCID) not used, restrictive inclusion

criteria, no follow up, no control group and limited generalisability.

Conclusions: Group A over four sessions elicited a statistically significant reduction in low

mood and rumination from pre-treatment to post-treatment did so quicker and more steeply

than Group B as predicted.


Key words: self-distancing, depression, group cognitive behavioural therapy, rumination


    COMMENT - 1

  • Peter John Sabatelli (Author) 17th Nov 2015 - 2:46 AM
    Would a repeated MANOVA have been better rather than repeated ANOVA??
    • Peter John Sabatelli (Author) 22nd Nov 2015 - 12:56 AM
      Yes a RMANOVA may have been the better option in this type of study but that type of statistical test can be a bit complicated
      and there is not much guidance on how to run in in SPSS and its interpretation.

  • COMMENT - 2

  • Peter John Sabatelli (Author) 18th Nov 2015 - 9:26 PM
    Yes a RMANOVA may have been the better option in this type of study.

  • COMMENT - 3

  • Peter John Sabatelli (Author) 18th Nov 2015 - 9:28 PM
    Since the ANOVA's were done was there bonferroni adjustments made??
    • Peter John Sabatelli (Author) 22nd Nov 2015 - 12:54 AM
      Yes there was at .01 from .05

  • COMMENT - 4

  • Peter John Sabatelli (Author) 22nd Nov 2015 - 12:53 AM
    Yes there was at .01 from .05

  • COMMENT - 5

  • Peter John Sabatelli (Author) 22nd Nov 2015 - 1:00 AM
    Why was there not any 3 month follow up??

  • COMMENT - 6

  • CHETNA PUNIA (Viewer) 23rd Nov 2015 - 10:42 AM
    Interesting work Peter. Is self distancing and suppression of negative thoughts similar?

  • COMMENT - 7

  • Peter John Sabatelli (Author) 23rd Nov 2015 - 2:23 PM
    Thank you for having a look and for your comments. Research indicate there is a difference between self-distancing and suppression. Although I cannot give the exact mechanisms involved i can provide some research on their definition and effects on depression. See below:

    Self-Distancing: Psychological distance has been defined as a process in which people’s direct egocentric

    experience of a stimulus in the here and now is diminished (Liberman, Trophe, 2008;

    Mischel, Rodriguez, 1993). Self-distancing may play an important role in enabling people to

    reflect over negative experiences adaptively, through adopting a broader perspective rather

    than focusing on details.

    So asking ‘’why’’ negative life events happened from a distanced perspective, has less

    negative affect that encourages more reconstructing of feelings, developing a new outlook,

    insight and closure (Kross, Ayduk, 2008) features not indicative of a ruminative style of

    thinking (Watkins, Moberley, Moulds, 2008). Cognitive avoidance was not ‘promoted’ when

    using self-distancing to help analyse negative feelings (Ayduk, Kross, 2010; Kross, Ayduk,

    2008; 2009; Kross, Gard, Deldin, Clifton, Ayduk, 2012) and is positively associated with

    problem solving (Ayduk, Kross, 2011).

    Suppression: Suppression is an avoidance strategy, defined as the effort not to think a particular thought

    (Wegner, Schneider, Carter, White, 1987) feeling, emotion, urge, sensations or memories that

    paradoxically increases them instead (Wegner, Erber, 1992; Wegner, Schneider, Carter,

    White, 1987; Wenzlaff, Wegner, 2000) that leads to rumination (Cribb, Moulds, Carter,

    2006; Moulds, Kandris, Starr,Wong, 2007) and a reduction in problem solving ( Hayes,

    et al, 2004). This increases depressive symptoms (Rude, Wenzlaaff, Gibbs, Vane, Whitney,

    2002) and increases the risk of depression (Aldao, Nolen-Hoeksema, Schweizer, 2010;

    Dalgleish, Yiend, 2006).

  • COMMENT - 8

  • KOO KIAN YONG (Viewer) 23rd Nov 2015 - 5:42 PM
    Thanks for sharing. I love to hear your opinion and experiences regarding the difficulty in conducting group cognitive behavioural therapy
    • Peter John Sabatelli (Author) 24th Nov 2015 - 12:24 AM
      Briefly, running group CBT for depression on the an acute psychiatric ward will probably be an open format, sessions shorter 4x1, module content basic and really will be psycho-education and largely dictatic and you will have little say on who will attend and who will not so many will be unsuitable.

      Out-patients referred by psychiatrists, OT's, nurses for group CBT within a day hospital will have more sessions (6-8) but covering a Beckian format but less focus on trying to change core beliefs; more likely to have greater say on inclusion criteria and who is suitable for CBT; will more likely have co-therapist; supervision but higher drop out rate, more difficulty homework compliance and often clients have complex co-morbid issues that the nature of the group cannot address.

      Group CBT for depression offered free as part of research within a community setting where you can set tighter inclusion criteria; greater use of measurements; voluntary participation assured; higher engagement; higher homework compliance; less drop out and non attendance rates; can increase therapeutic gains.

  • COMMENT - 9

  • Nileshkumar Madhubhai Baria (Viewer) 27th Nov 2015 - 5:30 PM
    Dr.Nileshkumar M Baria ( Viiewer ),
    present situation depression is become major psycho disorder in human. present life style responsible for this. it is one factor for this disorder. cognitive behavior therapy how much effective against depression ?

  • COMMENT - 10

  • Sincy Joseph (Viewer) 27th Nov 2015 - 6:08 PM
    The Review is well structured & brought out in a detailed manner...

  • COMMENT - 11

  • Obayori Olufunke Christianah (Viewer) 27th Nov 2015 - 6:52 PM
    Obayori Christianah Olufunke(Viewer)
    The structure is well organized and detailed. Weldone.