Nursing

  

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In a 5- to 10-slide PowerPoint presentation, address the following:

  • Provide      an overview of the article you selected, including answers to the      following questions:
  • What       type of group was discussed?
  • Who       were the participants in the group? Why were they selected?
  • What       was the setting of the group?
  • How       often did the group meet?
  • What       was the duration of the group therapy?
  • What       curative factors might be important       for this group and why?
  • What       “exclusion criteria” did the authors mention?
  • Explain      the findings/outcomes of the study in the article. Include whether this      will translate into practice with your own      client groups. If so, how? If not, why?
  • Explain      whether the limitations of the study might impact your ability to use the      findings/outcomes presented in the article.
  • lease use attached article.

Using Short-Term Group Psychotherapy as an Evidence-Based
Intervention for First-Time Mothers at Risk for
Postpartum Depression

  • ppc_350 202..209
  • Richard A. Pessagno, DNP, RN, APN-C, CGP, and Diane Hunker, PhD, MBA, RN

    Richard A. Pessagno, DNP, RN, APN-C, CGP, is Clinical Assistant Professor, Rutgers, The State University of New Jersey, College of Nursing, Newark,
    New Jersey, USA; and Diane Hunker, PhD, MBA, RN, is Assistant Professor, Chatham University, Pittsburgh, Pennsylvania, USA.

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    Search terms:
    First-time mothers, group psychotherapy,
    postpartum depression, psychiatric nursing

    Author contact:
    Richard.Pessagno@rutgers.edu, with a copy to
    the Editor: gpearson@uchc.edu

    Conflict of Interest Statement
    There are no financial disclosures to make
    relative to this manuscript.

    First Received March 12, 2012; Final Revision
    received June 25, 2012; Accepted for
    publication June 27, 2012.

    doi: 10.1111/j.1744-6163.2012.00350.x

    PURPOSE: The purposes were to (a) provide an 8-week, short-term, psychotherapy
    group as a nonpharmacologic, evidence-based intervention for first-time mothers
    at risk for postpartum depression (PPD) and (b) determine if women’s scores in
    the Edinburgh Postnatal Depression Scale changed after participation in the
    intervention.
    CONCLUSION: The women who participated in the short-term group psycho-
    therapy intervention experienced a decrease in their Edinburgh Postnatal Depres-
    sion Scale scores, reducing their risk for PPD.
    PRACTICE IMPLICATIONS: Group psychotherapy is an effective, evidence-based
    intervention to reduce the risk for PPD and should remain a current competency of
    psychiatric advanced practice nurses.

    Postpartum depression (PPD) is a serious medical condition
    that dates back to 400 B.C. (Tovino, 2009). Although it has
    been noted that nearly 85% of women experience some type
    of mood change after giving birth (Horowitz & Goodman,
    2005), the actual prevalence of PPD is between 10% and
    20% (Gjerdingen & Yawn, 2007). While in-hospital postpar-
    tum screening has helped to increase the recognition of
    those at risk for developing PPD (Perfetti, Clark, & Fillmore,
    2004), fewer than half of those women who are screened
    and who develop PPD will actually be identified and treated
    (Gjerdingen & Yawn, 2007; Logsdon, Wisner, & Pinto-Foltz,
    2006). As women are discharged from acute care hospitals
    quickly after giving birth, inpatients often lack readily avail-
    able access to interventions, even for women identified at
    risk for PPD.

    Pharmacological interventions are a common treatment
    option for PPD, but many women leave the acute setting,
    opting not to take medication and having limited resources to
    access mental health services. Taking medication, specifically
    psychotropic medication, can raise concerns for many
    women, especially for first-time mothers (Gjerdingen, 2003).
    Often, concerns are raised about the use of medications, espe-
    cially among those breast-feeding mothers, relative to the

    potential risk to their infants. Identifying and accessing timely
    nonpharmacological treatment can be difficult for women
    who are at risk for PPD or who have PPD. This article
    describes an evidence-based practice intervention that used
    short-term group psychotherapy as a nonpharmacologcial
    intervention with first-time mothers who were identified as
    being at risk for PPD.

    Background

    While various factors have been examined in relation to the
    etiology of PPD, such as hormonal and metabolic changes,
    lifestyle adjustments, obstetric factors, and changing new
    roles (Flores & Hendrick, 2002), epidemiological studies have
    fairly consistently demonstrated that the etiology of PPD is
    most closely linked to psychosocial factors (Beck, 1996a).
    PPD has often been associated with women who are from
    lower socioeconomic backgrounds, who are less educated,
    and who lack occupational prestige (Séguin, Potvin, St-Denis,
    & Loiselle, 2001). Yet Anderson (2009) found that PPD is also
    found in significant numbers among women who are well
    educated, middle class, and in stable relationships. These
    findings support the need to adequately screen and provide

    Perspectives in Psychiatric Care ISSN 0031-5990

    202 Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    mailto:Richard.Pessagno@rutgers.edu

    mailto:gpearson@uchc.edu

    early intervention to all women who give birth, and not only
    profiled women from disadvantaged backgrounds.

    The risk for PPD may be greatest for first-time mothers
    who hold high expectations regarding childbearing but no
    personal experience with which to compare their experiences
    (Epperson, 1999). Because new mothers may not be aware
    that they are experiencing PPD, they may normalize their
    feelings. New mothers may fear that others judge their feel-
    ings as an inappropriate maternal response (Logsdon, Foltz,
    Scheetz, & Myers, 2010). First-time mothers are less apt to
    express the need for help during the postpartum period
    because of the perceived stigma of being depressed, as well as
    the hesitancy to report depressive symptoms (Thurgood,
    Avery, & Williamson, 2009). The results can leave first-time
    mothers feeling even more isolated and unprepared to cope
    with multiple changes that can negatively impact their health
    status and parenting effectiveness (Reich, Silbert-Mazzarella,
    Spence, & Siegel, 2005).

    Impact of PPD

    The detrimental effects of PPD have gained increasing public
    awareness, with some extreme cases of PPD in which mothers
    have harmed their children (Logsdon, Wisner, & Shanahan,
    2007). Untreated PPD in first-time mothers, coupled with a
    lack of maternal experience and fear, can lead to a host of mal-
    adaptions for both the mother and her baby. These maladap-
    tions can include issues such as severe social isolation,
    decreased mother–child bonding, decreased maternal ability
    to care for the infant, increased incidence of developmental
    delay in infants, and a reduced rate of identifying infant cues
    (Reich et al., 2005). Although women who have given birth
    more than once have also been shown to be at risk for PPD,
    women with more than one child tend to seek intervention at
    a higher rate than first-time mothers (Rich-Edwards et al.,
    2006). The occurrence of PPD has been linked to a host of
    negative outcomes. Beck (1998) noted that women with PPD
    can negatively impact infant behaviors and influence child-
    hood development through the age of 14. A review of eight
    phenomenological studies on women with PPD suggested
    that mothers with PPD were often filled with guilt, had feel-
    ings of loss, and engaged in irrational thinking. These themes
    were linked to mothers experiencing a sense of detachment
    from their infants, as well as failure to respond to clues from
    her children (Beck, 1996b). Current research suggests that
    there is a negative relationship between the presence of PPD
    and infant development (Beck, Records, & Rice, 2006).

    Treatment of PPD

    Treatments for depression and PPD are varied and include
    psychotherapy, psychoeducation, and support groups, as well
    as pharmacotherapy. Treatment choices for patients depend

    on multiple factors, including availability, cost, convenience,
    the influence of family and friends, and patient preference
    (Burlingame, Fuhriman, & Mosier, 2003). The cost-
    effectiveness of group psychotherapy draws many patients to
    this treatment option (Burlingame et al., 2003; McRoberts,
    Burlingame, & Hoag, 1998).

    Group psychotherapy has been supported in the literature
    as being an efficient, cost-effective, nonpharmacologic,
    evidence-based intervention that can be used for patients
    exhibiting depressive symptoms. A meta-analysis of 48
    research studies examining the effect of group psychotherapy
    on depression revealed that group psychotherapy was effec-
    tive in reducing depressive symptoms, further noting that 43
    of the studies evidenced that group psychotherapy provided a
    statistically significant decrease in depressive symptoms for
    group participants (McDermut, Miller, & Brown, 2001).

    Several studies have reported that mothers with PPD
    responded well to group psychotherapy treatment. Klier,
    Muzik, Rosenblum, and Lenz (2001) noted in their study (n =
    17) that group psychotherapy was an effective intervention
    that decreased depressive symptoms, with a continued dimin-
    ishment of PPD symptoms 6 months after treatment. Honey,
    Bennett, and Morgan (2002), in a study of 45 women scoring
    12 or higher on the Edinburgh Postnatal Depression Scale
    (EPDS), identified that brief group experience reduced
    depressive symptoms, as evidenced by lower EPDS scores.
    Other studies on group psychotherapy as a treatment for PPD
    have reported similar trends (Gruen, 1993; Kurzweil, 2008;
    Meager & Milgrom, 1996; Ugarriza, 2004).

    The benefits of group psychotherapy have been linked to
    more rapid remission of symptoms, cost-effectiveness, and
    improved social support. The literature has also demon-
    strated that group psychotherapy can be an efficacious treat-
    ment for patients at risk for PPD. Some evidence supports the
    idea that group psychotherapy may provide longevity of
    symptom relief for some patients up to 6 months posttreat-
    ment. The literature cites the importance of screening and
    early identification of the risk for PPD in first-time mothers
    and the effectiveness of group psychotherapy as an evidence-
    based intervention.

    Interpersonal psychotherapy (IPT) is an effective, time-
    limited treatment, which has been shown to be highly
    effective for depression (Markowitz & Weissman, 2004).
    Depression is identified as a medical illness that connects an
    individual’s life events to the individual’s depression
    (Markowitz & Weissman, 2004). Therapy focuses on helping
    individuals to create or enhance one’s social relationships
    while addressing issues such as conflicts and role change.
    Within the context of a group environment, IPT can provide a
    setting where individuals with a similar diagnosis can meet to
    address relationship issues and explore how these issues may
    be leading to depressive symptoms or other struggles within
    various relationships.

    Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression

    203Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    For the purposes of this project, IPT was organized by
    using an unstructured format for group sessions. Group par-
    ticipants were asked to recognize and notice their affect
    response, cognitions, and reactions during sessions, and then
    use those recognitions as a means of relating to others in the
    groups. Participants were able to use group interactions to
    address their relationship issues and their role changes. The
    group was used to help participants improve interpersonal
    relationships, enhance their ability to empathize, and learn
    new skills.

    Intervention

    The purposes of this project were to (a) provide a non-
    pharmacologic, evidence-based intervention for first-time
    mothers at risk for PPD and to (b) determine if women’s
    scores in the EPDS change after participation in the interven-
    tion. The intervention was an 8-week, short-term psycho-
    therapy group offered by an advanced practice psychiatric
    nurse to first-time mothers. The project was approved by the
    Institutional Review Board for protection of all participants.

    Sample. A total of 202 women gave birth on the postpartum
    unit during the 3-week recruitment period for this project.All
    202 women completed the EPDS, and 24 women were then
    recruited for participation in the project. All 24 women com-
    pleted EPDS within 3 days after having given birth to their
    first child and had a score of 11 or higher on the EPDS.A score
    of 11 or higher triggered a psychiatric evaluation, which was
    established by hospital policy to determine fitness for dis-
    charge from the postpartum unit. After completing a psychi-
    atric screening, eligible women were approached by a
    postpartum nurse to determine if they were interested in par-
    ticipating in the group psychotherapy intervention. These eli-
    gible women then discussed their interest with the advanced
    practice psychiatric nurse who would be leading the interven-
    tion groups, and the women were given details about the
    groups. Sixteen (Table 1) of the 24 women chose to partici-
    pate in one of two short-term psychotherapy intervention
    groups.

    The age range of participants was between 20 and 38, with a
    mean age of 28.5 years. More than 68% of the women were
    between 26 and 30 years old. Thirteen, or 81.25%, of the
    women were married; two women had a significant other;
    and one woman was single. The majority of the women were
    Catholic (62.5%), and all 16 women were Caucasian. More
    than 92% had at least a high school education, with more than
    86% having completed a 4-year college degree. Ten (62%) of
    the women worked outside their homes in a variety of profes-
    sional, technical, and service industry roles.

    With regard to previous mental health treatment, six par-
    ticipants (37.5%) had some experience with previous mental
    health treatment. Four women had participated in counseling

    or psychotherapy, and two women had used psychotropic
    medications previously. None of the participants had previ-
    ously been hospitalized for psychiatric treatment. None of the
    women were taking psychotropic medication during the
    intervention. Six of the participants had been previously diag-
    nosed with depression.All 16 women had given birth within 1
    month before the start of the group intervention, with 5
    women giving birth to male children and 11 giving birth to
    female children.

    Women who did not participate decided against participa-
    tion because of childcare issues, concerns about length of the
    commitment to the group, and/or lack of interest in partici-
    pating in a group-related activity. Each participant was
    randomly assigned to one of the two short-term group psy-
    chotherapy intervention groups. The remaining women who
    did not meet the criteria for participation or who decided not
    to participate in the intervention were referred to other
    mental health services within the community. Screening for
    the project took place in May 2010.

    Procedure. The short-term group psychotherapy interven-
    tion was provided to two groups with eight women each for a
    period of 8 weeks. Each of the 8-week sessions lasted 90 min
    and started within 1 month of discharge from the hospital.

    Table 1. Demographics of

    Groups

    Variables
    Intervention
    Group 1 (n = 8)

    Intervention
    Group 2 (n = 8)

    Ages
    20–25 1 2
    26–30 6 4
    31–35 1 1
    36–38 0 1

    Education
    <12th grade 0 1 High school 2 0 College 5 5 Graduate school 1 2

    Marital status
    Single 1 0
    Married 6 7
    Partnered 1 1

    Work outside home
    Yes 2 8
    No 6 0

    Previous psych treatment
    Yes 4 2
    No 4 6

    Type of past treatment
    Psychotherapy 1 1
    Medication 1 1
    Both medication and therapy 2 0

    Previous mental health diagnosis
    Depressive disorder 4 2

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    204 Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    The groups were provided at no charge to participants, and
    childcare was provided to women in order make attending the
    groups easier. A master’s-prepared, advanced practice psychi-
    atric nurse, who was nationally board certified as a psychiatric
    nurse practitioner and as a group psychotherapist with more
    than 20 years of advanced practice psychiatric nursing experi-
    ence, was the group leader for each of the two intervention
    groups. This provided for consistency among interviews and
    among all group sessions. Psychotherapy group 1 was held on
    Tuesdays, and Psychotherapy Group 2 was held on Wednes-
    days. Both groups met on the same day of the week for all 8
    weeks. Both groups ran for 90 min. The scheduling and
    timing of intervention provide consistency of scheduling for
    participants. An interpersonal-focused theoretical model was
    used to structure the group, which guided the length of the
    group intervention, as well as the focus for each session. The
    interpersonal model was selected in order to help participants
    strengthen their relationships and to enhance their ability to
    identity and utilize resources to improve their functioning.
    This focus was structured to provide optimal opportunity in
    developing skills relative to their new maternal roles as new
    mothers, coping with depression and stress, honing commu-
    nication skills with their husbands and partners, and sharing
    their individual, weekly experiences.

    The first session for each group established ground rules for
    maintaining confidentiality for other group members;partici-
    pants were told to only talk about their own personal group
    experiences with nongroup members and to not repeat what
    other group members disclosed during the sessions. Members
    also agreed to attend group sessions on time or notify the
    author group leader about their absences. All members also
    agreed to attend all group sessions. During the first group
    session, the participants completed a demographic form.

    The subsequent seven sessions had a structured focus,
    which followed the interpersonal theoretical framework,
    addressing various relationship issues and helping partici-
    pants identify resources. Although the recommended length
    of typical interpersonal psychotherapy orientation is 12 to 15
    sessions, the number of sessions for this project was reduced
    to eight sessions based on group request. The final group
    session was used to address termination issues, as well as to
    identify group members who would need and benefit from
    additional mental health services, as well as refer identified
    group members who could benefit from additional mental

    health services. The EPDS, which had been administered
    prior to the intervention, was used again during this session.

    Setting. The setting for the intervention was a community
    hospital in New Jersey. In keeping with the hospital policy, all
    postpartum women needed to be screened for PPD within
    72 hr of delivery. This hospital policy adheres to the 2004 New
    Jersey state mandate that requires all postpartum women be
    screened for PPD before leaving any healthcare institution.

    EPDS Screening Tool. The EPDS was developed in Scotland
    within several healthcare centers in the cities of Livingston
    and Edinburgh (Cox, Holden, & Sagovsky, 1987). The tool
    was initially developed to assist primary care providers in
    identifying whether women who had recently given birth
    were suffering from postnatal depression, but now has appli-
    cations to a variety of clinical settings. For the purpose of this
    intervention, the first EPDS was completed 3 days postpar-
    tum and the second EPDS was completed during the last
    session of the group psychotherapy intervention.

    The EPDS is a publicly available PPD screening tool and is
    used within the hospital to screen for PPD. The EPDS is a
    10-question self-report questionnaire that has a maximum
    score of 30. Scores range from 0 to 30, with scores over 10
    indicating adjustment issues to the new baby, and scores over
    15 indicating a strong indication of clinical depression. Hos-
    pital policy states that a score of 11 or higher for women on
    the EPDS denotes a risk for PPD, and therefore, a psychiatric
    evaluation is required before the patient can be cleared for
    discharge. The EPDS has gained wide acceptance regarding
    the screening and identification of PPD. Therefore, a psychi-
    atric evaluation is required for all women with scores >11.
    The EPDS is easily administered and scored, making it an effi-
    cacious tool for utilization in a variety of postpartum health-
    care settings. The EPDS has been utilized in more than 20
    countries and is noted to have a significant level of sensitivity
    (86%), as well as specificity (78%), in identifying and indicat-
    ing symptoms of PPD (Harvey & Pun, 2007).

    Results

    The mean preintervention score on the EPDS for group 1 (3
    days postpartum) was 16.13 (SD = 2.78) and for group 2 was
    15.5 (SD = 1.19) (Table 2). These scores reflect the risk for

    Table 2. Pre- and Postintervention EPDS Scores

    Groups

    Preintervention Postintervention

    t (df) p

    M (SD) Range M (SD) Range

    1 16.12 (2.74) 11–18 6.38 (1.50) 4–9 21.51 (7) .001
    2 15.50 (1.19) 13–17 6.63 (1.99) 6–10 18.50 (7) .001

    Note: 8 women/group.

    EPDS, Edinburgh Postnatal Depression Scale.

    Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression

    205Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    depressive symptoms, in which a maximum potential score of
    30 would indicate severe depression and 0 noting no depres-
    sive symptomology. Scores of 10 or greater are indicative of
    symptoms presentation, which should warrant further evalu-
    ation. Following the intervention, the scores decreased sig-
    nificantly. The mean postintervention score for group 1 was
    6.38 (SD = 1.50) and for group 2 was 6.63 (SD = 1.99). These
    data represent the combined scores of all group members
    with and without a history of depression. There was a signifi-
    cant decrease in EPDS scores from preintervention to postint-
    ervention for both groups 1 and 2 (Table 2), as well as for
    women with previous depression and women with no previ-
    ous depression (Table 3), all indicating fewer self-reported
    symptoms that put women at risk for PPD.

    The long-term effects of the group intervention were
    evaluated at 6 months postintervention for participants from
    group 1 and group 2 (Table 4), and for women with each
    group based on previous history of depression and no previ-
    ous history of depression (Table 5). Both groups demon-
    strated a significant decrease in scores on the EPDS. These
    data demonstrate a continued effect of the group interven-
    tion for participants 6 months beyond the intervention. This

    is suggestive that group psychotherapy can have long-term
    effects to reduce risk for PPD for first-time mothers.

    During the initial group sessions, the women bonded
    quickly and developed a strong alliance with one another.
    Many of the women stated that they really enjoyed talking
    with other women who were struggling with similar issues
    and who were also first-time mothers. Several women stated
    they felt “safer” talking with other first-time mothers because
    they did not feel judged. Many of the women stated that they
    worried about being judged by others when they shared their
    worries or concerns about being new mothers. The homoge-
    neity of the group also seemed to be a factor that added to the
    success of the group.

    A common theme noted among the women in both groups
    was that the women looked forward to attending groups
    because the group offered a place where the women could be
    authentic, as well as a place to share “real feelings.” The theme
    of looking forward to the group could have been one factor
    that led to all the members attending all the group sessions.
    None of the women missed any of the sessions, which added
    to group cohesion, group process, and group stability. These
    factors could have also added to the effectiveness of the group.

    Table 3. EPDS Scores With Prior Depression
    and Without Prior Depression

    Groups
    Preintervention Postintervention
    t (df) pM (SD) Range M (SD) Range

    With previous depression
    1a (n = 4) 16.23 (1.50) 15–18 7.00 (2.16) 4–9 14.70 (3) .001
    2a (n = 2) 16.00 (1.41) 15–17 6.50 (2.12) 5–8 5.26 (2) .001

    No prior depression
    1b (n = 4) 16.00 (3.36) 11–18 6.38 (1.50) 4–9 5.43 (6) .001
    2b (n = 6) 15.50 (1.36) 13–17 6.67 (1.96) 4–9 8.86 (10) .001

    EPDS, Edinburgh Postnatal Depression Scale.

    Table 4. All Participants’ EPDS Scores at 8
    Weeks and 6 Months Postintervention

    Groups

    Postintervention 8 weeks Postintervention 6 Months

    M (SD) Range M (SD) Range

    1 6.38 (1.50) 4–9 6 (1.69) 3–8
    2 6.63 (1.99) 6–10 6.12 (1.45) 4–8

    Note: 8 women/group.
    EPDS, Edinburgh Postnatal Depression Scale.

    Table 5. EPDS Scores of Participants With Prior
    Depression and Without Prior Depression at 8
    Weeks and 6 Months PostinterventionGroups

    Postintervention 8 weeks Postintervention 6 Months
    M (SD) Range M (SD) Range

    With previous depression
    1 (n = 4) 7.50 (1.00) 4–9 6.25 (1.70) 4–8
    2 (n = 2) 6.50 (2.12) 5–8 5.50 (2.12) 4–7

    No previous depression
    1 (n = 4) 6.38 (1.50) 4–9 5.75 (1.89) 3–7
    2 (n = 6) 6.67 (1.96) 4–9 6.16 (1.32) 4–8

    EPDS, Edinburgh Postnatal Depression Scale.
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    206 Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    It was also noted that some of the women were referred for
    additional treatment after the intervention concluded. While
    all of the women showed a decreased risk for PPD postinter-
    vention, two of the women who had a previous history of
    depression requested additional psychotherapy support.
    Both women noted that the group had raised their awareness
    of the importance of remaining healthy and keeping their
    depression in remission. Both women believed that partici-
    pating in additional individual therapy would help them con-
    tinue to learn healthy ways of coping and adapting to their
    new roles.

    Effectiveness of Intervention

    The findings that participants in the group psychotherapy
    intervention experienced a decrease in their EPDS scores are
    congruent with the literature noting that participation in
    group psychotherapy is an effective means of reducing symp-
    toms associated with depression (Gruen, 1993; Klier et al.,
    2001; Kurzweil, 2008; Meager & Milgrom, 1996; Ugarriza,
    2004). The results demonstrate a gap in clinical services for
    first-time mothers at risk for PPD and subsequently support
    an evidence-based, psychiatric nursing intervention to bridge
    that gap. Providing a group psychotherapy intervention that
    was connected to an acute care hospital allowed for a more
    rapid and seamless referral process for women who were
    identified as being at risk for PPD. Barriers to treatment for
    women at risk for PPD vary and can include limited numbers
    of mental health providers skilled in treating PPD issues and
    long wait times to access treatment. Typically, hospital refer-
    rals for community-based mental health services for women
    at risk for PPD have led to long wait times to be seen for treat-
    ment. There is a lack of qualified mental health professionals
    who have knowledge and interest in working with the
    population.

    Identifying short-term group therapy as an intervention
    that could be provided by the psychiatric advanced practice
    nurse (APN) can bridge a potential gap in clinical services for
    first-time mothers at risk for PPD, who may otherwise have
    no other mental health services. Short-term group psycho-
    therapy can also provide an effective and cost-effective expan-
    sion of services for women who could potentially develop
    PPD. The utilization of short-term group psychotherapy has
    wide application across the healthcare system, as well as to
    various psychiatric disorders beyond PPD.

    Limitations

    The main limitation was the use of a nondirective group
    process style for this intervention. Nondirected group process
    lends itself to providing members the ability to focus more on
    relationships and developing empathy. The dynamics with a
    nondirective psychotherapy group may vary from group to

    group. This may provide some account for the differences
    appreciated in postintervention scores. Additionally, group
    EPDS scores versus individual EPDS scores were compared
    for preintervention and postintervention, which could also be
    noted as a limitation of the project. For the purposes of this
    project, all scores were aggregated together and compared as a
    cohort group.

    Another limitation of the project was that the group psy-
    chotherapy intervention was provided at no cost to partici-
    pants. Additionally, childcare was available to the women as
    well. It is realized that providing no-cost psychotherapy is not
    the norm in most cases, and childcare is not always available.
    Both of these issues may have also influenced the results of the
    project.

    Another limitation to take into account is the interpreta-
    tion of group scores. While this was an evidence-based prac-
    tice project that applied current research findings to address a
    clinical problem and not an original research project, it
    should be mentioned that change in EPDS scores have both a
    ceiling and a basement effect, and those members scoring on
    the higher end of the EPDS can change more dramatically
    than those members scoring on the lower end of the EPDS. It
    should be noted that members in group 2 who scored in the
    bottom range of the EPDS did not change significantly. The
    scope of the project was limited to implementing an
    evidence-based intervention based on already produced
    research evidence, so advanced interpretation of the changing
    score postintervention results was beyond the scope of this
    project. Still, a cautionary note must be mentioned relative to
    the interpretation of postintervention group scores.

    Implications for Nursing Practice

    For states that mandate screening for PPD, implementing
    nonpharmacologic interventions such as short-term group
    psychotherapy across settings is a logical progression of
    expansion of services for women at risk for PPD. Barriers to
    treatment for women at risk for PPD vary and can include
    limited numbers of mental health providers skilled in treating
    PPD issue and long wait times to access treatment. Develop-
    ing programs that include such interventions within health-
    care agencies where pregnant or postpartum mothers seek
    healthcare services could improve access to mental health care
    for these women and have a positive impact on both the
    physical and mental health of mothers and their infants.

    Nonpharmacologic interventions, such as short-term
    group psychotherapy, meet the needs of women who decide
    against the use of medication. Mental health providers should
    be exploring alternative interventions that augment choice
    for patients relative to pharmacologic and nonpharmacologic
    interventions. The efficacy of group psychotherapy in reduc-
    ing risk for the development of depressive symptoms may
    reduce or eliminate the need for subsequent medication use,

    Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression

    207Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    which has significant implications for healthcare spending for
    both the system as a whole and for individual consumers.
    Group psychotherapy has also been shown to be cost-effective
    when compared with the costs of individual psychotherapy
    (McCrone et al., 2005).

    While the cost of this intervention group was free of charge,
    the cost of group psychotherapy has historically been more
    cost-effective for consumers when compared with the cost for
    individual psychotherapy. Group psychotherapy also allows
    mental health providers the ability to treat several patients at
    the same time, which can allow the provider to see larger
    numbers of patients. Many healthcare insurance plans do
    provide coverage for group psychotherapy, and the short
    nature of this group psychotherapy intervention provides a
    discreet number of sessions over a discreet time frame, which
    might also be an incentive for insurance companies to
    encourage members to participate. With this type of time-
    limited intervention, insurance providers would know up
    front that their insured members would be in treatment for 8
    weeks. This type of intervention could be seen as a cost-
    effective service that provides evidence-based outcomes for
    this specific patient population, namely women at risk for
    PDD, which could potentially reduce the need for other
    mental health services.

    It is suggested that having a part-time psychiatric advanced
    practice position as a member of the women’s health service
    line could also prove to be cost-effective, as the services pro-
    vided by the psychiatric APN are potentially reimbursable.
    Additionally, having a psychiatric APN within a women’s
    health service line would provide access for patients and allow
    other healthcare providers, including nurses, easier access to a
    psychiatric practitioner for consultations.

    Within this project, the psychiatric APN’s salary came out
    of the psychiatric services cost center. The cost to the institu-
    tion offering the two groups for this project was incorporated
    into the costs of the psychiatric APN salary. Group psycho-
    therapy services offered for this project were a new service not
    previously provided by the psychiatric APN. This project
    articulated a potentially new revenue source as well.

    The outcomes of the intervention also articulated the need
    for psychiatric APNs to utilize the full spectrum of their edu-
    cation and clinical training to meet the needs of women at
    risk for PPD. Psychiatric APNs are uniquely trained to iden-
    tify and treat both those at risk for PPD and those who may
    have PPD. Psychiatric APNs can utilize both nonpharmaco-
    logic interventions, such as short-term group psychotherapy,
    and pharmacologic interventions management services to
    treat patients.

    In today’s mental health services market, significant focus
    is paid on the importance of medication management skills of
    the psychiatric APN, yet the intervention in this project sup-
    ports the need for continued education and training of
    advanced practice psychiatric nursing as psychotherapists

    with group psychotherapy skills. It is vital that advanced prac-
    tice psychiatric nurses be able to provide a wide variety of
    interventions, including psychopharmacologic and nonphar-
    macological therapies and group psychotherapy.

    When advanced practice psychiatric nurses are able to
    provide both pharmacological and nonpharmacological
    interventions, there is a potential expansion of psychiatric
    services, which could improve both the utilization and the
    access to mental health services by consumers. This expansion
    also creates potentially greater choice among the types of psy-
    chiatric services from which consumers can select. Advanced
    practice psychiatric nurses with training and skill in both
    pharmacologic and nonpharmacologic psychiatric interven-
    tions also become uniquely positioned within the mental
    health system as providers who offer a wide variety of
    services.

    Conclusion

    Short-term group psychotherapy as a nonpharmacological
    psychiatric nursing intervention for first-time mothers who
    were identified as being at risk for PPD is effective to reduce
    symptoms associated with depression. Identifying women at
    risk for developing PPD shortly before discharge from the
    hospital provided a means for engaging those women who
    might benefit from a short-term group psychotherapy inter-
    vention. Implementing short-term psychotherapy group
    interventions to two groups of eight first-time mothers dem-
    onstrated lower scores on the EPDS, reflecting a decrease in
    symptoms presentation and risk for PPD. Lowering the risk
    for PPD has been associated with a wide variety of improved
    healthcare outcomes for both new mothers and for their
    infants. Group psychotherapy should be taught to advance
    practice psychiatric nursing students and practiced by
    advance practice psychiatric nurses, in order to improve
    access to mental health services, improve outcomes, and to
    potentially impact healthcare spending.

    Acknowledgment

    The first author was a participant in the 2012 NLN Scholarly
    Writing Retreat sponsored by the NLN Foundation for
    Nursing Education.

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    209Perspectives in Psychiatric Care 49 (2013) 202–209
    © 2012 Wiley Periodicals, Inc.

    Copyright of Perspectives in Psychiatric Care is the property of Wiley-Blackwell and its
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      ppc_350 202..209

    Week 6: Foundations of Group Work and Types of Groups

    And as participants improve, the group as a whole benefits. Members can be agents of change for each other. Seeing others’ progress can help group members realize they, too, can cope and feel better.

    —Dr. Nina W. Brown, “Power in Numbers”

    Group therapy can be very beneficial for clients. In fact, research has shown that for many clients, group therapy is as effective as individual therapy. Members of groups are not only able to influence change within each other, but they are often able to more easily relate to the guidance of peers than that of a therapist. With the increasing popularity of this therapeutic approach, it is essential for you to have a strong foundation in psychotherapeutic techniques for groups.

    This week, as you explore group therapy, you consider how you might apply current literature to your own clinical practice. You also examine your own practicum experiences involving group therapy sessions.

    Photo Credit: [Tom Merton]/[Caiaimage]/Getty Images

    Learning Resources


    Note:

     To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

    Required Readings

    Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

    · Chapter 11, “Group Therapy” (Review pp. 407–428.)

    Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

    · Chapter 1, “The Therapeutic Factors” (pp. 1–18)

    Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

    · Chapter 2, “Interpersonal Learning” (pp. 19–52)

    Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

    · Chapter 3, “Group Cohesiveness” (pp. 53–76)

    Leszcz, M., & Kobos, J. C. (2008). Evidence-based group psychotherapy: Using AGPA’s practice guidelines to enhance clinical effectiveness. Journal of Clinical Psychology, 64(11), 1238–1260. doi:10.1002/jclp.20531

    Note: Retrieved from Walden Library databases

    .

    Marmarosh, C. L. (2014). Empirical research on attachment in group psychotherapy: Moving the field forward. Psychotherapy, 51(1), 88–92. doi:10.1037/a0032523

    Note: Retrieved from Walden Library databases.

    Microsoft. (2017). Basic tasks for creating a PowerPoint presentation. Retrieved from https://support.office.com/en-us/article/Basic-tasks-for-creating-a-PowerPoint-2013-presentation-efbbc1cd-c5f1-4264-b48e-c8a7b0334e36

    Tasca, G. A. (2014). Attachment and group psychotherapy: Introduction to a special section. Psychotherapy, 51(1), 53–56. doi:10.1037/a0033015

    Note: Retrieved from Walden Library databases.

    Tasca, G. A., Francis, K., & Balfour, L. (2014). Group psychotherapy levels of interventions: A clinical process commentary. Psychotherapy, 51(1), 25–29. doi:10.1037/a0032520

    Note: Retrieved from Walden Library databases.

    You will select one of the following articles on group therapy to evaluate for this week’s Assignment.

    Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015). The effect of cognitive-behavioral group marital therapy on marital happiness and problem solving self-appraisal. American Journal of Family Therapy, 43(2), 103–118. doi:10.1080/01926187.2014.956614

    Note: Retrieved from Walden Library databases.

    Himelhoch, S., Medoff, D., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care & Stds, 21(10), 732–739. doi:10.1089/apc.2007.0012

    Note: Retrieved from Walden Library databases.

    Pessagno, R. A., & Hunker, D. (2013). Using short-term group psychotherapy as an evidence-based intervention for first-time mothers at risk for postpartum depression. Perspectives in Psychiatric Care, 49(3), 202–209. doi:10.1111/j.1744-6163.2012.00350.x

    Note: Retrieved from Walden Library databases.

    Sayın, A., Candansayar, S., & Welkin, L. (2013). Group psychotherapy in women with a history of sexual abuse: What did they find helpful? Journal of Clinical Nursing, 22(23/24), 3249–3258. doi:10.1111/jocn.12168

    Note: Retrieved from Walden Library databases.

    Yildiran, H., & Holt, R. R. (2015). Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities. British Journal of Learning Disabilities, 43(1), 49–54. doi:10.1111/bld.12085

    Note: Retrieved from Walden Library databases

    Assignment: Applying Current Literature to Clinical Practice

    Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling. This makes it essential for you to be able to translate current literature from other disciplines into your own clinical practice. For this Assignment, you practice this skill by examining literature on group work and group therapy and considering its applicability to your own clients.

    Learning Objectives

    Students will:

    · Evaluate the application of current literature to clinical practice

    To prepare:

    · Review this week’s Learning Resources and reflect on the insights they provide on group work and group therapy.

    · Select one of the articles from the Learning Resources to evaluate for this Assignment.


    Note:

     In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

    The Assignment

    In a 5- to 10-slide PowerPoint presentation, address the following:

    · Provide an overview of the article you selected, including answers to the following questions:

    · What type of group was discussed?

    · Who were the participants in the group? Why were they selected?

    · What was the setting of the group?

    · How often did the group meet?

    · What was the duration of the group therapy?

    · What curative factors might be important for this group and why?

    · What “exclusion criteria” did the authors mention?

    · Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?

    · Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

    See Article selected highlighted in yellow.

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