Studies%20on%20treatment%20effects%20of%20psychodrama%20psychotherapy

1
Studies on treatment effects of psychodrama
psychotherapy
2
Speaker

• Michael Wieser, assistant prof. Dr.
• University of Klagenfurt.
• Bologna process coordinator
• Department of psychology.
• Austria/Europe.

3
Contents

• Terms
• Starting point
• Aim
• Sample characteristics
• Method of description
• Results
• Summary
• Conclusion

4
Terms

• Psychodrama as psychotherapy is based on theories
  of spontaneity, creativity and action.
• ICD-10 International Classification of Diseases,
  Version 10 of the WHO, chapter F00-99 for mental
  and behavioural disorders.
• Meta-analysis existing studies in treatment
  effectiveness are systematically compared.

5
Starting point

• Accredited by the government and social insurance
  systems in Austria (Ottomeyer Wieser, 1996), in
  Hungary (Pintér, 2001), and by the European
  Association of Psychotherapy (EAP Wieser,
  Fontaine, Tauvon Teszary, 2004).
• In Germany there is documentation, (Burmeister,
  Leutz, Diebels, n.d.) but there are problems in
  matching the mainstream standards in
  evidence-based psychotherapy.

6
Starting point

• The same with the meta-analysis developed by
  Grawe, Donati Bernauer (1994) in Switzerland
  preliminary acceptance by Swiss Charta of
  Psychotherapy
• Meta-analyses conducted outside German-speaking
  countries (Kipper, 1978 Schramski, Harvey,
  1983 Kellermann, 1987 Greenberg, Elliot,
  Lietaer, 1994 Kipper Ritchie, 2003 Elliott,
  Greenberg Lietaer, 2004) point to problems with
  research design.

7
Aim

• The aim of this presentation is to explore the
  kind of statistical evidence which researchers
  have for the effectiveness of psychodrama
  psychotherapy.

8
Sample characteristics

• Existing studies on the effectiveness of
  psychodrama psychotherapy provided in the
  literature
• Database PsycINFO, PsyNDEX
• English and German
• several decades

9
Sample characteristics

• Age children, youths, adults, elderly patients
• Type of mental and behavioural disorders acute
  to chronic
• Treatment program in- and outpatients, prisoners
• Setting individual, couple, family, group
• Length of treatment one session, weekend,
  marathon, long-term

10
Sample characteristics

• Comparative studies psychodrama psychotherapy
  with other psychotherapeutic methods or
  pharmaceutical therapy
• Outcome studies
• Process research
• Cost efficiency analyses are unknown

11
Sample characteristics

• Measuring instruments none (at least systematic
  self report, sociometry) to high standard tools
• Drop out rate all, should be noticed and
  reflected
• Most of the patients must have a diagnosis
  (ICD-10)
• Mostly psychodrama psychotherapy, not self
  experience
• Manualized psychotherapy mostly not
• Publication all kind
• Sixty one studies included Thirteen are
  randomised clinical trials, sixteen are
  controlled studies, thirty-two are naturalistic
  studies.

12
Method of description

• Classification of the studies
• Randomised clinical trial two groups of patients
  are chosen at random. One group is given
  psychotherapeutic treatment, the other, for
  example, has to wait.
• Controlled study psychotherapy group is compared
  with a non-treated group.
• Naturalistic study normal psychotherapeutic
  practice, single case study, systematic, and
  controlled by qualitative and/or quantitative
  methods

13
Method of description

• Mostly includes pre- and post measures, partly
  follow-up
• Effect size not all necessary information is
  available
• Statistical significant results
• plt0.05
• plt0.01
• plt0.001 (permille)
• plt0.0001
• probability of error in percent

14
Results F00-F09

• Organic, including symptomatic, mental disorders
  (ICD-10 F00-F09)
• To date, no studies have been reviewed.

15
Results F10-F19

• Mental and behavioural disorders due to
  psychoactive substance abuse (ICD-10 F10-F19)
• Five studies report positive results for adults
  and two of them also for youths.

16
Results F10-F19
Table 1. ICD-10 F10-F19 mental and behavioural disorders due to psychoactive substance abuse Table 1. ICD-10 F10-F19 mental and behavioural disorders due to psychoactive substance abuse Table 1. ICD-10 F10-F19 mental and behavioural disorders due to psychoactive substance abuse Table 1. ICD-10 F10-F19 mental and behavioural disorders due to psychoactive substance abuse
Study Research method Measure Findings
Mann Janis (1968) Randomized clinical trial, follow-up (2 weeks, 18 months) N35 women young adults Questionnaire, interview Less cigarette consumption after emotional role-playing

17
Results F10-F19
Zeng, H., Wang, P., Kong, Y., Jing, J., Li, L. Liu, H. (2002) Controlled trial, pre-post N224 Self-esteem Investigations Scale Significant Improvement
18
Results F10-F19
Wood, Del Nuovo, Bucky, Schein Michalik (1979) Comparative with small group psychotherapy matched with a similar group who did not do psychodrama. N101 age 28 98 men Comrey Personality Scales Mini Mult short form of MMPI (Minnesota Multiphasic Personality Inventory) State-Trait Anxiety Inventory (A-State Scale) More trust, emotional stability, and activity more defensive and controlled N.s.

19
Results F10-F19
Crawford (1989) Naturalistic, post, follow-up (2 years) N47 Questionnaire Great satisfaction with psychodrama led to good alcohol/drug status
20
Results F10-F19
Waniczek, Harter Wieser (2005) Naturalistic retrospective follow-up (1-4 years) comparison Group N70 comparison 1663 EBIS-A-sheet (EinrichtungsBezogenes InformationsSystem) SEDOS-inquiry-sheet sheet (Stationäres Einrichtungsbezogenes DokumentationsSystem) Abstinence rate of 72.9, high general satisfaction of life
21
Results F20-F29

• Schizophrenia, schizotypal and delusional
  disorders (ICD-10 F20 - F29)
• Seven of eight studies have good results even
  with chronic schizophrenics and people with
  delusions who are in short term psychodrama
  psychotherapy.

22
Results F20-F29
Table 2. ICD-10 F20-F29 schizophrenia, schizotypal and delusional disorders Table 2. ICD-10 F20-F29 schizophrenia, schizotypal and delusional disorders Table 2. ICD-10 F20-F29 schizophrenia, schizotypal and delusional disorders Table 2. ICD-10 F20-F29 schizophrenia, schizotypal and delusional disorders
Study Research method Measure Findings
Sturm Stuart (1974) Randomised clinical trial psychodrama- based role re- training and remotivation group Self created control group (treatment early terminators) pre-post-test N32 Tape recordings, observers Inpatient Presentableness Scale, raters No changes in feelings, happiness, thoughts, and plans of the five most regressed patients on each unit.
23
Results F20-F29
Zhou Tang (2002) Randomised clinical trial, pre-post N24 Age 33 SES (Self-Esteem Scale) FIS (Feeling of Inferior Scale) Increased Decreased
24
Results F20-F29
Zhou Gao (2004) Randomised clinical trial, pre-post N30 Trait-Anxiety Inventory (T-AI) Self Acceptance questionnaire (SAQ) Social Avoidance Distress Scale (SAD) Reduced Increased Reduced
25
Results F20-F29
Peters Jones (1951) Controlled Trial N21 men Porteus Maze Test Ages Mirror- Tracing Test Rorschach Draw-a- Person Test Gardner Behavior Chart Difference in the post scores of qualitative errors Improvement No report No report No report
26
Results F20-F29
Jones Peters (1952) Controlled Trial N32 Age adults men Qualitative Maze scores Mirror Tracing Test Gardner Behavior Chart Rorschach Test Draw-a-Man Test Picture Sorting Test Ratio of between groups variance to within groups variance Improvement Improvement N.s. In favour of the control group Increase of affective reactions
27
Results F20-F29
Harrow (1952) Controlled trial, Pre-post N29 Age 20-35 men Role (action) test Rorschach Test MAPS (Make-a-Picture Story Test) Scale of realism Improvement Improvement
Parrish (1959) Naturalistic N32 Age 36.5 women Ward observed and rated the behaviour Counted the amount of patients ready to leave hospital Improvement Improvement
28
Results F20-F29
Lee, S. F. C., Chang, Y.-L. Liu, J.-C. (2007) Naturalistic N18 Age 41.6 6 women, 12 men, Video-Interview, session records, Colaizzi key words Gain self awareness, interpersonal skills, value systems
29
Results F30-F39

• Mood (affective) disorders (ICD-10 F30-F39)
• Three studies with good results have been
  reported in this field

30
Results F30-F39
Table 3. ICD-10 F30-F39 mood (affective) disorders Table 3. ICD-10 F30-F39 mood (affective) disorders Table 3. ICD-10 F30-F39 mood (affective) disorders Table 3. ICD-10 F30-F39 mood (affective) disorders
Study Research method Measure Findings
Pour Rezaeian, Sen Sen Mazumdar (1997) Randomised clinical trial N54 Age 21.5 men BDI (Beck Depression Inventory) MMPI Better than a psychiatric group Not different from a combination group No report
31
Results F30-F39
Pour Rezaeian, Sen Mazumdar Sen (1997) Controlled trial N54 Men SLSCT (Sentence Completion Test) Better than the psychiatric group equal with the combination group
Ernst, Wiertz Sabel (1980) Naturalistic N13 Age 18-42 7 women, 5 men Questionnaire Sociometric choices increased well being improved
32
Results F40-F48

• Neurotic, stress-related and somatoform disorders
  (ICD-10 F40 - F48)
• In a total of twelve studies, more positive than
  negative results are reported.

33
Results F40-F48
Table 4. ICD-10 F40-F48 neurotic, stress-related and somatoform disorders Table 4. ICD-10 F40-F48 neurotic, stress-related and somatoform disorders Table 4. ICD-10 F40-F48 neurotic, stress-related and somatoform disorders Table 4. ICD-10 F40-F48 neurotic, stress-related and somatoform disorders
Study Research method Measure Findings
Lapierre, Lavallée Tétreault (1973) Randomised clinical trial double-blind matched N24 Age 19-51 12 women, 12 men Wittenborn Rating Scale Eysenck Personality Inventory Ad-hoc scale Mesoridazine (drug) group as compared with the placebo group had less pronounced affective involvement in psychodrama psychotherapy

34
Results F40-F48
Kipper Giladi (1978) Randomised clinical trial N36 Age 27 27 women, 9 men STABS (Suinn Test Anxiety Behavior Scale) EPI-N scale (Neuroticism Scale of Eysenck Personality Inventory) Background information form Improvement equally effective as systematic desensitization N.s. (normal range from the beginning)

35
Results F40-F48
Deng, Guo, Wang, He, Li Jiang (2004) Randomised clinical trial, pre-post N60 Age young adults 25 women, 35 men SCL-90 Self-Assessing Scale Improvement Self-worth
36
Results F40-F48
Bendorf, Doubrawa Klaffki (1976) Controlled trial follow-up (3-6 months) N49 Age 15-24 women FPI (Freiburg Personality Inventory) Well Being Scale (Zerssen) Interview, rating scale Nervousness, depression, sociability, self- consciousness extraversion, emotional unstableness and masculinity A normal population (post)
37
Results F40-F48
Arn, Theorell, Uvnäs-Moberg Jonsson (1989) Controlled trial, pre-post. follow-up (3 months, 3 years) N50, age 47 33 women, 17 men Symptom questionnaire Decrease of worry and tension
Schneider-Düker (1989) naturalistic, Comparative N23 Age 22-44 13 women, 10 men SYMLOG (System for the Multiple Level Observation of Groups) More difficult for psychotherapy groups to enrich the role repertoires
38
Results F40-F48
Eibach (1980) Naturalistic qualitative case Study N1, age 45, Men Questionnaire After 2 years no further somatization in the whole group
Newburger (1987) Naturalistic follow-up (7 months) N10, young adults Therapist rating All ten patients symptom free (post) 8 of 10 symptom free (follow-up)
39
Results F40-F48
Theorell, Konarski, Westerlund, Burell, Engström, Lagercrantz, Teszary Thulin (1998) Naturalistic pre-post follow-up (half year, 4 years) N24 Age 22-58 22 women, 2 men Self rating General Health Questionnaire Blood test in prolactine levels In art therapy anxiety-depression improved Improved Psychodrama better than other kind of art therapy
40
Results F40-F48
Hudgins, Drucker Metcalf (2000) Naturalistic single case study follow-up (6 weeks) N1 woman Videotape, evaluator DES (Dissociative Experience Scale) TSI (Trauma Symptom Inventory) BDI BSQ (Body Sensation Questionnaire) Narrative writing Improvement Improvement Improvement Improvement No report
41
Results F40-F48
Lind, Renner Ottomeyer (2006) Naturalistic psychodrama psychodynamic imaginative trauma therapy pre-post, follow-up N12 Age 18-29 women BSI Emotional and Behavioural Changes in Psychotherapy Questionnaire (VEV) Qualitative inquiry Decrease in symptom GSI pre-post g2.2, pre-follow-up g2.28 (very strong effect) Improvement Improvement
42
Results F40-F48
Renner, Lind Ottomeyer (2008) Naturalistic psychodrama psychodynamic imaginative trauma therapy, psycho-social intervention pre-post N32 Age 34.4 women BSI Emotional and Behavioural Changes in Psychotherapy Questionnaire (VEV-R-2001) Decrease in symptom GSI pre-post d1.65, (very strong effect) Reliable Change Index Recovery 38 Positive response 66 Improvement
43
Results F50-F59

• Behavioural syndromes associated with
  physiological disturbances and physical factors
  (ICD-10 F50 - F59)
• To date, no studies have been reviewed.

44
Results F60-F69

• Disorders of adult personality and behaviour
  (ICD-10 F60-F69)
• To date, no studies have been reviewed.

45
Results F70-F79

• Mental retardation (ICD-10 F70-F79)
• Three studies report positive results but are
  more a kind of social pedagogical psychodrama.

46
Results F70-F79
Table 5. ICD-10 F70-F79 Mental retardation Table 5. ICD-10 F70-F79 Mental retardation Table 5. ICD-10 F70-F79 Mental retardation Table 5. ICD-10 F70-F79 Mental retardation
Study Research method Measure Findings
Strain (1975) Naturalistic N8 Age 4 4 girls, 4 boys Observer, raters Sociodrama led to more engagement in social play afterwards
Amesberger, Fritsch, Gisinger, Siebert, Sotzko Weber (1993) Naturalistic Age youths Observer Improvements in personality development and conflict solution
47
Results F70-F79
Amesberger (1995) Naturalistic N33 Age youths Observer, Interview, rating Improvements in personality development and conflict solution
48
Results F80-F89

• Disorders of psychological development (ICD-10
  F80-F89)
• To date, no studies have been reviewed.

49
Results F90-F98

• Behavioural emotional disorders with onset
  usually occurring in childhood or adolescence
  (ICD-10 F90-F98)
• Two studies report positive results with
  techniques related to psychodrama psychotherapy.

50
Results F90-F98
Table 6. ICD-10 F90-F98 Behavioural emotional disorders with onset usually occurring in childhood or adolescence Table 6. ICD-10 F90-F98 Behavioural emotional disorders with onset usually occurring in childhood or adolescence Table 6. ICD-10 F90-F98 Behavioural emotional disorders with onset usually occurring in childhood or adolescence Table 6. ICD-10 F90-F98 Behavioural emotional disorders with onset usually occurring in childhood or adolescence
Study Research method Measure Findings
Gelcer (1978) Randomised clinical trial N30 Age 8-15 9 girls, 21 boys RTT (Role Taking Task) BSAG-School (Bristol Social Adjustments Guide) Improvement with role-play Improvement
Dequine Pearson-Davis (1983) Controlled trial N14 Age 12-17 Norwicki- Strickland Personal Reaction Survey interview With drama therapy, more internal control
51
Results mixed groups

• Mixed groups of disorders
• Eleven studies report more positive results, two
  also in individual modality. Steffan (2000)
  compares psychodrama psychotherapy with
  integrative psychotherapy, Anbeh and Tschuschke
  (2001) with group analysis and Tschuschke and
  Anbeh (2000) with eclectic psychotherapy.

52
Results mixed groups
Table 7. Mixed groups of disorders Table 7. Mixed groups of disorders Table 7. Mixed groups of disorders Table 7. Mixed groups of disorders
Study Research method Measure Findings
Bender et al. (1979) Randomised clinical trial follow-up (9, 10, 22 weeks) N22 Age 17-54 11 women, 11 men AMDP (Working Group for Methods and Documentation in Psychiatry) MMPI SAF (Social Adjustment Questionnaire) EWL (Adjective List) Giessen Questionnaire Decrease pre-post Paranoia and schizoid In the whole and in the scale leisure Emotional irritation Social power (for neurosis)
53
Results mixed groups
Carpenter Sandberg (1985) Controlled Trial N17 Age 14-16 Jessness Asocial Index High School Personality Questionnaire I-E- (Introversion- Extraversion) Scale Reduction between and within subjects Ego strength between subjects and pre to post-test Became more introverted
54
Results mixed groups
Bender et al. (1981) Naturalistic comparative pre-post process, follow-up (three months) N10 Age 34.8 6 women, 4 men MMPI EWL Bf-S (Well-Being Scale) SAF (Social Adjustment Questionnaire) Giessen Questionnaire FPI N.s. Well-being (neurotics) worsening (psychotics) N.s. N.s. Amenability N.s.
55
Results mixed groups
Bender et al. (1981) Naturalistic, comparative, pre-post, process, follow-up (three months) N10 Age 34.8 6 women, 4 men AMDP 3 Goal Attainment Scoring (100mm line) Therapy Assessment Scale Video-recording and questionnaire Psychopathology N.s. N.s. Protagonist improvement
56
Results mixed groups
Herfurth (1999) Naturalistic follow-up (one to three years) N6 Age 44.5 3 women, 3 men Problem-centred interview Questionnaire Context journal Role play Improvement Transfer problems Goals of the clinic attained No report
57
Results mixed groups
Lemke (1999) Naturalistic follow-up N5 Age 42.4 women Problem-centred interview Improvement in therapy success (coping strategies, competency in perception, broadening the room for action)
58
Results mixed groups
Petzold et al. (n.d.) Naturalistic pre-post, process follow-up (six months) N29 Age 35 80 women GSI-SCL-90R IIP-C (Inventory of Interpersonal Problems) Therapist questionnaire Therapy assessment scale Client questionnaire Relations questionnaire Session questionnaire ES0.63 ES0.11 Improvement Improvement Improvement Improvement No report
59
Results mixed groups
Steffan (2000) Naturalistic comparative, pre-post process follow-up (six months) N16 Age 32.9 12.5 women, 87.5 men Therapist questionnaire Client questionnaire GSI-SCL-90R IIP-C Therapy assessment scale Relations questionnaire Session questionnaire Improvement Improvement ES0.39 ES0.52 Improvement Improvement No report
60
Results mixed groups
Tschuschke and Anbeh (2000) Naturalistic comparative, pre-post N297 Age 47.9 185 women, 112 men IIP GSI-SCL-90R Therapy Goal Attainment Scale GAF (Global Assessment of Functioning Scale) N.s., ES0.22 Improvements, ES0.2 Improvements, ES0.9 Improvements, ES0.44
61
Results mixed groups
Anbeh and Tschuschke (2001) Naturalistic comparative, pre-post N592, Age 37.9 382 women, 210 men IIP GSI-SCL-90R Therapy Goal Attainment Scale GAF ES0.57 (plt0.0001) ES0.66 ES2.32 ES1.28
62
Results mixed groups
Tschuschke and Anbeh (2004) Naturalistic pre-post N212 168 women, 44 men IIP GSI-SCL-90R Therapy Goal Attainment Scale GAF ES0.47 ES0.55 ES1.55 ES1.18 Mean ES0.94
63
Results area of disorder unknown

• Area of disorder unknown
• Seventeen studies were included with more
  positive results. Three investigated the
  psychodramatic double technique. Petzold (1979)
  is concerned with elderly people, and two other
  studies deal with youths.

64
Results area of disorder unknown
Table 8. Area of disorder unknown Table 8. Area of disorder unknown Table 8. Area of disorder unknown Table 8. Area of disorder unknown
Study Research method Measure Findings
Kipper Ben Ely (1979) Randomised clinical trial N64 Youths 32 women, 32 men Modified Accurate Empathic Scale After a role- playing procedure, differences
65
Results area of disorder unknown
Hudgins Kiesler (1987) Randomised clinical Trial N16 Age 19-25 women IMI (Impact Message Inventory) RI (Relationship Inventory) Videofeedback (Likert scale) REV(Revealing-ness Scale) Effects, postive impacts higher empathic understanding interviewer statements got more accurate Higher scores
66
Results area of disorder unknown
Joyce, Dyck, Prazoff, Shen Azim (n.d.) Controlled trial pre-post, process, follow-up (6 months) N65 Age 30.6 SCL-90, SAS-SR, I-E, PO, VO, TGSS, own questionnaire, SEQ, GAS, CFQ Paranoid ideation, anxiety, GSI, SAS, TGSS, Coping, feeling, arousal, GAS
67
Results area of disorder unknown
Culbertson (1957) Controlled Trial, comparison Pre-post, process N95 Young adults Own attitude measure, Observer (16pt scale) Role players, observers
68
Results area of disorder unknown
Schönke (1975) Controlled Trial Pre-post N12 Young adults 6 women, 6 men FPI, ENNR, MAS, FSE, SED, own instrument Aggression (neg.), calmless (neg.), dominance, rigidity, sociability, openness, extraversion
69
Results area of disorder unknown
Petzold (1979) Controlled Trial retrospect N40 Age 72.8 21 women, 19 men Social atom Consistency no significance counted
70
Results area of disorder unknown
Schramski, Feldman, Harvey Holiman (1984) Controlled Trial Comparison Pre-post N66 Age 23 men Correctional Institutions Environmental Scale (CIES), SCL-90R, Group Environment Scale (GES)
71
Results area of disorder unknown
Toeman (1948) OConnell Hanson (1970) Ploeger, Seelbach Steinmeyer (1972) Enke (1984) Schmidt (1980) Ernst (1989) Geßmann (1994, 1995) Baim, Allam, Eames, Dunford Hunt (1997, 1999) Naturalistic
72
Summary
Table 9 overview studies on treatment effects of psychodrama psychotherapy Table 9 overview studies on treatment effects of psychodrama psychotherapy Table 9 overview studies on treatment effects of psychodrama psychotherapy Table 9 overview studies on treatment effects of psychodrama psychotherapy
ICD-10 Method Method Method
RCT CT Naturalistic
F00-09
F10-19 1 2 2
F20-29 3 3 2
F30-39 1 1 1
F40-48 3 3 6
73
Summary
ICD-10 Method Method Method
RCT CT Naturalistic
F50-59
F60-69
F70-79 3
F80-89
F90-98 1 1
Mixed 1 1 8
74
Summary
ICD-10 Findings Findings Findings
Negative Equal Positive
F00-09
F10-19 1 9
F20-29 12 10
F30-39 3 3
F40-48 4 25
75
Summary
ICD-10 Findings Findings Findings
Negative Equal Positive
F50-59
F60-69
F70-79
F80-89
F90-98 3
Mixed 1 8 22
76
Conclusion

• Fill the gaps
• A strong need for a consensus on the kind of
  measurement instruments
• Improve the research quality

77
References

• Wieser M. (2004). Wirksamkeitsnachweise für die
  Psychodrama-Therapie Proof in effectiveness of
  psychodrama therapy. In J. Fürst, K. Ottomeyer,
  H. Pruckner (Eds.), Psychodrama-Therapie. Ein
  Handbuch Psychodrama therapy. A handbook (pp.
  427-446). Vienna Facultas.
• Wieser, M. (2007). Studies on treatment effects
  of psychodrama psychotherapy. In C. Baim, J.
  Burmeister, M. Maciel (Eds.), Psychodrama.
  Advances in Theory and Practice (pp. 271-292).
  London Brunner/Routledge.

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• Thank you for your attention and I am looking
  forward to your questions.
• Obrigado!
• Homepage
• http//www.uni-klu.ac.at/mwieser