Ejecución de proyectos de inversión y giro de recursos de los mismos

A review of the literature has shown that many studies have been done comparing individual therapy versus group therapy for subjects such as therapeutic factors, process variables, depression, social phobia and OCD, eating disorder, obesity, childhood aggression or other problems, sexually abused women, borderline personality disorder. There is a gap in the literature comparing treatment of panic disorder in an individual therapy modality versus group therapy modality. Only a few studies have examined whether individual and group treatments are equally effective in the treatment of panic disorder (Sharp, Power & Swanson, 2004; Neron, Sylvain, Lacroix, Denis, Chaput & Yves, 1995).

The question whether individual and group treatments are equally effective is important for several reasons, the foremost perhaps being economical. If group therapies are as effective as individual therapies, this could decrease the costs of treatment substantially, since group therapy is considerably less expensive than individual therapy (Vos et al., 2005).

From a clinical and scientific perspective, if these treatments are equally effective, this suggests that the presence of other patients during the treatment does not hinder the treatment of the individual patient. On the other hand, it may also be possible that the treatments result in comparable effects but through different mechanisms (Yalom & Leszcz 2005). For example, in individual treatment the relationship between client and therapist may be stronger, while in group therapy other mechanisms, such as cohesion and social support play the greater role (Yalom & Leszcz 2005). If individual and group treatments are not equally effective, this would suggest that one is not as good as the other in teaching the patient techniques that help reduce panic disorder. Or it could be possible that group processes interfere with the therapeutic process (Yalom & Leszcz 2005). But before these questions can be answered, it first has to be known whether group and individual treatments are indeed equally effective.

There has been a gradual accumulation of research comparing group to individual treatments over the past five decades, and what has been shown is that there are no significant differences between the two treatments format (McRoberts et al, 1998). Research has also shown there are different therapeutic processes in the two modalities (Holmes & Kivlighan, 2000). At the same time however, little is

understood about the similarities or difference between the processes in these two treatment modalities (McRoberts et al., 1998), and few studies have examined them (Holmes & Kivlighan, 2000).

Outcomes of empirical studies comparing the effectiveness of individual and group therapy interventions demonstrate that both treatment modalities according to various theoretical orientations are substantially more effective than no treatment or minimal treatments for a variety of psychological disorders and problems (Bednar & Kaul, 1994; Fuhriman & Burlingame, 1994).

Burlingame, MacKenzie, & Strauss (2004), examined 107 studies and 14 meta- analyses published between 1990 and 2002 across six disorders: mood disorder, anxiety, eating disorder, substance abuse, personality disorder and psychosis. They reported that there was adequate evidence to conclude that group therapy is as effective as individual therapy either as the primary treatment or as a part of a

treatment program.

Toseland & Siporin (1986), conducted a meta-analysis of 74 empirical studies which participants were randomly allocated to receive individual or group treatment (for various diagnosis). The same modality and technique were used with all subjects in both the group and individual formats. The results obtained in 75% of the studies two treatment format were equally effective and in 25% of studies group therapy was more effective than individual therapy.

In a meta-analysis of 700 group therapy studies, Fuhriman and Burlingame (1994), concluded that group psychotherapy is as effective as individual therapy in treating a range of psychological problems and across treatment models.

McRoberts et al (1998) conducted a meta-analysis of 23 empirical studies which individual and group therapies were compared directly. Results of this review demonstrated that no treatment outcome differences were found for group versus individual therapy formats; a finding that supports earlier reviews (Berman, & Niemeyer, 1990; Tillitski, 1990).

Other meta-analytic studies demonstrate group therapy's effectiveness with a variety of populations in different treatment settings (e.g., Burlingame, et al., 2003; Kösters, Burlingame, Nachtigall, & Strauss, 2006; McDermut, et al., 2001; Payne & Marcus, 2008). These studies implie that mode of therapy does not appear to affect outcome, with individual and group therapy demonstrating comparable effectiveness

(McRoberts et al., 1998). This finding holds true across a number of variables, including "the chronicity of the disorder, gender, or age of the client" (McRoberts et al, 1998, p. 108). Additionally, no significant differences in effectiveness have been observed between theoretical orientations or treatment settings when comparing individual and group therapy (McRoberts et al., 1998). Individuals who participate in group therapy are better off than those on wait lists, with 72-85% of participants demonstrating treatment gains (Burlingame et al., 2003; McDermut et al., 2001). A conclusion based on Morrison’s review (2001), and Petrocelli’s meta-analysis

(2002), showed that for the most part there was little difference in results between CBGT and individual CBT treatment studies.

The research shows, although group therapy may be a viable and cost-effective alternative to traditional individual therapy services, nevertheless, what has been shown is that most patients have a strong preference for individual over group treatment (Cuijpers, van Straten & Warmerdam, 2008). Additionally most of the treatment experiences of mental health professionals, about 80%, tend to be in

individual therapy, with other modalities being significantly underutilized (Norcross et al., 1988). For example, the numbers of psychotherapists using group therapy as a form of personal therapy are significantly lower than those engaging in individual therapy (Guy et al., 1988). Group therapy is only undertaken by about 4% to 30% of professionals (Norcross et al., 1988).

However, these authors also assert that in some situations individual therapy might represent the more effective treatment setting. For instance, a client may feel more comfortable discussing emotional topics with an individual therapist. This may be especially true when the client is shy, or dislikes talking in front of many people. The individual format may also facilitate discussions related to more intimate issues that may be serving as impediments to treatment progress (Cuijpers, van Straten & Warmerdam, 2008).

Lazarus (1971) proposed that individual treatment may lead clients to experience a greater feeling of involvement, higher motivation, and better adherence. Findings by Subich and Coursal (1985), support these assertions. These authors found that

compared to subjects assigned to group therapy, clients in individual treatment expected to be both more open and responsible in therapy. But on the other side, group therapy may also offer additional benefits that may not be found in individual therapy because of the unique interactional experiences that take place between those participating in the group. As compared with individual therapy, in group therapy participants can learn effective social skills and try out new styles of relating with other members of the group (Corey, 2008). In addition, the phenomen of social support, social pressure and vicarious learning remain unique to a group

sources (e.g., Yalom & Leszcz, 2005; Yalom, Cox & Vinogradov 2008), most notably group cohesion and universality, which collectively describe the connectedness group members experience with each other. These are perhaps the most important benefits of group therapy, being described by numerous authors. While some

beneficial aspects of the group approach also apply to the individual paradigm (e.g., modeling), the phenomen of social support, social pressure and vicarious learning remain unique to a group intervention. The added benefits of these variables seem to lend support to the contention that group treatment is an effective approach (Yalom & Leszcz, 2005).

1.4.4 Previous Research on Individual Therapy versus Group Therapy