Advances in Group Work Research

Aaron Brower, Sheldon D Rose

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138873179
• eBook ISBN: 9781317736516
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this comprehensive overview of the state of the art in the field, group workers and social scientists explore group research issues. Learn how they grapple with the major problems associated with doing research on treatment groups. While discussing the outcomes of their group treatment programs, the authors address such issues as non-random assignment, impact of group process on outcome, retrospective research design, the unit of analysis, multivariate analysis, single-case designs, and small samples. Each insightful chapter illustrates the decisions and compromises that researchers must make to explore group phenomenon and treatment. Advances in Group Work Research is an ideal supplementary text or casebook for practice-research courses. It will also be useful for those interested in empirical group work, group research, and practice research generally.This book presents a sample of papers from the last three years'Annual Symposium on Empirical Foundations of Group Work.

Teaching Clients to Cope with Stress: The Effectiveness of Structured Group Stress Management Training

Richard M. Tolman
Sheldon D. Rose

SUMMARY. This study evaluated a structured group coping skills intervention designed to reduce stress. The treatment focused specifically on modifying cognitive mediation of events and on improving coping with ongoing routine stressors, and contained relaxation, cognitive restructuring, and social skill training components. The experimental treatment was compared to a relaxation-only treatment and to a waiting list control condition. Treated subjects significantly improved on three of four dependent measures of stress. Although no statistically significant differences were found between the conditions, the study provided support for further examination of the intervention.

Richard M. Tolman, PhD, is Assistant Professor, Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL 60680, and Sheldon D. Rose, PhD, is Professor, School of Social Work, University of Wisconsin, Madison, WI 53706.

The research on which this article is based was supported in part by a grant from the University of Wisconsin-Madison Alumni Research Foundation. Preparation of this article was supported in part by a National Institute of Mental Health Grant 1T32-MH17152-01 awarded to Richard M. Tolman. Address correspondence to Richard M. Tolman.

The link between psychosocial stress and many emotional disorders and somatic illnesses has been well documented (see Dohrenwend and Dohrenwend, 1974, Kiritz and Moos, 1974; Lipowski, 1977). Social workers aware of the link between stress and various problems may attempt to prevent or treat stress-related disorders by improving an individual’s ability to deal with those stressors. Recent years have seen a rapid increase in interest in stress management techniques. Purveyors of stress reduction programs bombard the public with approaches as diverse as exercise classes, special diets, yoga and meditation, drugs and vitamins, hypnosis, and progressive relaxation. Research evaluating the effectiveness of these various approaches can help practitioners make critical judgments about the usefulness of various stress management techniques for their clients.

This study evaluated the efficacy of a structured group cognitive-behavioral approach to stress management. The development of the approach and its theoretical underpinnings have been described in detail elsewhere (Tolman and Rose, 1985) and will be briefly described here. The multiple-method stress management treatment program (MM) was developed at the Interpersonal Skills Training and Research Project at the University of Wisconsin, School of Social Work. In order to develop a treatment approach that social workers could apply to the broad range of concerns presented by their clients, existing stress management approaches were reviewed. This review and a series of clinical pilot studies resulted in a treatment program which integrates several different stress management techniques, relaxation, cognitive restructuring and social skills training, into a structured time-limited group format. These components and the unique features of MM are discussed below.

Relaxation approaches to stress management aim at reducing physiological arousal to stressors. The relaxation approach included in MM emphasizes the teaching of abbreviated progressive relaxation techniques (Bernstein and Given, 1984) to reduce chronic stress reactions by relaxing at specific intervals, and the use of relaxation techniques which can aid coping with acute arousal, such as a diaghramatic breathing technique. (Everly and Rosenfeld, 1981).

Stress theorists (Lazarus and Launier, 1978; Cameron and Meichenbaum, 1982) have emphasized the transactional nature of stress. This view posits that one’s cognitive appraisal of a stressor mediates one’s response to that stressor. From this framework, a client’s perceptions of both the stressfulness of a situation and of her or his ability to successfully cope with a situation become targets of intervention. Based on the work of Meichenbaum (1977), Ellis (1970), and Beck (1976), the cognitive restructuring component of the stress management treatment focuses on direct modification of cognitions that are viewed as dysfunctional or non-adaptive.

Individuals’ attempts to cope with stressors can be focused on attempts to modify the environment itself. Clients can be taught skills which can improve their ability to change their environments. As many of the stressors that clients report are interpersonal in nature, social skills, particularly assertion training, are particularly relevant to stress management. A widely shared clinical observation is that the inability to express emotions effectively is linked to psychosomatic illness. Assertiveness training may be effective in the reduction of such illness (see discussion in Stoyva and Anderson, 1982). Social skills training has considerable support as to its efficacy in changing interpersonal behavior and in reducing anxiety (see reviews by Alberti, 1977; Twentyman and Zimmering, 1978; Bellack and Hersen, 1979).

The MM approach has several distinctive features. The focus of treatment is on coping with routine stressors rather than major life events. There is evidence that frequent daily stressful situations that to some degree characterize everyday transactions with the environment are more closely linked to and may have a greater effect on moods and health than major undesirable life events (Kanner, Coyne, Schaefer and Lazarus, 1981). Clients are trained to recognize their routine stressors and to modify their response to the stressors.

Although the MM approach is highly structured, the program combines training in the component skills with individualized application. Group members bring descriptions of problem situations they are encountering to the group. Through discussion, problem-solving, role-playing, and homework assignments clients learn to apply the skills to their particular circumstances.

Cognitive-behavioral treatment approaches have generally ignored group process as relevant to treatment outcome (Rose, Tolman and Tallant, 1985). The MM approach emphasizes the group as a means rather than as a context of change. Careful attention is given to maximizing participation, involvement and appropriate self-disclosure of members, to building cohesion among group members, and to encouraging positive group norms.

A short-term structured group treatment for stress has a number of advantages as a social work intervention. Clients need not commit themselves to a lengthy, costly process. The structured nature of intervention makes training of leaders a simpler, more replicable process. Effective dissemination of such an approach is more feasible than that of complex, poorly defined treatments. The set of skills taught in MM are broadly applicable, flexible, and presumably generalizable to a great many problems facing the clients to whom social workers address their helping efforts. Because treatment is provided in groups, service is cost-effective.

In this study, the integrated multi-method stress management treatment was compared to a credible alternative treatment. The alternative treatment was a similarly structured program which utilized only relaxation training techniques. It was hypothesized that the combination of relaxation, cognitive, and behavioral techniques would be more effective in helping clients to cope with routine stressors than would relaxation alone. Related studies support this hypothesis (see review by Lehrer and Woolfolk, 1984). Both treatments were compared to a control group of subjects who requested treatment but were placed on a waiting list. It was hypothesized that subjects in both treatments would show greater improvement on stress measures than the waiting list subjects.

METHOD

Subjects

Subjects were recruited from the general public via posters, newspaper advertisements, and through social service agencies likely to have contact with people experiencing difficulties dealing with stress. In all, 45 subjects who identified themselves as needing stress management training completed pregroup interviews. Subjects were initially interviewed by one of nine graduate student interviewers. The interviewers screened subjects who were inappropriate for treatment, explained experimental procedures, gathered demographic, and other relevant clinical data to be used by the leaders, and administered the pretest measures.

One subject was deemed inappropriate for the study because she presented herself as desiring an opportunity to learn stress management techniques to aid her in her social work practice. Three subjects dropped out of the study prior to the start of treatment. The total number of subjects participating in the study was reduced to 41.

The mean age of the subjects was 36.3. The mean education in years was 15.6, indicating a relatively well-educated group. Twenty-nine subjects were women, and 12 were men. All subjects were Caucasian, with the exception of one Asian man. A third of the subjects (14) were professionals. The other subjects were somewhat evenly represented in technical (4), clerical (7), student (6), unemployed (5) and other categories (5).

The types of stress that subjects were experiencing were quite varied. In response to a pretest interview question about the stressors that led them to seek help, the largest category was difficulties in interpersonal relationships. In all 23 subjects listed 44 different interpersonal stressors, including having little social life or feeling lonely (8), separation, divorce or remarriage issues (7), addiction or other health problems of family members (6), and death of family members (4). The next largest category was work and school-related problems. Twenty-three subjects named 27 total stressors, for example added responsibilities, impending layoffs, unemployment, and domineering employers. Seventeen subjects reported 25 intrapersonal stressors, for example setting unrealistic goals, lack of direction, and inability to express feelings. The fourth largest category was health related problems. In all eight subjects listed 12 different health problems including hypertension, ulcers, back problems, fatigue, gout, PMS, and diet problems. Finally, 11 subjects reported financial difficulties as major stressors leading them to seek intervention. It can be seen from this brief description that the subjects were heterogenous in their stress-related problems. Stressors named as major concerns included both major life crises, as well as more chronic, daily hassles.

Design

The study used an experimental between-groups design, comparing the MM treatment to a relaxation-only (RO) control, and a waiting list (WL) control group. Following the completion of all the pregroup interviews, subjects deemed appropriate for treatment were randomly assigned to the treatment conditions, blocking for sex and preference for meeting time.

Two MM and two RO groups were conducted. Two leaders, the first author and an experienc...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• About the Editors
• The Group Work Research Dilemma
• Client Perceptions of the Effectiveness of Divorce Adjustment Groups
• A Comparison of Two Types of Pregroup Preparation for Men Who Batter
• Teaching Clients to Cope with Stress: The Effectiveness of Structured Group Stress Management Training
• Life Skills Training with Mothers of Handicapped Children
• The Effect of Process and Structured Content on Outcome in Stress Management Groups
• Four Studies Toward an Empirical Foundation for Group Therapy