Integrating Psychodrama and Cognitive Therapy:

An Exploratory Study

by Michelle N. Boury

The present study evaluated the effects of participating in a group

course which integrated psychodramatic and cognitive-

behavioral techniques on changes in the number of core beliefs,

number of automatic thoughts, mood and alleviating depression.

Cognitive Model

• Thoughts influence emotions and behaviors.• Dysfunctional thoughts are frequently

associated with psychological distress.• Such thoughts are provoked by core beliefs.• Core beliefs are based in early childhood

and are the content of the cognitive structures (schema) within the mind.

• Early Maladaptive Schemas (EMS).

Cognitive Triad

Future

 

Self World

Psychodramatic Triad

Warm-up Action Closure

Inte

nsi

ty o

f E

mot

ion

Selection of patient

Catharsis

Sharing

Cognitive Theory of Depression

• Depressed individuals negatively misinterpret facts and experiences.

• The more negative thoughts the greater the severity of other depressive symptoms.

• Depression is maintained by negative thoughts.• To reduced depression there needs to be a

reduction in negative thoughts.• Cognitive-Behavioral Therapy (CBT) evokes

change in thoughts and underlying beliefs.

Research on Cognitive-Behavioral Therapy

• CBT has shown to be as effective as pharmacology, psychoanalysis, interpersonal and behavioral therapy.

• CBT has been effective in both individual and group settings.

Present Study

• Purpose– Examine the effects of completing the Thought

Record Form (TRF) with the integration of psychodramatic and Cognitive-Behavioral techniques.

– Examine the relationship among the variables derived from the TRF and depression.

Present Study

• Beck’s Model– When an individual is depressed there is an

increase in negative thought content about the self, future, and world.

– Therapy should decrease depression because of the awareness it brings to the negative thought process.

Present Study

• The Psychodrama Course

– Cognitive techniques

– Psychodramatic techniques

– Group setting

Methods

• Participants– 40 Undergraduate and graduate students.– 24 females and 16 males.– Enrolled in 1 of 5 group psychodrama courses

at West Chester University between the fall of 1997 and the fall of 1999.

– The course was 14 weeks long, meeting once a week for 3 hours.

Instruments

• Thought Record Form– Identifies negative thoughts evoked by a

particular situation.

• Beck Depression Inventory II– Self-report measure of depression.

Thought Record Form Variables

• Number of distressing situations. • Number of negative moods identified.• Average initial mood rating.• Number of automatic thoughts.• Number of implied core beliefs.• Number of implied different types of core beliefs.• Number of balanced thoughts.• Number of moods reported after completion of

balanced thoughts.• Average new mood rating.

Procedure

• BDI-II were computed weekly.

• Gradual introduction of the TRF.

• TRFs were completed as weekly homework assignments.

Results

• Review of main purpose of this study– To evaluate if the group class had any impact

on changes in number of core beliefs, automatic thoughts, mood and BDI-II scores.

– To examine the correlation among various measures derived from the TRFs and BDI-II scores.

Effect of the Group Course

• More situations were mentioned in the first three weeks of the course than the last three weeks of the course.

Effect of the Group Course

• There was no difference in the following variables from the first three weeks to the last three weeks of the course:– The number of automatic thoughts.– The number of core beliefs.– BDI-II scores.– The number of mood reported at the beginning of the

TRF.– The average mood rating at the beginning of the TRF.– The average mood rating after writing balanced thoughts.

Effect of the Group Course

• More moods were reported in the beginning of the TRF than in the end for both the first and last three weeks of the course.

• The difference between the number of moods reported from the beginning of the TRF and the end was greater in the first three weeks of the course.

• There were more moods reported at the end of the TRF in the last three weeks than the first three weeks.

Effect of the Group Course

• The average mood rating decreased from the beginning of the TRF to the end, after writing the balanced thoughts, in both the first three weeks and last three weeks of the course.

• There was a greater reduction of mood rating from the beginning to the end of the TRF in the first three weeks than the last three weeks.

TRF Variables and BDI-II Scores

• The BDI-II correlated with the following variables in the first three weeks:– Number of moods in the beginning of the TRF.– Number of automatic thoughts.– Number of implied core beliefs.– Number of different implied core beliefs.

TRF Variables and BDI-II Scores

• The BDI-II correlated with the following variables in the last three weeks:– Number of situations.– Number of moods in the beginning of the TRF.– Number of automatic thoughts. – Number of implied core beliefs.– Number of new moods.– The average new mood rating.

Correlations Among the TRF Variables

• The number of situations were positively correlated with:– Number of moods in the beginning of the TRF.– Number of automatic thoughts.– Number of core beliefs.– Number of different core beliefs.

Correlations Among the TRF Variables

• The number of moods and balanced thoughts were correlated with:– Number of automatic thoughts.– Number of implied core beliefs.– Number of different core beliefs

Summary and Conclusion

• BDI-II scores did not differ from the first three weeks to the last three weeks.

• Average mood ratings decreased as a result of writing balanced thoughts.

• No reduction in negative moods as a result of completing TRF weekly.

Summary and Conclusion

• Immediate positive effects of writing balanced thoughts.

• These effects did not generalize to other situations.

Suggestions

• Improved way of accessing mood.

• Clinical population.

• Longer term intervention.

• Larger sample size.