{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:14:38Z","timestamp":1790237678582,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients\u2019 experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.<\/jats:p>","DOI":"10.3390\/ijerph18105324","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T12:19:57Z","timestamp":1621253997000},"page":"5324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["\u201cDespite the Differences, We Were All the Same\u201d. Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Anne","family":"Bryde Christensen","sequence":"first","affiliation":[{"name":"Research Unit for Psychotherapy &amp; Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Signe","family":"Wahr\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Copenhagen, 1353 K\u00f8benhavn K, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5117-9376","authenticated-orcid":false,"given":"Nina","family":"Reinholt","sequence":"additional","affiliation":[{"name":"Research Unit for Psychotherapy &amp; Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0536-1820","authenticated-orcid":false,"given":"Stig","family":"Poulsen","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Copenhagen, 1353 K\u00f8benhavn K, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6382-8492","authenticated-orcid":false,"given":"Morten","family":"Hvenegaard","sequence":"additional","affiliation":[{"name":"Mental Health Services, Capital Region of Denmark, 2200 K\u00f8benhavn N, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Simonsen","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Region Zealand, 4200 Slagelse, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2200 K\u00f8benhavn N, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidse","family":"Arnfred","sequence":"additional","affiliation":[{"name":"Research Unit for Psychotherapy &amp; Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2200 K\u00f8benhavn N, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1037\/pst0000172","article-title":"The alliance in adult psychotherapy: A meta-analytic synthesis","volume":"55","author":"Wampold","year":"2018","journal-title":"Psychother"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"DeLucia-Waack, J.L., Kalonder, C.R., and Riva, M.T. (2004). The importance of therapeutic factors: A typology of therapeutic factor studies. Handbook of Group Counselling and Psychotherapy, Sage Publications.","DOI":"10.4135\/9781452229683"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1037\/0033-3204.38.4.373","article-title":"Cohesion in group psychotherapy","volume":"38","author":"Burlingame","year":"2001","journal-title":"Psychother. Theory Res. Pract. Train."},{"key":"ref_4","unstructured":"Yalom, I.D. (1995). The Theory and Practice of Group Psychotherapy, Basic Books (AZ)."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1136\/ebmh.11.1.5","article-title":"Cognitive-behavioural therapies: Achievements and challenges","volume":"11","author":"Gaudiano","year":"2008","journal-title":"\u00c9vid. Based Ment. Heal."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.brat.2006.06.004","article-title":"Group cohesion in cognitive-behavioral group therapy for social phobia","volume":"45","author":"Suvak","year":"2007","journal-title":"Behav. Res. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1037\/pst0000173","article-title":"Cohesion in group therapy: A meta-analysis","volume":"55","author":"Burlingame","year":"2018","journal-title":"Psychotherapy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1080\/00207284.1997.11490846","article-title":"The Contribution of Group Cohesion and Group Alliance to the Outcome of Group Psychotherapy","volume":"47","author":"Marziali","year":"1997","journal-title":"Int. J. Group Psychother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1159\/000069733","article-title":"Group Cohesion and Working Alliance: Prediction of Treatment Outcome in Cardiac Patients Receiving Cognitive Behavioral Group Psychotherapy","volume":"72","author":"Erdman","year":"2003","journal-title":"Psychother. Psychosom."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/10503300902855514","article-title":"Effects of individual cohesion and patient interpersonal style on outcome in psychodynamically oriented inpatient group psychotherapy","volume":"20","author":"Dinger","year":"2010","journal-title":"Psychother. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s10608-012-9476-1","article-title":"The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses","volume":"36","author":"Hofmann","year":"2012","journal-title":"Cogn. Ther. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1016\/j.psychres.2014.08.036","article-title":"Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic","volume":"220","author":"Oei","year":"2014","journal-title":"Psychiatry Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1521\/ijgp.2010.60.1.153","article-title":"Cohesion in Cognitive-Behavioral Group Therapy for Anxiety Disorders and Major Depression","volume":"60","author":"Johnson","year":"2010","journal-title":"Int. J. Group Psychother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jad.2006.02.004","article-title":"Cognitive change process during group cognitive behaviour therapy for depression","volume":"92","author":"Oei","year":"2006","journal-title":"J. Affect. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1037\/0022-006X.73.1.38","article-title":"Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder","volume":"73","author":"Kaufman","year":"2005","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1192\/bjp.124.6.588","article-title":"Group Exposure (Flooding) in vivo for Agoraphobics","volume":"124","author":"Hand","year":"1974","journal-title":"Br. J. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.beth.2010.08.011","article-title":"A Randomized Clinical Trial of Transdiagnostic CBT for Anxiety Disorder by Comparison to Relaxation Training","volume":"43","author":"Norton","year":"2012","journal-title":"Behav. Ther."},{"key":"ref_18","unstructured":"Barlow, D.H., Farchione, T.J., Bullis, J.R., Gallagher, M.W., Murray-Latin, H., Sauer-Zavala, S., and Cassiello-Robbins, C. (2010). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide, Oxford University Press."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Reinholt, N., Hvenegaard, M., Bryde Christensen, A., Eskildsen, A., Hjorth\u00f8j, C., Poulsen, S., Arendt, M.B., Rosenberg, N.K., Gryesten, J.R., and Christensen, C.W. (2021). Transdiagnostic versus Diagnosis-specific Group Cognitive-behavioral Therapy for Anxiety Disorder and Depression: A Randomized Controlled Trial. Psychother. Psychosom., in press.","DOI":"10.1159\/000516380"},{"key":"ref_20","unstructured":"Bieling, P.J., McCabe, R.E., and Anthony, M.M. (2009). Cognitive Behavioral Therapy in Groups, The Guilford Press."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"McLeod, J. (2011). Qualitative Research in Counselling and Psychotherapy, Sage.","DOI":"10.4135\/9781446287897"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e12278","DOI":"10.1111\/cpsp.12278","article-title":"What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention","volume":"26","author":"Bullis","year":"2019","journal-title":"Clin. Psychol. Sci. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1002\/da.20735","article-title":"Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders","volume":"27","author":"Wilamowska","year":"2010","journal-title":"Depress. Anxiety"},{"key":"ref_24","unstructured":"Danske Regioner (2020, August 28). Pakkeforl\u00f8b for Angst. Available online: https:\/\/www.regioner.dk\/media\/5548\/pakkeforloeb-for-angst.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Arnfred, S.M., Aharoni, R., Hvenegaard, M., Poulsen, S., Bach, B., Arendt, M., Rosenberg, N.K., and Reinholt, N. (2017). Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia\/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-016-1175-0"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1080\/02845710127474","article-title":"Experiences of patients in cognitive behavioural group therapy: A qualitative study of eating disorders","volume":"30","author":"Laberg","year":"2001","journal-title":"Scand. J. Behav. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/S1352465898000071","article-title":"Group cbt for people with schizophrenia: A preliminary evaluation","volume":"26","author":"Gledhill","year":"1998","journal-title":"Behav. Cogn. Psychother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/jir.12144","article-title":"\u2018It\u2019s made all of us bond since that course\u2026\u2019\u2014A qualitative study of service users\u2019 experiences of a CBT anger management group intervention","volume":"59","author":"MacMahon","year":"2015","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1348\/147608306X110148","article-title":"More than just a place to talk: Young people\u2019s experiences of group psychological therapy as an early intervention for auditory hallucinations","volume":"80","author":"Newton","year":"2007","journal-title":"Psychol. Psychother."},{"key":"ref_31","first-page":"31","article-title":"De-privatization: Client Experience of Short-term Dynamic Group Psychotherapy","volume":"28","author":"Poulsen","year":"2004","journal-title":"Group"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/10\/5324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:02:43Z","timestamp":1760162563000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/10\/5324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,17]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["ijerph18105324"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18105324","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,17]]}}}