Answer each topic in at least two paragraphs.Topic 1 List.docx

Answer each topic in at least two paragraphs.
Topic 1: List and briefly discuss various operating system
services.
Topic 2: Briefly discuss the user interfaces of operating systems
Topic 3: Discuss how the round robin scheduling algorithm
works.
Topic 4: Discuss the strength and weakness of each of the CPU
scheduling algorithm.
Topic 5: Briefly discuss the needs for virtual memory.
Topic 6: Briefly discuss how virtual memory works.
Topic 7: What Ubuntu features do you like the best? Why?
Topic 8: What Ubuntu features do you like the least? Why?
Week 6: Foundations of Group Work and Types of Groups
And as participants improve, the group as a whole benefits.
Members can be agents of change for each other. Seeing others'
progress can help group members realize they, too, can cope and
feel better.
—Dr. Nina W. Brown, “Power in Numbers”
Group therapy can be very beneficial for clients. In fact,
research has shown that for many clients, group therapy is as

effective as individual therapy. Members of groups are not only
able to influence change within each other, but they are often
able to more easily relate to the guidance of peers than that of a
therapist. With the increasing popularity of this therapeutic
approach, it is essential for you to have a strong foundation in
psychotherapeutic techniques for groups.
This week, as you explore group therapy, you consider how you
might apply current literature to your own clinical practice. You
also examine your own practicum experiences involving group
therapy sessions.
Photo Credit: [Tom Merton]/[Caiaimage]/Getty Images
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course Readings List, found in
the Course Materials section of your Syllabus.
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for evidence-based
practice. New York, NY: Springer.
· Chapter 11, “Group Therapy” (Review pp. 407–428.)
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of
group psychotherapy (5th ed.). New York, NY: Basic Books.
· Chapter 1, “The Therapeutic Factors” (pp. 1–18)
· Chapter 2, “Interpersonal Learning” (pp. 19–52)
· Chapter 3, “Group Cohesiveness” (pp. 53–76)
Leszcz, M., & Kobos, J. C. (2008). Evidence-based group
psychotherapy: Using AGPA's practice guidelines to enhance
clinical effectiveness. Journal of Clinical Psychology, 64(11),
1238–1260. doi:10.1002/jclp.20531
Note: Retrieved from Walden Library databases.
Marmarosh, C. L. (2014). Empirical research on attachment in
group psychotherapy: Moving the field forward. Psychotherapy,

51(1), 88–92. doi:10.1037/a0032523
Microsoft. (2017). Basic tasks for creating a PowerPoint
presentation. Retrieved from https://support.office.com/en-
us/article/Basic-tasks-for-creating-a-PowerPoint-2013-
presentation-efbbc1cd-c5f1-4264-b48e-c8a7b0334e36
Tasca, G. A. (2014). Attachment and group psychotherapy:
Introduction to a special section. Psychotherapy, 51(1), 53–56.
doi:10.1037/a0033015
Tasca, G. A., Francis, K., & Balfour, L. (2014). Group
psychotherapy levels of interventions: A clinical process
commentary. Psychotherapy, 51(1), 25–29.
doi:10.1037/a0032520
You will select one of the following articles on group therapy to
evaluate for this week’s Assignment.
Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015).
The effect of cognitive-behavioral group marital therapy on
marital happiness and problem solving self-appraisal. American
Journal of Family Therapy, 43(2), 103–118.
doi:10.1080/01926187.2014.956614
Himelhoch, S., Medoff, D., & Oyeniyi, G. (2007). Efficacy of
group psychotherapy to reduce depressive symptoms among
HIV-infected individuals: A systematic review and meta-
analysis. AIDS Patient Care & Stds, 21(10), 732–739.
doi:10.1089/apc.2007.0012
Pessagno, R. A., & Hunker, D. (2013). Using short-term group
psychotherapy as an evidence-based intervention for first-time
mothers at risk for postpartum depression. Perspectives in
Psychiatric Care, 49(3), 202–209. doi:10.1111/j.1744-
6163.2012.00350.x
Sayın, A., Candansayar, S., & Welkin, L. (2013). Group

psychotherapy in women with a history of sexual abuse: What
did they find helpful? Journal of Clinical Nursing, 22(23/24),
3249–3258. doi:10.1111/jocn.12168
Yildiran, H., & Holt, R. R. (2015). Thematic analysis of the
effectiveness of an inpatient mindfulness group for adults with
intellectual disabilities. British Journal of Learning Disabilities,
43(1), 49–54. doi:10.1111/bld.12085
Note: Retrieved from Walden Library databases
Assignment: Applying Current Literature to Clinical Practice
Psychiatric mental health nursing practice is one of the newest
disciplines to be licensed to provide psychotherapy As such, the
majority of psychotherapy research is centered on other
disciplines such as psychology, social work, marriage/family
therapy, art therapy, psychiatry, and mental health counseling.
This makes it essential for you to be able to translate current
literature from other disciplines into your own clinical practice.
For this Assignment, you practice this skill by examining
literature on group work and group therapy and considering its
applicability to your own clients.
Learning Objectives
Students will:
· Evaluate the application of current literature to clinical
practice
To prepare:
· Review this week’s Learning Resources and reflect on the
insights they provide on group work and group therapy.
· Select one of the articles from the Learning Resources to
evaluate for this Assignment.
Note: In nursing practice, it is not uncommon to review current
literature and share findings with your colleagues. Approach
this Assignment as though you were presenting the information
to your colleagues.
The Assignment
In a 5- to 10-slide PowerPoint presentation, address the
following:

· Provide an overview of the article you selected, including
answers to the following questions:
· What type of group was discussed?
· Who were the participants in the group? Why were they
selected?
· What was the setting of the group?
· How often did the group meet?
· What was the duration of the group therapy?
· What curative factors might be important for this group and
why?
· What “exclusion criteria” did the authors mention?
· Explain the findings/outcomes of the study in the article.
Include whether this will translate into practice with your own
client groups. If so, how? If not, why?
· Explain whether the limitations of the study might impact your
ability to use the findings/outcomes presented in the article.
See Article selected highlighted in yellow.
Using Short-Term Group Psychotherapy as an Evidence-Based
Intervention for First-Time Mothers at Risk for
Postpartum Depressionppc_350 202..209
Richard A. Pessagno, DNP, RN, APN-C, CGP, and Diane
Hunker, PhD, MBA, RN
Richard A. Pessagno, DNP, RN, APN-C, CGP, is Clinical
Assistant Professor, Rutgers, The State University of New
Jersey, College of Nursing, Newark,
New Jersey, USA; and Diane Hunker, PhD, MBA, RN, is
Assistant Professor, Chatham University, Pittsburgh,
Pennsylvania, USA.
Search terms:
First-time mothers, group psychotherapy,
postpartum depression, psychiatric nursing

Author contact:
[email protected], with a copy to
the Editor: [email protected]
Conflict of Interest Statement
There are no financial disclosures to make
relative to this manuscript.
First Received March 12, 2012; Final Revision
received June 25, 2012; Accepted for
publication June 27, 2012.
doi: 10.1111/j.1744-6163.2012.00350.x
PURPOSE: The purposes were to (a) provide an 8-week, short-
term, psychotherapy
group as a nonpharmacologic, evidence-based intervention for
first-time mothers
at risk for postpartum depression (PPD) and (b) determine if
women’s scores in
the Edinburgh Postnatal Depression Scale changed after
participation in the
intervention.
CONCLUSION: The women who participated in the short-term
group psycho-
therapy intervention experienced a decrease in their Edinburgh
Postnatal Depres-
sion Scale scores, reducing their risk for PPD.
PRACTICE IMPLICATIONS: Group psychotherapy is an
effective, evidence-based
intervention to reduce the risk for PPD and should remain a
current competency of
psychiatric advanced practice nurses.
Postpartum depression (PPD) is a serious medical condition
that dates back to 400 B.C. (Tovino, 2009). Although it has

been noted that nearly 85% of women experience some type
of mood change after giving birth (Horowitz & Goodman,
2005), the actual prevalence of PPD is between 10% and
20% (Gjerdingen & Yawn, 2007). While in-hospital postpar-
tum screening has helped to increase the recognition of
those at risk for developing PPD (Perfetti, Clark, & Fillmore,
2004), fewer than half of those women who are screened
and who develop PPD will actually be identified and treated
(Gjerdingen & Yawn, 2007; Logsdon, Wisner, & Pinto-Foltz,
2006). As women are discharged from acute care hospitals
quickly after giving birth, inpatients often lack readily avail-
able access to interventions, even for women identified at
risk for PPD.
Pharmacological interventions are a common treatment
option for PPD, but many women leave the acute setting,
opting not to take medication and having limited resources to
access mental health services. Taking medication, specifically
psychotropic medication, can raise concerns for many
women, especially for first-time mothers (Gjerdingen, 2003).
Often, concerns are raised about the use of medications, espe-
cially among those breast-feeding mothers, relative to the
potential risk to their infants. Identifying and accessing timely
nonpharmacological treatment can be difficult for women
who are at risk for PPD or who have PPD. This article
describes an evidence-based practice intervention that used
short-term group psychotherapy as a nonpharmacologcial
intervention with first-time mothers who were identified as
being at risk for PPD.
Background
While various factors have been examined in relation to the
etiology of PPD, such as hormonal and metabolic changes,
lifestyle adjustments, obstetric factors, and changing new

roles (Flores & Hendrick, 2002), epidemiological studies have
fairly consistently demonstrated that the etiology of PPD is
most closely linked to psychosocial factors (Beck, 1996a).
PPD has often been associated with women who are from
lower socioeconomic backgrounds, who are less educated,
and who lack occupational prestige (Séguin, Potvin, St-Denis,
& Loiselle, 2001). Yet Anderson (2009) found that PPD is also
found in significant numbers among women who are well
educated, middle class, and in stable relationships. These
findings support the need to adequately screen and provide
Perspectives in Psychiatric Care ISSN 0031-5990
202 Perspectives in Psychiatric Care 49 (2013) 202–209
© 2012 Wiley Periodicals, Inc.
mailto:[email protected]
mailto:[email protected]
early intervention to all women who give birth, and not only
profiled women from disadvantaged backgrounds.
The risk for PPD may be greatest for first-time mothers
who hold high expectations regarding childbearing but no
personal experience with which to compare their experiences
(Epperson, 1999). Because new mothers may not be aware
that they are experiencing PPD, they may normalize their
feelings. New mothers may fear that others judge their feel-
ings as an inappropriate maternal response (Logsdon, Foltz,
Scheetz, & Myers, 2010). First-time mothers are less apt to
express the need for help during the postpartum period
because of the perceived stigma of being depressed, as well as
the hesitancy to report depressive symptoms (Thurgood,
Avery, & Williamson, 2009). The results can leave first-time
mothers feeling even more isolated and unprepared to cope

with multiple changes that can negatively impact their health
status and parenting effectiveness (Reich, Silbert-Mazzarella,
Spence, & Siegel, 2005).
Impact of PPD
The detrimental effects of PPD have gained increasing public
awareness, with some extreme cases of PPD in which mothers
have harmed their children (Logsdon, Wisner, & Shanahan,
2007). Untreated PPD in first-time mothers, coupled with a
lack of maternal experience and fear, can lead to a host of mal-
adaptions for both the mother and her baby. These maladap-
tions can include issues such as severe social isolation,
decreased mother–child bonding, decreased maternal ability
to care for the infant, increased incidence of developmental
delay in infants, and a reduced rate of identifying infant cues
(Reich et al., 2005). Although women who have given birth
more than once have also been shown to be at risk for PPD,
women with more than one child tend to seek intervention at
a higher rate than first-time mothers (Rich-Edwards et al.,
2006). The occurrence of PPD has been linked to a host of
negative outcomes. Beck (1998) noted that women with PPD
can negatively impact infant behaviors and influence child-
hood development through the age of 14. A review of eight
phenomenological studies on women with PPD suggested
that mothers with PPD were often filled with guilt, had feel-
ings of loss, and engaged in irrational thinking. These themes
were linked to mothers experiencing a sense of detachment
from their infants, as well as failure to respond to clues from
her children (Beck, 1996b). Current research suggests that
there is a negative relationship between the presence of PPD
and infant development (Beck, Records, & Rice, 2006).
Treatment of PPD
Treatments for depression and PPD are varied and include

psychotherapy, psychoeducation, and support groups, as well
as pharmacotherapy. Treatment choices for patients depend
on multiple factors, including availability, cost, convenience,
the influence of family and friends, and patient preference
(Burlingame, Fuhriman, & Mosier, 2003). The cost-
effectiveness of group psychotherapy draws many patients to
this treatment option (Burlingame et al., 2003; McRoberts,
Burlingame, & Hoag, 1998).
Group psychotherapy has been supported in the literature
as being an efficient, cost-effective, nonpharmacologic,
evidence-based intervention that can be used for patients
exhibiting depressive symptoms. A meta-analysis of 48
research studies examining the effect of group psychotherapy
on depression revealed that group psychotherapy was effec-
tive in reducing depressive symptoms, further noting that 43
of the studies evidenced that group psychotherapy provided a
statistically significant decrease in depressive symptoms for
group participants (McDermut, Miller, & Brown, 2001).
Several studies have reported that mothers with PPD
responded well to group psychotherapy treatment. Klier,
Muzik, Rosenblum, and Lenz (2001) noted in their study (n =
17) that group psychotherapy was an effective intervention
that decreased depressive symptoms, with a continued dimin-
ishment of PPD symptoms 6 months after treatment. Honey,
Bennett, and Morgan (2002), in a study of 45 women scoring
12 or higher on the Edinburgh Postnatal Depression Scale
(EPDS), identified that brief group experience reduced
depressive symptoms, as evidenced by lower EPDS scores.
Other studies on group psychotherapy as a treatment for PPD
have reported similar trends (Gruen, 1993; Kurzweil, 2008;
Meager & Milgrom, 1996; Ugarriza, 2004).
The benefits of group psychotherapy have been linked to

more rapid remission of symptoms, cost-effectiveness, and
improved social support. The literature has also demon-
strated that group psychotherapy can be an efficacious treat-
ment for patients at risk for PPD. Some evidence supports the
idea that group psychotherapy may provide longevity of
symptom relief for some patients up to 6 months posttreat-
ment. The literature cites the importance of screening and
early identification of the risk for PPD in first-time mothers
and the effectiveness of group psychotherapy as an evidence-
based intervention.
Interpersonal psychotherapy (IPT) is an effective, time-
limited treatment, which has been shown to be highly
effective for depression (Markowitz & Weissman, 2004).
Depression is identified as a medical illness that connects an
individual’s life events to the individual’s depression
(Markowitz & Weissman, 2004). Therapy focuses on helping
individuals to create or enhance one’s social relationships
while addressing issues such as conflicts and role change.
Within the context of a group environment, IPT can provide a
setting where individuals with a similar diagnosis can meet to
address relationship issues and explore how these issues may
be leading to depressive symptoms or other struggles within
various relationships.
Intervention for First-Time Mothers at Risk for Postpartum
Depression
203Perspectives in Psychiatric Care 49 (2013) 202–209
For the purposes of this project, IPT was organized by
using an unstructured format for group sessions. Group par-

ticipants were asked to recognize and notice their affect
response, cognitions, and reactions during sessions, and then
use those recognitions as a means of relating to others in the
groups. Participants were able to use group interactions to
address their relationship issues and their role changes. The
group was used to help participants improve interpersonal
relationships, enhance their ability to empathize, and learn
new skills.
Intervention
The purposes of this project were to (a) provide a non-
pharmacologic, evidence-based intervention for first-time
mothers at risk for PPD and to (b) determine if women’s
scores in the EPDS change after participation in the interven-
tion. The intervention was an 8-week, short-term psycho-
therapy group offered by an advanced practice psychiatric
nurse to first-time mothers. The project was approved by the
Institutional Review Board for protection of all participants.
Sample. A total of 202 women gave birth on the postpartum
unit during the 3-week recruitment period for this project.All
202 women completed the EPDS, and 24 women were then
recruited for participation in the project. All 24 women com-
pleted EPDS within 3 days after having given birth to their
first child and had a score of 11 or higher on the EPDS.A score
of 11 or higher triggered a psychiatric evaluation, which was
established by hospital policy to determine fitness for dis-
charge from the postpartum unit. After completing a psychi-
atric screening, eligible women were approached by a
postpartum nurse to determine if they were interested in par-
ticipating in the group psychotherapy intervention. These eli-
gible women then discussed their interest with the advanced
practice psychiatric nurse who would be leading the interven-
tion groups, and the women were given details about the
groups. Sixteen (Table 1) of the 24 women chose to partici-

pate in one of two short-term psychotherapy intervention
groups.
The age range of participants was between 20 and 38, with a
mean age of 28.5 years. More than 68% of the women were
between 26 and 30 years old. Thirteen, or 81.25%, of the
women were married; two women had a significant other;
and one woman was single. The majority of the women were
Catholic (62.5%), and all 16 women were Caucasian. More
than 92% had at least a high school education, with more than
86% having completed a 4-year college degree. Ten (62%) of
the women worked outside their homes in a variety of profes-
sional, technical, and service industry roles.
With regard to previous mental health treatment, six par-
ticipants (37.5%) had some experience with previous mental
health treatment. Four women had participated in counseling
or psychotherapy, and two women had used psychotropic
medications previously. None of the participants had previ-
ously been hospitalized for psychiatric treatment. None of the
women were taking psychotropic medication during the
intervention. Six of the participants had been previously diag-
nosed with depression.All 16 women had given birth within 1
month before the start of the group intervention, with 5
women giving birth to male children and 11 giving birth to
female children.
Women who did not participate decided against participa-
tion because of childcare issues, concerns about length of the
commitment to the group, and/or lack of interest in partici-
pating in a group-related activity. Each participant was
randomly assigned to one of the two short-term group psy-
chotherapy intervention groups. The remaining women who
did not meet the criteria for participation or who decided not
to participate in the intervention were referred to other

mental health services within the community. Screening for
the project took place in May 2010.
Procedure. The short-term group psychotherapy interven-
tion was provided to two groups with eight women each for a
period of 8 weeks. Each of the 8-week sessions lasted 90 min
and started within 1 month of discharge from the hospital.
Table 1. Demographics of Groups
Variables
Intervention
Group 1 (n = 8)
Intervention
Group 2 (n = 8)
Ages
20–25 1 2
26–30 6 4
31–35 1 1
36–38 0 1
Education
<12th grade 0 1
High school 2 0
College 5 5
Graduate school 1 2
Marital status
Single 1 0
Married 6 7
Partnered 1 1
Work outside home
Yes 2 8

No 6 0
Previous psych treatment
Yes 4 2
No 4 6
Type of past treatment
Psychotherapy 1 1
Medication 1 1
Both medication and therapy 2 0
Previous mental health diagnosis
Depressive disorder 4 2
Depression
The groups were provided at no charge to participants, and
childcare was provided to women in order make attending the
groups easier. A master’s-prepared, advanced practice psychi-
atric nurse, who was nationally board certified as a psychiatric
nurse practitioner and as a group psychotherapist with more
than 20 years of advanced practice psychiatric nursing experi-
ence, was the group leader for each of the two intervention
groups. This provided for consistency among interviews and
among all group sessions. Psychotherapy group 1 was held on
Tuesdays, and Psychotherapy Group 2 was held on Wednes-
days. Both groups met on the same day of the week for all 8
weeks. Both groups ran for 90 min. The scheduling and
timing of intervention provide consistency of scheduling for

participants. An interpersonal-focused theoretical model was
used to structure the group, which guided the length of the
group intervention, as well as the focus for each session. The
interpersonal model was selected in order to help participants
strengthen their relationships and to enhance their ability to
identity and utilize resources to improve their functioning.
This focus was structured to provide optimal opportunity in
developing skills relative to their new maternal roles as new
mothers, coping with depression and stress, honing commu-
nication skills with their husbands and partners, and sharing
their individual, weekly experiences.
The first session for each group established ground rules for
maintaining confidentiality for other group members;partici-
pants were told to only talk about their own personal group
experiences with nongroup members and to not repeat what
other group members disclosed during the sessions. Members
also agreed to attend group sessions on time or notify the
author group leader about their absences. All members also
agreed to attend all group sessions. During the first group
session, the participants completed a demographic form.
The subsequent seven sessions had a structured focus,
which followed the interpersonal theoretical framework,
addressing various relationship issues and helping partici-
pants identify resources. Although the recommended length
of typical interpersonal psychotherapy orientation is 12 to 15
sessions, the number of sessions for this project was reduced
to eight sessions based on group request. The final group
session was used to address termination issues, as well as to
identify group members who would need and benefit from
additional mental health services, as well as refer identified
group members who could benefit from additional mental
health services. The EPDS, which had been administered
prior to the intervention, was used again during this session.

Setting. The setting for the intervention was a community
hospital in New Jersey. In keeping with the hospital policy, all
postpartum women needed to be screened for PPD within
72 hr of delivery. This hospital policy adheres to the 2004 New
Jersey state mandate that requires all postpartum women be
screened for PPD before leaving any healthcare institution.
EPDS Screening Tool. The EPDS was developed in Scotland
within several healthcare centers in the cities of Livingston
and Edinburgh (Cox, Holden, & Sagovsky, 1987). The tool
was initially developed to assist primary care providers in
identifying whether women who had recently given birth
were suffering from postnatal depression, but now has appli-
cations to a variety of clinical settings. For the purpose of this
intervention, the first EPDS was completed 3 days postpar-
tum and the second EPDS was completed during the last
session of the group psychotherapy intervention.
The EPDS is a publicly available PPD screening tool and is
used within the hospital to screen for PPD. The EPDS is a
10-question self-report questionnaire that has a maximum
score of 30. Scores range from 0 to 30, with scores over 10
indicating adjustment issues to the new baby, and scores over
15 indicating a strong indication of clinical depression. Hos-
pital policy states that a score of 11 or higher for women on
the EPDS denotes a risk for PPD, and therefore, a psychiatric
evaluation is required before the patient can be cleared for
discharge. The EPDS has gained wide acceptance regarding
the screening and identification of PPD. Therefore, a psychi-
atric evaluation is required for all women with scores >11.
The EPDS is easily administered and scored, making it an effi-
cacious tool for utilization in a variety of postpartum health-
care settings. The EPDS has been utilized in more than 20
countries and is noted to have a significant level of sensitivity
(86%), as well as specificity (78%), in identifying and indicat-

ing symptoms of PPD (Harvey & Pun, 2007).
Results
The mean preintervention score on the EPDS for group 1 (3
days postpartum) was 16.13 (SD = 2.78) and for group 2 was
15.5 (SD = 1.19) (Table 2). These scores reflect the risk for
Table 2. Pre- and Postintervention EPDS Scores
Groups
Preintervention Postintervention
t (df) pM (SD) Range M (SD) Range
1 16.12 (2.74) 11–18 6.38 (1.50) 4–9 21.51 (7) .001
2 15.50 (1.19) 13–17 6.63 (1.99) 6–10 18.50 (7) .001
Note: 8 women/group.
EPDS, Edinburgh Postnatal Depression Scale.
Depression
depressive symptoms, in which a maximum potential score of
30 would indicate severe depression and 0 noting no depres-
sive symptomology. Scores of 10 or greater are indicative of
symptoms presentation, which should warrant further evalu-
ation. Following the intervention, the scores decreased sig-

nificantly. The mean postintervention score for group 1 was
6.38 (SD = 1.50) and for group 2 was 6.63 (SD = 1.99). These
data represent the combined scores of all group members
with and without a history of depression. There was a signifi-
cant decrease in EPDS scores from preintervention to postint-
ervention for both groups 1 and 2 (Table 2), as well as for
women with previous depression and women with no previ-
ous depression (Table 3), all indicating fewer self-reported
symptoms that put women at risk for PPD.
The long-term effects of the group intervention were
evaluated at 6 months postintervention for participants from
group 1 and group 2 (Table 4), and for women with each
group based on previous history of depression and no previ-
ous history of depression (Table 5). Both groups demon-
strated a significant decrease in scores on the EPDS. These
data demonstrate a continued effect of the group interven-
tion for participants 6 months beyond the intervention. This
is suggestive that group psychotherapy can have long-term
effects to reduce risk for PPD for first-time mothers.
During the initial group sessions, the women bonded
quickly and developed a strong alliance with one another.
Many of the women stated that they really enjoyed talking
with other women who were struggling with similar issues
and who were also first-time mothers. Several women stated
they felt “safer” talking with other first-time mothers because
they did not feel judged. Many of the women stated that they
worried about being judged by others when they shared their
worries or concerns about being new mothers. The homoge-
neity of the group also seemed to be a factor that added to the
success of the group.
A common theme noted among the women in both groups
was that the women looked forward to attending groups

because the group offered a place where the women could be
authentic, as well as a place to share “real feelings.” The theme
of looking forward to the group could have been one factor
that led to all the members attending all the group sessions.
None of the women missed any of the sessions, which added
to group cohesion, group process, and group stability. These
factors could have also added to the effectiveness of the group.
Table 3. EPDS Scores With Prior Depression
and Without Prior Depression
Groups
Preintervention Postintervention
t (df) pM (SD) Range M (SD) Range
With previous depression
1a (n = 4) 16.23 (1.50) 15–18 7.00 (2.16) 4–9 14.70 (3) .001
2a (n = 2) 16.00 (1.41) 15–17 6.50 (2.12) 5–8 5.26 (2) .001
No prior depression
1b (n = 4) 16.00 (3.36) 11–18 6.38 (1.50) 4–9 5.43 (6) .001
2b (n = 6) 15.50 (1.36) 13–17 6.67 (1.96) 4–9 8.86 (10) .001
Table 4. All Participants’ EPDS Scores at 8
Weeks and 6 Months Postintervention
Groups
Postintervention 8 weeks Postintervention 6 Months
M (SD) Range M (SD) Range

1 6.38 (1.50) 4–9 6 (1.69) 3–8
2 6.63 (1.99) 6–10 6.12 (1.45) 4–8
Note: 8 women/group.
Table 5. EPDS Scores of Participants With Prior
Depression and Without Prior Depression at 8
Weeks and 6 Months PostinterventionGroups
Postintervention 8 weeks Postintervention 6 Months
M (SD) Range M (SD) Range
With previous depression
1 (n = 4) 7.50 (1.00) 4–9 6.25 (1.70) 4–8
2 (n = 2) 6.50 (2.12) 5–8 5.50 (2.12) 4–7
No previous depression
1 (n = 4) 6.38 (1.50) 4–9 5.75 (1.89) 3–7
2 (n = 6) 6.67 (1.96) 4–9 6.16 (1.32) 4–8
Depression
It was also noted that some of the women were referred for
additional treatment after the intervention concluded. While
all of the women showed a decreased risk for PPD postinter-

vention, two of the women who had a previous history of
depression requested additional psychotherapy support.
Both women noted that the group had raised their awareness
of the importance of remaining healthy and keeping their
depression in remission. Both women believed that partici-
pating in additional individual therapy would help them con-
tinue to learn healthy ways of coping and adapting to their
new roles.
Effectiveness of Intervention
The findings that participants in the group psychotherapy
intervention experienced a decrease in their EPDS scores are
congruent with the literature noting that participation in
group psychotherapy is an effective means of reducing symp-
toms associated with depression (Gruen, 1993; Klier et al.,
2001; Kurzweil, 2008; Meager & Milgrom, 1996; Ugarriza,
2004). The results demonstrate a gap in clinical services for
first-time mothers at risk for PPD and subsequently support
an evidence-based, psychiatric nursing intervention to bridge
that gap. Providing a group psychotherapy intervention that
was connected to an acute care hospital allowed for a more
rapid and seamless referral process for women who were
identified as being at risk for PPD. Barriers to treatment for
women at risk for PPD vary and can include limited numbers
of mental health providers skilled in treating PPD issues and
long wait times to access treatment. Typically, hospital refer-
rals for community-based mental health services for women
at risk for PPD have led to long wait times to be seen for treat-
ment. There is a lack of qualified mental health professionals
who have knowledge and interest in working with the
population.
Identifying short-term group therapy as an intervention
that could be provided by the psychiatric advanced practice
nurse (APN) can bridge a potential gap in clinical services for

first-time mothers at risk for PPD, who may otherwise have
no other mental health services. Short-term group psycho-
therapy can also provide an effective and cost-effective expan-
sion of services for women who could potentially develop
PPD. The utilization of short-term group psychotherapy has
wide application across the healthcare system, as well as to
various psychiatric disorders beyond PPD.
Limitations
The main limitation was the use of a nondirective group
process style for this intervention. Nondirected group process
lends itself to providing members the ability to focus more on
relationships and developing empathy. The dynamics with a
nondirective psychotherapy group may vary from group to
group. This may provide some account for the differences
appreciated in postintervention scores. Additionally, group
EPDS scores versus individual EPDS scores were compared
for preintervention and postintervention, which could also be
noted as a limitation of the project. For the purposes of this
project, all scores were aggregated together and compared as a
cohort group.
Another limitation of the project was that the group psy-
chotherapy intervention was provided at no cost to partici-
pants. Additionally, childcare was available to the women as
well. It is realized that providing no-cost psychotherapy is not
the norm in most cases, and childcare is not always available.
Both of these issues may have also influenced the results of the
project.
Another limitation to take into account is the interpreta-
tion of group scores. While this was an evidence-based prac-
tice project that applied current research findings to address a
clinical problem and not an original research project, it

should be mentioned that change in EPDS scores have both a
ceiling and a basement effect, and those members scoring on
the higher end of the EPDS can change more dramatically
than those members scoring on the lower end of the EPDS. It
should be noted that members in group 2 who scored in the
bottom range of the EPDS did not change significantly. The
scope of the project was limited to implementing an
evidence-based intervention based on already produced
research evidence, so advanced interpretation of the changing
score postintervention results was beyond the scope of this
project. Still, a cautionary note must be mentioned relative to
the interpretation of postintervention group scores.
Implications for Nursing Practice
For states that mandate screening for PPD, implementing
nonpharmacologic interventions such as short-term group
psychotherapy across settings is a logical progression of
expansion of services for women at risk for PPD. Barriers to
treatment for women at risk for PPD vary and can include
limited numbers of mental health providers skilled in treating
PPD issue and long wait times to access treatment. Develop-
ing programs that include such interventions within health-
care agencies where pregnant or postpartum mothers seek
healthcare services could improve access to mental health care
for these women and have a positive impact on both the
physical and mental health of mothers and their infants.
Nonpharmacologic interventions, such as short-term
group psychotherapy, meet the needs of women who decide
against the use of medication. Mental health providers should
be exploring alternative interventions that augment choice
for patients relative to pharmacologic and nonpharmacologic
interventions. The efficacy of group psychotherapy in reduc-
ing risk for the development of depressive symptoms may
reduce or eliminate the need for subsequent medication use,

Depression
which has significant implications for healthcare spending for
both the system as a whole and for individual consumers.
Group psychotherapy has also been shown to be cost-effective
when compared with the costs of individual psychotherapy
(McCrone et al., 2005).
While the cost of this intervention group was free of charge,
the cost of group psychotherapy has historically been more
cost-effective for consumers when compared with the cost for
individual psychotherapy. Group psychotherapy also allows
mental health providers the ability to treat several patients at
the same time, which can allow the provider to see larger
numbers of patients. Many healthcare insurance plans do
provide coverage for group psychotherapy, and the short
nature of this group psychotherapy intervention provides a
discreet number of sessions over a discreet time frame, which
might also be an incentive for insurance companies to
encourage members to participate. With this type of time-
limited intervention, insurance providers would know up
front that their insured members would be in treatment for 8
weeks. This type of intervention could be seen as a cost-
effective service that provides evidence-based outcomes for
this specific patient population, namely women at risk for
PDD, which could potentially reduce the need for other
mental health services.

It is suggested that having a part-time psychiatric advanced
practice position as a member of the women’s health service
line could also prove to be cost-effective, as the services pro-
vided by the psychiatric APN are potentially reimbursable.
Additionally, having a psychiatric APN within a women’s
health service line would provide access for patients and allow
other healthcare providers, including nurses, easier access to a
psychiatric practitioner for consultations.
Within this project, the psychiatric APN’s salary came out
of the psychiatric services cost center. The cost to the institu-
tion offering the two groups for this project was incorporated
into the costs of the psychiatric APN salary. Group psycho-
therapy services offered for this project were a new service not
previously provided by the psychiatric APN. This project
articulated a potentially new revenue source as well.
The outcomes of the intervention also articulated the need
for psychiatric APNs to utilize the full spectrum of their edu-
cation and clinical training to meet the needs of women at
risk for PPD. Psychiatric APNs are uniquely trained to iden-
tify and treat both those at risk for PPD and those who may
have PPD. Psychiatric APNs can utilize both nonpharmaco-
logic interventions, such as short-term group psychotherapy,
and pharmacologic interventions management services to
treat patients.
In today’s mental health services market, significant focus
is paid on the importance of medication management skills of
the psychiatric APN, yet the intervention in this project sup-
ports the need for continued education and training of
advanced practice psychiatric nursing as psychotherapists
with group psychotherapy skills. It is vital that advanced prac-
tice psychiatric nurses be able to provide a wide variety of
interventions, including psychopharmacologic and nonphar-

macological therapies and group psychotherapy.
When advanced practice psychiatric nurses are able to
provide both pharmacological and nonpharmacological
interventions, there is a potential expansion of psychiatric
services, which could improve both the utilization and the
access to mental health services by consumers. This expansion
also creates potentially greater choice among the types of psy-
chiatric services from which consumers can select. Advanced
practice psychiatric nurses with training and skill in both
pharmacologic and nonpharmacologic psychiatric interven-
tions also become uniquely positioned within the mental
health system as providers who offer a wide variety of
services.
Conclusion
Short-term group psychotherapy as a nonpharmacological
psychiatric nursing intervention for first-time mothers who
were identified as being at risk for PPD is effective to reduce
symptoms associated with depression. Identifying women at
risk for developing PPD shortly before discharge from the
hospital provided a means for engaging those women who
might benefit from a short-term group psychotherapy inter-
vention. Implementing short-term psychotherapy group
interventions to two groups of eight first-time mothers dem-
onstrated lower scores on the EPDS, reflecting a decrease in
symptoms presentation and risk for PPD. Lowering the risk
for PPD has been associated with a wide variety of improved
healthcare outcomes for both new mothers and for their
infants. Group psychotherapy should be taught to advance
practice psychiatric nursing students and practiced by
advance practice psychiatric nurses, in order to improve
access to mental health services, improve outcomes, and to
potentially impact healthcare spending.

Acknowledgment
The first author was a participant in the 2012 NLN Scholarly
Writing Retreat sponsored by the NLN Foundation for
Nursing Education.
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