Home > DARE Reviews > The effectiveness of psychodramatic...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The effectiveness of psychodramatic techniques: a meta-analysis

DA Kipper and TD Ritchie.

Review published: 2003.

CRD summary

This meta-analysis investigated the effectiveness of psychodramatic techniques. The authors concluded that their findings appear to shed a positive light on the validity of psychodramatic techniques and they should be researched further and integrated into psychotherapy practice. The limited reporting of the included studies and methods used mean that these findings may not be reliable.

Authors' objectives

The authors investigated the effectiveness of psychodramatic techniques, and whether there were significant differences in effectiveness between different techniques.

Searching

The authors stated that they performed computerised searches (e.g. PsycLIT and Social Sciences Index), but they did not provide a comprehensive list of all electronic databases searched. The search terms and dates were not reported, although the authors stated that the search focused on studies published between 1965 and 1999. They also searched published and unpublished psychodrama bibliographies. Only studies published in the English language in professional refereed journals were eligible for inclusion.

Study selection

Study designs of evaluations included in the review

Controlled studies including at least one experimental and one control group were eligible for inclusion in the review.

Specific interventions included in the review

Studies of psychodrama, defined as a method that uses dramatisations of personal experiences through role-playing and enactment under a variety of simulated conditions, including at least one scene and one psychodramatic technique, were eligible for inclusion in the review. Studies that investigated hypotheses related to sociometry were excluded. The included studies were categorised into the following four techniques: role reversal, role-playing (enactment), doubling and multiple techniques. Just over half of the included studies used techniques administered in one session, whilst others spread the intervention across multiple sessions, usually on a weekly basis.

Participants included in the review

The authors did not state any inclusion criteria relating to the participants of interest. The majority of the included studies had students as their participants, whilst others included hospitalised patients, prisoners or correctional inmates, and special populations with developmental and physical disability. Most studies included both genders.

Outcomes assessed in the review

Studies that reported sufficient data to calculate effect sizes (ESs) were eligible for inclusion. The outcomes measured in the included studies included conflict solutions, attitudes, aggression, involvement, decision-making and realism, body image, anxiety, group behaviour, social-emotional assessment, social avoidance and distress.

How were decisions on the relevance of primary studies made?

Two reviewers independently selected studies for inclusion. The level of agreement between the two reviewers was assessed.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. The ES for each outcome from each study was calculated using Cohen's d method. These were used to calculate the mean ES and corresponding standard deviation (SD) for each study.

Methods of synthesis

How were the studies combined?

The mean ES was calculated over all studies and according to each of the four psychodramatic techniques. Details of the statistical methods used to pool the studies were not reported. Publication bias was assessed using Rosenthal's file-drawer method.

How were differences between studies investigated?

Subgroup analyses were performed according to the gender of the participants, clinical versus non-clinical participants, and single session versus multiple sessions; the groups were compared using a t-test. A one-way analysis of variance comparing the estimated ESs between each specific technique was also performed.

Results of the review

Twenty-five controlled studies with a total of 1,325 participants were included in the review.

When all 25 studies were combined, there was a statistically significant moderate to large ES (mean ES 0.95, SD 0.69, P<0.01) that suggested a beneficial effect for all the psychodramatic techniques under investigation.

The results for the four different techniques differed significantly from each other (P<0.01). When the results were combined by technique, the ESs for role reversal (100 effect measures from 10 studies: mean ES 0.93, SD 0.74) and doubling (118 effect measures from 5 studies: mean ES 1.29, SD 0.51) were moderate to large, whilst the ES of multiple techniques (46 effect measures from 6 studies: mean ES 0.42, SD 0.30) was small to moderate, and the results for role-playing (17 effect measures from 4 studies: mean ES 0.17, SD 0.68) showed very little improvement.

There was a statistically significant difference between studies of only one gender and studies of mixed gender groups (P=0.01): mixed gender groups tended to report higher ESs (mean ES 0.99, SD 0.75) than single gender groups (mean ES 0.72, SD 53).

There was no statistically significant difference between studies with students as their participants (mean ES 0.89, SD 0.77) and studies of clinical populations (mean ES 1.01, SD 0.60). There was also no statistically significant difference between studies that involved a single session (mean ES 0.88, SD 0.78) and those that involved multiple sessions (mean ES 1.02, SD 0.61).

In the assessment of publication bias, the authors calculated that it would need 1,057 statistically insignificant results to challenge the findings of this meta-analysis. They concluded that given the paucity of research in this area, the studies included in the meta-analysis did not represent a selection bias.

Authors' conclusions

The authors concluded that their findings appeared to shed a positive light on the issue of the validity of psychodramatic interventions and encouraged research into the specific psychotherapeutic effects of its basic techniques.

CRD commentary

The research question was not stated clearly, in particular regarding the participants and outcomes of interest. The search strategy was poorly reported and only studies published in the English language in professional refereed journals were eligible for inclusion, thereby increasing the potential for publication bias and language bias. Two authors independently selected studies for inclusion, thus reducing the potential for bias and error. The authors did not state how the data were extracted, therefore this part of the process could not be assessed for bias and error. The studies were not assessed for validity. The included studies were conducted between 1965 and 1999, with almost half conducted before 1980, thus the conduct of the studies and interventions might have changed over this period. Only limited details of the participants, interventions and outcomes were reported. The majority of the studies were conducted with students as the participants; the authors did not state which clinical group this intervention would be aimed at in practice, therefore, the effectiveness of psychodramatic interventions in different populations cannot be assessed.

Multiple effect sizes were obtained from each study but the authors did not provide any details of what these were, other than the name of the overall measurement tool used. Calculations were based on Cohen's d ES, which is used when studies are measuring the same outcome but using different measurement tools. However, the included studies appeared to be measuring a range of different outcomes, in different populations, so the validity of pooling them in a meta-analysis is questionable. Details of the statistical methods used to obtain the mean ES for each study and to pool these across studies were not reported, so it is not possible to comment on the appropriateness of the meta-analytic methods. The authors also did not investigate statistical heterogeneity. Whilst the results of this meta-analysis suggested some overall benefit of psychodramatic techniques, the lack of details on the included studies and methods used mean that the findings may not be reliable.

Implications of the review for practice and research

Practice: The authors stated that separate psychodramatic techniques can be adopted and incorporated into various forms of group psychotherapy; role reversal, doubling and role-playing, singularly or together, could add to the psychotherapeutic endeavour of many forms of group treatment.

Research: The authors recommended further studies based on the differential psychological effect hypothesis, and continued research into the therapeutic effectiveness of single psychodramatic techniques.

Bibliographic details

Kipper D A, Ritchie T D. The effectiveness of psychodramatic techniques: a meta-analysis. Group Dynamics: Theory, Research and Practice 2003; 7(1): 13-25.

Indexing Status

Subject indexing assigned by CRD

MeSH

Psychodrama /methods /trends; Psychotherapeutic Processes; Psychotherapy, Group /trends

AccessionNumber

12003009428

Database entry date

31/10/2006

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.