Studies on treatment
effects of psychodrama
psychotherapy
Speaker
Michael Wieser, assistant prof. Dr.
University of Klagenfurt.
Bologna process coordinator
Department of psychology.
Austria/Europe.
Contents
 Terms
 Starting
point
 Aim
 Sample
characteristics
 Method of description
 Results
 Summary
 Conclusion
Terms
 Psychodrama as
psychotherapy is based on
theories of spontaneity, creativity and action.
 ICD-10: International Classification of
Diseases, Version 10 of the WHO, chapter
F00-99 for mental and behavioural disorders.
 Meta-analysis: existing studies in treatment
effectiveness are systematically compared.
Starting point

Accredited by the government and social insurance
systems in Austria (Ottomeyer & Wieser, 1996), in
Hungary (Pintér, 2001), and by the European
Association of Psychotherapy (EAP; Wieser,
Fontaine, Tauvon & Teszary, 2004).
 In Germany there is documentation, (Burmeister,
Leutz, & Diebels, n.d.) but there are problems in
matching the mainstream standards in evidence-based
psychotherapy.
Starting point
 The
same with the meta-analysis developed by
Grawe, Donati & Bernauer (1994) in
Switzerland; preliminary acceptance by Swiss
Charta of Psychotherapy
 Meta-analyses conducted outside Germanspeaking countries (Kipper, 1978; Schramski,
& Harvey, 1983; Kellermann, 1987;
Greenberg, Elliot, & Lietaer, 1994; Kipper &
Ritchie, 2003; Elliott, Greenberg & Lietaer,
2004) point to problems with research design.
Aim
The
aim of this presentation is to
explore the kind of statistical
evidence which researchers have
for the effectiveness of
psychodrama psychotherapy.
Sample characteristics
 Existing
studies on the effectiveness of
psychodrama psychotherapy provided in
the literature
 Database: PsycINFO, PsyNDEX
 English and German
 several decades
Sample characteristics
 Age:
children, youths, adults, elderly patients
 Type of mental and behavioural disorders:
acute to chronic
 Treatment program: in- and outpatients,
prisoners
 Setting: individual, couple, family, group
 Length of treatment: one session, weekend,
marathon, long-term
Sample characteristics
 Comparative
studies: psychodrama
psychotherapy with other
psychotherapeutic methods or
pharmaceutical therapy
 Outcome studies
 Process research
 Cost efficiency analyses are unknown
Sample characteristics







Measuring instruments: none (at least systematic
self report, sociometry) to high standard tools
Drop out rate: all, should be noticed and reflected
Most of the patients must have a diagnosis (ICD10)
Mostly psychodrama psychotherapy, not self
experience
Manualized psychotherapy: mostly not
Publication: all kind
Sixty one studies included: Thirteen are
randomised clinical trials, sixteen are controlled
studies, thirty-two are naturalistic studies.
Method of description

Classification of the studies:
• Randomised clinical trial: two groups of patients
are chosen at random. One group is given
psychotherapeutic treatment, the other, for
example, has to wait.
• Controlled study: psychotherapy group is
compared with a non-treated group.
• Naturalistic study: normal psychotherapeutic
practice, single case study, systematic, and
controlled by qualitative and/or quantitative
methods
Method of description
Mostly includes “pre- and post” measures, partly
follow-up
 Effect size: not all necessary information is available
 Statistical significant results:
*
= p<0.05
** = p<0.01
*** = p<0.001 (permille)
****= p<0.0001
probability of error in percent

Results: F00-F09
 Organic,
including symptomatic, mental
disorders (ICD-10 F00-F09)
To date, no studies have been reviewed.
Results: F10-F19
 Mental
and behavioural disorders due to
psychoactive substance abuse (ICD-10 F10F19)
Five studies report positive results for adults
and two of them also for youths.
Results: F10-F19
Table 1. ICD-10 F10-F19 mental and behavioural disorders
due to psychoactive substance abuse
Study
Research
Measure
Findings
method
Mann & Randomized
Questionnaire,
Less cigarette
Janis
clinical trial, interview
consumption
(1968)
follow-up (2
after emotional
weeks, 18
role-playing*
months)
N=35: women;
young adults
Results: F10-F19
Zeng, H.,
Wang, P.,
Kong, Y.,
Jing, J.,
Li, L. &
Liu, H.
(2002)
Controlled
trial,
pre-post
N=224
Self-esteem
Investigations Scale
Significant
Improvement**
Results: F10-F19
Wood,
Del
Nuovo,
Bucky,
Schein &
Michalik
(1979)
Comparative
with small
group
psychotherapy;
matched with a
similar group
who did not do
psychodrama.
N=101;
age: 28;
98 men
Comrey
More trust*,
Personality Scales; emotional stability*,
and activity*
Mini Mult [short
more defensive**
form of MMPI
and controlled**
(Minnesota
Multiphasic
Personality
Inventory)]
State-Trait Anxiety N.s.
Inventory (A-State
Scale)
Results: F10-F19
Crawford
(1989)
Naturalistic,
post,
follow-up
(2 years)
N=47
Questionnaire
Great satisfaction
with psychodrama
led to good
alcohol/drug status*
Results: F10-F19
Waniczek,
Harter &
Wieser
(2005)
Naturalistic
retrospective
follow-up
(1-4 years);
comparison
Group
N=70;
comparison:
1663
EBIS-A-sheet
(EinrichtungsBezogenes
InformationsSystem);
SEDOS-inquiry-sheet
sheet (Stationäres
Einrichtungsbezogenes
DokumentationsSystem)
Abstinence
rate of
72.9%,
high
general
satisfaction
of
life**
Results: F20-F29
 Schizophrenia, schizotypal and
delusional
disorders (ICD-10 F20 - F29)
Seven of eight studies have good results even
with chronic schizophrenics and people with
delusions who are in short term psychodrama
psychotherapy.
Results: F20-F29
Table 2. ICD-10 F20-F29 schizophrenia, schizotypal and delusional
disorders
Study
Research method
Sturm &
Randomised
Stuart (1974) clinical trial;
psychodramabased role retraining and
remotivation
group; Self
created control
group (treatment
early terminators);
pre-post-test
N=32
Measure
Findings
Tape
recordings,
observers;
Inpatient
Presentableness
Scale,
raters
No changes in
feelings,
happiness,
thoughts,
and plans of the
five most regressed
patients on each
unit.
Results: F20-F29
Zhou &
Randomised SES (SelfTang (2002) clinical trial, Esteem
Scale)
pre-post
N=24
Age: 33
Increased**
FIS (Feeling Decreased**
of Inferior
Scale)
Results: F20-F29
Zhou & Gao
(2004)
Randomised
clinical trial,
pre-post
Trait-Anxiety
Inventory (TAI)
N=30
Self Acceptance Increased**
questionnaire
(SAQ)
Social
Avoidance &
Distress Scale
(SAD)
Reduced**
Reduced**
Results: F20-F29
Peters &
Jones
(1951)
Controlled Porteus Maze Difference in the post
Trial
Test Ages
scores of qualitative
errors**
N=21
MirrorImprovement
men
Tracing Test
Rorschach
No report
Draw-aNo report
Person Test
Gardner
No report
Behavior
Chart
Results: F20-F29
Jones & Controlled Qualitative
Peters
Trial
Maze scores
(1952)
N=32
Mirror Tracing
Age:
Test; Gardner
adults Behavior Chart
men
Rorschach Test
Draw-a-Man
Test
Picture Sorting
Test
Ratio of between groups
variance to within groups
variance**
Improvement*
Improvement*
N.s.
In favour of the control
group
Increase of affective
reactions
Results: F20-F29
Harrow
(1952)
Controlled trial,
Pre-post
N=29
Age: 20-35
men
Parrish
(1959)
Naturalistic
N=32
Age: 36.5
women
Role (action) test
Scale of realism*
Rorschach Test
Improvement
MAPS (Make-aImprovement
Picture Story Test)
Ward observed and
rated the behaviour
Counted the amount
of patients ready to
leave hospital
Improvement
Improvement
Results: F20-F29
Lee, S. F. C., Naturalistic
Chang, Y.-L.
& Liu, J.-C. N=18
(2007)
Age: 41.6
6 women,
12 men,
VideoInterview,
session
records,
Colaizzi key
words
Gain self
awareness,
interpersonal
skills, value
systems
Results: F30-F39
 Mood
(affective) disorders (ICD-10 F30-F39)
Three studies with good results have been
reported in this field
Results: F30-F39
Table 3. ICD-10 F30-F39 mood (affective) disorders
Study
Research method Measure
Findings
Pour Rezaeian,
Sen & Sen
Mazumdar
(1997)
Randomised
clinical trial
Better than a
psychiatric
group**
Not different
from a
combination
group
No report
BDI (Beck
Depression
Inventory)
N=54
Age: 21.5
men
MMPI
Results: F30-F39
Pour Rezaeian,
Sen Mazumdar
& Sen (1997)
Controlled trial
N=54
Men
SLSCT (Sentence Better than the
Completion
psychiatric
Test)
group**; equal
with the
combination
group
Ernst, Wiertz &
Sabel (1980)
Naturalistic
Questionnaire
N=13
Age: 18-42
7 women, 5 men
Sociometric
choices
increased**;
well being
improved
Results: F40-F48
 Neurotic,
stress-related and somatoform
disorders (ICD-10 F40 - F48)
In a total of twelve studies, more positive than
negative results are reported.
Results: F40-F48
Table 4. ICD-10 F40-F48 neurotic, stress-related and somatoform disorders
Study
Research method
Lapierre, Lavallée Randomised
& Tétreault (1973) clinical trial;
double-blind;
matched
N=24
Age: 19-51
12 women, 12 men
Measure
Findings
Wittenborn Rating
Scale;
Eysenck
Personality
Inventory;
Ad-hoc scale
Mesoridazine
(drug) group as
compared with the
placebo group had
less pronounced
affective
involvement in
psychodrama
psychotherapy*
Results: F40-F48
Kipper &
Giladi (1978)
Randomised
clinical trial
N=36
Age: 27
27 women,
9 men
STABS (Suinn
Test Anxiety
Behavior Scale)
Improvement***;
equally effective
as systematic
desensitization;
EPI-N scale
N.s. (normal
(Neuroticism
range from the
Scale of Eysenck beginning)
Personality
Inventory);
Background
information form
Results: F40-F48
Deng, Guo,
Wang, He, Li
& Jiang
(2004)
Randomised
clinical trial,
pre-post
N=60
Age: young
adults
25 women,
35 men
SCL-90
SelfAssessing
Scale
Improvement
**
Self-worth**
Results: F40-F48
Bendorf,
Doubrawa &
Klaffki (1976)
Controlled trial;
follow-up (3-6
months)
N=49
Age: 15-24
women
FPI (Freiburg
Personality
Inventory)
Nervousness**,
depression**,
sociability**,
selfconsciousness**;
extraversion*,
emotional
unstableness* and
masculinity*
Well Being Scale A normal
(Zerssen)
population
Interview, rating
(post)
scale
Results: F40-F48
Arn, Theorell,
Uvnäs-Moberg
& Jonsson
(1989)
Controlled trial,
pre-post.
follow-up (3
months, 3 years)
N=50, age: 47
33 women,
17 men
Schneider-Düker naturalistic,
(1989)
Comparative
N=23
Age: 22-44
13 women,
10 men
Symptom
questionnaire
Decrease of
worry and
tension*
SYMLOG
(System for the
Multiple Level
Observation of
Groups)
More difficult
for
psychotherapy
groups to enrich
the role
repertoires
Results: F40-F48
Eibach (1980)
Naturalistic;
Questionnaire
qualitative case
Study
After 2 years no
further
somatization in
the whole group
N=1, age: 45,
Men
Newburger
(1987)
Naturalistic
follow-up (7
months)
N=10,
young adults
Therapist rating All ten patients
symptom free
(post)
8 of 10 symptom
free (follow-up)
Results: F40-F48
Theorell,
Konarski,
Westerlund,
Burell,
Engström,
Lagercrantz,
Teszary &
Thulin (1998)
Naturalistic;
pre-post;
follow-up (half
year, 4 years)
N=24
Age: 22-58
22 women, 2 men
Self rating
General Health
Questionnaire
Blood test in
prolactine levels
In art therapy
anxietydepression
improved
Improved*
Psychodrama
better
than other kind of
art
therapy*
Results: F40-F48
Hudgins,
Drucker &
Metcalf (2000)
Naturalistic;
single case
study;
follow-up (6
weeks)
N=1
woman
Videotape,
evaluator
DES (Dissociative
Experience
Scale)
TSI (Trauma
Symptom
Inventory)
BDI
BSQ (Body
Sensation
Questionnaire)
Narrative writing
Improvement**
Improvement**
Improvement*
Improvement*
No report
Results: F40-F48
Lind, Renner & Naturalistic;
BSI
Ottomeyer
psychodrama
(2006)
& psychodynamic
imaginative trauma
therapy;
pre-post, follow-up
Emotional
N=12
and
Age: 18-29
Behavioural
women
Changes in
Psychotherapy
Questionnaire
(VEV)
Qualitative
inquiry
Decrease in
symptom**; GSI
pre-post g=2.2,
pre-follow-up
g=2.28 (very
strong effect)
Improvement***
Improvement
Results: F40-F48
Renner, Lind &
Naturalistic;
BSI
Ottomeyer (2008) psychodrama
& psychodynamic
imaginative
trauma
therapy, psychosocial
Emotional
intervention;
and
pre-post
Behavioural
Changes in
N=32
Psychotherapy
Age: 34.4
Questionnaire
women
(VEV-R-2001)
Decrease in
symptom**; GSI
pre-post d=1.65,
(very strong
effect)
Reliable Change
Index*
Recovery 38%
Positive response
66%
Improvement***
Results: F50-F59
 Behavioural syndromes
associated with
physiological disturbances and physical factors
(ICD-10 F50 - F59)
To date, no studies have been reviewed.
Results: F60-F69
 Disorders
of adult personality and behaviour
(ICD-10 F60-F69)
To date, no studies have been reviewed.
Results: F70-F79
 Mental
retardation (ICD-10 F70-F79)
Three studies report positive results but are
more a kind of social pedagogical
psychodrama.
Results: F70-F79
Table 5. ICD-10 F70-F79 Mental retardation
Study
Research method Measure
Findings
Strain (1975)
Naturalistic
Observer, raters
Sociodrama led
to more
engagement in
social play
afterwards
Observer
Improvements in
personality
development and
conflict solution
N=8
Age: 4
4 girls, 4 boys
Amesberger,
Fritsch,
Gisinger,
Siebert, Sotzko
& Weber (1993)
Naturalistic
Age: youths
Results: F70-F79
Amesberger
(1995)
Naturalistic
N=33
Age: youths
Observer,
Interview, rating
Improvements in
personality
development and
conflict solution
Results: F80-F89
 Disorders
of psychological development (ICD10 F80-F89)
To date, no studies have been reviewed.
Results: F90-F98
 Behavioural emotional disorders
with onset
usually occurring in childhood or adolescence
(ICD-10 F90-F98)
Two studies report positive results with
techniques related to psychodrama
psychotherapy.
Results: F90-F98
Table 6. ICD-10 F90-F98 Behavioural emotional disorders with onset
usually occurring in childhood or adolescence
Study
Research method Measure
Findings
Gelcer (1978)
Randomised
clinical trial
Improvement
with role-play**
N=30
Age: 8-15
9 girls, 21 boys
Dequine &
Pearson-Davis
(1983)
Controlled trial
N=14
Age: 12-17
RTT (Role
Taking Task);
BSAG-School
(Bristol Social
Adjustments
Guide)
Improvement*
NorwickiWith drama
Strickland
therapy, more
Personal
internal control*
Reaction Survey;
interview
Results: mixed groups
 Mixed
groups of disorders
Eleven studies report more positive results,
two also in individual modality. Steffan (2000)
compares psychodrama psychotherapy with
integrative psychotherapy, Anbeh and
Tschuschke (2001) with group analysis and
Tschuschke and Anbeh (2000) with eclectic
psychotherapy.
Results: mixed groups
Table 7. Mixed groups of disorders
Study
Research
method
Measure
Findings
Bender et al.
(1979)
Randomised AMDP (Working
Decrease pre-post*
clinical
Group for Methods
trial;
and Documentation
follow-up (9,
in Psychiatry)
10, 22
MMPI
Paranoia* and schizoid*
weeks)
SAF (Social
In the whole* and in the
Adjustment
scale leisure*
N=22
Questionnaire)
Age: 17-54
EWL (Adjective List) Emotional irritation*
11 women,
Giessen Questionnaire Social power (for
11 men
neurosis)
Results: mixed groups
Carpenter &
Sandberg
(1985)
Controlled
Trial
Jessness
Asocial Index
Reduction
between and
within
subjects**
High School
Personality
Questionnaire
Ego strength
between
subjects and pre
to post-test**
I-E(IntroversionExtraversion)
Scale
Became more
introverted**
N=17
Age: 14-16
Results: mixed groups
Bender et Naturalistic;
MMPI
al. (1981) comparative
EWL
pre-post; process,
follow-up
(three months)
N=10
Age: 34.8
6 women, 4 men
Bf-S (Well-Being
Scale)
SAF (Social
Adjustment
Questionnaire)
Giessen
Questionnaire
FPI
N.s.
Well-being*
(neurotics);
worsening*
(psychotics)
N.s.
N.s.
Amenability*
N.s.
Results: mixed groups
Bender et al.
(1981)
Naturalistic,
comparative,
pre-post,
process,
follow-up
(three months)
N=10
Age: 34.8
6 women, 4
men
AMDP 3
Goal Attainment
Scoring (100mm
line)
Therapy
Assessment
Scale
Video-recording
and
questionnaire
Psychopathology*
N.s.
N.s.
Protagonist
improvement*
Results: mixed groups
Herfurth Naturalistic;
(1999) follow-up (one
to three years)
N=6
Age: 44.5
3 women, 3 men
Problemcentred
interview
Questionnaire
Context
journal
Improvement
Role play
No report
Transfer
problems
Goals of the
clinic attained
Results: mixed groups
Lemke Naturalistic; Problem-centred
(1999) follow-up
interview
N=5
Age: 42.4
women
Improvement in
therapy success
(coping
strategies,
competency in
perception,
broadening the
room for action)
Results: mixed groups
Petzold et
al. (n.d.)
Naturalistic; prepost,
process; follow-up
(six months)
N=29
Age: 35
80% women
GSI-SCL-90R
IIP-C (Inventory
ES=0.63
ES=0.11
of Interpersonal
Problems)
Therapist
questionnaire
Therapy
assessment scale
Client
questionnaire
Relations
questionnaire
Session
questionnaire
Improvement
Improvement
Improvement
Improvement
No report
Results: mixed groups
Steffan (2000)
Naturalistic;
comparative,
pre-post
process
follow-up
(six months)
N=16
Age: 32.9
12.5% women,
87.5% men
Therapist
questionnaire
Client
questionnaire
GSI-SCL-90R
IIP-C
Therapy
assessment
scale
Relations
questionnaire
Session
questionnaire
Improvement
Improvement
ES=0.39
ES=0.52
Improvement
Improvement
No report
Results: mixed groups
Tschuschke Naturalistic;
and Anbeh comparative,
(2000)
pre-post
N=297
Age: 47.9
185 women,
112 men
IIP
GSI-SCL-90R
Therapy Goal
Attainment
Scale
GAF (Global
Assessment of
Functioning
Scale)
N.s., ES=0.22
Improvements,
ES=0.2
Improvements,
ES=0.9
Improvements,
ES=0.44
Results: mixed groups
Anbeh and
Tschuschke
(2001)
Naturalistic;
comparative,
pre-post
N=592,
Age: 37.9
382 women,
210 men
IIP
ES=0.57****
(p<0.0001)
GSI-SCL90R
ES=0.66****
Therapy Goal ES=2.32****
Attainment
Scale
GAF
ES=1.28****
Results: mixed groups
Tschuschke
and Anbeh
(2004)
Naturalistic;
pre-post
N=212
168 women,
44 men
IIP
GSI-SCL90R
Therapy Goal
Attainment
Scale
GAF
ES=0.47****
ES=0.55****
ES=1.55****
ES=1.18****
Mean
ES=0.94
Results: area of disorder unknown
 Area
of disorder unknown
Seventeen studies were included with more
positive results. Three investigated the
psychodramatic double technique. Petzold
(1979) is concerned with elderly people, and
two other studies deal with youths.
Results: area of disorder unknown
Table 8. Area of disorder unknown
Study
Research
method
Measure
Findings
Kipper &
Ben Ely
(1979)
Randomised
clinical trial
N=64
Youths
32 women,
32 men
Modified
Accurate
Empathic
Scale
After a roleplaying
procedure,
differences***
Results: area of disorder unknown
Hudgins &
Kiesler
(1987)
Randomised IMI (Impact
clinical
Message
Trial
Inventory)
N=16
Age: 19-25
women
Effects***,
postive impacts;
RI (Relationship higher empathic
Inventory)
understanding**
Videofeedback
(Likert scale)
interviewer
statements got
more accurate*
REV(Revealingness Scale)
Higher scores**
Results: area of disorder unknown
Joyce,
Dyck,
Prazoff,
Shen &
Azim
(n.d.)
Controlled
trial
pre-post,
process,
follow-up (6
months)
N=65
Age: 30.6
SCL-90, SASSR, I-E, PO,
VO,
TGSS, own
questionnaire,
SEQ, GAS,
CFQ
Paranoid
ideation*,
anxiety*,
GSI**,
SAS*,
TGSS**,
Coping*,
feeling*,
arousal*,
GAS*
Results: area of disorder unknown
Role
Culbertson Controlled Own
attitude
players***,
(1957)
Trial,
comparison measure,
Observer
observers**
Pre-post,
(16pt scale)
process
N=95
Young
adults
Results: area of disorder unknown
Schönke Controlled
(1975) Trial
Pre-post
N=12
Young adults
6 women,
6 men
FPI,
ENNR,
MAS, FSE,
SED, own
instrument
Aggression*
(neg.),
calmless**
(neg.),
dominance*,
rigidity*,
sociability*,
openness*,
extraversion*
Results: area of disorder unknown
Petzold Controlled
(1979) Trial
retrospect
N=40
Age: 72.8
21 women,
19 men
Social Consistency
atom no significance
counted
Results: area of disorder unknown
Schramski, Controlled Trial
Feldman, Comparison
Harvey & Pre-post
Holiman
(1984)
N=66
Age: 23
men
Correctional
***
Institutions
Environmental
Scale (CIES),
SCL-90R,
Group
Environment
Scale (GES)
**
**
Results: area of disorder unknown
Toeman (1948)
O´Connell & Hanson (1970)
Ploeger, Seelbach & Steinmeyer
(1972)
Enke (1984)
Schmidt (1980)
Ernst (1989)
Geßmann (1994, 1995)
Baim, Allam, Eames, Dunford &
Hunt (1997, 1999)
Naturalistic
Summary
Table 9: overview: studies on treatment effects
of psychodrama psychotherapy
ICD-10
Method
RCT
CT
Naturalistic
F00-09
F10-19
1
2
2
F20-29
3
3
2
F30-39
1
1
1
F40-48
3
3
6
Summary
ICD-10
Method
RCT
CT
Naturalistic
F50-59
F60-69
F70-79
3
F80-89
F90-98
1
1
Mixed
1
1
8
Summary
ICD-10
F00-09
F10-19
F20-29
F30-39
F40-48
Findings
Negative
Equal
Positive
1
12
3
4
9
10
3
25
Summary
ICD-10
Findings
Negative
Equal
Positive
F50-59
F60-69
F70-79
F80-89
F90-98
Mixed
3
1
8
22
Conclusion
 Fill
the gaps
 A strong need for a consensus on the kind of
measurement instruments
 Improve the research quality
References

Wieser M. (2004). Wirksamkeitsnachweise für
die Psychodrama-Therapie [Proof in
effectiveness of psychodrama therapy]. In J.
Fürst, K. Ottomeyer, & H. Pruckner (Eds.),
Psychodrama-Therapie. Ein Handbuch
[Psychodrama therapy. A handbook] (pp. 427446). Vienna: Facultas.
 Wieser, M. (2007). Studies on treatment effects
of psychodrama psychotherapy. In C. Baim, J.
Burmeister, & M. Maciel (Eds.), Psychodrama.
Advances in Theory and Practice (pp. 271-292).
London: Brunner/Routledge.

Thank you for your attention and I am looking
forward to your questions.

Obrigado!

Homepage:
http://www.uni-klu.ac.at/~mwieser