# An Action-Based Psychosocial Group Intervention in Psychiatric Inpatient Care: A Pragmatic Add-On Study to Talk-Based Psychotherapy

## TL;DR

A study found that adding action-based group therapy (psychodrama) to standard talk therapy in psychiatric hospitals is feasible and may help patients with emotional and behavioral needs during acute crises.

## Contribution

The study demonstrates the practical feasibility of integrating psychodrama as an action-based add-on to standard inpatient talk-based psychotherapy.

## Key findings

- Both groups showed symptom reductions, but no significant differences were found between psychodrama plus TBP and TBP alone.
- Psychodrama was found to be a viable, real-world add-on intervention for acute psychiatric inpatient care.
- The intervention allowed for the observation of symptom trajectories under real-world constraints.

## Abstract

What are the main findings?
An action-based psychosocial group intervention (psychodrama) was feasible to deliver as a pragmatic add-on to routine talk-based psychotherapy (TBP) in an acute inpatient setting, allowing for the exploratory observation of symptom trajectories under real-world constraints.While exploratory observations noted pre-to-post changes in internalizing and depressive symptom scores, between-group comparisons did not show statistical differences compared to TBP alone; however, the results support its practical viability as an additional clinical option.

An action-based psychosocial group intervention (psychodrama) was feasible to deliver as a pragmatic add-on to routine talk-based psychotherapy (TBP) in an acute inpatient setting, allowing for the exploratory observation of symptom trajectories under real-world constraints.

While exploratory observations noted pre-to-post changes in internalizing and depressive symptom scores, between-group comparisons did not show statistical differences compared to TBP alone; however, the results support its practical viability as an additional clinical option.

What are the implications of the main findings?
MDT co-facilitation of psychodrama broadens feasible psychosocial pathways, particularly for inpatients who may have difficulty sustaining exclusively verbal engagement during acute crises.Embedding action-based modalities alongside routine TBP may support MDT coordination and implementation of diversified, patient-centered psychiatric rehabilitation pathways within real-world ward workflows.

MDT co-facilitation of psychodrama broadens feasible psychosocial pathways, particularly for inpatients who may have difficulty sustaining exclusively verbal engagement during acute crises.

Embedding action-based modalities alongside routine TBP may support MDT coordination and implementation of diversified, patient-centered psychiatric rehabilitation pathways within real-world ward workflows.

Background/Objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined the feasibility and implementation of psychodrama as a pragmatic add-on to routine inpatient TBP under real-world ward conditions. Methods: A quasi-experimental pragmatic add-on design was used (N = 84). All participants received routine TBP; the experimental group (n = 47) additionally participated in psychodrama co-facilitated by a multidisciplinary team (MDT). Outcomes were assessed using the ASEBA-ASR. Non-parametric tests with effect sizes and 95% confidence intervals were used to evaluate pre–post symptom changes over four weeks, and between-group differences were assessed using change-score comparisons. Results: Both groups demonstrated significant within-group symptom reductions following the intervention. However, between-group comparisons of change scores showed no statistically significant differences (all p > 0.05), with small effect sizes and confidence intervals including zero. Conclusions: Psychodrama appears feasible to implement as an action-based psychosocial add-on in acute inpatient settings. Although statistical superiority over TBP alone was not demonstrated, the intervention allowed for the characterization of symptom trajectories under real-world constraints, suggesting that psychodrama may represent an action-based option to diversify psychosocial pathways within MDT-delivered care. Future adequately powered studies are needed to examine how action-based modalities may fit within multidimensional, complexity-informed inpatient care pathways.