Psychodrama: implementation, study design and effectiveness: a systematic review

Psychodrama is a psychotherapy model in which action-focused techniques are used to improve the quality of life of patients. A systematic review of the psychodrama interventions published between 2018 and 2022 is carried out in order to recognize the implementation of psychodrama (population, objectives, theoretical model, modality, intensity, periodicity, duration of sessions, psychodramatic techniques, and sistematization); to analyze the methodological design for evaluating the impact of psychodrama interventions (study design and RCT); and to consider the results of the effectiveness of psychodrama.

Following the PRISMA declaration protocol, 27 indexed studies have been selected in three databases: PsycINFO, Scopus and Medline. The selected articles met the following inclusion criteria: peer-reviewed papers, written in English, empirical studies, including quantitative, qualitative, or mixed-methods research, corresponding to interventions or treatments based on psychodrama and evaluating the effectiveness of the interventions with 10 participants in pretest-posttest.

In relation to the implementation, psychodrama was applied in a group format with diverse population, especially adolescents and adults, and most of the interventions were implemented weekly (8-13 sessions) and lasted approximately two hours. Generally, these interventions were based on Morenian Psychodrama. Role reversal, doubling and mirror were the techniques most used. No manualized psychodrama treatments were reported. In relation to study design, 62% were evaluated using a quantitative design, 27% with mixed methods, and 11% with a qualitative evaluation. 26% included follow-up assessment. The number of randomized controlled trials (RCTs) is low (11%), mostly detecting quasi-experimental controlled studies (48%) and single group studies (40%). In relation to the effectiveness of psychodrama, positive and significant results were found, for example, in the reduction of post-traumatic stress levels, the empowerment of women in vulnerable situations, improvement in the quality of life and symptoms of patients with schizophrenia, or improvement in antisocial behavior in adolescents. In 40% of the studies, effect sizes were reported, which were typically medium or large. However, the sample size was small for drawing solid conclusions. 22% of the studies did not find significant changes in any dimension. No iatrogenic effects were found.

This data supports the implementation of Morenian Psychodrama in group format across a wide variety of populations, although there are no clear profiles that have a greater impact. However, the methodological design of psychodrama needs improvement: RCTs and quasi-experimental designs, larger sample sizes, follow-up evaluations, and effect size measurement. Additionally, structuring interventions and their manualization in specific populations can help establish evidence-based treatments.