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Cognitive Behavioral Group Therapy

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Jessica Clay

on 6 November 2013

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Transcript of Cognitive Behavioral Group Therapy

What is Cognitive-Behavioral Therapy (CBT)?

CBT For Substance Abuse Overview
Substance Abuse is defined as excessive use of potentially addictive substances, such as alcohol and drugs
CBT strategies are based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role
Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse
CBT is structured, goal-oriented, and focused on the immediate problems faced by cocaine abusers entering treatment who are struggling to control their cocaine use
CBT helps patients recognize, avoid, and cope. They recognize the situations in which they are more likely to abuse substances, avoid these situations when appropriate, and cope more effectively with problems and behaviors associated with substance abuse

Group CBT For Body Dysmorphic Disorder
Adolescent Group CBT Overview
Adolescent Group CBT is designed to improve communication skills with others.
Help in dealing with fears.
Build trust for authorities if traumatized.
Interrupt thoughts that lead to addictive or other self-destructive behaviors.
Improve self esteem
Identify positive responses to stress.
Change negative thought patterns.
A group is also capable to reach a large number of adolescents at one time.

Family- based CBT overview
Both children and caregivers learn about how their thoughts, feelings, and behaviors are connected and how to change thoughts and behaviors to change negative patterns.
Families learn how to communicate their feelings and thoughts effectively.
Parents learn how to support and encourage their child to face their fears and master their anxiety.
Parents learn strategies to manage their child’s anxiety without giving in to their child’s unrealistic fears.
Families learn problem solving strategies that increase adaptive coping and decrease manipulative patterns.

Presented by:

Kristine Polevacik
Jessica Clay
Stephanie Hathorn
Verna Rodriguez

CBT is based on the concept that changing negative thinking patterns and self-defeating behaviors can have a powerful effect on a person’s emotions.
Together with a therapist, clients examine all elements that maintain a problem, including their thoughts, feelings, and behaviors.


help clients develop coping skills that enable them to be more in control of their thoughts (that’s the cognitive part) and their actions (that’s the behavioral part).
recognize that those suffering from excess anxiety tend to focus on, and exaggerate, the frightening aspects of certain situations, so they help them gain a more realistic perspective in order to decrease their anxiety.
know that individuals with anxiety often avoid situations they fear, and that avoidance often makes things worse by prolonging anxiety. Therefore, CBT therapists help the client overcome avoidance by gradually helping them face their fears.

Cognitive Behavioral Therapy

Group treatment programs successfully help patients coping with anxiety and several related problems.
Within the group format, individuals learn how to manage their behaviors using cognitive behavioral strategies, while gaining support and encouragement from others who are coping with similar difficulties.


These four types are:
Family-based CBT
CBT for body dysmorphic disorder
CBT for substance abuse
CBT for adolescent behavioral disorders
Description of family-based CBT sessions
School aged children (5-18), adult children, and their parents or caregivers participate in separate but coordinating therapy sessions, often using somewhat parallel treatment materials.
In addition, children and parents attend joint sessions together at various times throughout treatment.
This approach seeks to address individual and parent-child issues in an integrated fashion.
Family-based CBT elements include:
Conducting a family assessment using multiple methods and identifying family treatment goals.
Encouraging a commitment to increasing the use of positive behavior as an alternative to the use of force.
Conducting a clarification session in which the caregiver can support the child by providing an apology, taking responsibility for the abuse/conflict, and showing a commitment to safety plans and rules in order to keep the family safe and intact.
Training in communication skills to encourage constructive interactions.
Training in nonaggressive problem-solving skills with home practice applications.
Involving community and social systems, as needed.

Effectiveness of CBT Family Therapy:

During the past four decades, many of the procedures incorporated into CBT have been evaluated by outside investigators as effective in:
Improving child, parent, and/or family functioning
Promoting safety and or/ reducing abuse risk or re-abuse among various populations of parents, children, and families
These procedures have included the use of stress management and anger-control training, cognitive restructuring, parenting skills training, psychoeducational information regarding the use and impact of physical force and hostility, social skills training, imaginal exposure, and family interventions focusing on reducing conflict.


Limitations of Family Cognitive Behavioral Therapy:

Parents with psychiatric disorders that may significantly impair their general functioning or their ability to learn new skills.
Children or parents with very limited intellectual functioning, or very young children, may require more simplified services or translations of some of the more complicated treatment concepts.
Children with psychiatric disorders such as significant attention-deficit disorder or major depression may benefit from additional interventions.
Sexually abused children may respond better to trauma-focused therapy.

How can Group CBT help this family?
What is BDD?
BDD Group CBT Overview
Cognitive behavioral models of BDD show that individuals with the disorder tend to:

focus on minor details in their appearance
base their self worth on the way they look
react to perceived flaws with strong negative emotions
avoid social situations
attempt to neutralize negative feelings with ritualistic behaviors (eg, mirror checking)

Group CBT aims to:

target dysfunctional BDD related thoughts and behavior patterns through psychoeducation, cognitive restructuring and exposure with response prevention

Treatment was provided in groups of up to five patients and one therapist
Eight weekly 2-hour sessions were held
Subjects were provided with a CBT audiotape program on body image therapy for structured homework assignments.
Therapy begins with an explanation of BDD.
The therapist helps subjects identify the developmental, sociocultural, familial, and immediate sources of body image distress.
Subjects share their distress with group members, and they then receive objective feedback regarding their perceived defect
“For example, subjects with exaggerated complaints of excessively large thighs or facial features estimated the size or shape of the distressing part with drawings or moveable markers. These subjective perceptions were compared with actual size or shape using anthropometric calipers or silhouettes drawn by other group members. Subjects then rehearsed more accurate representations of their appearance defects.”
Exposure therapy, thought stopping, and relaxation were used to alleviate distress
Subjects are taught to refrain from critical self talk and to substitute more objective sensory descriptions of their body
Subjects keep a body image diary and track the effect of body image thoughts on mood and behavior
Exposure therapy techniques such as wearing more form-fitting clothes instead of hiding in baggy clothing, not hiding facial features, and physical proximity are all practiced in the group setting first

Summarized Description of
Group BDD CBT Session
based on “Cognitive-Behavioral Body Image Therapy for Body Dysmorphic Disorder” by James C. Rosen, Jeff Reiter, and Pam Orosan, University of Vermont

What do CBT therapists do?
Advantage of Group CBT
Lets explore four different types of Cognitive-behavior therapy!
According to a 2013 review of Group BDD
efficacy:
“Individuals in the treatment group showed statistically significant decreases in severity of BDD symptoms, as compared with patients on the waiting list, who did not receive any type of treatment."
Post-treatment measures revealed that symptoms of BDD ... decreased significantly in 82% of cases"
... we found two studies on group CBT in BDD… and both studies supported the efficacy of group CBT in BDD”.
According to the 1995 Study:
"...patients inspired each other to complete homework and invest themselves in therapy at times when they felt like dropping out."
it seemed therapeutic for the subjects to observe other women conquer the same type of maladaptive beliefs about appearance
and self-worth that they held themselves.
According to Rosen's Study:
Treatment is not uniformly effective
Some patients need longer, more intensive treatment with supervised exposure outside of the group
Research comparing the use of SSI only versus Group CBT is needed

Effectiveness
Limitations
Functional Analysis
•The therapist and patient identify the thoughts, feelings, and circumstances that put the patient at a high risk for substance abuse
•Analysis is done throughout therapy cycle to identify situations that are continuing to trigger abuse

Skills Training
•Individuals learn healthy and constructive coping skills that help prevent substance abuse
•Training begins with a focus on situations that are directly linked to abuse
•Once skills are learned to cope with specific situations, the training broadens to new coping skills that may indirectly lead to substance abuse

CBT for Substance Abuse Treatment Components

Cognitive Behavioral Group Therapy
CBGT, although leader directed, strives to change negative thinking patterns using the expertise of the group as a motivation for change
The group discusses what types of thinking patterns lead to abuse and try to correct each other’s inaccurate ways of thinking
The group also works through triggers to abuse and coping strategies leading away from temptation

CBT for Substance Abuse Group Sessions

Research indicates that the skills individuals learn in CBT remain after the completion of treatment
CBGT has proven especially beneficial for teens in substance abuse recovery programs
When it is combined with medication, the result is better than medication or CBT alone

CBT works best with voluntary patients. If someone chooses therapy only to avoid prison, they are not likely to improve
There are some conditions where CBT alone is not effective – a patient may require other types of psychotherapy

Effectiveness
Limitations
CBT approach at a Substance Abuse Recovery Center
Adolescents are ages between 12 to 17 years.
Adolescents may attend joint sessions that are eight 90 minute weekly sessions followed by six monthly sessions.
This approach is goal-oriented and helps adolescents set goals, plan ways to achieve those goals, and check progress.
The therapist works with the adolescents to identify problems and what exactly needs to change.

Description of Group CBT for Adolescents
Conducting an Adolescent assessment using multiple methods and identifying treatment goals.
Involving homework related to behavior as needed.
Gaining support and encouragement from others who are coping with similar difficulties.
Encouraging a commitment to increasing the use of positive behavior as an alternative to the use of force.
Designed to help patients understand how their thoughts and attitudes affect how they feel.
Individuals learn how to manage their anxiety using cognitive behavioral strategies.
Training in nonaggressive problem-solving skills with home and school practice applications.

Adolescent Group CBT
Elements
Effectiveness
Limitations
One of the most effective treatments for conditions of anxiety or depression.
The most effective psychological treatment for moderate and severe depression.
It’s as effective as antidepressants for many types of depression.
Used widely in youth justice and in the probation and prison services.
Effective with juvenile and young adult offenders.
Most effective in reducing further criminal behavior than any other intervention.
CBT can help restructure distorted thinking and perception.

CBT is not a quick fix.
In a group session it can be difficult to concentrate and get motivated when feeling low.
Must confront anxiety with group, so may lead client to feel more anxious.
Group CBT is NOT for everyone.

Examples of Adolescent who can benefit from group CBT
An 11 year old who’s mother left him and siblings with grandmother unexpectedly one day.
A 12 year old girl who heard on the news in February 2013 that they found her mother dead in a hotel.
A 13 year old depressed that parents were discussing about a divorce.
An insecure adolescent with anger problems.

Application of Adolescent Group Therapy
What elements of CBT do you see in this video?
Dr. Aaron Beck Discusses CBT for Adolescents
Summary
Group CBT stresses the importance of building trust and facing fears on a regular basis. The more you practice, the faster you’ll trust, and your fears will fade! Having success and feeling good about your progress is a powerful motivator to keep going.


References
Full transcript