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CBT Group Therapy
Transcript of CBT Group Therapy
Considerations Adam Barboff, Lacey Weber,
& Lauren Guillory Cognitive Behavioral Therapy
Approach to Group
- a good working relationship is necessary but not sufficient as a condition of change
- a collaborative partnership is created that is flexible & versatile
- CBT therapists must be able to use different therapy styles and techniques and willing to adjust interventions Characteristics of a CBT Group
- Active, directive, detailed, concrete, problem oriented, short term & structured
- Time limited with short term interventions aimed at problem solving
- Members are urged to take responsibility for their progress by role playing inside of therapy and experimenting outside of therapy Assumptions of CBT Group Therapists
CBT therapists "must be skilled technicians who also possess the human qualities that lead to the climate of trust and care necessary for the effective application of these therapeutic techniques" Role of CBT Group Therapists - Leaders are teachers who encourage members to learn and practice social skills that can be applied in everyday life
- Model active participation and appropriate behaviors
- Observe and assess behaviors that are related to problems so as to facilitate change
- When members identify behaviors they wish to change or enhance, interventions are created to model skills
- Reinforcement even for small behavioral change
- Emphasize an active plan for change- insight is not enough from a CBT perspective
- Early preparation for termination Group Counseling Assessment Heavy Behavioral Assessment- a set of procedures used to obtain information that will guide a specific treatment plan for each client and will help measure effectiveness 1. Gather unique and detailed info about the clients problem
2. Focuses on the clients current functioning and life conditions
3. Concerned with the client's behaviors in various situations and typical functioning
4. Narrow focus
5. Is integrated all throughout therapy CBT Group Stages Initial stage: collaborative empiricism, initial interview, given explanation of CBT and time limit, CBT relies on techniques that are proven to be effective, learn how the group functions, establish cohesion and trust,
Working Stage: modeling, rehearsing, coaching, homework, feedback, reinforcement, cognitive restructuring, problem solving, the buddy system
Final Stage: feedback, identify effective behaviors, apply changes, possible set backs, review group experience Modeling Behavior Rehearsal Coaching Homework Feedback Reinforcement Cognitive Restructuring Problem Solving Buddy System Schools AODA Women with Eating Disorders PTSD Children with Autism and Anxiety Female Adolescents with Social Phobia Advantages Aaron Beck The client learns through observation and imitation of the leader and members in the group. This is the process of practicing a new behavior in group that will be used in everyday life. This is where the general guidelines are laid out to help bring about a particular action in the client. - Easy to understand, adaptable
- Short, brief, structured
- Remediation and prevention
- Emotional/behavioral self-control, coping and acceptance skills, empowerment, interpersonal and self-management skills, etc. - 150 participants assigned to either CBGT or individual CBT
- Both groups presented similar levels of drug consumption, dependence and associated problems at follow-up. Group treated participants reported slightly higher levels of alcohol consumption at baseline and follow-up.
- Alcoholics in group tended to have higher compliance with treatment
- Ultimately, there was no statistically significant different found in effectiveness between group and individual treatments for this population - 38 women (half in group treatment, half in waitlist control group) were looked at in regards to body image, adherence and satisfaction with treatment
- Psychoeducation, self-monitoring, systematic desensitization, cognitive restructuring
- Women in group reported less depression and eating disorder pathology, intervention was well received and highly acceptable - Meta-analysis that included 651 participants with PTSD comparing effectiveness of CBGT with individual therapy as well as looking at the effects of in-session imaginal exposure
- Attrition rates were similar, may not be as effective as individual
- Authors suggest that there’s not enough research on this topic and that the use of exposure-based CBGT is a promising treatment option for PTSD - 50 children with high-functioning autism and anxiety were randomized into either CBGT or TAU for 12 weeks.
- 50% in the CBGT group had a “clinically meaningful positive treatment response” compared to just 8.7% in the TAU group - 35 participants with social phobia randomly assigned to treatment or no treatment
- Assessments at baseline, after treatment, and one year follow up
- 16 weeks of group therapy showed significant improvement in reduction of symptoms of social anxiety right after therapy. However, there were no significant differences found between the two groups at the one year follow up - Psychoeducational, active, short, structured, task oriented
- Uses client’s belief system, can be individualized
- Acknowledges cultural/outside influences, teaches empowerment and inner resources for change, learn skills for everyday life Disadvantages - May not be good for cultures that value subtle communication, interdependence
- Assertiveness training may be difficult for some populations
- Asian population—deference to authority, interpersonal harmony, modesty, avoidance of public shame
- Chinese population—traditional, being assertive can lead to problems, children expected to be obedient This is a key element in CBT putting into action what the learn in group. They can apply the skills they learned in group to the real world. Group members practice a new behavior and they are able to obtain reactions that evaluate how they are doing. "Refers to a specified event that
strengthens a tendency for a response to be repeated." This is one of the main concepts of CBT. Identify and replace negative thoughts and patterns with more realistic, appropriate, and adaptive thoughts. The main goal of problem-solving therapy is to find the best way to solve their problem and provide cognitive and behavioral methods to help them overcome challenges and hurdles in the future. A client is assigned or chooses another person in the group to help them observe and guide them through the healing process. Create an Arousal Hierarchy Rank anxiety from least stressful to most stressful Learn Relaxation Techniques Muscle Relaxation
Meditation Perform a Risk Appraisal ID the client's sense of threat and means they have to rise above those pressures Acquire Knowledge through Psychoeducation Example: Education on the composition of panic attacks or anxiety Barrera, T.L., Mott, J.M., Hofstein, R.F. & Teng, E.J. (2013). A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clinical Psychology Review, 33(1), 24-32.
Bhatnagar, K.A., Wisniewski, L., Solomon, M. & Heinberg, L. (2013). Effectiveness and feasibility of a cognitive-behavioral group intervention for body image disturbance in women with eatingdisorders. Journal of Clinical Psychology, 69(1), 1-13.
Corey, G. (2008). Theory and practice of group counseling. (eighth ed.). Belmont: Brooks/Cole.
Hayward, C., Varady, S., Albano, A.M., Thienemann, M., Henderson, L. & Schatzberg, A.F. (2000). Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 39(6), 721-726.
Lillian Huang, C., & Lehman, J. (2007). Eating Disorders and Body Image Concerns in Asian American Women: Assessment and Treatment from a Multicultural and Feminist Perspective. Eating Disorders, 15(3),217-230. doi:10.1080/10640260701323474
Marques, A.C. & Formigoni, M.L. (2001). Comparison of individual and group cognitive-behavioral therapy for alcohol and/or drug-dependent patients. Addiction, 96(6), 835-846.
Reaven, J.R., Blakeley-Smith, A., Culhane-Shelburne, K. & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410-419.
Yalom, I. (2005). The theory and practice of group psychotherapy. (5th ed.). New York: Basic Books. References CBGT has been used to treat ...
- Medical Issues
- Eating Disorders
- Military Veterans
- Students Marques et al, 2001 Bhatnagar et al, 2013 Barrera et al, 2013 Realen et al, 2012 Hayward et al, 2000 Strengths - Education AND prevention
- Specific, problem-oriented, brief
- Empirically supported
- Positive Reinforcement from Group
- Wide range of techniques Limitations - May be too structured
- May be too rigid
- May overlook problems origins Populations That May Not Benefit/ Other Disadvantages - Those looking for insight may be unsatisfied with CBT. Those who seek CBT may often be uncomfortable with insight centered therapies
- Long term Change is unknown
- CBT is recommended for moderate depression
- May be bias in the studies of CBT effectiveness
- CBT patients are often selected from depressed patients with little to no other mental issues.
http://www.integratedsociopsychology.net/cbt.html Corey & Corey, 2006 QUESTIONS?