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Cognitive Behavioral Group Therapy

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Kat Palmer

on 14 June 2013

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Transcript of Cognitive Behavioral Group Therapy

Group Counselling
Cognitive Behaviour Therapy
Cognitive Behavioral Therapy in Group Counselling
Presented By: Kathryn and Jenn
Cognitive Behavioral Therapy

- CBT is a structured, goal-oriented, and action-focused therapy based on psycho-educational principles

- Based on the early works of Aaron Beck and Albert Ellis

- Three important constructs: Thoughts, behaviours, and emotions
An Overview
- short term, and encourages goal setting, concrete plans of action, and homework
- Dysfunctional or maladaptive thoughts, behaviours, and emotions are learned processes that can be modified in order to improve functioning
- Psychological distress occurs due to maladaptive cognitions, resulting in disturbances in emotion and behaviour
- Present-focused and empirically supported
Overview (Continued...)
Goals of CBT in Group Work
Traditionally meant for individual counselling; however, group counselling has a number of benefits. Goals include:
- Provide opportunities for group
members to observe others' models
of behaviour
- Provide exposure to social situations and for members to provide feedback
"...member-to-member interaction is a primary mechanism of change"
- Raise awareness of own patterns based
on others and test new learned/modified
behaviours in a controlled environment
- Learn cognitive errors made by the self
and others and address them within the group
Roles and Functions of the Leader in Group CBT
Therapeutic Alliance: Collaborative with direction
- Psycho-education of adaptive vs. maladaptive behaviours (interactive)
- Homework: assigned so groups can practice their skills and relate their experiences of doing so with one another
- Introducing in-group activities and exercises (active not passive)
- Keep solution focus and engage group members to participate
- Instill skills training in each group member and tools to become their own therapist
Depression
Specific Areas of Population and Application for which CBT is best suited
- Evidence indicates benefits of CBT for depression. Outcome studies suggest that CBT is at least as effective as pharmacological intervention and may be even more effective in preventing relapse of depression than phamachotherapy alone.
Anxiety
- CBT has also been proven to be effective particularly for clients suffering from anxiety disorders (Panic disorder, PTSD, GAD, OCD, and social anxiety)
Corey, Corey, & Corey, 2014; Beck & Weishaar, 2011.
Corey, Corey, & Corey, 2014; Beck & Weishaar, 2011
Bieling, McCabe & Antony, 2006
Bieling, McCabe & Antony, 2006
Crosby & Altman, 2012; Stewart & Chambless, 2009
Process vs. Technique
Technique: Tools and strategies used by group members that are learned through psych-education; any strategy designed to change thought, emotion, and behaviour.


Process: Interpersonal interactions among group members with one another, and with the group leader
Discussion Question:
What are some possible mistakes that you think CBT group therapists could make?
References
Beck, A.T., & Weishaar, M.E. (2011). Cognitive therapy. In R. Corsini & D. Wedding (Eds.), Current Psychotherapies (pp. 276-309). Belmont, CA: Brooks/Cole.

Bieling, P. J., McCabe, R. E., & Antony, M. M. (2009). Cognitive-behavioral therapy in groups. The Guilford Press.

Burlingame, G. M., MacKenzie, K. R., & Strauss, B. (2004). Small group treatment: Evidence for effectiveness and mechanisms of change. Handbook of psychotherapy and behavior change, 5, 647-696.

Corey, M. S., Corey, G., & Corey, C. C. (2014). Groups: Process and practice. Brooks/Cole Publishing Company. 9th

Crosby, G., & Altman, D. (2012). Integrative cognitive behavioral group therapy. In J. L. Kleinberg (Eds.), The Wiley-Blackwell Handbook of Group Psychotherapy (pp. 89-112). John Wiley & Sons, Ltd.

Hackney, H. L., & Cormier, S. (2013). The professional counselor: A process guide to helping. New Jersey: Pearson Education, Inc.

Stewart, R. E., & Chambless, D. L. (2009) Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology. 77(4), 595-606.

Whalley, M. (2013). CBT thought record. Psychology Tools. Retrieved from: http://www.psychologytools.org/download-therapy-worksheets.html
Therapeutic outcome in CBT groups is determined by formal CBT strategies and the small-group process present in the group context

Critical factors: group development, therapeutic factors, degree and timing of group feedback, and interpersonal feedback
Burlingame, MacKenzie, & Strauss, 2004; Bieling, McCabe & Antony, 2006
Bieling, McCabe, & Antony, 2009; Beck & Weishaar, 2011.
Therapist and patient work collaboratively to examine thoughts and experiences, jointly set treatment goals, provide feedback, and demystify how therapeutic change occurs.
Collaborative Empiricism
Line of questioning that results in a
logical conclusion about one’s experience.
Socratic Dialogue
Therapist helps patient understand the meaning of thoughts and problems in logic from which they learn new ways of thinking, acting, and feeling.
Guided Discovery
1. Collaborative Empiricism

2. Socratic Dialogue

3. Guided Discovery
Fundamental Concepts
GROUP
Relationship expands between group members
Role of Therapist: Modeling, Reflection, Summary
1. Clarify or define problems.

2. Assist in the identification of thoughts, images, and assumptions.

3. Examine the meanings of events for the patient.

4. Assess the consequences of maintaining maladaptive thoughts and behaviors.
GROUP
More complex questioning process between multiple individuals
Role of therapist: Open-ended questions
Purposes of Therapist’s Questions:
GROUP
Role of therapist: lead exercises and examples
--> Use judgment in accepting examples from the group
1. Connecting thoughts to situations and affect.

2. Evidence gathering to become more objective about one’s thoughts.

3. Use of experiments.

4. Exploring underlying beliefs and assumption.
Cognitive Techniques
Elicit automatic thoughts
Examine connection between “inner dialogue” and affective reactions
-->Homework (thought records) or recall situations
1. Connecting Thoughts to Situations and Affect
http://www.psychologytools.org/download-therapy-worksheets.html
Example Thought Record
Socratic Dialogue--> question automatic thoughts
Not about invalidating thoughts but rather examining objectively and nondefensively
2. Use Evidence Gathering to Examine Thoughts
Bieling, McCabe, & Antony, 2009
3. Experiments
Bieling, McCabe, & Antony 2009; Beck and Weishaar 2011; Corey, Corey, Hackney & Cormier, 2013.
Emotional rule
Decatastrophizing (Downward arrow): if...then
Ex- ‘If I make a mistake at work, I am a failure’ or ‘If my children do not listen to me, then they do not love me.’
Cognitive restructuring
4. Explore Underlying Beliefs and Assumptions
Bieling, McCabe, & Antony, 2009.
Example: Panic Attack Record
Behavioral Self-Monitoring
Social Skills Training

Problem-Solving Training

Relaxation Training

Mindfulness-based
meditation
Other Behavioral Techniques
Bieling, McCabe, & Antony, 2009; Beck and Weishaar 2011; Hackney & Cormier, 2013.
Exposure-based strategies:
In Vivo exposure
Role-play
Simulated exposure
Imaginal exposure
Symptom exposure
Behavioral Techniques
GROUP
Questioning and Dialogue
Role of therapist: connect events with thoughts, model questioning
Arbitrary inference, selective abstraction, overgeneralization, magnification, personalization, black-and-white thinking, mind reading...
Illuminate cognitive errors and distortions:
Get missing information needed to conclude the accuracy of a thought

Test two hypotheses and discuss what is likely to emerge
Deepest form of cognition- absolute, one-sided view of self, other, or world
Ex- I am a failure, I am unlovable
Same techniques used to change automatic thoughts- but longer process
Activity
What techniques was the therapist using?

What roles did the other group members play in helping Ron?

What thought distortions was Ron using?

What other cognitive or behavioral techniques could be useful for Ron?

Any guesses on his conditional assumptions or core beliefs?
GROUP
Whole group or break into smaller groups and practice
Homework
Conditional Assumptions:
Core Beliefs or Schemas:
Strengths and Limitations
Similarities and Differences
With Other Approaches
Bieling, McCabe, & Antony, 2009; Beck and Weishaar 2011; Corey, Corey, & Corey, 2013
Bieling, McCabe, & Antony, 2009; Beck and Weishaar 2011; Corey, Corey, & Corey, 2014
Bieling, McCabe, & Antony, 2009; Beck & Weishaar, 2011.
Bieling, McCabe, & Antony, 2009; Beck & Weishaar, 2011.
Bieling, McCabe, & Antony, 2009; Beck & Weishaar, 2011.
Bieling, McCabe, & Antony, 2009; Beck & Weishaar, 2011.
Bieling, McCabe, & Antony, 2009; Beck and Weishaar 2011; Hackney & Cormier, 2013.
Full transcript