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WHY

COGNITIVE BEHAVIORAL APPROACHES TO GROUP COUNSELING

Büşra Altıntaş

ıntroductıon

CBT is a form of treatment that focuses on examining the relationships between thoughts, feelings, and behaviors.

Cognitive therapy perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality.

Cognitive behavioral practitioners use a brief, active, directive, collaborative, present-focused, didactic, psychoeducational model of therapy that relies on empirical validation of its concepts and techniques (Reinecke & Freeman, 2003)

THE COGNITIVE TRIANGLE

COGNITIVE TRIANGLE

AUTOMATIC THOUGHTS

KEY CONCEPTS

Key CONCEPTS

Cognitive behavioral therapy relies on the principles and procedures of the scientific method, and these experimentally derived principles of learning are systematically applied to help people change maladaptive behaviors.

The specific unique characteristics of behavior therapy include ;

  • Behavioral assessment
  • Precise treatment goals
  • Treatment plan
  • Objective evaluation

bEHAVIORAL ASSESSMENT

BEHAVIORAL ASSESSMENT

Behavioral assessment

(1) is aimed at gathering unique and detailed information about a client’s problem,

(2) focuses on the client’s current functioning and life conditions,

(3) is concerned with taking samples of a client’s behaviors to provide information about how the client typically functions in various situations,

(4) is narrowly focused rather than dealing with a client’s total personality, and (5) is integrated with therapy.

PRECISE THERapeutıc goals

Precıse therapeutıc goals

  • The task of the group leader is to help group participants break down broad, general goals into specific, concrete, measurable goals that can be pursued.
  • At the beginning of each session an agenda is set to prioritize members’ goals and to outline how the time will be spent. This agenda is co-created by members and the group leader

TREATMENT PLAN

Initially, the group leader generally develops the plans in a collaborative fashion that includes each group member.

After an initial assessment, and as the members learn the necessary skills, the group participants together with the group leader brainstorm intervention strategies that might be used or specific actions that might be taken.

Ultimately, the person with the problem is the judge of the strategy or actions he or she must take.

OBJECTIVE EVALUATION

Once target behaviors have been clearly identified, treatment goals specified, and therapeutic procedures delineated, the outcomes of therapy can be objectively assessed.

At every subsequent session an assessment of behavioral changes may be made so members can determine how successfully their objectives are being met. Providing members with feedback is a vital part of cognitive behavioral group therapy.

ROLE & FUNCTIONS OF GROUP LEADER

Group leader

Cognitive behavioral group leaders assume the role of teacher and encourage members to learn and practice social skills in the group that they can apply to everyday living.

They expected to assume an active, directive, and supportive role in the group and to apply their knowledge of behavioral principles and skills to resolution of problems.

GROUP LEADER

GROUP LEADER'S EDUCATIONAL AND THERAPEUTIC FUNCTIONS

  • Conducting intake interviews with prospective members and ongoing assessment of members' problems
  • Drawing on a wide array of techniques designed to achieve the members' stated goals
  • Serving as a model of appropriate behaviors
  • Providing reinforcement to members
  • Teaching group members that they are responsible for becoming actively both in the group and outside of therapy
  • Emphasizing a plan for change and helping members that verbalizations and insight are not enough to produce change
  • Preparing for termination

STAGES OF COGNITIVE BEHAVIORAL GROUP

Group STAGES

Multimethod Group Approach (Rose & Edleson, 1987) uses various coping strategies for dealing with specific problems;

  • Training group members in systematic problem solving
  • Cognitive restructuring
  • Assertion training
  • Relaxation training
  • Behavioral Rehearsal

Increasing members' participation and involvement in setting specific goals, planning, decision making, and mutual helping of other

INITIAL STAGE

Pregroup individual interviews and the first group session are devoted to exploring the prospective members' expectations and to helping them decide whether they will join the group

INITIAL STAGE

4 key points that can be a part of the informed consent process in a group;

  • Collaborative empiricism, partnership between the group therapist and the members in addressing the problems they bring to a group
  • Members should be informed that CBT is generally a time-limited form of treatment
  • Goals can be accomplished relatively quickly because CBT is an active, structured, directive, problem-focused, and present-focused approach to helping people deal with psychological problems
  • CBT practitioners rely upon techniques that have proven to be effective

WORKING STAGE

Assessment and evaluation continue throughout the working stage, and group leaders must continually evaluate the degree of effectiveness of the sessions and how well treatment goals are being attained.

WORKING STAGE

STRATEGIES

By means of this continuing evaluation process, both the members and the leader have a basis for looking at alternative and more effective strategies. Some of the strategies typically used during the working stage are

  • Modeling
  • Behavior Rehearsal
  • Coaching
  • Homework
  • Feedback
  • Reinforcement
  • Cognitive Restructuring
  • Problem Solving
  • The Buddy System

FINAL STAGE

During the final stage of a cognitive behavioral group, the leader is primarily concerned with having members transfer the changes they have exhibited in the group to their everyday environment.

The fol lowing tasks are characteristic of the final phase of a group:

  • Giving and receiving feedback
  • Providing many opportunities to practice new and more effective behaviors
  • Carrying learning further by developing a specific plan of action to continue applying changes to situations outside of the group
  • Preparing members for dealing with possible setbacks
  • Assisting members in reviewing the group experience and the meaning it holds for them

APPLICATION OF THERAPEUTIC

TECHNIQUES & PROCEDURES

Cognitive behavioral approaches to groups offer great promise for those who want to learn the skills necessary for self-management.

The techniques have been grouped under four general approaches that can be applied to the practice of cognitive behavioral groups:

(1) social skills training groups,

(2) cognitive therapy groups,

(3) stress management groups,

(4) mindfulness and acceptance-based cognitive behavior therapy.

Socıal skılls traınıng groups

SOCIAL SKILLS TRAINING GROUPS

Individuals who experience psychosocial problems that are partly caused by interpersonal difficulties are good candidates for social skills training. The goal of SST is to enhance a person’s functioning in social and performance situations (Bieling et al., 2006). Social skills training includes strategies such as psychoeducation, modeling, behavioral rehearsal, role playing, and feedback.

  • Social effectiveness training
  • Assertion training

Cognıtıve therapy groups

COGNITIVE THERAPY GROUPS

Changing maladaptive and dysfunctional beliefs, interpretations, behaviors, and attitudes.

Some of the most common interventions include automatic thought records, disputing beliefs, monitoring moods, developing an arousel hierarchy, monitoring activities, problem solving, socratic questioning, relaxation methods, risk assessment, and relapse preventions (Petrocelli, 2002).

STRESS MANAGEMENT TRAINING IN GROUPS

Stress management can be used both as a primary focus of treatment and as an adjunctive treatment for people who experience significant problems in the biopsychological sphere (Kaplan & Laygo, 2003).

STRESS MANAGEMENT GROUPS

"how we appraise events in life determines whether stress will affect us positively or negatively"

MINDFULNESS AND ACCEPTANCE APPROACHES IN COGNITIVE BEHAVIOR THERAPY

MINDFULNESS AND ACCEPTANCE BASED CBT

Mindfulness is a process that involves becoming increasingly observant and aware of external and internal stimuli in the present moment and adopting an open attitude toward accepting what is rather than judging the current situation (Kabat-Zinn, 1994; Segal, Williams, & Teasdale, 2002).

Acceptance is a process involving receiving one’s present experience with- out judgment or preference, but with curiosity and kindness, and striving for full awareness of the present moment (Germer, 2005b).

GROUP WORK IN SCHOOL

One of the most compelling reasons for employing CBT groups in schools is that they can be used for both remediation and prevention (Vernon, 2004).

Vernon provides some reasons for the effectiveness of cognitive behavioral therapies with school-aged populations:

  • Easy to understand, adapted to children of most ages and from many cultural backgrounds
  • Short term and employ brief interventions
  • Emotional and behavioral self-control through understanding the connection between thoughts, feelings, and behaviors
  • Empower young people to deal with both present concerns and future problems

EVALUATION OF THE COGNITIVE BEHAVIORAL APPROACH

Research Studies

WHEn

Unlike medication, CBT treats more than just the symptoms of anxiety. Using CBT for anxiety can help uncover the underlying cause of the anxiety triggers; the patient learns ways to relax, and develop better coping and problem solving skills.

A study by Coull & Morris (2011) used CBT as a treatment for anxiety disorders

  • 201 participant diagnosed with panic disorder were asked to test out thoughts they have thet trigger attacks and develop more realistic responses to their triggers.
  • The study showed a decrease in both frequency and intensity of patient panic attacks.

REFERENCES

REFERENCES

Bieling, P. J., McCabe, R. E., & Antony, M. M. (2006). Cognitive-behavioral therapy in groups. NewYork: Guilford Press.

Germer, C. K. (2005b). Teaching mindfulness in therapy. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 113–129). NewYork: Guilford Press.

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York: Hyperion.

Kaplan, A., & Laygo, R. (2003). Stress management. In W. O’Donohue, J. E. Fisher, & S. C. Hayes (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (pp. 411–416). Hoboken, NJ: Wiley.

Rose, S. D., & Edleson, J. (1987). Working with children and adolescents in groups. San Francisco: Jossey-Bass.

Vernon, A. (2004). Using cognitive behavioral techniques. In B. T. Erford (Ed.), Professional school counseling: A handbook of theories, programs & practices (pp. 91–99). Austin, TX: CAPS Press.

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