Using Groups to Address Anger, Anxiety, Depression and Addiction

Using Groups to Address
Anger, Anxiety, Depression and Addiction
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs.com
Host: Counselor Toolbox Podcast

Purchase CEUs at: https://allceus.com/member/cart/index/product/id/1112/c/

Objectives
– Review the benefits of groups
– Identify the modalities for group
– Discuss goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression
– Explore activities that can be used to enhance group engagement
Benefits of Group
– Cost effective
– Peer feedback and support
– Development of interpersonal skills
– Reduce isolation and “uniqueness”
– Many observers

Modalities for Group
– Face-to-face
– Web-meeting
– Video with or without breakout rooms
– Chat
– Asynchronous
– Psychoeducational/skills video
– Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician
– HIPAA, HITECH and 42 CFR Part 2 all apply
Commonalities
– Low self esteem
– Cognitive distortions
– Emotional dysregulation
– Poor Interpersonal Skills
– Fear of isolation, rejection, failure, loss of control, the unknown
– Poor lifestyle behaviors

Awareness (2)
– Learn about anger, anxiety, depression and addiction and their symptoms
– Learn about the Mind-Body Connection (Jeopardy)
– Potential causes of symptoms
– Effects of symptoms
– Interventions for symptoms
– Have clients identify (Worksheet/Beach Ball or Jenga)
– Symptoms
– What changed which causes or worsens the symptom
– How they have dealt with the symptom in the past
– Impact of the symptom on them
Awareness (1)
– Negative Triggers
– Those things that cause or worsen the symptom
– Hungry Angry Lonely Tired (HALT)
– False Evidence Appearing Real (FEAR)
– People Places Things
– Times (of day, anniversaries, holidays)
– Small Group Activity/Presentation
– Which ones can be avoided or prevented-
– Which ones are unavoidable-
– Identify three ways to deal with the unavoidable ones to mitigate their impact.

Awareness (1)
– Positive Triggers (Flip chart stations)
– Those things that remind you to use your new tools
– Sights
– Sounds
– Smells
– Touch
– Those things that trigger positive emotions
– Sights
– Sounds
– Smells
– Touch
– How can you add those to your environment-

Awareness (1)
– Vulnerabilities
– Explain the concept of vulnerabilities
– Identify the most common vulnerabilities: What causes them and how to prevent and mitigate them
– Emotional (anger, jealousy, envy, depression, anxiety, guilt, grief)
– Mental (Poor concentration, rigid thinking, poor problem solving)
– Physical (Sleep, nutrition, pain)
– Social (lack of supportive relationships, presence of unsupportive relationships)
– Environmental
Awareness (1)
– Mindfulness and Vulnerability Prevention
– Learn about mindfulness
– Purpose
– Benefits
– Difference from meditation
– Methods
– 5 minute exercise
– 5,4,3,2,1
– Color focus: Find all the things that are blue
– What are my thoughts, urges, sensations when I feel stress, anger, fear, depression, happiness, excitement

Awareness (1)
– Goal Identification (Top 3s) What is most important to focus your energy on so you can be happy- // What does happiness/recovery look like to you- (Collage)
– What 3 things are most important to you-
– What 3 relationships are important to you and what do you want them to look like-
– What 3 personal growth goals are important to you-
– What are your values that support your goals (Top 3)
Distress Tolerance (1)
– Clients with mood or addictive disorders tend to
– Get stuck in the unpleasant emotion
– Impulsively act to eliminate/escape from distress
– Distress tolerance skills help them learn that urges and feelings:
– Come in waves
– Do not have to be acted upon
– Can be tolerated

Distress Tolerance (1)
– Distress tolerance skills help them learn that urges and feelings:
– Can help them practice the pause to make choices which will keep them using their energy to move toward their goals.
– Bee metaphor
– Rewrite the lyrics to Stop In the Name of Love by the Supremes
– Stop, step back, observe, then proceed mindfully
– Stop, step back, observe, then proceed mindfully
– Think it over
– Think it over …and so on…

Distress Tolerance (1)
– Address Distress Intolerant Thoughts using the ABCs
– Activating Event (brainstorm triggers)
– Beliefs (D.I.T) (Beach ball, hat, eggs)
– Consequences
– Dispute DITs with alternate statements
– Evaluate which outcome represents a more effective use of energy and helps get the client closer to goals.
Distress Tolerance Skills (2)
– The wave metaphor
– The cloud metaphor (Actually watch clouds)
– Discuss the concept of radical acceptance
– Differentiate from agreement or powerlessness
– Use the house metaphor
– Have clients brainstorm ways and create an action plan to:
– IMPROVE the moment (T-shirt/Water Bottle/Mug (picture))
– ACCEPT reality (Button Pins)
Cognitive Distortions (1)
– Educate about CDs and help clients learn to identify them (Game—Clients read a statement and identify which CD it is.)
– Arbitrary Inference (What is the evidence)
– Availability Heuristic (What does history say)
– Negative Mental Filter / Minimizing the Positive (Dialectics)
– Overgeneralization (Exceptions)
– Mind-Reading (Facts)
– Magnification (Probability)
– All-or-Nothing (Exceptions)
– Personalization (Alternate explanations)
– Clothes pin game
Challenging Questions (1)
– Activity: People’s Court
– Plaintiff, state your belief
– Defendant, state your belief
– Plaintiff, what are the facts supporting your belief- (Object to feelings) How reliable is the source of the evidence-
– Defendant, what are the facts against the plaintiff’s belief- How reliable is the source of the evidence-
– Judge highlights all or nothing thinking. “So I hear the plaintiff saying that this always happens. Defendant…Are there any exceptions-”
– Plaintiff, what is the evidence that [The belief] is probable-
– Defendant, what is the evidence that your belief is probable
– Plaintiff: Help me understand the big picture. Who else was/is there- What else was/is going on that is contributing-
– Defendant: What else do you have to add to what the plaintiff said-
Locus of Control (1)
– Internal: I have the ability to control everything
– External: Destiny and fate are in total control
– Serenity prayer
– Grant me the serenity to accept the things I cannot change
– The Courage to change the things I can
– The Wisdom to know the difference

Locus of Control cont…
– Explore
– How it feels/what it means to not be able to control something
– What powerlessness represents in that person’s life
– Ways to cope with those things that are out of personal control
– What stressors are within and outside of personal control (Envelope with elements:
– My relationship with… (What he says. What he thinks. What he does. How he reacts. What I say. What I think. What I do. How I react. My exposure to him.) How do you feel when you see which parts are in your control-
– Smoking (How it makes me feel. Urges. How I react. Exposure to smoking triggers. Exposure to nonsmoking triggers. Engagement in relapse prevention strategies)
Attributions (1)
– Explain what attributions are.
– You do something nice or You get a promotion
– Internal vs. External
– Stable vs. Changeable
– Global vs. Specific
– You wipe out on the sidewalk or Your new BFF comes over and your house is a disaster.
– Internal vs. External
– Stable vs. Changeable
– Global vs. Specific
– Come up with 6-10 scenarios. Have one group create an internal, stable, blobal attribution and the other create an external, changeable and specific attribution.
– Discuss how changing attributions changes how people feel about a situation-

Purposeful Action Pathway (1)
– Starting Point
– Dysphoric Feelings
– Mind-set (Distress Intolerance, Cog. Distortions)
– Physical health (Poor sleep, pain, nutrition)
– Relationships
– Self-Esteem
Self Esteem (1)
– Self esteem is the relationship with yourself
– What qualities do you look for in a friend-
– Activity: “Order a friend”
– Have participants complete their orders
– Tally up requests to identify characteristics most people are looking for
– Ask participants, which of those qualities do you have-
– How can you be your own best friend-
– Do you hold yourself to a higher standard than you hold anyone else to-

Self Esteem (1)
– Describe who you think you should be, and who you are right now.
– Similarities-
– Differences-
– Are those differences important-
– If so, make a plan to start achieving one
– If not, how can you let that go-

Interpersonal Effectiveness (3)
– Being able to ask for what you need and get it
– Asking for help and saying “no.”
– Win/Win
– Make a list of needs: Call if you are going to be late. Drop off dry cleaning. Tell me you are busy instead of just stopping responding. Help me move this weekend.
– Have group members brainstorm how to create a win-win
– Being able to set and maintain healthy boundaries
– Emotional. Handling someone who is unhappy.
– Mental. Handling someone with different points of view.
– Physical. Handling someone who invades your space.
– Skits
Interpersonal Effectiveness (3)
– Being able to develop and maintain supportive relationships.
– Communication skills
– Listen-Confirm-Respond. Practice sharing about their day. (Give prompts: So what you are saying is… It sounds like when that happened… It must have been [frustrating] when…
– Objective “I” statements (Hat with “you” or incorrectly formed “I” statements– You make me so angry when… I get so angry when you are disrespectful…)
Problem Solving (1)
– Using all skills learned thus far, have clients identify triggers or problems in a small group and choose/explain how to:
– Stay miserable and three effects
– Tolerate distress and three effects
– Change how they feel and think about the situation, and the three effects
– Change the situation and three effects
Summary
– Groups are extremely cost effective
– This series of 24 groups provides the foundation for clients to begin living a happier life.
– It is recommended to use written/visual material in addition to lecture and interactive application to help clients fully acquire knowledge and skills