CBT Interventions
Group Activities
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counseling CEUs and Specialty Certificates
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery
Objectives
~ Explore ways to teach Cognitive behavioral interventions in group
Basis
~ Changing thoughts (cognitions) has a direct impact on physiological response (urges and behaviors)
~ Changing behaviors has a direct response on thoughts and emotional reactions
~ At its core CBT has the principles of noticing, understanding and addressing thoughts feelings and behaviors
Functional Analysis
~ The process of identifying the antecedents (causes/triggers) and consequences (positive/negative) of behaviors
~ Causes
~ Emotional
~ Mental
~ Physical
~ Social
~ Environmental (including time & Date)
Problem Identification and Solving
~ Stop. Use self talk, distress tolerance and/or relaxation techniques to restrain impulsive actions
~ Identify the problem—Who, where, what, why
~ Develop alternative solutions
~ Explore the short and long term consequences/outcomes of solutions
~ Choose a response
~ Evaluate the outcome
Activity
~ When you experience a problem…
~ How can you remember to practice the pause?
~ What techniques can you use to get through the initial adrenaline rush?
~ Describe a time you get upset and effectively managed it.
~ Give an example of a time you got upset and did not effectively manage it.
~ What was the difference?
Activity
~ Practice identifying the problem
~ Who is involved –Think broadly
~ What happened – Explore objectively
~ When did it take place – In the chain of events
~ Where did it take place – Is there significance to this place
~ Why did it happen? Why did it bother you? – Explore broadly
~ Identify alternatives
~ Immediate response – Benefits and drawbacks
~ Alternate responses – Benefits and drawbacks
~ Choose and implement the response
Contracting
~ Identify the problem/target behavior
~ Identify a new behavior to replace it
~ Identify rewards
~ Write a contract
~ Monitor behavior
Activity
~ Target Behaviors
~ Persistent worrying
~ Not getting out of bed
~ Anger outbursts
~ Smoking
~ Stress-Eating
~ Caving/being overly passive
~ Identify the antecedents of each
~ Identify the benefits and drawbacks of each
~ Identify alternate ways of dealing with the behavior
Cognitive Distortions
~ Personalization
~ Taking everything personally—Its your fault. It was meant to hurt you.
~ Exaggeration
~ Making a mountain out of a molehill or seeing the worst-case scenario
~ All-or-Nothing
~ Viewing things in dichotomous terms
~ Availability Heuristic
~ Noticing what is most prominent in your mind
Cognitive Distortions
~ Minimization
~ Not giving credit where credit is due
~ When you do good things
~ When other factors are involved
~ Selective Abstraction
~ Seeing only what fits your mood/perspective
Activity
~ Give an example of when you have used each distortion
~ Discuss why each distortion may develop
~ Explore the benefits and drawbacks of each distortion
~ Identify ways to address each distortion
~ Personalization
~ Exaggeration
~ All-or-Nothing
~ Minimization
~ Selective Abstraction
~ Availability Heuristic
ABC-DE
~ A=Activating Event
~ B=Automatic Beliefs
~ C=Consequences
~ D=Dispute automatic beliefs
~ E=Evaluate effectiveness of reactions
Activity
~ Target Behaviors
~ Identify 3 things that trigger anxiety (Bridges, authority figures, tests, relative coming to visit)
~ Identify 3 things that trigger anger (Tailgating, lying, computer problems, laziness)
~ Apply the ABC-DEs
~ A=Activating Event
~ B=Automatic Beliefs
~ C=Consequences
~ D=Dispute automatic beliefs
~ E=Evaluate effectiveness of reactions
Cognitive Restructuring
~ Literally changing your thoughts
~ Find meaning in the current event
~ Challenge the interpretation
~ Develop a both/and perspective
~ Examples of restructuring (Have clients give examples and practice)
~ Threat vs. challenge (Interview, public speaking)
~ Failure vs. learning experience (Relationships, hobby)
~ Loss vs. opportunity (Job, relationship)
~ Powerless vs. empowered (Forgiveness)
Activity
~ Identify 3 common triggers for anxiety or anger.
~ Find meaning in the current event
~ Interpret the event as a challenge instead of a threat
~ Develop a both/and perspective
~ Examples
~ SO not responding to a text
~ Not getting a promotion
~ First date
Systematic Desensitization
~ Learning to effectively use coping skills to reduce distress through gradual exposure
~ Levels
~ Level 1: Imagine and describe the distressing event
~ Level 2: Expose yourself, at a safe distance, to the distressing event
~ Level 3: Experience the distressing event
~ Process
~ For each level, rate distress on a scale from 1-5.
~ Use skills of choice to reduce your distress until you are at a 1.
~ Practice until you can think about the event without getting distressed.
Activity
~ Distressing Events
~ Public speaking
~ First date
~ Airplane ride
~ Personal example
~ For each event, identify how you would work through levels 1, 2 and 3
Cognitive Processing Therapy
~ Using analytical questions to help identify cognitive errors and make more effective choices
~ Questions
~ What is the evidence for and against?
~ Is this based on facts or feelings?
~ Are all aspects of the situation being considered?
~ Are you using all or nothing terms?
~ Are you confusing high and low probability events?
~ What is the most logical course of action?
~ Example: Anxiety about heart attack/dying
Activity
~ Identify 3 things you are worried about right now. (Not being good enough, failure, being alone forever)
~ Questions
~ What is the evidence for and against?
~ Is this based on facts or feelings?
~ Are all aspects of the situation being considered?
~ Are you using all or nothing terms?
~ Are you confusing high and low probability events?
~ What is the most logical course of action?
Acceptance and Commitment
~ Accepting reality as it is and committing to choosing thoughts and behaviors which will help you move toward a rich and meaningful life
~ Commitment
~ Determination to improve the next moment
~ Realization that there are multiple aspects to commit to in your rich and meaningful life
Activity
~ Define rich and meaningful life
~ What are your top 5 values? What 5 characteristics do you want to be known for? (Handout values worksheet)
~ Which people are important in your life
~ Which people are unimportant but you let them have your energy anyway?
~ What things/hobbies/activities are important in your life?
Activity
Summary
~ There are a variety of ways to help people explore and address the thoughts which may be keeping them stuck.
~ Some techniques will work better in certain situations
~ Since cognition is based on prior experiences, teaching CBT in group can help clients explore alternate interpretations and information in similar situations
~ By developing a broader understanding of situations people can explore the effectiveness of their thinking in terms of how it impacts their ability to live a rich and meaningful life.