COGNITIVE

BEHAVIORAL
APPROACHES TO GROUP
Presented By: Jessica Rey Tan
 Aaron T. Beck
Was born in Providence, Rhode Island.

A graduate of Brown University and Yale School

of Medicine.

Beck believes clients can assume an active role

in modifying their dysfunctional thinking and

thereby gain relief from a range of psychiatric

conditions.

He is founder of the Berk Institute, which is a

research and training center directed by one of

PROPONENT his four children.

His continues research in the areas of

psychopathology and the utility of cognitive

therapy has earned him a place of prominence in

the scientific community in the United States.

 KEY CONCEPT
Cognitive behavior therapy has some unique characteristics that set it

apart from most of the other group approaches discussed in this book.

It 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:

Conducting a behavioral assessment

Precisely spelling out collaborative treatment goals

Formulating a specific treatment procedure appropriate to a

particular problem

Objectively evaluating the outcomes of therapy

 BEHAVIORAL
ASSESSMENT
Consist of a set of procedures

used to obtain information that

will guide the development of a

specific treatment plan for

each client and help measure

the effectiveness of treatment.

 FIVE CHARACTERISTICS
Aimed at gathering unique and detailed information about

client’s problem.

Focuses on the client's current functioning and life

conditions

Concerned with taking samples of client’s behavior to

provide information about how the client typically functions

in various situations

Narrowly focused rather than dealing with a client's total

personality

Integrated with therapy

PRECISE THERAPEUTIC GOALS
The most unique aspect of CBT with groups is the specific goals

of change.

CBT approach to group therapy focuses more concretely on

specific target areas of change than any other modality.

In most CBT groups, the initial stages of group work are devoted

to client’s expanding the final step of their assessment by

formulating specific statements of the personal goals they want

to achieve.

The group leader guides the discussion of goals, but the group

members are responsible for selecting their personal goals.

A CBT at its best is a collaborative endeavor

 TREATMENT PLAN
Once members have specified their goal, a treatment plan to

achieve these goals is formulated.

Some of the most commonly used techniques include modeling,

shaping, reinforcement, behavioral rehearsal, coaching,

homework, feedback, cognitive restructuring, problem solving,

meditations, relaxation training, stress management and

information giving.
 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 objective are being met. Providing members

with feedback is a vital part of cognitive behavioral group

therapy.
ROLE AND FUNCTIONS OF THE
GROUP LEADER
Cognitive behavioral groups leader assume the role of teacher

and encourage members to learn and practice social skills in the

group that they can apply to everyday living.

Group leaders are expected to assume an active, directive, and

supportive role in the group and to apply their knowledge of

behavioral principles and skills to the resolution of problems.

Group leaders carefully observe and assess behavior to determine

the conditions that are related to certain problems and the

conditions that will facilitate change.

The group leader is expected to perform a number of specific
educational and therapeutic functions and tasks, some of which
include the following:
Group leader conduct intake interviews during which the preliminary assessment and

orientation and also conduct an ongoing assessment of members’ problems.

Leaders draw a wide array of technique designed to achieve the members’ goals

Serving as a model of appropriate behaviors.

Provide reinforcement to members for their newly developing behavior and skills

Teach group members that they are responsible for becoming actively involved both

in the group and outside o therapy.

Emphasize a plan for change and an active stance on the part of the members and

help members understand that verbalization and insight are not enough to produce

change.

Help members prepare for termination well ahead of the group’s ending date
 STAGES OF
COGNITIVE
BEHAVIORAL
GROUP
 INITIAL STAGE
Pre-group individual interview and the first session are devoted to

exploring the prospective members’ expectations and to helping them

decide whether they will join the group.

Group members should be informed about what CBT is, how it works,

and what is unique about this therapeutic approach.

Key task of this stage is to help members get acquainted, orienting

members, increasing the motivation of group members, providing a sense

of hope that change is possible, identifying problem areas for

exploration, creating a sense of safety, and establishing the beginnings

of cohesion.
WORKING STAGE: TREATMENT PLAN AND
APPLICATION IF TECHNIQUE
Treatment planning involves choosing the most appropriate set of procedures

from among specific strategies that have been demonstrated to be effective

in achieving behavioral change.

In evaluation, leaders continue to collect data on matters such as

participation, members satisfaction, attendance and completion of agreed-

upon assignments between sessions.

Throughout the course of a group, individuals monitor their behaviors and the

situations in which they occur. In this way they can identify easily those

strategies that are effective or ineffective.

 Refers to the process in which clients learn

Modeling through observation and imitation of both the

leader and the other members.

Practicing in a group session a new behavior

Behavior that will be used in everyday situations.

It aim to prepare members to perform the

Rehearsal desired behaviors outside the group, when

modeling cues will not be available.

 This process consists of providing the members with

general principles for performing the desires behavior

Coaching effectively.

When members gets stuck and does not know hot to

proceed, another group member can whisper

suggestions. After one or two coached rehearsal,

members will rehearse independently before trying out

a new role in the real world.

Homework
Aimed at putting into action what

members explore during a group

session, which, in essence, is the crux

of the matter.
 After members practice a new behavior in a group session or

report on their homework assignments in daily life, fellow group

members or the group leader can provide verbal reactions to

Feedback these performance.

Feedback typically has two aspects: praise and encouragement

for the behavior and specific suggestions for correcting or

modifying errors.

Refers to a specified event that strengthens the tendency for a

response to be repeated.

Reinforcement Social reinforcement is a powerful method of shaping desired

behaviors. Self- reinforcement is a key method of helping

members change.

Participants are taught how to reinforce themselves to increase

their self-control and become less dependent on others

 Cognitive Restructuring
Process of identifying and evaluating one’s cognitions, understand

the negative behavioral impact of certain thoughts, and learning to

replace these cognitions with more realistic, appropriate and

adaptive thoughts.

Basic components of the cognitive restructuring process:

1. Clients are given an orientation

2. Clients learn to identify thoughts pertaining to problem situations

3. Coping thoughts are introduced and practiced.

4. There is a shift from self-defeating to coping thoughts.

5. Clients learn and practice reinforcing self-statements.

6. Homework is carried out, and there is follow-up

 Problem Solving
The main goal is to identify the most effective solution to a problem and to provide

systematic training in cognitive and behavioral skills so the client can generate more

adaptive ways of coping with stressful problems in living and also cope effectively

with future problems.

Seven stages in the problem-solving process:

Adopt a problem-solving orientation

Define the problem

Set goals

Brainstorm alternative solutions

Make a decision

Implement the solution

Evaluate the effectiveness of the action.

 FINAL STAGE
Practice sessions involving simulations of the real world are used to

promote this transfer.

Members rehearse what they want to say to significant people in their life

and practice new behaviors.

Sessions are systematically designed so that new behaviors are gradually

carried into daily life.

Consolidation of learning and developing strategies for transferring what

was learned in the group to daily life are key goals of the final stage.
 FINAL STAGE
The following 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

holds for them

Termination and follow-up are issues of special concern to CBT group

practitioners. Short and long-term follow-up interviews are scheduled,

at which time data are collected to determine the outcomes of a

group.

Follow-up interviews can serve as "booster sessions" that help

members maintain the changed behaviors and continue to engage in

self-directed change.

Relapse prevention - helps the members think about ways to deal with

the potential problems they may face when they no longer have the

support of a group.
APPLICATION: THERAPEUTIC
TECHNIQUES AND PROCEDURES
This section deals with some common behavioral and cognitive

techniques that are applicable to group work. for purpose of this

discussion, the techniques have been grouped under four general

approaches that can be applied to the practice of cognitive

behavioral groups:

Social skills training groups

Cognitive therapy groups

Stress management groups

Mindfulness and acceptance-based cognitive behavior

therapy
 Social Skills Training Groups
Good social skills enable people to communicate with others in way

that is both appropriate and effective.

Social skills training is a broad category that deals with one's ability

to interact effectively with others in a variety of social situations.

The goal of SST is to enhance individual's capacity to function in

social situations.
 Social Skills Training Groups
Social Effectiveness Training - one model of the SST, which is

multifaceted treatment program designed to reduce social anxiety,

improve interpersonal skills, and increase the range of enjoyable

social activities.

This group experience focuses on training in these 3 areas:

Social environment awareness, Interpersonal skill enhancement,

and Presentation skill enhancement.

 Cognitive Therapy Groups
CBT utilizes a group dynamics, in conjunction with standard cognitive

behavioral techniques, to change maladaptive and dysfunctional

beliefs, interpretations behaviors and attitudes.

Giving great emphasize on collaboration and active participation is the

foundation for effective practice.

Cognitive therapist teaches group member how to identify these

distorted and dysfunctional cognitions through a process of evaluation.

 Cognitive Therapy Groups
Group leader assists members in forming hypotheses and testing their

assumptions, which is know as collaborative empiricism.

Through collaborative effort, group members learn to discriminate

between their own thoughts and events that occur in reality. They learn

the influence that cognition has on their feelings and behaviors and

even on environmental events.

Stress Management Training in Groups
SMT has potentially useful applications for a wide variety of problems

and client populations, both for remediation of stress disorders and for

prevention.

SMT is useful in dealing with anger, anxiety, phobias and medical

problems.

The goal of SMT is not to eliminate stress but to educate clients about

its nature and effects and to teach them a variety of intrapersonal and

interpersonal skills to deal with stress constructively.

Stress Management Training in Groups
Stress Inoculation Training used for both preventive and treatment purposes

with a broad range of people who experience stress responses. this

approach is designed to teach coping skills that can be applied to both

present problems and future stressors when they are encountered.

SIT uses 3 core techniques: (1) Eliciting the client's thought, feelings and

interpretations of events; (2) Gathering evidence with the client to either

support of disprove these interpretations and (3) Designing homework

assignments to test the validity of the interpretations and to gather more

data for discussion.

Mindfulness and Acceptance Approaches
in Cognitive Behavior Therapy
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.

The essence of mindfulness is becoming aware of one's mind from one

moment to the next, with gentle acceptance.

Acceptance is a process involving receiving one's present experience

without judgement of preference, but with curiosity and kindness, and

striving for full awareness of the present moment.

The 4 Major Approaches
 Dialect Behavior Therapy (DBT)
This approach makes use of mindfulness and was developed to help clients regulate

emotions and behavior associated with depression.

DBT emphasizes the importance of the psychotherapeutic relationship, validation of the

client, and the etiologic importance of the client having experienced an " invalidating

environment" as a child.

DBT involves teaching clients both mindfulness and acceptance. The practice of

acceptance involves being in the present moment, seeing reality as it is without

distortions, without judgement, without evaluation, and without trying to hang on to an

experience or it get rid of it.

In mindfulness it focuses in breathing, staying with the present, identifying and

describing feelings, attending to emotions without trying to avoid them when they are

painful, letting thoughts fow, assuming a nonjudgemetal stance, focusing on one thing

at a time, and accepting all feelings.

Mindfulness-Based Stress Reduction
Basically, all the skills taught in the MBSR program, such as sitting

meditation and mindful yoga, are aimed at cultivating mindfulness.

The program includes a body scan meditation that helps clients to

observe all the sensations in their body. This attitude of mindfulness is

encouraged in every aspect of daily life including standing, walking, and

eating.

It is mainly designed to teach participants to relate to external and

internal sources of stress in constructive ways.

Aim to teach people how to live more fully in the present rather than

ruminating about the past or being overly concerned about the future.
Mindfulness-Based Cognitive Therapy
This is a comprehensive integration of the principles and skills of

mindfulness applied to the treatment of depression.

Client learn mindfulness meditation that involves an open and

nonjudgmental posture regarding negative thinking, emptions and bodily

states.

MBCT aims at changing client's awareness of and relation to their

negative thoughts.
Acceptance and Commitment Therapy
It involves fully accepting present experience and mindfully letting go of

obstacles.

ACT is designed to help clients learn that suppressing negative or

unwanted thoughts or painful feelings does not work.

ACT involves teaching clients become aware of what is important to

them and then to begin to shift values.

The goal of ACT is to increase client's psychological flexibility.

Focus on allowing experience to come and go while pursuing a

meaningful life.
 Contributions
It emphasis given to education and prevention.

CBT is precise in specifying goals, target behaviors and therapy

procedures, which are defined in unambiguous and measurable terms.

This specificity allows for links among assessment, treatment, and

evaluation strategies. Because of this specify, explicit criteria for

evaluating the success of treatment can be established.

The attention given to replacing maladaptive cognitions, behaviors and

emotions with more adaptive ones.

CBT has a wide range of techniques that participants can use to specify

their goals and to develop the skills needed to achieve these goals.
 Limitations
CBT groups have a didactic emphasis, which can be both a strength

and limitations.

Groups have an educative function, yet this didactic aspect needs to

be balanced with the experiential aspects of group work.

When CBT is too rigidly applied, the group leader may lose sight of the

people in the group by focusing exclusively on techniques or on

solving specific problems.

THANK YOU!!!