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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.