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Cognitive Behavioral Group Therapy: Challenges and Opportunities

ISBN: 978-1-118-51035-3
392 pages
September 2014, Wiley-Blackwell
Cognitive Behavioral Group Therapy: Challenges and Opportunities (1118510356) cover image

Description

With coverage of the latest theory and research, this is a complete guide to implementing cognitive behavioral group therapy for practitioners and trainees in a range of mental health disciplines.

 

  • Presents evidence-based protocols for depression, panic, social anxiety, generalized anxiety, posttraumatic stress, OCD, compulsive hoarding, psychosis, and addiction
  • Provides innovative solutions for achieving efficient, effective therapy as mandated by emerging health care priorities, as well as trouble-shoots for common problems such as dropouts
  • Details unique strategies for working with ethnic minorities and clients across the age spectrum, along with material on mindfulness augmentation and transdiagnostic approaches
  • Includes clear, accessible instructions, complete with references to DSM-5 diagnostic changes, real-life clinical examples, and group session transcripts
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Table of Contents

About the Author xv

Acknowledgments xvi

Introduction: The Depth and Breadth of Cognitive Behavior Group Therapy 1

Part 1 The Basics of Cognitive Behavioral Group Therapy 5

1 Extending CBT to Groups 7

Why CBT Is Increasingly Used for Common Mental Health Problems 7

Principles of CBT 9

Cost-Effectiveness of CBT 11

Transporting Individual CBT to a Group Setting 12

Adapting CBT to CBGT: panic disorder illustration 13

Managing the group process across CBGT 15

Unique Benefits of the Group Format 17

How to Start a CBT Group 19

Setting up the group room 20

The first session 20

Absences and being late 22

Confidentiality and socializing outside the group 22

Member introductions 23

Expectations for CBGT commitment 24

Note-taking by CBGT therapists 24

Subsequent sessions 25

Summary 25

Notes 26

Recommended Readings for Clinicians 26

References 26

2 Working with Process and Content 29

Process and Content in Group Therapy 30

Group Process in Theory 31

Group Process in Practice: Obsessive–Compulsive Disorder Illustration 32

Instillation of hope 32

Universality 34

Imitative behavior and peer modeling 34

Imparting of information 35

Altruism 35

Group cohesiveness 36

Existential factors 37

Catharsis 37

Interpersonal learning and new ways of socializing 38

Experiencing the group as similar to one’s family of origin 39

Group process research and CBGT application 40

Scott’s General Group Therapeutic Skills Rating Scale 41

Summary 42

Note 42

Recommended Readings for Clinicians 42

References 42

3 Effectiveness of CBGT Compared to Individual CBT: Research Review 44

Depression 46

Social Anxiety Disorder (SAD) 47

Obsessive–Compulsive Disorder (OCD) 49

Generalized Anxiety Disorder (GAD) 50

Panic Disorder 50

Posttraumatic Stress Disorder (PTSD) 51

Addictions 52

Psychosis 52

Hoarding 52

Language and Culture 53

What to Take Away from the Research Findings 53

Summary 54

References 54

4 CBGT for Depression: Psychoeducation and Behavioral Interventions 59

The Diagnoses of Depression 60

Treatment Protocols Informed by Beck’s Cognitive Model of Depression 61

An Example of a CBGT Depression Protocol 63

Psychoeducation 63

Behavioral Interventions 66

Focus on Emotions in Preparation for the Thought Records 70

Capitalizing on the Group in CBGT for Depression 71

Summary 72

Notes 72

Recommended Readings for Clinicians 72

References 72

5 CBGT for Depression: Cognitive Interventions and Relapse Prevention 74

The Thought Record in a Group 76

Other Cognitive Interventions 81

Testing assumptions 82

Testing core beliefs 83

Behavioral experiments 84

CBGT Psychodrama 85

Relapse Prevention 86

Mindfulness-Based Cognitive Therapy (MBCT) 87

Summary 90

Note 90

Recommended Readings for Clinicians 90

References 91

Part 2 Challenges of Cognitive Behavioral Group Therapy 93

6 How to “Sell” CBGT, Prevent Dropouts, and Evaluate Outcomes 95

Drawing People into CBGT 95

Preparing Clients for CBGT 96

Individual pregroup orientation 98

Group pregroup orientation 99

Rapid access group orientation 99

Preventing Dropouts 100

Expectations for CBGT 101

Client Characteristics Impacting CBGT 103

Chronic pain 103

Gender 104

Evaluating CBGT Outcomes 106

The benefits of outcome measures 106

The CORE-R outcome battery 108

Summary 110

Note 110

Recommended Reading and Viewing for Clinicians 111

References 111

7 Transdiagnostic and Other Heterogeneous Groups 115

Why Consider Transdiagnostic Groups? 116

What Do Transdiagnostic CBGT Protocols Include? 118

Mixing anxiety with depression in the same group 118

Mixing different anxiety disorders in the same group 120

CBGT for Social Anxiety and Panic Disorder 122

The diagnosis of social anxiety disorder 122

Why groups can be challenging for people with social anxiety 123

Why a transdiagnostic group is attractive for people with social anxiety 123

Key features of a mixed social anxiety and panic group 124

In-session social anxiety exposures 126

CBGT for Different Types of Trauma 127

The diagnosis of posttraumatic stress disorder (PTSD) 127

From homogeneous to heterogeneous trauma groups 128

Self-care skills as a prerequisite 128

Cognitive processing therapy (CPT) in heterogeneous CBGT for trauma 130

The role of exposure in CBGT for trauma 132

Capitalizing on the group in heterogeneous CBGT for trauma 133

Summary 134

Notes 134

Recommended Readings for Clinicians 134

References 135

8 Augmenting CBGT with Other Therapy Approaches 138

Integrating CBGT and Mindfulness: Generalized Anxiety Disorder (GAD) 139

The diagnosis of generalized anxiety disorder 139

CBGT for GAD 139

Intolerance of uncertainty 140

Problem solving 141

Imaginary exposure 143

GAD and mindfulness 144

Integrating mindfulness into CBGT 145

CBGT and Interpersonal Therapy: Perinatal Depression 146

Integrating interpersonal therapy (IPT) into CBGT 148

What exactly is IPT? 148

Research support for IPT and CBT in treating perinatal depression 150

Example of combined IPT and CBGT for perinatal depression 151

Summary 153

Notes 153

Recommended Readings for Clinicians 154

References 154

9 How to Fine-Tune CBGT Interventions 156

Why Exposure Hierarchies are Important 156

How to develop exposure hierarchies in the group 159

How to Support Homework Completion 162

How to Plan for Termination 165

Becoming one’s own therapist 166

Formal and informal booster sessions 167

How to Handle the Last CBGT Session 168

Summary 169

References 169

10 Who Is Qualified to Offer CBGT? 170

Standards for Training and Qualifications 170

How to Become a CBGT Therapist 172

Qualifications of the competent CBGT therapist 172

Declarative knowledge about core CBT competencies 173

Implementing declarative knowledge into real groups 174

Ongoing observational learning and supervision 175

Equal Cofacilitation 178

Students in CBGT Training 179

How to Stay Competent as a CBGT Therapist 180

Summary 181

Recommended Resources for Clinicians 181

References 182

Part 3 Cognitive Behavioral Group Therapy Across Ages and Populations 183

11 Later Life Depression and Anxiety 185

Depression and Anxiety in the Elderly 185

Psychotherapy for the Elderly 186

Group therapy 187

CBGT for the elderly 188

CBGT Protocol for the Elderly 188

Psychoeducation in CBGT for the elderly 189

Goal setting in CBGT for the elderly 190

Challenging unhelpful thinking in CBGT for the elderly 191

Capitalizing on the Group for the Elderly 192

Common Challenges in Later Life CBGT 194

Summary 196

Note 196

Recommended Readings for Clinicians 196

References 197

12 Youth with Anxiety and Depression 199

Anxiety and Depression in Children and Adolescents 199

Child-Focused CBT 200

The role of parents 201

CBGT for children and adolescents with anxiety 203

CBGT for children and adolescents with depression 205

CBGT Protocol for Anxious Children 207

Psychoeducation 208

Basic and advanced tools for combating anxiety 209

Self-rewards 211

Capitalizing on the Group for Youth with Anxiety and Depression 211

Common Challenges in CBGT for Children and Adolescents 211

Summary 213

Note 213

Recommended Readings for Clinicians 214

References 214

13 Youth Obsessive–Compulsive Disorder (OCD) 217

OCD in Children and Adolescents 218

CBT for Youth OCD 219

Behavioral interventions 219

Cognitive interventions 220

CBGT for youth OCD 221

CBGT Protocol for Youth OCD 222

Psychoeducation in CBGT for adolescent OCD 223

Exposure, response prevention, and refocusing 225

Capitalizing on the Group for Youth OCD 227

Disorders Related to OCD 228

Common Challenges in CBGT for Youth OCD 230

Summary 231

Note 232

Recommended Readings for Clinicians 232

References 232

14 Language, Culture, and Immigration 235

A Chinese Cognitive Behavioral Treatment Program for Chinese Immigrants 236

Chinese CBGT Program Rationale 236

Referral Issues 238

Assessment 239

CBGT Treatment Issues for Depressed Chinese People 241

Challenging unhelpful thinking 241

How to improve homework compliance? 242

Capitalizing on the group for Chinese immigrants 243

A Spanish-Language Cognitive Behavioral Treatment Program for Latino Immigrants 244

Referral and Access Issues 244

Assessment 245

Latino CBGT Program Rationale 245

CBGT Treatment Issues 246

The people module 246

How to improve homework compliance? 246

Capitalizing on the group in CBGT for Latino immigrants 247

A CBGT Program for African American Women 248

Common Challenges in Culturally Sensitive CBGT 249

Summary 251

Note 251

Recommended Readings for Clinicians 251

References 252

15 Hoarding 254

The Diagnosis and Features of Hoarding Disorder 256

Financial and social burdens 257

Why do people hoard? 257

CBT for Compulsive Hoarding 258

CBT model of compulsive hoarding 258

Assessment 260

Hoarding-specific CBT 261

CBGT for Compulsive Hoarding 261

CBGT Protocol for Compulsive Hoarding 262

Psychoeducation 262

Motivation and goal setting 263

Skills training for organizing and problem solving 264

Challenging unhelpful thinking 265

Exposures and behavioral experiments 265

Homework 266

Relapse prevention 267

Capitalizing on the Group for Compulsive Hoarding 268

Common Challenges in CBGT for Hoarding 269

Summary 270

Recommended Readings and Viewing for Clinicians 270

References 271

16 Psychosis 273

The Diagnoses of Schizophrenia Spectrum and Other Psychotic Disorders 274

Vulnerability to Psychotic Disorders 275

CBT for Psychosis 276

Assessment 279

Increasing Evidence Supports CBGT for Psychosis 280

Integrating evolving trends in CBGT for psychosis 282

Narrative enhancement and cognitive therapy 283

Compassion-focused therapy 283

Person-based cognitive therapy 285

Metacognitive training 286

Capitalizing on the Group for Psychosis 288

Common Challenges in CBGT for Psychosis 288

Summary 289

Notes 290

Recommended Readings for Clinicians 290

References 290

17 Addictions 294

The Diagnoses of Substance-Related and Addictive Disorders 296

Why do people become addicted? 297

CBT for Addictions 298

Assessment 300

CBGT for Addictions 301

Co-occurring CBGT 301

CBGT protocols for addictions 302

Psychoeducation 304

Motivation and stages of change 305

Functional analysis 305

Challenging unhelpful thinking 307

Coping skills training 307

Homework 308

Relapse prevention 308

Mindfulness-based relapse prevention 309

Spiritually oriented relapse prevention 311

Capitalizing on the Group for Addictions 313

Common Challenges in CBGT for Addictions 314

Summary 315

Notes 315

Recommended Readings for Clinicians 316

References 316

Appendix A 320

Appendix B 321

Appendix C 323

Appendix D 324

Appendix E 325

Appendix F 329

Appendix G 334

Appendix H 338

Appendix I 343

Appendix J 344

Author Index 347

Subject Index 360

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Author Information

Ingrid Söchting is Chief Psychologist in an outpatient mental health program and Clinical Assistant Professor in the Department of Psychiatry at the University of British Columbia. She has been instrumental in developing CBT group therapy programs for depression, OCD, panic disorder, social anxiety, and PTSD, as well as interpersonal therapy (IPT) groups for later life depression. She supervises and teaches CBT and IPT to psychology and psychiatry residents, and is co-director of the Richmond Psychotherapy Training Program. She has also published over 25 peer-reviewed journal articles and book chapters in the field; and is a Canadian certified CBT therapist and a Certified Group Therapist of the American Group Psychotherapy Association.

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Reviews

“Even the most experienced clinician will be able to find some practical help, useful tips and research references.”  (British Psychological Society, 1 January 2015)

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