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COGNITIVE BEHAVIOUR

APPROACHES TO GROUP

Mohd Saiful Zaidi bin Mazlan


*Please refer Corey, G (2012). Theory & Practice of Group
Counseling. Brooks/Cole MPP141266
*Please refer Corey, G (2013). Theory & Practice of Counseling
& Psychotherapy. Brooks/Cole
Page 345
INTRODUCTION
 Previously known as ‘Behavior Therapy’.
 The structure nature of the group appeals to many who facilitates
psychoeducational groups.

 Basic Assumptions:-
1. Most problematic behaviors, cognitions and emotions have been
learned can be modified by new learning (often call therapy;
significant component of the process is educational)
2. The behaviors that clients express are the problem (not merely the
symptoms of problem).
3. Group practitioners with cognitive behavior framework may develop
techniques and strategies from diverse theoretical viewpoints
(must come with scientific demonstration.

 In this topic, (Cognitive Behavior Therapy) CBT will be the focal point
than traditional behavior therapy-due to environmental determinism.
Page 279
BRIEFLY ON CBT & 280

Focal Point of Concept = Relationship between thoughts,


feelings and behavior Cognitive Distortion – “Logical Errors”

Arbitrary Inferences
 making conclusion without evidence
Selective Abstraction
 Conclusion based on an isolated details of an
event
Overgeneralization
 Extreme belief
Magnification & Minimization
 Perceiving things greater or less than actual
Personalization
 Relate external event to themselves
1. Labeling & Mislabeling
 Self-stamping/price tag
1. Dichotomous Thinking
 Polarized thinking/black-and-white
Page 269
BRIEFLY ON CBT
Model explaining mechanism of therapeutic process (ABC’s of CBT)
Page 347
KEY CONCEPTS
 Relies on the principles and procedures of the scientific method;
experimentally derived principles of learning are systematically applied to
help people change maladaptive behaviors
 Distinguish characteristics = systematic adherence to specification and
measurement
 Specific unique characteristics of CBA;-

1. Behavioral
Assessment

Specific 2. Precise
Unique Therapeutic Goals
Characteristic

3. Treatment Plan
4. Objective
Evaluation
Page 347
1. BEHAVIORAL ASSESSMENT
 Consists of a set of procedure used to obtain information that will guide
the development of a specific treatment plan for each clients and help
measure the effectiveness of treatment
 Five characteristics of behavioral assessment

1. Aimed at gathering unique


and detailed information about
a client’s problem

Characteristics 2. Focused on client’s


5. Intergrated with of behavioral current functioning
therapy and life condition
assessment

4. Narrowly focused than 3. Taking samples of a client’s


dealing with client’s total behaviors to provide information
personality about how clients typically
functions in vrious situation
Page 347
2. PRECISE THERAPEUTIC GOALS
 Unique aspect; specific goals of change
 Group leader guides discussion of goals; group members select their
own personal goals
 Concrete problematic behavior to change and new skills to learn
 At the beginning of session, agenda is set to prioritize member’s goals
and to outline how session will be spent.
 Agenda co-created by members and group leaders
 Task of group leader= help participants to find specific and concrete
goals that can be pursued.
Page 348
3. TREATMENT PLAN
 Designed to achieve these specific goal
 Action-oriented; members take an active role
 Initial stage, group leader develop plans with members
 Participants and group leader brainstorm intervention strategies after
initial assessment.
 The person with the problem become the judge of strategy/action
he/she must take
Page 348
4. OBJECTIVE EVALUATION
 Because CBT group emphasize the importance of evaluating
effectiveness of the techniques employed, assessment of client’s
progress is ongoing.
 At every subsequent session, assessment of behavioral changes may
be made; to determine the successfulness of objective
 Providing members feedback is vital
 Decision to use what techniques lies on its effectiveness; CBT
practitioners eclectic in their choices of treatment
Page 349
ROLES & FUNCTIONS OF GROUP LEADER
Skilled in drawing
Assisting members
variety of brief
developing new Assume an active,
interventions that
skills directive and
solving problems
efficiently supportive role

Model active
participation leaders provide
collaboratively in imitation of social
creating an agenda,
generating adaptive MAIN ROLE modeling as
fundamental process in
responses, designing learning new behavior
homework and
teaching skills

apply knowledge of encourages members to


behavioral learn and practice social
principles to solve skills in group
the problems
Page 349
ROLES & FUNCTIONS OF GROUP LEADER & 350

Draw variety of Serve as model of


techniques to achieve appropriate behavior;
goals coach members by
role playing

Conduct intake SPECIFIC


survey on-going EDUCATIONAL Teach group members;
assessment actively involve and
problems with & experiment in group and
prospective THERAPEUTIC do homework assignments
members ROLE

Help members prepare Reinforce members for


for termination well their new behavior and
ahead of the group’s Emphasize a plan skills
ending date and help members
to produce change
STAGES OF A COGNITIVE
BEHAVIORAL GROUP
Page 351
1. INITIAL STAGE
 Participants informed about group process before joining
 Pregroup individual interviews and first group session done
to explore prospective members’ expectation and decision
to join the group
 Those whom join will negotiate a treatment contract; what
group leader and members expect from each other.
 Ladley addressed 4 key points of informed consent;
1.Members should know meaning of ‘collaborative
empiricism’
2.Members should be informed about CBT; time limited
treatment and its uniqueness of this approach.
3.Tell members that their goal can be accomplished
quickly because of nature of CBT
4.Members informed that CBT practitioners rely upon
effective techniques
Page 352
1. INITIAL STAGE (Cont…)
 Members learned how group functions and how each session structured
 Building cohesion as the foundation for effective work during each stage
of group’s development; leader as the central role to establish trust and
sense of safety and establishing cohesion
 Each session conclude with a review or summary; to clarify their goals
 Formulating homework and develop
 As group evolves, leader will train members instead of directing
Page 352
2. WORKING STAGE
Behavior Homework
Rehearsal
Coaching

Modeling

Feedback

APPLICATION
Buddy System OF
TECHNIQUES

Reinforcement
Problem
Solving
Cognitive
Restructuring
Page 352
APPLICATION OF TECHNIQUES & 353

Modeling
 Clients learn through observation and imitation inside group
 Offers a variety of social and role models to imitate
 Carried out in role playing during session and practiced in vivo

Behavior Rehearsal
 Practicing new behavior that will be used in everyday situation
 To prepare members to perform desirable behavior outside group
 Practiced in safe context that stimulates real world – increase
members willingness to experiment in their daily life

Coaching
 Providing members with general principles for performing desired
behavior effectively
 When a member stuck, group members can whisper suggestions
 Coaching is reduced subsequently
Page 353
APPLICATION OF TECHNIQUES & 354
Homework
 Aimed at putting into action what members explore during group session
 Affords many opportunities to practice new skills in the real world
 Vital role to ensure changes of behavior
 Factor determine effectiveness of homework; therapist clarity on
homework
 Done collaboratively

Feedback
 Verbal reactions after practicing new behavior or reporting homework
assignments
 Two aspects;
1. Praise and encouragement for the behavior
2. Specific suggestions for correcting or modifying errors

Reinforcement
 Through praise, approval, support and attention
 Better reporting succession than failure; even if it is a small achievement
 Critical to maintain members’ gain
Page 355
APPLICATION OF TECHNIQUES
Cognitive Restructuring (Core procedure)
 Process of identifying and evaluation one’s cognitions, understanding the
negative behavioral impact of certain thoughts, and learning to replace
these cognition with adaptive thoughts.
 Members are expected to identify self defeating cognitions and monitor
self-talk.
 Initially, leader teaches members how to differentiate self-defeating and
self-enhancement statements.
 After deciding a set of realistic statements, cognitive modeling is used;
imaging themselves in stressful situation and substitute self-defeating
statements.
 Finally, homework is assigned at the end of the session
 As members make progress, assignments can be developed at successive
levels of difficulty
Page 355
APPLICATION OF TECHNIQUES & 356

Problem Solving
 Cognitive behavioral strategy that teaches individuals ways to deal with problems
in daily life
 Main goal: identify the most effective solution to a problem and to provide
systematic training in cognitive and behavioral skills so the client can apply and
cope effectively with future problem
 Spiegler and Guevremont (2010) describe seven stages in problem solving process

1. Adopt problem 3. Set Goals


2.Define the problem
solving orientation

6. Evaluate the Spiegler and


4. Brainstorm
effectiveness of Guevremont alternative solution
the action (2010)

6. Implement a 5. Make a decision


solution
Page 356
APPLICATION OF TECHNIQUES
Buddy System – Rose (1998)
 A form of therapeutic alliance between members.
 A client is assigned/chosen as monitor and coach throughout the group treatment
process
 Members monitor each other’s behavior in the group and remind each other to
stick with their assignment
 Buddies are trained to give reinforcement for achievement and receiving
feedback; self-help network
Page 357
FINAL STAGE
 Key goals: transferring what was learned in a group to daily life
 Simulations of the real world

Giving and
receiving
feedback Provide many
Assisting
members in opportunities to
reviewing the practice new &
group experience Characteristics more effective
and the meaning of the Final behavior
it holds for them Stage

Preparing members Developing specific plan of


for dealing with action to continue applying
possible setbacks changes to situation outside
of the group
Page 358
COMMON BEHAVIORAL TECHNIQUES IN GROUP & 359

Social Skills Training (SST) Groups


 Broad category deals with one’s ability to interact with other effectively in
a variety of social situation
 Suitable candidate= people with psychosocial problem
 Bieling et al., 2006; to enhance person’s functioning in social and
performance situation
 2 types of training
1. Social Effectiveness Training (SET)
 Multifaceted treatment program to reduce social anxiety and
increase enjoyable social activities
 Focus on three areas: social environment awareness, interpersonal
skill enhancement, presentation skill enhancement
2. Assertion Training
 Goal: people have the right to express their feelings, thoughts, belief
and attitude; choose, not obligated
 Focus on recognizing maladaptive thoughts concerning assertiveness
Page
COMMON BEHAVIORAL TECHNIQUES IN GROUP 360-362

Cognitive Therapy Groups


 (Petrocelli, 2002: White, 2000b)= Utilize a group of dynamic format to
change maladaptive and dysfunctional beliefs, interpretations, behaviors
and attitudes in conjunction to standard CB techniques
 Intervention: automatic thoughts records, disputing beliefs, monitoring
moods, arousal hierarchy, monitoring activities, problem solving, Socratic
questioning, relaxation methods, risk assessment, relapse prevention.
 Emphasize on present and time limited approach.

Stress Management Groups (Meichenbaum’s Stress Inoculation Training)-SIT


 Goals= not to eliminate stress but teaching people specific coping skills
 SIT consist of combination of information giving, Socratic discussion and
CB techniques
 Coping techniques used as preventive and treatment purpose that can be
applied in the present and future
 Three-stage model
Page 363
COMMON BEHAVIORAL TECHNIQUES IN GROUP

3. Application and 1. Conceptual


follow through Educational
Three-stage  Creating working
model in relationship by
 Transferring and educating clients
maintaining changes SIT the nature of
from therapeutic stress
situation to daily life
 Carefully check from
time to time 2. Skills Acquisition,
Consolidation and
Rehearsal  Client learn and
rehearse coping
strategies
 Therapist introduce
relaxation or any
techniques to reduce
stress
Page 365
COMMON BEHAVIORAL TECHNIQUES IN GROUP
Mindfulness and Acceptance-Based Cognitive Behavior Therapy
 Third generation behavior therapy
 Keywords;
1. Mindfulness = process involve becoming increasingly observant and aware of
external and internal stimuli in the present and adopting open attitude towards
accepting instead of judging the current situation
2. Acceptance = process involving receiving one’s present experience without
judgement or preference, but with curiosity and kindness and striving for full
awareness of the present moment
 Expansion of four major approaches;-
1. Dialectical Behavior Therapy (DBT) – borderline personality disorder
2.Mindfulness-based stress reduction (MBSR) – coping with stress
3.Mindfulness-based Congitive Therapy (MBCT) – primarily treating depression
4.Acceptance and Commitment Therapy (ACT) – Encouraging member to accept,
rather than to control/change unpleasant sensations
Page 371
ADVANTAGES -373

Nature of Cognitive Behavior Therapy


 Emphasis given to education and prevention
 Precise in specifying goals, target behaviors, and therapy procedures; can
be established
 Attention given to replacing maladaptive cognitions, behaviors, and
emotions
 Open towards integrating with various theories
 Rigorously experimented – evolving for improvement
 Broadly applied
 Humanistic dimension = collaborative involvement

Advantages of Group Cognitive Behavioral Approaches


 Permits and augments individual behavior changes in which is not
possible in individual therapy
 Creating safe environment to practice; willingness
 Wide range of techniques
Page
LIMITATIONS 373&374

 Too highly structured; members might avoid meeting personal needs


 Didactic emphasize; becoming strengths/limitations
 Will be focusing too much on techniques if applied rigidly by group leader