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CBT STAGES

 Leaders teach group members that they are responsible for becoming actively involved both in the group and outside of therapy. To broaden their repertoire of adaptive behaviors, members are urged to experiment in the group and to practice homework assignments.  

CBT-INITIAL STAGE

Leaders help members prepare for termination well ahead of the groups ending date so that members have adequate time to discuss their reactions, to consolidate what they have learned, and to practice new skills to apply at home and work. Appropriate referrals are made when reasonable goals have not been achieved.

CBT

Leaders draw on a wide array of techniques designed to achieve the mem-bers stated goals.  A major function of leaders is serving as a model of appropriate behaviors.

Leaders prepare and coach members to model by role playing for one another how an individual might respond in a particular situation. 

Leaders provide reinforcement to members for their newly developing behavior and skills by making sure that even small achievements are recognized.

CBT-INITIAL STAGE

The multimethod group approach uses various coping strategies for dealing with specific problems:

Training group members in systematic problem solving, cognitive restructuring, assertion training, relaxation training, behavioral rehearsal, and other strategies that are appropriate for specific problems.

CBT groups often have a common theme, such as,stress management, pain control, anger control, etc.

CBT

Pregroup individual interviews and the first group session are devoted to exploring the prospective members expectations and to helping them decide whether they will join the group.

CBT-INITIAL STAGE

Key tasks at this stage deal with helping members get acquainted, orienting members, increasing the motivation of group members, identifying problematic behaviors that need to be corrected, and building cohesiveness ( Rose, 1998).

CBT-INITIAL STAGE

Generally, each session opens with group members checking in by stating significant developments during the week, reporting on their homework, and identifying topics or issues they would like to put on the agenda for the session.

CBT-WORKING STAGE

Leaders create many functional roles that members can play in the group, delegate the leadership responsibility to the members in a gradual and appropriate manner, present situations in which the members function as therapeutic partners for each other, control excessive group conflict, and find ways of involving all members in group interactions.

CBT-WORKING STAGE

Assessment and evaluation continue throughout the working stage, and group leaders must continually evaluate the degree of effectiveness of the sessions and how well treatment goals are being attained.

CBT-WORKING STAGE

In behavioral groups, social reinforcement is a major intervention provided by the group leader and by other members.

CBT-SOCIAL REINFORCEMENT

It is a good idea to begin each session with members reporting their successes rather than their failures.

CBT-SOCIAL REINFORCEMENT

Participants are taught how to reinforce themselves to increase their self-control and become less dependent on others.

CBT-SOCIAL REINFORCEMENT

Modeling refers to a process in which clients learn through observation and imitation of both the leader and the other members.

CBT-ROLE MODELING

Role modeling is one of the most powerful teaching tools available to the group leader.

CBT-ROLE MODELING

Behavioral rehearsal is an integral part of modeling as members are typically asked to participate by perform-ing the behavior immediately after it has been modeled for them.

CBT-BEHAVIOR REHEARSAL

Remind members of the importance of completing homework assignments, by devoting some time in each session to deciding on appropriate assignments, and by routinely beginning each group session by checking on the assignments of each member.

CBT- HOMEWORK

Coaching seems to work best when the coach sits behind the client who is rehearsing. When a member gets stuck and does not know how to proceed, another group member can whisper suggestions.

CBT-COACHING

Therapeutic homework is aimed at putting into action what members explore during a group session, which, in essence, is the crux of the matter. Homework affords many opportunities for members to practice new skills in the real world.

CBT- HOMEWORK

Unless group members participate in designing their own homework assignments, it is unlikely that they will retain a cooperative spirit and keep the motivation needed to carry out the homework. This is particularly important because collaboration is a key element of a CBT group.

CBT - HOMEWORK

Feedback typically has two aspects: praise and encouragement for the behavior and specific sugges-tions for correcting or modifying errors. Feedback is a useful part of learning new behaviors, especially if it is constructive, specific, and positive.

CBT - FEEDBACK

In cognitive behavioral groups, homework is an essential part of the process.

CBT - HOMEWORK

After one or two coached rehearsals, the coaching is reduced in subsequent role playing. Members rehearse independently before trying out a new role in the real world

CBT- COACHING

This process consists of providing the members with general principles for performing the desired behavior effectively.

CBT-COACHING

Feedback is a useful mechanism of change during behavior rehearsals. Once members achieve successful performance in the group situation, they need to be made aware that application in real life is a basic part of behavior rehearsal.

CBT-FEEDBACK

Practicing in a group session a new behavior that will be used in everyday situations is called behavioral rehearsal.

CBT-BEHAVIOR REHEARSAL

Effective contingency contracts should have the follow-ing features:
( 1) a clear description of the specific behaviors to be performed in the assignments;
( 2) a specification of the immediate reinforcement to be received as well as the group reinforcement; and ( 3) a description of the means by which the assignment is to be observed, measured, and recorded

CBT-CONTINGENCY CONTRACTS

Contingency contracts spell out the behaviors to be performed, changed, or discontinued; the rewards associated with the achievement of these goals; and the conditions under which rewards are to be received.

CBT-CONTINGENCY CONTRACTS

Social reinforcement is a powerful method of shaping desired behaviors. In addition, self-reinforcement is a key method of helping members change.

CBT-SOCIAL REINFORCEMENT

In addition to the reinforcement provided by the group leader, other members reinforce one another through praise, approval, support, and attention.

CBT-SOCIAL REINFORCEMENT

Leaders continue to collect data on matters such as participation, member satisfaction, attendance, and completion of agreed upon assignments between sessions.

CBT-WORKING STAGE

As the group evolves, leaders move from being directive to training the members in performing these functions for themselves.

CBT-WORKING STAGE

Reinecke and Freeman ( 2003) suggest that each session can conclude with a review or a summary of the session. This process, which is best done by the group members, offers participants an opportunity to clarify their goals and identify insights and skills that have been explored. Homework can then be collaboratively developed.

CBT-WORKING STAGE

During the initial phase of a group, members learn how the group functions and how each of the sessions is structured.

CBT-INITIAL STAGE

Those who decide to join negotiate a treatment contract, spelling out what the group leader expects from the member over the course of the group, as well as what the client can expect from the leader.

CBT-INITIAL STAGE

Members in cognitive behavioral groups identify specific skills that they lack or would like to enhance. They proceed through a series of training sessions that involve interventions such as modeling the skill, behavioral rehearsal and coaching, feedback, practicing skills both in the group sessions and through homework, and self- monitoring.

CBT

Leaders prepare and coach members to model by role playing for one another how an individual might respond in a particular situation. 

CBT-INITIAL STAGE

Leaders emphasize a plan for change and an active stance on the part of the members and help members understand that verbalizations and insight are not enough to produce change.

CBT-INITIAL STAGE

Group leaders conduct intake interviews with prospective members during which the preliminary assessment and orientation to the group takes place, and they also conduct an ongoing assessment of members problems.

CBT-INITIAL STAGE

Cognitive restructuring is the process of identifying and evaluating ones cognitions, understanding the negative behavioral impact of certain thoughts, and learning to replace these cognitions with more realistic and appropriate thoughts.

CBT-RESTRUCTURING

Both cognitive therapy and rational emotive behavior therapy use cognitive restructuring as a core procedure in changing an individuals interpretations and thinking processes, which have a powerful effect on his or her feelings and actions. Later in this chapter, cognitive therapy groups are briefly discussed.

CBT & REBT-RESTRUCTURING

The main goal is to identify the most effective solution to a problem and to provide sys-tematic training in cognitive and behavioral skills so the client can apply them

CBT-PROBLEM SOLVING

The buddy system becomes a self- help network that functions after the group terminates

CBT-BUDDY SYSTEM

1. Adopt a problem-solving orientation (clients are helped to assess, define and understand the problem
2. Clients define the problem and formulate specific goals.
3. Clients are taught to brainstorm alternative solutions to the problem.

CBT- PROBLEM SOLVING STAGES PAGE 1

4. Clients make a decision based on the alternatives they developed during the brainstorming stage.
5. Clients implement the chosen solution and evaluate its effects

CBT-PROBLEM SOLVING STAGES PAGE 2

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

CBT-TERMINATION AND BOOSTER SESSIONS

Relapse prevention is an essential part of terminating a therapy group. It is easy for members to revert to ingrained patterns of old learn-ing, especially when they are faced with a new crisis or when stress escalates.

CBT-TERMINATION AND BOOSTER SESSIONS

Generally, social skills training includes strategies such as psychoeducation, modeling, behavioral rehearsal, role playing, and feedback

CBT-SOCIAL SKILLS TRAINING

This group experience focuses on training in three areas:
( 1) social environment awareness,
( 2) interpersonal skill enhancement,
( 3) presentation skill enhancement. In these three areas, participants

CBT- Social effectiveness training ( or SET),
The social skills training component is conducted in weekly small group sessions over a 12- week period.

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