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Cognitive Behavioral Group Therapy


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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

About the Author

Ingrid Sochting is Chief Psychologist in anoutpatient mental health program and Clinical Assistant Professorin the Department of Psychiatry at the University of BritishColumbia. She has been instrumental in developing CBT group therapyprograms for depression, OCD, panic disorder, social anxiety, andPTSD, as well as interpersonal therapy (IPT) groups for later lifedepression. She supervises and teaches CBT and IPT to psychologyand psychiatry residents, and is co-director of the RichmondPsychotherapy Training Program. She has also published over 25peer-reviewed journal articles and book chapters in the field; andis a Canadian certified CBT therapist and a Certified GroupTherapist of the American Group Psychotherapy Association.


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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