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
