CBT in Groups
Cognitive-behavioral therapy is a type of psychotherapy that can be used to help teach a person, or group of people, how to change and maintain new behaviors through altering how they view a topic or situation (Nichols & Davis, 2020). In other words, a therapist can guide a patient to recognize a set of dysfunctional emotional or behavioral patterns, and then leads them in challenging these cognitions which result in a change in behavior (Nichols & Davis, 2020). This type of therapy is generally more structured than typical talk therapy and is intended to have a limited duration of treatment than other types of psychotherapy. The length of treatment is frequently determined but the behavior that is being targeted (Nichols & Davis, 2020).
There is some evidence that indicates CBT may work equally well in both group settings and individual sessions (Straus, 2021). Conversely, there is a larger body of evidence that indicates group work may actually be more effective than individual therapy for some subjects (Murphy, et al., 2020). In a randomized control trial, men that had partner-directed violence were found to have significantly fewer incidents of abuse after receiving group CBT treatment versus those that only received individual CBT therapy (Murphy, et al., 2020). The trick to a successful CBT group is how well the group is facilitated. The structure must be established from the beginning, creating a set of rules will help to form the structure when introduced at the start (Straus, 2021).
These rules will need to be clear and provided to the group at the beginning of each session. It may be helpful to include feedback from members of the therapy group to help create buy-in and a sense of ownership. An additional benefit of using CBT in groups is the opportunity to incorporate other group therapy modalities into the session which can enhance the chances of recovery and behavior modification (Straus, 2021). Incorporating mindfulness into group CBT sessions is an easy way to offer a holistic method to long-term recovery (Straus, 2021).
In group work, the topic should be either pre-determined or proposed during the session by its members. For instance, a CBT group for co-occurring disorders may have the topic of stigma or substance use, all the members would share their thoughts and experiences with the topic and then the therapist can challenge the negative cognitions one by one as the group works together to change how the problem is viewed. Using CBT is group settings can also introduce a number of unique challenges not typically observed with individual or even family-based therapy sessions, groups are dynamic and can take on a life of their own. They need to be tightly managed to maintain structure but still allow for collaboration and fluidity. Rules are paramount, and respect must be a strong component of group therapy sessions.
Family CBT therapy is often centered on the needs of a specific family member who gets treatment individually and with the rest of the family with focus on a set ‘problem’ (Stewart, et al., 2020). Research has found that certain behaviors are better managed when the family’s reactions to the individual’s behavior are modified in addition to having the behavior focused on (Stewart, et al., 2020). In family CBT, the therapist talks to an individual and then sees the family as a unit, they are then able to identify patterns and bring those back to the family. The group can then set goals and start to work on problem areas. Families are interactive and CBT can be trialed in real-time with its various members, where they can practice their communication with each other in the moment with a therapist to assist. It is possible that some of the communication/ negative cognitions can be fixed while still in session, in real-time.
Challenges
Some challenges APRNs may face are resistance to homework and the duty of maintaining confidentiality in groups/families. Possible solutions for these issues is to get a commitment from group members for the homework piece, make them accountable to themselves and one another. There can be such a thing as healthy peer pressure, this method has been shown to be effective in 12-step groups and the same principle applies to CBT groups because they are similar in the way they challenge an individual’s thoughts and emotions surrounding maladaptive behaviors. For confidentiality concerns, full disclosure would need to be provided at the beginning of the first group and at the opening of each session thereafter.
References
Murphy, C. M., Eckhardt, C. I., Clifford, J. M., LaMotte, A. D., & Meis, L. A. (2020). Individual versus group cognitive-behavioral therapy for partner-violent men: A preliminary randomized trial. Journal of Interpersonal Violence, 35(15–16), 2846–2868. https://doi.org/10.1177/0886260517705666
Nichols, M. P., & Davis, S. D. (2020). Chapter 9: Cognitive-behavioral family therapy. In The Essentials of Family Therapy. essay, Pearson Education, Inc.
Stewart, K. E., Sumantry, D., & Malivoire, B. L. (2020). Family and couple integrated cognitive-behavioural therapy for adults with OCD: A meta-analysis. Journal of Affective Disorders, 277, 159–168. https://doi.org/10.1016/j.jad.2020.07.140
Straus, B. (2021). Review of cognitive-behavioral group therapy: Challenges and opportunities: by Ingrid Sochting. West Sussex, UK: Wiley Blackwell, 2014, 368 pp. International Journal of Group Psychotherapy, 71(2), 332–337.
Review of Cognitive Behavioral Group Therapy Challenges and Opportunities.pdf (338.892 KB)
Discussion: Cognitive Behavioral Therapy: Family Settings Versus Individual Settings
In recent years, cognitive-behavioral therapy has garnered the attention of both mental health patients and treatment specialists. CBT is a more cost-effective treatment option since it is often used for a shorter period. Cognitive therapy has been demonstrated to enhance clients’ performance and assist them in overcoming maladaptive tendencies (American Nurses Association & International Society of Psychiatric-Mental Health Nurses, 2007). CBT is the most extensively explored psychotherapeutic paradigm. It is useful in treating a wide range of emotional and behavioral disorders, making it suited for application in several situations and populations, including individual, group, and family settings.
Comparing Group CBT to Family and Individual Settings
CBT is a sort of cognitive-behavioral therapy that is applied in a variety of different scenarios. The most effective therapy is determined by the individuals in a group setting. Individual CBT has the drawback of being ineffectual if the treatment isn’t committed (Edwards, 2015). While the practitioner’s role is to counsel and support you on the proper road, the client must be dedicated to and sensitive to change. Group cognitive-behavioral therapy has the drawback of leaving less time for tailoring treatment programs to the individual needs of each group (Dallos & Draper, 2015). The principles and techniques of family therapy are rooted in academic thought. Families who are going through a difficult time, have had a major life event, or have a family member who needs treatment for a mental health condition may benefit from family therapy (Edwards, 2015). My practicum for this quarter is in group therapy, which I have seen and participated. I have noticed that individuals in medication-assisted treatment groups are quite frank and willing to express their experiences. If a patient is excited about participating in a group setting, they will receive more benefit from the session than if they simply come in and sit through it.
CBT for individuals has the individual goal of minimizing harm, notably in the case of those suffering from substance abuse or anxiety disorders. Individual CBT is a treatment in which the therapist and the patient work together to determine the goals and physiology of the patient before coming up with a treatment plan. With the help of cognitive-behavioral therapy, patients may learn to recognize and avoid upsetting situations, thoughts, and feelings (CBT). The next step in CBT is to determine whether the client wants to change their current problems. According to cognitive behavioral therapy, people are prone to have pessimistic beliefs about themselves, their prospects, and the world. Additionally, CBT analyzes the individual’s intention to modify their present challenges. Attitudes developed due to childhood experiences and other life events may encourage negative thinking.
Challenges of CBT in Family Settings
As previously mentioned, some patients struggle to reach up to others. It is simply that some consumers have a harder time being open and honest about their struggles than others (Wheeler, 2016). This may be a barrier when practicing CBT in a family or group setting. Because of this, I have seen both sides of the coin where I am now doing my practicum. Occasionally, a consumer will remain the whole hour-long group session. Certain folks merely sit and listen throughout the session. Certain consumers prefer individual sessions. So, the therapist could try to find ways to get their patient more engaged in the group setting by gradually introducing them to it, hoping that they will develop an interest there.
References
American Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2007). Psychiatric-mental health nursing: Scope and standards of practice. Amer Nurses Assn. http://repository.poltekkes-kaltim.ac.id/601/1/Psychiatric-Mental%20Health%20Nursing%20%28%20PDFDrive.com%20%29.pdf
Dallos, R., & Draper, R. (2015). EBOOK: An Introduction to Family Therapy: Systemic Theory and Practice. McGraw-Hill Education (UK). https://books.google.com/books?hl=en&lr=&id=1skvEAAAQBAJ&oi=fnd&pg=PP1&dq=The+essentials+of+family+therapy+pdf&ots=KAU0tkVphq&sig=8yMWPhaZqSDK-y6UdZEstOij6kk
Edwards, E. A. (2015). Group Cognitive Behavioral Therapy Over Individual Cognitive Behavioral Therapy. A Meta-analysis Of Effective Treatment Of Anxiety Disorders In Middle Childhood. Electronic Theses, Projects, and Dissertations. http://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?article=1268&context=etd
Wheeler, K. (2016). Psychotherapy for the advanced practice psychiatric nurse. St. Louis, MO: Mosby. https://connect.springerpub.com/binary/sgrworks/0bb2ebdb7c4178af/27768bc17972f9b2fd45dbcb1f8287fc12be8ca6e9406ea1861e6fccb18126d2/9780826136251.pdf
21.pdf.pdfWheeler_Ancillary.pdfGROUP COGNITIVE BEHAVIORAL THERAPY OVER INDIVIDUAL COGNITIVE BEHA.pdf
Psychiatric-Mental Health Nursing ( PDFDrive.com ).pdf (4.101 MB)
Week 5 
Cognitive Behavioral Therapy
In cognitive therapy, the therapist first try’s to find where the person may be using faulty thinking pattern. When the therapist reveals the faulty thinking pattern to the patient, the patient can try to change the negative thinking pattern. It can be changed by improving the client’s awareness of when the negative thinking pattern occurs and once the client recognizes it on their own, they can think of how to change the negative patterns. This prevents the client from jumping to the worst possible scenario when something bad happens.
Group therapy is where people work on their individual problems but in a group setting. There could be a group, such as bulimia nervosa and all members are suffering with their own individual problem, but they work on it as a collective group (Murphy et al., 2016). One benefit of group setting is it encourages socialization of the individual. In a group setting, a person has to get along with other people, communicate with a group of different people, and receive feedback from different members of the group. An individual with a problem may believe nobody else understands, but when in a group that person can relate to other people with a similar problem. This improves patient outcome.
Family therapy looks at the family as an arrangement of relationships (Weinstein et al, 2018). This relationship influences all members of the family and can be important for disorders. So one member in the arrangement of relationships can impact the family as a whole. For example, depression with one member of the family with diabetes, then it might be important to look at what kind of pressure this puts on other members of the family (Newby et al., 2017).
There are numerous challenges a PMHNP may encounter in group therapy. First, you cannot assume that just because a group shares a disorder that their individual needs will be the same. The therapist has to deal with the group as a whole and cannot give each individual the attention they may need. Therefore, the therapist may not know fine details of an individual because there simply isn’t enough time in group. Another challenge is group dynamics. Some people may be outspoken and use much of the group time, while some may not feel comfortable sharing with a group personal information they would feel more comfortable with one-on-one therapy. Also, when in group, an individual can get use to their disorder. Before an individual may have thought he/she was alone; now in group, the individual meets other people with the same problem and gets use to their own problem as a regular issue.
Cognitive behavioral therapy is direct. It is action oriented and problem focused. The therapist and patient work alongside of each other and focus on a narrow area to improve. Then they come up with a plan of behavior that will aid in making rapid progress in that area.
References
Murphy R, Straebler S, Cooper Z, Fairburn CG. (2016). Cognitive behavioral therapy for eating
disorders. Psychiatric Clinic North America. 33(3):611-27.
https://0.1016/j.psc.2010.04.004.
Newby J, Robins L, Wilhelm K, Smith J, Fletcher T, Gillis I, Ma T, Finch A, Campbell L,
Andrews G. (2017). Cognitive behavior therapy for depression in people with diabetes
mellitus: A randomized controlled trial. Journal Medical Internet Research. 19(5).
https://10.2196/jmir.7274.
Weinstein SM, Cruz RA, Isaia AR, Peters AT, West AE. (2018). Child- and Family-Focused
cognitive behavioral therapy for pediatric bipolar disorder: Applications for suicide
prevention. Suicide Life Threat Behavior. 48(6):797-811. https://10.1111/sltb.12416.
Cognitive Behavioral Therapy for Eating Disorders.pdf
Child- and Family-Focused Cognitive Behavioral Therapy for.pdf
Web-Based Cognitive Behavior Therapy for Depression in People.pdf
