131 -Group Counseling with Anger, Anxiety, Addiction and Depression
Counselor Toolbox

 
 
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Using Groups to Address Anger, Anxiety, Depression and Addiction
Presented by: Dr. Dawn-Elise Snipes  Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017)

Objectives
Review the benefits of groups
Identify the modalities for group
goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression
Explore activities that can be used to enhance group engagement
Benefits of Group
Cost effective
Peer feedback and support
Development of interpersonal skills
Reduce isolation and “uniqueness”
Many observers

Modalities for Group
Face-to-face
Web-meeting
Video
Chat
Asynchronous
Psychoeducational/skills video
Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician
HIPAA, HITECH and 42 CFR Part 2 all apply

TRANSDIAGNOSTIC GROUPS
Awareness
Learn about anger, anxiety, depression and addiction and their symptoms
Learn about the Mind-Body Connection
Potential causes of symptoms
Effects of symptoms
Interventions for symptoms
Have clients identify
Their symptoms
What changed which causes or worsens the symptom
How they have dealt with the symptom in the past
Impact of the symptom on them
Awareness
Negative Triggers
Those things that cause or worsen the symptom
Hungry Angry Lonely Tired
False Evidence Appearing Real
People
Places
Things
Times (of day, anniversaries, holidays)
Which ones can be avoided or prevented?
Identify three ways to deal with the unavoidable ones

Awareness
Positive Triggers
Those things that remind you to use your new tools
How can you add those to your environment?
Sights
Sounds
Smells
Social
Environment

Awareness
Vulnerabilities
Explain the concept of vulnerabilities
Identify the most common vulnerabilities
Emotional (guilt, envy, depression, anxiety, anger)
Mental (negativity, unhelpful thoughts, fogginess)
Physical (pain, exhaustion, illness, medication)
Social (stressful people/environments; abandonment fears)
Environmental (too chaotic/quiet; disorganized, dark…)
Awareness
Mindfulness and Vulnerability Prevention
Learn about mindfulness
Purpose
Benefits
Methods
Anchored Scan
3 minute thoughts
3 minute observations
Difference from meditation
Awareness
Help clients brainstorm interventions and develop a plan for becoming more mindful of strengths and needs in order to:
Prevent vulnerabilities (home, work, family/social gatherings)
Mitigate vulnerabilities
Prevent unnecessary distress
Mitigate unavoidable distress
Awareness
Goal Identification:  What is most important to focus your energy on so you can be happy?  // What does happiness/recovery look like to you?
What 5 things are important to you?
What 5 relationships are important to you and what do you want them to look like?
What 5 personal growth goals are important to you?
What are your top 5 values that support your goals
Distress Tolerance
Clients with mood or addictive disorders tend to
Get stuck in the unpleasant emotion
Impulsively act to eliminate/escape from distress
Distress tolerance skills help them learn that urges and feelings:
Come in waves
Do not have to be acted upon
Can be tolerated
Can help them practice to pause to make choices which will keep them using their energy to move toward their goals
Bee metaphor

Distress Tolerance
Address Distress Intolerant Thoughts using the ABCs
Activating Event (brainstorm triggers)
Beliefs (D.I.T)
Consequences
Dispute DITs with alternate statements
Evaluate which outcome represents a more effective use of energy and helps get the client closer to goals.
Distress Tolerance Skills
The wave metaphor
The cloud metaphor
Discuss the concept of radical acceptance
Differentiate from agreement or powerlessness
Use the house metaphor
Have clients brainstorm ways and create an action plan to:
IMPROVE the moment
ACCEPT reality
Cognitive Distortions
Identify what each distortion is, and when clients have used each one.
Discuss the impact of the distortions
Identify ways to address distortions
Arbitrary Inference (drawing conclusions with insufficient info)
Availability Heuristic (basing decisions on most prominent memory)
Selective Abstraction (seeing only what you want to)
Negative Mental Filter / Minimizing the Positive
Overgeneralization (This happened once…so it is true every time)
Magnification (Making something an 8 when it is a 2)
All-or-Nothing
Personalization (Its my fault or was an attack on me)
Irrational Thoughts: Who Said & Why
You must have love and approval from others all the time
In order to be worthwhile, you must be competent at everything all of the time.
People who make you feel bad, and should be punished.
If you do not get my own way, awful things will happen.
Unbearable emotional misery comes from external pressures.
If something is dangerous or fearsome, you can't help but to dwell on it.
It is easier to avoid than face life's difficulties.
Your past must determine your feelings and actions today.
It is awful if you do not find quick solutions
Challenging Questions (1 with CD/IR)
What is your evidence?
Do you have the big picture, or are you focusing on one aspect?
How reliable is the source of the evidence?
Are you using emotional reasoning?
Does the belief contain all-or-none terms?
Are there any exceptions?
Are you confusing something that is possible with something that is likely?
Locus of Control
Explain the concept of LOC
Internal: I have the ability to control everything
External: Destiny and fate are in total control
Serenity prayer
Grant me the serenity to accept the things I cannot change
The Courage to change the things I can
The Wisdom to know the difference
Explore
What stressors are within and outside of personal control
How it feels/what it means to not be able to control something
What powerlessness represents in that person’s life
Ways to cope with those things that are out of personal control
Attributions
Explain what they are
Internal vs. External
Stable vs. Changeable
Global vs. Specific

How does changing attributions change how people feel about a situation?

Examples
I am a lumbering ox  vs. I tripped on my shoelace today
I am a failure at everything I do  vs. Another person had skills I need to develop to get that type of job
I am depressed vs. there is a lot of stuff that is stressful and depressing in my life right now that I need to address
Purposeful Action Pathway
Starting Point
Feelings
Mind-set (Distress Intolerance, Cog. Distortions)
Physical health (sleep, pain, immunity)
Relationships
Self-Esteem
Self Esteem
Self esteem is the relationship with yourself
What qualities do you look for in a friend?
Which of those qualities do you have?
How can you be your own best friend?
Do you hold yourself to a higher standard than you hold anyone else to?

Self Esteem
Describe who you think you should be, and who you are right now.
Similarities?
Differences?
Are those differences important?
If so, make a plan to start achieving one
If not, how can you let that go?

Interpersonal Effectiveness
Being able to ask for what you need and get it
Win/Win
Being able to set and maintain healthy boundaries
Asking and saying “no.”
Being able to develop and maintain supportive relationships.
Communication skills
Problem Solving
Using all skills learned thus far, have clients identify triggers or problems and choose/explain how to:
Stay miserable and the effects
Tolerate distress and the effects
Change how they feel and think about the situation, and the effects
Change the situation and the effects
Summary
Groups are extremely cost effective
This series of 24 groups provides the foundation for clients to begin living a happier life.
It is recommended to use written/visual material in addition to lecture and interactive application to help clients fully acquire knowledge and skills
When looking for group activities, consult self help workbooks.  Use the activities to launch discussion or create discussion stations

Resources
Excellent resources for activities that can be easily translated to group activities…