Behavioral Activation Group Therapy Therapist Manual

Participation: participation by everyone is expected

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Participation: participation by everyone is expected.

  • Homework: between session activities are expected.

  • Co-therapist dialogue: comment on co-therapist dialogue so that when it is utilized the process does not confuse the group members.

  • Describe some of the benefits of group therapy:

  • Learn from other members who have similar experiences

  • Opportunity to interact with others in a safe environment

  • Peer support and feedback

    (About 5-10 minutes)

    • Introduction of group members:

    • Name, personal information

    • What do you want to be different at the end of this 10-week experience?

    (About 10 minutes)

    • Introduce the behavioral theory of depression:

    • Depression is characterized by feeling terrible, losing interest or pleasure in most activities, change in weight and eating habits, change in sleep pattern, feeling exhausted all of the time, feeling worthless or guilty much of the time, difficult concentrating, and thoughts of death or dying.

    • Depression occurs when changes in a person’s life occur that reduce the number of pleasurable and meaningful experiences. This reduction causes the person to experience some of the symptoms of depression. Once the person becomes depressed, her/his way of responding to the depression often make the depression worse. For example, instead of working to restore the level of pleasurable experiences, the person often withdraws and further reduces pleasurable experiences. A final factor is that not all people are equally vulnerable to depression. What causes one person to become depressed may not cause another person to become depressed. Whether or not a person becomes depressed is determined by her/his genes and her/his history of experiences.

    • Behavioral Activation

    • The goal of behavioral activation is to assist the patient in making changes in behavior that will maximize the opportunities for pleasurable or meaningful experiences.

    • This is accomplished by learning to cope differently in a way that increases these opportunities. Also, the patient is helped to change parts of his environment so that it will become more pleasurable. Finally, the patient will learn to nip future episodes of depression in the bud by coping better with adversity, thereby making himself less vulnerable to depression.

    • It is important to communicate to the group members that while behavioral activation has been shown to be effective in reducing depression, there is no magic change that takes place. Group members should expect difficulties in completing homework assignments, particularly early in therapy. Depression can be relieved through continued use of behavioral activation over a period of several weeks.

    • Role of the therapists:

    • Therapist as a personal trainer: job is to help patients identify what is going wrong in their lives and guide them in actions that will help improve their life situations, and thereby make the less depressed.

    (About 15 minutes)

    • Go-Around:

    • Each member gets about 5-10 minutes to tell her/his story about why s/he is in the group and what her/his life has been like recently.

    • Therapists take turns processing information for group member and assist them by using open-ended probes, clarifications, and empathic responses.

    • After each group member finishes, allow for vicarious sharing (not advice) from other group members.

    • Co-therapist dialogue to introduce the concept of homework.

    • Introduce Activity Schedules and explain the rationale for them and ask all group members to keep one for the next week.

    • Introduce workbooks for group members. Explain the purpose of having each group member become familiar with the different treatment techniques. Ask each group member to read her/his workbook and be able to describe how and why the technique is used to the group during the next session.

    • Spend a few minutes with each group member contracting for one additional homework assignment that will begin the activation process.

    (About 50 minutes)

    • Closure

    • Thank all members for their participation and acknowledge the difficulty of sharing personal feelings in a group.

    • Be encouraging about the first session’s progress

    • Explain that in future sessions, group members will be asked for more feedback to peers.

    (About 5 minutes)

    BAGT Second Session Agenda

    I. Warm-up exercise (progressive muscle relaxation, imagery, etc.)

    Other therapist reviews the clients’ BDIs

    II. Group members each have a turn presenting the treatment techniques from their workbooks. The therapists assist by prompting the clients with questions or expanding on the clients’ descriptions when needed.

    III. Go-Around

    • Each group member gets approximately 5 minutes to talk about the past week’s experiences and the therapists should assist by reflecting, probing and clarifying with the mindset of identifying behaviors to target for intervening upon with a balance between in-session interventions and homework assignments.

    • At this early stage of treatment, the therapists will be the primary resources for intervention for the group members. Therapists should deflect duties to group members when appropriate and when there is good reason to believe that the group member can handle the task.

    IV. Closure

    • Firm up homework assignments with each group member and get a verbal commitment of homework from each group member.

    BAGT Sessions 3-6 Agenda

    I. Warm-up exercise

    Other therapist reviews BDIs

    II. Go-around

    • Each group member reports on homework experiences and other relevant experiences.

    • In-session interventions are utilized more often as treatment progresses and more information about each group member is obtained.

    • Increase homework assignments in terms of assignments that may be more difficult and have more potential antidepressant value.

    • As treatment progresses, the therapists should be deflecting increasing amounts of responsibility to the group members and should be functioning as facilitators more than interventionists. This involves having clients take on more responsibility for their own treatment as well as for helping other group members with treatment.

    III. Closure

    • Firm-up homework assignments

    BAGT Sessions 7-9

    I. Warm-up exercise

    II. Go-around

    • Group members report on their own significant BDI items.

    • Group members report on homework experiences and other relevant experiences.

    • In-session interventions and homework assignments become increasingly more substantial.

    • Group members are taking the majority of responsibility for their own treatment and the treatment of other group members.

    III. Relapse Prevention

    • Provide rationale for relapse planning.

    • Begin reviewing the types of experiences each person has had during treatment that have been successful in relieving the depression.

    • Emphasize the role that the client has played in that s/he has done all of the work and that the therapists and group members have only assisted.

    IV. Closure

    • Firm-up homework assignments.

    BAGT Last Session Agenda

    I. Warm-up exercise

    II. Brief go-around

    • Group members share any meaningful experiences they have had during the past week.

    III. Relapse Prevention

    • Therapists spend time with each group member identifying significant experiences that have occurred during treatment with an emphasis on those types of homework experiences that have been particularly effective with each individual.

    • Each individual is encouraged to use the knowledge and skills that s/he has gained from therapy to manage difficult situations in the future and defend against future depression.

    IV. Closure

    • Therapists summarize the gains that have been made by the group members and highlight some of the most meaningful examples of Behavioral Activation success.

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