Cognitive behavioral therapies (CBT)


 Cognitive behavioral therapies (CBT) have long been recognized as having great benefit and efficacy for the treatment of a variety of patient issues ranging from chronic pain, to anxiety and depression, and in fact CBT has been shown to generally produce at least a minor positive effect on all patients treated no matter what their initial baseline symptoms may be (Turner et al., 2007). CBT, especially group based, has been found to be a cost-effective way to encourage social behaviors and skills, and also provide often immediate feedback from multiple sources that relate to the patient, and thus reduce isolation and stigma for the engaged patient (PsychExamReview, 2019). CBT, while generally found to be advantageous for most, if not all, patients who are engaged in treatment, has been found to have a different impact depending if it is performed in a group setting versus individual setting.

 While individual CBT has long been shown to be able to produce positive changes in patient’s cognitive and behavioral symptoms, its benefits are largely limited by the patient’s own inherent self-efficacy  (Turner et al., 2007). The same has not been found to be true, however, with group-based CBT. In fact, it has been shown that in a direct comparison of results between group and individual CBT, group therapy was found to be more effective than individual CBT in producing long lasting and effective positive changes in the recipients/patients (Dogaheh et al., 2011). This may be due, at least in part, to the added sense of support and validation offered by the group setting members who can help in identifying with the patient’s experiences, lending the patient more of a sense of inclusion and safety and hope in the context that if another person can work through these issues, so might they themselves (Marziali & Munroe-Blum, 1995).

 Indeed, in individual CBT therapy, the focus is often on the therapist attempting to help the patient to reframe or challenge their own assumptions, behaviors, shame, and guilt, which can be difficult to do in a supportive and nonconfrontational way at times, so that the patient in essence learns to be their own therapists and better cope with their difficulties (Gilbert, 2010). In group CBT, however, there is a greater focus on the structure and interplay of the group as a supportive, safe, and healing environment that works together for mutual benefit, healing, and positive change (Marziali & Munroe-Blum, 1995).

 The group setting, while generally found to be more advantageous for positive patient outcomes, is also prone to more problems as there are multiple patients, personalities, and problems to integrate into the therapeutic environment by the therapist. Problems that can arise in the group setting are often placed into two subgroups of issues, with the first being disruptiveness, and the second being hesitancy or member reluctance to engage with others or the therapist in the group setting (Gladding & Binkley, 2007). 

 With the first group, the disruptive patients, often the therapist must expend extra time and effort to reemphasize the group rules and to build trust not only between the therapist and the disruptive member, but also between that patient and the other group members so as to foster a sense of belonging and support which would negate the problematic patient’s need to cause disruptions as a way to deflect attention from their actual issues/needs/guilt (Gladding & Binkley, 2007). With the second group, much the same approach is used, as the therapist must take extra time and effort, and occasionally meet individually with the hesitant member so as to build enough trust and rapport so that they (the patient) feel empowered and safe enough to actively and productively engage with the group (Gladding & Binkley, 2007). The attached articles and references are deemed to be scholarly by virtue of being published and peer reviewed articles written and developed by experts in the related fields described therein.

ACAPCD-11.pdfAn_Interpersonal_Approach_to_G.pdfAPTFinal.pdfcomparison of group and individual cbt.pdfmediators moderators and predictors.pdf

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