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You have definitely heard about CBT.

You may not know it, or you may not immediately assign meaning to those three letters placed side by side, but there’s almost no doubt that you have at least a passing familiarity with CBT.

If you’ve ever interacted with a therapist, a counselor, or a clinician in a professional setting, you have likely participated in CBT. If you’ve ever heard friends or loved ones talk about how a mental health professional helped them recognize their fears or sources of distress and aided them in altering their behavior to more effectively work towards their goals, you’ve heard about the impacts of CBT.

CBT, or cognitive behavioral therapy, is one of the most used tools in the psychologist’s toolbox. It’s based on a fairly simple idea which, when put into practice, can have wildly positive outcomes.

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What is CBT?

This simple idea is that our unique patterns of thinking, feeling, and behaving are significant factors in our experiences, both good and bad. Since these patterns have such a significant impact on our experiences, it follows that altering these patterns can change our experiences (Martin, 2016).

CBT aims to change our thought patterns, the beliefs we may or may not know we hold, our attitudes, and ultimately our behavior in order to help us face our difficulties and more effectively strive towards our goals.

The founder of CBT is a psychiatrist named Aaron Beck, a man who practiced psychoanalysis until he noticed the prevalence of internal dialogues in his clients, and realized how strong the link between thoughts and feelings can be. He altered the therapy he practiced in order to help his clients identify, understand, and deal with the automatic, emotion-filled thoughts that arise throughout the day.

Beck found that a combination of cognitive therapy and behavioral techniques produced the best results for his clients. In describing and honing this new therapy, Beck laid the foundations of the most popular and influential form of therapy of the last 50 years.

This form of therapy is not designed for lifelong participation, but focuses more on helping clients meet their goals in the near future. Most CBT treatment regimens last from five to ten months, with one 50 to 60 minute session per week.

CBT is a hands-on approach that requires both the therapist and the client to be invested in the process and willing to actively participate. The therapist and client work together as a team to identify the problems the client is facing, come up with new strategies for addressing them, and thinking up positive solutions (Martin, 2016).

Cognitive Distortions

Many of the most popular and effective CBT techniques are applied to what psychologists call “cognitive distortions” (Grohol, 2016).

Cognitive distortions: inaccurate thoughts that reinforce negative thought patterns or emotions.

Cognitive distortions are faulty ways of thinking that convince us of a reality that is simply not true.

There are 15 main cognitive distortions that can plague even the most balanced thinkers at times:

Filtering

Filtering refers to the way many of us can somehow ignore all of the positive and good things in our day to focus solely on the negative. It can be far too easy to dwell on a single negative aspect, even when surrounded by an abundance of good things.

Polarized Thinking / “Black and White” Thinking

This cognitive distortion is all about seeing black and white only, with no shades of grey. This is all-or-nothing thinking, with no room for complexity or nuance. If you don’t perform perfectly in some area, then you may see yourself as a total failure instead of simply unskilled in one area.

Overgeneralization

Overgeneralization is taking a single incident or point in time and using it as the sole piece of evidence for a broad general conclusion. For example, a person may be on the lookout for a job but have a bad interview experience, but instead of brushing it off as one bad interview and trying again, they conclude that they are terrible at interviewing and will never get a job offer.

Jumping to Conclusions

Similar to overgeneralization, this distortion involves faulty reasoning in how we make conclusions. Instead of overgeneralizing one incident, however, jumping to conclusions refers to the tendency to be sure of something without any evidence at all. We may be convinced that someone dislikes us with only the flimsiest of proof, or we may be convinced that our fears will come true before we have a chance to find out.

Catastrophizing / Magnifying or Minimizing

This distortion involves expectations that the worst will happen or has happened, based on a slight incident that is nowhere near the tragedy that it is made out to be. For example, you may make a small mistake at work and be convinced that it will ruin the project you are working on, your boss will be furious, and you will lose your job. Alternatively, we may minimize the importance of positive things, such as an accomplishment at work or a desirable personal characteristic.

Personalization

This is a distortion where an individual believes that everything they do has an impact on external events or other people, no matter how irrational the link between. The person suffering from this distortion will feel that they have an unreasonably important role in the bad things that happen around them. For instance, a person may believe that the meeting they were a few minutes late in getting to was derailed because of them, and that everything would have been fine if they were on time.

Control Fallacies

Another distortion involves feeling that everything that happens to you is a result of external forces or due to your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what happens is due to our actions, but the false thinking is in assuming that it is always one or the other. We may assume that the quality of our work is due to working with difficult people, or alternatively that every mistake someone else makes is due to something we did.

Fallacy of Fairness

We are often concerned about fairness, but this concern can be taken to extremes. As we know, life is not always fair. The person who goes through life looking for fairness in all their experiences will end up resentful and unhappy. Sometimes things will go our way, and sometimes they will not, regardless of how fair it may seem.

Blaming

When things don’t go our way, there are many ways we can explain or assign responsibility for the outcome. One method of assigning responsibility is blaming others for what goes wrong. Sometimes we may blame others for making us feel or act a certain way, but this is a cognitive distortion because we are the only ones responsible for the way we feel or act.

Shoulds

“Shoulds” refer to the implicit or explicit rules we have about how we and others should behave. When others break our rules, we are upset. When we break our own rules, we feel guilty. For example, we may have an unofficial rule that customer service representatives should always be accommodating to the customer. When we interact with a customer service representative that is not immediately accommodating, we might get angry. If we have an implicit rule that we are irresponsible if we spend money on unnecessary things, we may feel exceedingly guilty when we spend even a small amount of money on something we don’t need.

Emotional Reasoning

This distortion involves thinking that if we feel a certain way, it must be true. For example, if we feel unattractive or uninteresting in the current moment, we must be unattractive or uninteresting. This cognitive distortion boils down to:

“I feel it, therefore it must be true.”

Clearly our emotions are not always indicative of the objective truth, but it can be difficult to look past how we feel.

Fallacy of Change

The fallacy of change lies in expecting other people to change as it suits us. This ties into the feeling that our happinessdepends on other people, and their unwillingness or inability to change, even if we push and press and demand it, keeps us from being happy. This is clearly a damaging way to think, since no one is responsible for our happiness except for us.

Global Labeling / Mislabeling

This cognitive distortion is an extreme form of generalizing, in which we generalize one or two instances or qualities into a global judgment. For example, if we fail at a specific task, we may conclude that we are a total failure in not only this area, but all areas. Alternatively, when a stranger says something a bit rude, we may conclude that he or she is an unfriendly person in general. Mislabeling is specific to using exaggerated and emotionally loaded language, such as saying a woman has abandoned her children when she leaves her children with a babysitter to enjoy a night out.

Always Being Right

While we all enjoy being right, this distortion makes us think we must be right, that being wrong is unacceptable. We may believe that being right is more important than the feelings of others, being able to admit when we’ve made a mistake, or being fair and objective.

Heaven’s Reward Fallacy

This distortion involves expecting that any sacrifice or self-denial on our part will pay off. We may consider this karma, and expect that karma will always immediately reward us for our good deeds. Of course, this results in feelings of bitterness when we do not receive our reward (Grohol, 2016).

Many tools and techniques found in CBT are intended to address or reverse these cognitive distortions.

You can download the printable version of the infographic here.

 

9 Essential CBT Techniques and Tools

There are many tools and techniques used in CBT, many of which have spread from the therapy context to everyday life. The nine techniques and tools listed below are some of the most common and effective CBT practices.

Journaling

This technique is a way of “gathering data” about our moods and our thoughts. This journal can include the time of the mood or thought, the source of it, the extent or intensity, and how we responded to it, among other factors. This technique can help us to identify our thought patterns and emotional tendencies, describe them, and find out how to change, adapt, or cope with them.

Unraveling Cognitive Distortions

This is a main goal of CBT, and can be practiced with or without the help of a therapist. In order to unravel the cognitive distortions you hold, you must first become aware of which distortions you are most vulnerable to. Part of this involves identifying and challenging our harmful automatic thoughts, which frequently fall into one of the categories listed earlier.

Cognitive Restructuring

Once you identify the distortions or inaccurate views on the world you hold, you can begin to learn about how this distortion took root and why you came to believe it. When you discover a belief that is destructive or harmful, you can begin to challenge it. For example, if you believe that you must have a high paying job to be a respectable person, but you lose your high paying job, you will begin to feel bad about yourself.

Instead of accepting this faulty belief that leads you to think unreasonably negative thoughts about yourself, you could take this opportunity to think about what makes a person “respectable,” a belief you may not have explicitly considered before.

Exposure and Response Prevention

This technique is specifically effective for those who suffer from obsessive compulsive disorder (OCD). You can practice this technique by exposing yourself to whatever it is that normally elicits a compulsive behavior, but doing your best to refrain from the behavior and writing about it. You can combine journaling with this technique, or use journaling to understand how this technique makes you feel.

Interoceptive Exposure

This technique is intended to treat panic and anxiety. It involves exposure to feared bodily sensations in order to elicit the response, activate any unhelpful beliefs associated with the sensations, maintain the sensations without distraction or avoidance, and allow new learning about the sensations to take place. It is intended to help the sufferer see that symptoms of panic are not dangerous, although they may be uncomfortable.

Nightmare Exposure and Rescripting

Nightmare exposure and rescripting is intended specifically for those suffering from nightmares. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion. Once the emotion has arisen, the client and therapist work together to identify the desired emotion and develop a new image to accompany the desired emotion.

Play the Script Until the End

This technique is especially useful for those suffering from fear and anxiety. In this technique, the individual who is vulnerable to crippling fear or anxiety conducts a sort of thought experiment, where they imagine the outcome of the worst case scenario. Letting this scenario play out can help the individual to recognize that even if everything they fear comes to pass, it will likely turn out okay.

Progressive Muscle Relaxation (PMR)

This is a familiar technique to those who practice mindfulness. Similar to the body scan, this technique instructs you to relax one muscle group at a time until your whole body is in a state of relaxation. You can use audio guidance, a YouTube video, or simply your own mind to practice this technique, and it can be especially helpful for calming nerves and soothing a busy and unfocused mind.

Relaxed Breathing

This is another technique that is not specific to CBT, but will be familiar to practitioners of mindfulness. There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, YouTube videos, and scripts. Bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decision making (Megan, 2016).

These techniques can help those suffering from a range of mental illnesses and afflictions, including anxiety, depression, OCD, and panic disorder, and they can be practiced with or without the guidance of a therapist. To try some of these techniques without the help of a therapist, see the next section for worksheets and handouts to assist with your practice.

You can download the printable version of the infographichere.

Cognitive Behavioral Therapy Worksheets (PDF) To Print and Use

If you’re a therapist looking for ways to guide your client through treatment or a hands-on person who loves to learn by doing, there are many CBT worksheets that can help.

Alternative Action Formulation

This worksheet instructs the user to first list any problems or difficulties you are having. Next, you list your vulnerabilities (i.e., why you are more likely to experience these problems than someone else) and triggers (i.e., the stimulus or source of these problems).

Once you have defined the problems and understand why you are struggling with them, you go on to list coping strategies. These are not solutions to problems, but ways in which you can deal with the effects of these problems that can have a temporary impact. Next, you list the effects of these coping strategies, such as how they make you feel in the short-term and long-term, and the advantages and disadvantages of each strategy.

Finally, you move on to listing alternative actions. If your coping strategies are not totally effective against the problems and difficulties that are happening, you are instructed to list other strategies that may work better.

This worksheet gets you (or your client) thinking about what you are doing now and whether it is the best way forward. You can find it here.

Functional Analysis

One popular technique in CBT is functional analysis. This technique helps you (or the client) learn about yourself, specifically what leads to specific behaviors and what consequences result from those behaviors.

In the middle of the worksheet is a box labeled “Behaviors.” In this box, you write down any potentially problematic behaviors or other behaviors you wish to analyze.

On the left side of the worksheet is a box labeled “Antecedents,” in which you or the client write down the factors that preceded a particular behavior. These are factors that led up to the behavior under consideration, either directly or indirectly.

On the right side is the final box, labeled “Consequences.” This is where you write down the consequences of the behavior, or what happened as a result of the behavior under consideration. “Consequences” may sound inherently negative, but they are not necessarily negative; some positive consequences can arise from many types of behaviors, even if more negative consequences result as well.

This worksheet can help you or your client to find out whether particular behaviors are adaptive and helpful in striving towards your goals, or destructive and self-defeating. Follow this linkto print out this worksheet and give it a try.

Longitudinal Formulation

This worksheet helps you address what some CBT therapists call the “5 P Factors” – presenting, predisposing, precipitating, perpetuating, and positives. This formulation process can help you connect the dots between your core beliefs and thought patterns and your present behavior.

This worksheet presents five boxes at the top of the page, which should be completed before moving on to the rest of the worksheet.

  1. The first box is labeled “Precipitating Events / Triggers,” and corresponds with the Precipitating factor. In this box, you are instructed to write down the events or stimuli that provoke a certain behavior.
  2. The next box is labeled “Early Experiences” and corresponds to the Predisposing factor. This is where you list the experiences that you had early on, all the way back to childhood, that may have contributed to the behavior.
  3. The third box is “Core Beliefs,” which is also related to the Predisposing factor. This is where you write down some of the relevant core beliefs you have regarding this behavior. These are beliefs that may not be explicit, but that you believe deep down, such as “I’m bad” or “I’m not good enough.”
  4. The fourth box is “Old Rules for Living,” which is where you list the rules that you adhere to, whether consciously or subconsciously. These implicit or explicit rules can perpetuate the behavior, even if it is not helpful or adaptive. Rules are if-then statements that provide a judgment based on a set of circumstances. For instance, you may have the rule “If I do not do something perfectly, I’m a complete failure.”
  5. The final box is labeled “Presenting Problems / Effects of Old Rules.” This is where you write down how well these rules are working for you. Are they helping you to be the best you can be? Are they helping you to effectively strive towards your goals?

 

Below this box there are two flow charts that you can fill out based on how these behaviors and feelings are perpetuated. You are instructed to think of a situation that produces a negative automatic thought, and record the emotion and the behavior that this thought provokes, as well as the bodily sensations that can result. Filling out these flow charts can help you see what drives your behavior or thought and what results from it.

Below these two charts is the box “Protective Factors.” This is where you list the factors that can help you deal with the problematic behavior or thought, and perhaps help you break the perpetuating cycle. This can be things that help you cope once the thought or behavior arises or things that can disrupt the pattern once it is in motion.

Finally, the last box is “New Rules for Living.” This box relates to the Positive factor, in that it provides you with an opportunity to create new rules for yourself that will disrupt the destructive cycle and allow you to become more effective in meeting your therapeutic goals. Click here if you’d like to try this worksheet.

Dysfunctional Thought Record

This worksheet is especially helpful for people who are struggling with negative thoughts and need to figure out when and why they are most likely to pop up. By learning more about what provokes certain automatic thoughts, they become easier to address and reverse.

The worksheet is divided into seven columns:

  1. On the far left, there is space to write down the date and time a dysfunctional thought arose.
  2. The second column is where the situation is listed. The user is instructed to describe the event that led up to the dysfunctional thought in detail.
  3. The third column is for the automatic thought. This is where the dysfunctional automatic thought is recorded, along with a rating of belief in the thought on a scale from 0% to 100%.
  4. The next column is where the emotion or emotions elicited by this thought are listed, also with a rating of intensity on a scale from 0% to 100%.
  5. The fifth column is labeled “Distortion.” This column is where the user will identify which cognitive distortion(s) they are suffering from with regards to this specific dysfunctional thought, such as all-or-nothing thinking, filtering, jumping to conclusions, etc.
  6. The second to last column is for the user to write down alternative thoughts, more positive and functional thoughts that can replace the negative one.
  7. Finally, the last column is for the user to write down the outcome of this exercise. Were you able to confront the dysfunctional thought? Did you write down a convincing alternative thought? Did your belief in the thought and/or the intensity of your emotion(s) decrease? To give this worksheet a try, click here.

Fact or Opinion

One of my favorite CBT worksheets is the “Fact or Opinion” worksheet, because it can be extremely helpful in recognizing that your thoughts are not necessarily true.

At the top of this worksheet is an important lesson:

Thoughts are not facts.

Of course, it can be hard to accept this, especially when we are in the throes of a dysfunctional thought or intense emotion. Filling out this worksheet can help you come to this realization.

The worksheet includes 16 statements that the user must decide are either fact or opinion. These statements include:

  • I’m a bad person.
  • I failed the test.
  • I’m selfish.
  • I didn’t lend my friend money when they asked.

 

This is not a trick – there is a right answer for each of these statements. (In case you’re wondering, the right answers for the statements above are as follows: opinion, fact, opinion, fact.)

This simple exercise can help the user to see that while we have lots of emotionally charged thoughts, they are not all objective truths. Recognizing the difference between fact and opinion can assist us in challenging the dysfunctional or harmful opinions we have about ourselves and others.

If you’d like to print out this worksheet to give it a try, click here.

Cognitive Restructuring

This worksheet employs the use of Socratic questioning, a technique that can help the user to challenge irrational or illogical thoughts.

The top of the worksheet describes how thoughts are a running dialogue in our minds, and they can come and go so fast that we hardly have time to address them. This worksheet aims to help us capture one or two of these thoughts and analyze them.

  1. The first box to be filled out is “Thoughts to be questioned.” This is where you write down a specific thought, usually one you suspect is destructive or irrational.
  2. Next, you write down the evidence for and against this thought. What evidence is there that this thought is accurate? What evidence exists that calls it into question?
  3. Once you have identified the evidence, you can make a judgment on this thought, specifically whether it is based on facts or your feelings.
  4. Next, you answer a question on whether this thought is truly a black and white situation, or whether reality leaves room for shades of grey. This is where you think about whether you are using all-or-nothing thinking, or making things unreasonably simple when they are truly complex.
  5. In the last box on this page, you consider whether you could be misinterpreting the evidence or making any unverified assumptions.

 

On the next page, you are instructed to think about whether other people might have different interpretations of the same situation, and what those interpretations might be.

Next, ask yourself whether you are looking at all the relevant evidence, or just the evidence that backs up the belief you already hold. Try to be as objective as possible.

The next box asks you whether your thought may an exaggeration of a truth. Some negative thoughts are based in truth, but extended past their logical boundaries.

Next, you are instructed to consider whether you are entertaining this negative thought out of habit or because the facts truly support it.

Once you have decided whether the facts support this thought, you are encouraged to think about how this thought came to you. Was it passed on from someone else? If so, are they a reliable source for truth?

Finally, you complete the worksheet by identifying how likely the scenario your thought brings up actually is, and whether it is the worst case scenario.

These “Socratic questions” encourage a deep dive into the thoughts that may plague you, and offer an opportunity to analyze and evaluate them for truth. If you are having thoughts that do not come from a place of truth, this worksheet can be an excellent tool for identifying and defusing them.

For more CBT worksheets and handouts, visit this website

Some More CBT Interventions and Exercises

Haven’t had enough CBT toolsand techniques yet? Continue on for more useful and effective exercises!

Behavioral Experiments

These are related to thought experiments, in that you engage in a “what if” consideration. Behavioral experiments differ from thought experiments in that you actually test out these “what ifs” outside of your thoughts (Boyes, 2012).

In order to test a thought, you can experiment with the outcomes that different thoughts produce. For example, you can test the thought:

“If I criticize myself, I will be motivated to work harder” vs. “If I am kind to myself, I will be motivated to work harder.”

First, you would try criticizing yourself when you need motivation to work harder and record the results. Then you would try being kind to yourself and recording the results. Next, you would compare the results to see which thought was closer to the truth.

These behavioral experiments can help you learn how to best strive towards your therapeutic goals and how to be your best self.

Thought Records

Thought records are useful in testing the validity of your thoughts (Boyes, 2012). They involve gathering and evaluating the evidence for and against a particular thought, allowing for an evidence-based conclusion on whether the thought is valid or not.

For example, you may have the belief “My friend thinks I’m a bad friend.” You would think of all the evidence for this belief, such as “She didn’t answer the phone the last time I called” or “She cancelled our plans at the last minute”, and evidence against this belief, like “She called me back after not answering the phone” and “She invited me to her barbecue next week. If she thought I was a bad friend, she probably wouldn’t have invited me.”

Once you have evidence for and against, the goal is to come up with more balanced thoughts, such as

“My friend is busy and has other friends, so she can’t always answer the phone when I call. If I am understanding of this, I will truly be a good friend.”

Thought records apply the use of logic to ward off unreasonable negative thoughts and replace them with more balanced, rational thoughts (Boyes, 2012).

Pleasant Activity Scheduling

This technique can be especially helpful for dealing with depression (Boyes, 2012). It involves scheduling activities in the near future that you can look forward to.

For example, you may write down one activity per day that you will engage in over the next week. This can be as simple as watching a movie you are excited to see or calling a friend to chat. It can be anything that is pleasant to you, as long as it is not unhealthy (i.e., eating a whole cake in one sitting or smoking).

You can also try scheduling an activity for each day that provides you with a sense of mastery or accomplishment (Boyes, 2012). It’s great to do something pleasant, but doing something small that can make you feel accomplished may have longer lasting and farther reaching effects.

This simple technique can introduce more positivity into your day and help you make your thinking less negative.

Imagery Based Exposure

This exercise involves thinking about a recent memory that produced strong negative emotions and analyzing the situation.

For example, if you recently had a fight with your significant other and they said something hurtful, you can bring that situation to mind and try to remember it in detail. Next, you would try to label the emotions and thoughts you experienced during the situation and identify the urges you felt (e.g., to run away, to yell at your significant other, to cry).

Visualizing this negative situation, especially for a prolonged period of time, can help you to take away its ability to trigger you and reduce avoidance coping (Boyes, 2012). When you expose yourself to all of the feelings and urges you felt in the situation and survive experiencing the memory, it takes some of its power away.

Situation Exposure Hierarchies

This technique may sound complicated, but it’s relatively simple.

Situation Exposure Hierarchies involves making a list of things that you would normally avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid making a phone call instead of emailing or asking someone on a date.

Next, you rate each item on how distressed you think you would be, on a scale from 0 to 10, if you engaged in it. For the person suffering from severe social anxiety, asking someone on a date may be rated a 10 on the scale, while making a phone call instead of emailing might be rated closer to a 3 or 4.

Once you have rated each item, you rank them according to their distress rating. This will help you recognize the biggest difficulties you face, which can help you decide which items to address and in what order. It may be best to start with the less distressing items and work your way up to the most distressing items.

A CBT Manual and Workbook for Your Own Practice + for Your Client

If you’re interested in giving CBT a try with your clients, there are many books and manuals that can help get you started. Some of these books are for the therapist only, and some are to be navigated as a team or with guidance from the therapist.

There are many manuals out there for helping therapists apply CBT in their work, but these are some of the most popular:

 

For clients or for therapist and client to work through together, these are some of the most popular manuals and workbooks:

There are many other manuals and workbooks out there that can help get you started with CBT, but these are a good start.

5 Last Cognitive Behavioral Activities

Before we go, there are a few more CBT activities and exercises that may be helpful for you or your clients that we’d like to cover.

Mindfulness Meditation

As readers of this blog will likely know by now, mindfulness can have a wide range of positive impacts, including helping with depression, anxiety, addiction, and many other mental illnesses or difficulties.

Mindfulness can help those suffering from harmful automatic thoughts to disengage from rumination and obsession over these thoughts by helping them stay firmly grounded in the present.

Successive Approximation

This is a somewhat fancy name for a simple idea that you have likely already hear of: breaking up large tasks into small steps to make it easier to accomplish.

It can be overwhelming to be faced with a huge goal we would like to accomplish, like opening a business or remodeling a house. This is true in mental health treatment as well, since the goal to overcome depression or anxiety and achieve mental wellness can seem like a monumental task to those who are suffering from severe symptoms.

By breaking the large goal into small, easy to accomplish steps, we can map out the path to success and make the journey seem a little less overwhelming.

Writing Self-Statements to Counteract Negative Thoughts

This technique can be difficult for someone just beginning their CBT treatment or suffering from severe symptoms, but it can also be extremely effective (Anderson, 2014).

When you (or your client) are being plagued by negative thoughts, it can be hard to confront them, especially if your belief in these thoughts is strong. To counteract these negative thoughts, it can be helpful to write down a positive, opposite thought.

For example, if the thought that you are worthless keeps popping into your head, try writing down a statement like “I am a person with worth” or “I am person with potential.” In the beginning, it can be difficult to accept these replacement thoughts, but the more you bring out these positive thoughts to counteract the negative ones, the stronger the association will be.

Visualize the Best Parts of Your Day

When you are feeling depressed or negative, it is difficult to recognize that there is good in your life as well. This simple technique of bringing to mind the good parts of your day can be a small step in the direction of recognizing the positive (Anderson, 2014).

All you need to do is write down the things in your life that you are most thankful for or the things that are most positive in your day. The simple act of writing down these good things can forge new associations in your mind which make it easier to see the positive, even when there is plenty of negative as well.

Reframe Your Negative Thoughts

It can be all too easy to succumb to negative thoughts as a default setting. If you find yourself immediately thinking a negative thought when you see something new, such as entering an unfamiliar room and thinking “I hate the color of that wall,” give reframing a try (Anderson, 2014).

Reframing involves countering the negative thought(s) by noticing things you feel positive about as quickly as possible. For instance, in the example where you immediately think of how much you hate the color of that wall, you would push yourself to notice five things in the room that you feel positively about (e.g., the carpet looks comfortable, the lampshade is pretty, the windows let in a lot of sunshine).

You can set your phone to remind you throughout the day to stop what you are doing and think of the positive things around you. This can help you to push your thoughts back into the realm of the positive instead of the negative.

You can download the printable version of the infographic here.

A Take Home Message

As always, I hope this post has been helpful. There are a lot of great tips and techniques in here that can be extremely effective in the battle against depression, anxiety, OCD, and a host of other problems or difficulties.

However, as is the case with many treatments, they depend on you (or your client) putting in a lot of effort. I would encourage you to give these techniques a real try, and allow yourself the luxury of thinking they may actually work. When we approach a potential solution with the assumption that it will not work, then it will probably not work. When we approach a potential solution with an open mind and the thought that it just might work, it has a much better chance of succeeding.

So if you are struggling with negative automatic thoughts, please consider these tips and techniques and give them a real shot. Likewise, if your client is struggling, encourage them to make the effort, because the payoff can be better than they can imagine.

If you are struggling with severe symptoms of depression or suicidal thoughts, please call the following number in your respective country:

  • USA: National Suicide Prevention Hotline at 1-800-273-8255
  • UK: Samaritans hotline at 116 123
  • The Netherlands: Netherlands Suicide Hotline at 09000767
  • France: Suicide écoute at 01 45 39 40 00
  • Germany: Telefonseelsorge at 0800 111 0 111 for Protestants, 0800 111 0 222 for Catholics, and 0800 111 0 333 for children and youth

For a list of other suicide prevention websites, phone numbers, and resources, see this website.

Please know that there are people out there who care and that there are treatments that can help.

Thank you for reading, and please let us know about your experiences with CBT in the comments section. Have you tried it? How did it work for you? Are there any other helpful exercises or techniques that we did not touch on in this piece?

More Positive CBT Tools? Check Out The Positive Psychology Toolkit

Become a Science-Based Practitioner!

The Positive Psychology toolkit is a science-based, online platform containing 135+ exercises, activities, interventions, questionnaires, assessments and scales.

  • References

    • Anderson, J. (2014, June 12). 5 get-positive techniques from Cognitive Behavioral Therapy. Everyday Health. Retrieved from http://www.everydayhealth.com/hs/major-depression-living-well/cognitive-behavioral-therapy-techniques/
    • Boyes, A. (2012, December 6). Cognitive behavioral therapy techniques that work: Mix and match Cognitive Behavioral Therapy techniques to fit your preferences. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-practice/201212/cognitive-behavioral-therapy-techniques-work
    • Grohol, J. (2016). 15 common cognitive distortions. Psych Central. Retrieved from https://psychcentral.com/lib/15-common-cognitive-distortions/
    • http://www.infocounselling.com/list-of-cbt-techniques/
    • Martin, B. (2016). In-Depth: Cognitive Behavioral Therapy. Psych Central. Retrieved from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/
    • Megan, R. (2016, August 8). List of CBT techniques – cognitive behavioral therapy. Info Counselling. Retrieved from http://www.infocounselling.com/list-of-cbt-techniques/
    • http://psychologytools.com
    • http://www.therapistaid.com
    • www.webmd.com - http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression#1
About the Author
Courtney Ackerman is a graduate of the positive organizational psychology and evaluation program at Claremont Graduate University. She is currently working as a researcher for the State of California and her professional interests include survey research, well-being in the workplace, and compassion. When she’s not gleefully crafting survey reminders, she loves spending time with her dogs, visiting wine country, and curling up in front of the fireplace with a good book or video game.

Home » Therapies » Group Therapy: 32 Activities, Worksheets and Discussion Topics for Adults and Teens

“The best part about being with a group is that you don’t have to do everything alone.” – Anonymous

This quote may seem like a pretty obvious truth – of course you won’t do everything alone if you’re in a group!

However, it is an obvious truth that we often forget.

It can be easy to slide into isolation when we’re feeling down, especially for those suffering from an invisible illness or problem, but this is the exact opposite of the action that is most likely to help us climb out of that pit. Loneliness and isolation tend to breed more loneliness and isolation, but making the (often difficult or exhausting) effort to connect with others is just the thing we may need to start feeling better.

As uncomfortable as it may sound, sometimes sharing difficult thoughts and feelings in a group setting can be extremely effective in facilitating healing.

This quote describes how sharing can help:

“Some of the most comforting words in the universe are ‘me too.’ That moment when you find out that your struggle is also someone else’s struggle, that you’re not alone, and that others have been down the same road.” – Anonymous

Luckily, there is already an established type of therapy built on this idea. This article will define group therapy, describe typical sessions, and provide several activities and exercises you can put to use in your group therapy sessions.

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What is Group Therapy? Definitions and Theories

At the most basic level, group therapy is:

“a form of psychotherapy that involves one or more therapists working with several people at the same time” (Cherry, 2017).

It is usually a complement to individual therapy and sometimes medication as well, although it may be used as a standalone treatment for certain issues or problems.

According to one of the most renowned group therapists, Dr. Irvin D. Yalom, there are 11 key principles of group therapy:

  • The instillation of hope. Since group therapy often includes clients at different stages in their treatment, some of the newer clients can find encouragement from seeing the positive impacts on clients further along in their treatment.
  • Universality. Just being part of a group of people who understand what you are going through and have experienced similar problems will help clients see that they are not alone, and that suffering is universal.
  • Imparting information. Group members can be a great resource of information for each other.
  • Altruism. Group therapy gives members a chance to practice altruism by helping others in the group, an experience which will likely help them as well.
  • The corrective recapitulation of the primary family group. This long-winded principle refers to the process of clients learning and exploring the childhood experiences, personalities, behaviors, and feelings of themselves and other group members, and learning how to identify and avoid destructive or non-helpful behaviors.
  • Development of socialization techniques. The simple experience of working in a group provides excellent opportunities to socialize, practice new behaviors, and experiment in a safe environment.
  • Imitative behavior. Clients can observe and imitate or model positive and helpful behaviors for others in the group, including the therapist.
  • Interpersonal learning. Interacting with the therapist and other group members and receiving feedback can help a client learn more about themselves.
  • Group cohesiveness. Group therapy sessions can facilitate a shared sense of belonging and acceptance of one another.
  • Catharsis. This principle is based on the healing powers of sharing with others; talking through your feelings and experiences in a group can help relieve pain, guilt, and stress.
  • Existential factors. Although group therapy offers guidance and support through the group, it also helps clients realize that they are responsible for their own actions and the consequences that follow (Cherry, 2017).

 

Going back to the first quote about the best part of being in a group, this set of principles makes it clear that there are many advantages to working with a group rather than individually. Some of these principles may apply in individual therapy, but most of them require a group setting.

Group Therapy Session Outline

The general tone and direction of the group therapy session will vary depending on the type of group. There are many different kinds of groups with different areas of focus, but they generally fall into one of two categories:

1) Psychoeducational – These groups are intended to provide members with information they need to address or cope with whatever it is that brought them to the group; they are usually structured with specific topics or modules to cover.

2) Process- Oriented – These groups are more focused on experience, sharing with one another, and making connections; discussion among the members dominates this group rather than a set agenda (Good Therapy, 2013).

Further, groups can be broken down by discussion topics and the structure of the group itself. Some of the most common therapy groups include:

  1. Self-Help Groups – These are generally led by someone who is not a professional group facilitator, but has struggled with a problem or successfully overcome or addressed a problem, and wishes to help others through the process.
  2. Medication Groups – The focus of these groups is on compliance with prescribed medication; the intent is to educate clients about their medication, ensure compliance with the doctor’s instruction, and decreasing their sense of isolation.
  3. Interpersonal Therapy Groups – This type of group is intended to dive deeper into the clients’ current relationships to understand current problems; the present is the focus of these groups rather than the past.
  4. Encounter Groups – These groups aim to immerse members in potentially uncomfortable and intense group situations in the hopes of provoking greater change than a typical therapy group.
  5. Psychodrama – This unique type of group therapy is based on members acting out significant portions of their life. These dramatic reenactments can provoke strong emotions, which are discussed after each “scene” (Counselling Connection, 2010).

The number of participants in a group therapy sessions also depends on the type of group, but can range from only three or four people to twelve or more (although more than twelve participants may not be as effective). Typically, group sessions are held once or twice a week for one or two hours a session. The minimum recommended number of sessions is generally six, but group therapy often continues for up to a year or more (Cherry, 2017).

There are two kinds of group therapy sessions:

1) Open groups: new participants are welcome to join sessions at any time; for example, Alcoholics Anonymous is an open session which invites new members to join in any session.
2) Closed groups: the therapy sessions are closed to a core group of participants; new participants may only be welcomed when a new group is formed (Cherry, 2017).

In terms of what will actually happen in a group therapy session, sessions can vary based on the topic, participants, and treatment progress, but these are some of the common features:

  • The participants will meet in a room with chairs formed into a large circle.
  • The session may begin with group members introducing themselves and explaining why they are in therapy.
  • In subsequent sessions (in closed groups) or in every session (in open groups), members may also share their progress and any updates since the previous group meeting.

 

The flow of the session will depend on the same factors described above, but it will likely follow one of these general paths:

1) Free-form: each participant will engage with the group as much or as little as s/he wants, and participants are the main drivers of the discussion with facilitation and guidance from the therapist.
2) Planned: in other cases, the therapist may have a set agenda for the meeting with planned activities and skill building exercises for group members to engage in (Cherry, 2017).

5 Guidelines and Rules for Group Therapy

Whatever type of group therapy you attend, the general rules will likely be the same. These are the rules must be followed for the safety of the group and effectiveness of the treatment. Certain types of groups may have additional rules, but there is a core set of five rules that are essential for successful group therapy.

These five rules are:

  1. Maintain Confidentiality. It is essential that everything said in group therapy is kept private by all group members and leaders. Failing to adhere to this rule can undermine trust within the group and hinder members’ attempts to heal.
  2. Commitment to Attendance. This is another essential rule for nearly any group – it is vital that each member attend every session, arrive on time, and stay for the entire session. In addition to the absent member missing valuable information and practice, absence or late arrival/early leaving can interrupt the whole group.
  3. No Socializing with Group Members. Group therapy is not a social activity, it is (hopefully!) a therapeutic one. Forming close friendships or other bonds with group members can interfere with group success, especially if members become hesitant to share personal information because of another group member. Friendships should be saved for after the group has disbanded.
  4. Communicate with Words, Not Actions. This rule could be considered the exact opposite of the standard advice storytellers receive: “Show, don’t tell!” People have different reactions to physical contact, so expressing yourself through words instead of physical actions is an important rule to follow.
  5. Participate. Group therapy doesn’t have much of a therapeutic effect if the members do not participate! The potential for healing and growth rests on how much group members are able to connect, share, and learn from one another. It is essential for all group members to truly participate for this treatment to be effective.

 

See here, here, and here for examples of rules and guidelines for different types of group therapy.

How to Become a Group Therapist

There is no specific path to become a group therapist beyond the path to becoming a therapist in general. Most therapists who mainly offer group therapy also offer individual therapy and vice versa.

In general, the path to becoming a therapist consists of three components:

  • Education: To practice as a licensed therapist in most states and countries, you must complete a Master’s program in any of the areas listed below. Many therapists choose to earn a doctoral degree as well, which qualifies them to be a licensed clinical or counseling psychologist. Visit www.cacrep.org to learn about accredited graduate level counseling programs.

1) Social
2) Work
3) Child Psychology
4) Counseling
5) Marriage and Family Therapy
6) Psychology

  • Clinical Experience: The requirements will vary by state and country, but expect to complete at least a couple thousand hours of supervised experience. For example, in California, you will need to complete at least 3,000 hours of supervised experience over the course of at least two full years, with at least 1,750 of those hours spent in direct counseling (www.counselor-license.com).
  • Licensing Exams: Once you have completed your degree and your clinical experience, you can apply for a license and take the licensing exams. In the United States, this will likely be the National Clinical Mental Health Counselor Examination or the National Counselor Examination for Licensure and Certification. Again, requirements will vary by state and country, but in most cases you will need to pass a rigorous examination to qualify for your license.

 

Depending on where you are located, you may also want to pursue membership as a Certified Group Psychotherapist (CGP) with the International Board for Certification of Group Psychotherapists. Becoming a CGP requires all of the same steps as becoming a therapist in addition to 12 hours of coursework in group psychotherapy theory and practice, 300 hours of clinical experience working with groups, 75 supervised hours of group psychotherapy, and references from a supervisor and colleague.

For more information on becoming a CGP, click here.

Curriculum

So what courses will you take on your journey to becoming a group therapist?

As noted earlier, that will depend on where you are pursuing a license to practice group therapy, but in general your coursework will include:

  • Psychological Theories
  • Research Methods
  • Clinical Best Practices
  • Ethics in Therapy
  • Interpersonal Psychology
  • Group Psychology
  • Family Psychology
  • Child Psychology
  • Specialty courses in your area of choice (www.goodtherapy.org)

 

In addition to these courses, you may take courses in diversity and social justice in counseling, career and life development, couples therapy and marriage counseling, courses on addiction and substance abuse, and human development.

It is important for therapists to be well-educated and knowledgeable about several different arenas of human psychology, even if they plan on specializing, because you can never be sure about the problems that will arise when your client opens up. Cases that seem relatively straightforward may surprise you with layered complexity, while another client may present with a myriad of problems that can be addressed with a simple solution.

Therapists must be ready for anything, which is why a good foundation in all areas of clinical and counseling psychology is so important to build.

Benefits of Group Therapy

For participants, there are many reasons why group therapy is a treatment worth considering.

The main advantages include:

  • It allows participants to receive support and encouragement from other members of the group, helping them to feel less alone or isolated.
  • Group therapy provides an opportunity for group members to act as role models for other members, especially when the group is composed of participants at different stages of treatment. Even if all participants are at the same stage, some participants will naturally be more successful at managing certain types of problems than others, and group members can share their experiences and learn from each other.
  • It is usually more affordable than individual treatment, since the therapist’s time is shared with other clients.
  • Group therapy provides a safe environment for group members to practice new behaviors without fear of judgment.
  • Interacting with others in group therapy will help the therapist to see first-hand how a client interacts with others and behaves in a social situation, allowing the therapist to provide targeted feedback and suggestions to each client (Cherry, 2017).

 

The American Psychological Association notes another important benefit of group therapy: diversity. We all have different experiences, backgrounds, and personalities, which leads us to our own unique perspective on the world. Working with a group can help clients see things from a new perspective, which may illuminate new ways to take on old problems and new strategies to overcome obstacles that seem insurmountable (APA, 2017).

To make sure you are taking advantage of these benefits of group therapy, follow these suggestions from Dr. Patti Cox, the president of the Eastern Group Psychotherapy Society and experienced group therapist:

  1. Take a pledge. Signing a contract that outlines what is expected of each participant can encourage participants to engage and contribute to group discussions, and provide incentive to engage even when it is difficult.
  2. Participate. Some days are more difficult than others when it comes to socializing and sharing with others, and that’s okay. However, the more a client pushes him- or herself to engage, the more likely they are to benefit from the session.
  3. Share. Even if a client feels that nobody cares about their problems or they have nothing useful to share with the group, chances are this is not consistent with reality. Everybody has something to share with others, and helping others has a funny way of helping you as well (Cherry, 2017).

You can download the printable version of the infographic here

Common Discussion Topics in Group Therapy

The topics discussed in group therapy will depend on the focus of the group. Some groups are formed for specific reasons, like dealing with addiction or grief, or specific diagnoses, like depressionor anxiety, while others are formed for broader purposes, such as anyone struggling with stress in college or LGBTQ individuals who could benefit from general social support.

The long list of reasons that a therapy group may be formed includes:

  • Death of a loved one
  • Marriage problems
  • Family problems
  • Loss of a job
  • Social anxiety
  • Depression
  • Stress
  • Burnout
  • Substance abuse
  • Major life transitions
  • Breakup or divorce
  • Child behavior problems
  • And many, many more

 

In groups formed around substance abuse, discussion topics may include:

  • Icebreakers
  • Triggers
  • Stay-busy activities (to cope with cravings)
  • Preparing a speech for students (whether the speech will occur or not)
  • Challenging perceptions
  • Role models and behaviors to emulate
  • A history lesson and planning for the future (history of substances and future of substance use and legality in the group’s country)
  • Self-care (SimplePractice, 2017)

 

Blake Flannery (2014) outlines seven major categories of discussion topics and provides suggestions for each category. These topics include:

  • Health and Wellness
    Sleep patterns
    Exercise
    Nutrition
    Medication education
    Recognizing warning signs
  • Personal Control
    Anger management
    Stress management
    Personal hygiene
    Impulse control
    Cognitive Behavioral Therapy (CBT) or Rational Behavioral Therapy (RBT)
  • Relationships
    Assertiveness
    Boundaries
    Conflict management
    Grief, loss, and forgiveness
    Parenting skills
  • Values and Beliefs
    Goal setting
    Values
    Beliefs
    Goals
  • Safety Planning
    Warning signs for recidivism
    Identifying supports
    Discharge/Safety planning
  • Mental Health Systems
    How to talk to your doctor
    How to get the support you need
  • Chemical Dependency
    12 steps / Alcoholics Anonymous or Narcotics Anonymous
    Dual diagnosis (co-morbidity of multiple mental health conditions)

As this list of suggested topics demonstrates, there are dozens, if not hundreds, of topics for discussion in group therapy. Some of them will only be appropriate or effective in specific groups or situations, but some will be useful in all types of groups. The best discussion topics will depend on the focus of the group, the stage of treatment, and the type of session.

7 Group Therapy Ice Breakers and Activities for Adults

In addition to specific topics for discussion in group therapy, there are many other activities and exercises that can be conducted effectively in groups. A few of these activities are described below.

Session Planning PDF

While this PDF is not an exercise or activity per say, it does provide an excellent resource for planning your first group session. You will find session objectives, procedures, planning tips, discussion questions, and more in this PDF.

The activities and procedures are geared towards addiction or substance abuse groups, many of the suggestions and planning materials can be applied to any therapy groups.

For example, the PDF includes a set of group rules and a guide on discussing the rules with group members. These rules can be extended to many other groups, including:

  • Maintain confidentiality
  • Attending group on time and calling if you cannot make it
  • Not discussing absent members in the group
  • Completing any homework assignments and bringing them to the group
  • All members need to participate in all sessions

 

In addition, there are excellent suggestions for questions the therapist can ask to facilitate discussion on goal setting and goal striving, including:

1) How realistic is your goal?
2) What obstacles, if any, are you experiencing in trying to achieve your goal?
3) You made some very major changes in your alcohol or drug use (or anger management, negative automatic thoughts, etc.). How were you able to do that and how do you feel about these changes?

This PDF provides tons of other information and suggestions for positive group interaction. To see what else it has to offer, follow this or this link.

Relationship Growth Activity

This activity can be an excellent icebreaker for couples therapy groups. These questions don’t probe too deeply, but can be a good reminder of the couple’s emotional connection and relationship history. In addition, it can help them learn more about themselves and their partner.

The instructions are for the couple to simply take turns asking each other a question from each section below, or ask them all if they want a challenge or believe they have the right answers.

The questions are divided into six categories:

  1. The Fun Things (example question: What song is your partner into right now?)
  2. About Us (example question: When did your partner realize they were interested in you? Was there a specific moment?)
  3. Hopes & Dreams (example question: What is the happiest life your partner can imagine?)
  4. Work Life (example question: What is the most challenging task your partner has to do at their job?)
  5. Emotions (example question: When in your partner’s life did they feel the most scared?)
  6. Other Relationships (example question: Who does your partner feel closest to in their family?)

 

Asking and answering these questions can help couples feel closer, learn about each other, and reminisce or dream for the future together. If the couples are comfortable with this idea, they can share out to the group on something they learned about their partner or a fun memory they recalled together.

You can find this worksheet here or here.

Two Truths and a Lie

This activity is a great icebreaker, but is also fun to do with group members that are already familiar with one another. It allows participants to share something about themselves, use their creativity and imagination to come up with a convincing lie, and learn interesting things about the other group members.

To lead a group through this activity, instruct all group members to take a few minutes to think about interesting aspects of their life. Give them five minutes or so to write down three “facts” about them, two of which are true and one of which is a lie.

Then, have the group members take turns reading their two truths and a lie, and let the other group members guess which ones are true and which one is a lie.

This activity can spark some great discussion and encourage positive social interaction between group members, so make sure not to cut it off too early.

Addiction Discussion Questions Handout

This handout provides six discussion questions for therapy groups focused on substance abuse and addiction. These questions can spark enlightening discussions between group members and promote the sharing of experiences, strategies, and techniques.

These questions cover a few different topics and will provide excellent fodder for deep and meaningful discussion about coping with and overcoming addiction.

The first question is written as follows:

“Oftentimes, a person’s relationship with drugs and alcohol will change over time. For example, drugs might start out as a fun ‘every now-and-then’ activity, but eventually become an everyday habit. How has your relationship with drugs changed from the time that you first used to now? Do you still use for the same reasons, or have those reasons changed?”

To see the other questions or print this handout for use in your group sessions, click here or here.

Cooking

Engaging group members in an activity that requires both busy hands and concentration is a great way to help anxious members get comfortable with one another and open up.

Cooking is perfect for this type of activity, since it gets members working together, doing something fun, and it requires interaction with the other members of the group.

Further, the idea that food is a universal language is a common one, because it is one of the few things that brings everyone together! Everyone eats, and virtually everyone likes to talk about their favorite foods.

Gather the ingredients necessary for group members to work together to create a meal or snack that everyone can enjoy. Salads, sushi, and smoothies are recommended options for this activity since they don’t require a full kitchen to make.

If you want to capitalize on the atmosphere facilitated by group cooking, you can come up with discussion questions to guide the group afterwards.

To read more about this activity and other activities that can act as icebreakers or therapeutic group exercises, click here.

Creative Coloring

This activity is a great way to encourage teamwork and warm group members up for discussion.

You will need a different colored marker, crayon, or colored pencil for each group member and a large sheet of paper.

Give each group member a different colored market, crayon, or pencil and instruct them that this is the only color they can use throughout the project.

Next, show the group a picture and tell them they will need to work as a group, each using only their assigned color, to draw and color in this picture.

Once participants have finished drawing and coloring the picture, guide the group through a discussion using these questions:

  1. Was this a difficult task for the group? Why or why not?
  2. How did you work as a group to complete the picture?
  3. Was teamwork needed or could everyone work on their own. Is everyone in the group happy with the picture that was created? Why or why not?
  4. Is it easier to do things by yourself or with others?
  5. Why is it important to be able to work with others as a member of a team?

 

This activity and the following discussion will give group members a chance to work together, to think about why teamwork is important, and consider what they can do to be a better teammate.

To learn more about this activity, click here.

Check-In Questions

As noted earlier, most therapy groups begin with each member “checking in,” providing any progress updates, and perhaps sharing something interesting about their week or something they have learned since the last session. If you are working with members that don’t jump at the chance to speak in front of the group, having a specific set of questions to guide the check-in process can be helpful.

Group therapist Amanda Fenton provides an excellent set of guidelines and suggestions for check-in questions.

Fenton (2014) encourages therapists to ask themselves these questions when considering an effective check-in question:

  1. How much time do you have for the check-in? Two sentences? Two minutes? Five minutes?
  2. How can the check-in connect and support the rest of the agenda and the overall purpose of the gathering?
  3. What kind of tone do you want to create through the check-in? Playful? Serious? Connecting?
  4. Is this a group that is familiar with check-ins and has been meeting together regularly?

 

The most appropriate check-in question will depend on your answers to these questions.

For example, if you have time for a longer check-in from each member, a phrase like “Tell us the story of…” can be a good prompt for members to share more than a few words. If you’re short on time and just want a quick update, using “Say a few words on…” may be the better option.

To see these tips and check out Fenton’s long list of potential check-in questions, click here.

10 Group Therapy Techniques, Ideas, and Games for Youth and Teens

Many of the exercises and activities described above can be applied to group therapy with younger members, but some are more appropriate than others. Several exercises and techniques that work well in younger groups are listed below.

Icebreakers and Trust-Building

This section is actually a sort of bonus section – it includes over two dozen different ideas!

There are many icebreakers that are appropriate for both teens and adults in group therapy.

Some examples include:

Categories
In this icebreaker, participants are asked to organize themselves into smaller groups based on a category, such as favorite color, favorite food, number of siblings, etc. It will help teens to get more comfortable interacting with each other and learn something new about the other members.

Human Knot
This activity requires group members to physically interact with each other, so it may not be appropriate for all groups. All members get in a circle and take the hand of someone who is not right next to them, then try to unravel the knot they have created without letting go of anyone’s hand.

Fear in a Hat
This icebreaker is best applied in a setting where everyone is at least somewhat familiar with the other members of the group. Everyone writes down their deepest, darkest fear on a piece of paper. These pieces of paper are gathered and placed in a hat. Each member will draw one fear each, read it aloud, and try to identify who wrote it.

Trust-building activities are also great ways to get group members comfortable with one another and encourage a safe and secure place to share.

Examples of trust-building activities that can be used with teens and adolescents include:

Mine Field
Pair off the group members. If there is an odd number of members, the therapist can pair with a member to make it even. Instruct each pair to blindfold one member and tell the other member to guide them around the room in search of a particular object or objects. If there is enough time, the partners can switch when the object(s) has been found.

Eye Contact
This extremely simple exercise simply divides members into pairs and requires them to look into each other’s eyes for 60 seconds. Maintaining prolonged eye contact will help group members get comfortable with each other, practice an important part of social interaction, and connect with each other on a deeper level.

Trust Fall
This classic trust exercise is still a great way to build trust within a group. Have each member take their turn climbing onto a table and falling backwards into the other members of the group without looking behind them. This one is a classic for a reason – it works!

To see more icebreakers and trust-building activities, visit this page.

Joyful Memory

This engaging activity is a great opportunity for teens and adolescents to exercise their creativity and express themselves.

Instruct each member to bring to mind their most joyful memory. Once each group member has settled on a happy memory, have them prepare a scene based on this memory.

They will need to cast other group members in whatever roles are necessary, write lines or suggest ideas for lines, and direct the scene.

The other group members are encouraged to watch the scenes and share the feelings and memories that each scene brings to the surface.

You can read about this activity here.

Three Animals

This activity is great for children and young adults, with a perfect mixture of creativity, imagination, silliness, and active engagement in a task.

Instruct the group members to come up with their three favorite animals, in order. For each animal, the members are to write down the name of the animal and write three qualities you like about the animal.

Once each group member has identified and described their three favorite animals, ask them to consider that each animal represents you, in different ways. The first animal and its three qualities represent how you want others to see you, the second represents how people actually see you, and the third represents who you really are. This can be a great discussion for group members, helping them to explore their thoughts and feelings in a fun and easy way. It can also generate a lot of laughs!

Finally, have each member combine their three favorite animals into one, and draw or paint a picture of this animal in its habitat. Tell the members to share these creations with the rest of the group, and prepare for a silly discussion!

You can read more about this activity and others like it here.

Thoughts, Feelings, and Behaviors Worksheet

This worksheet can be a great tool for families with young children in therapy. It is intended for a child to complete, and the results can be discussed as a family to facilitate understanding and come up with solutions for family problems.

This worksheet includes an outline of a person or child with six boxes to fill in, three on each side.

The directions instruct the child to fill in this blank “When I am…” with a specific emotion.

Thinking about this emotion in a specific situation, the child is instructed to fill in the three boxes on the left side of the worksheet:

  • I think… (box pointing to the head)
  • I feel like this in my body… (box pointing to the midsection)
  • I behave this way… (box underneath the feet)

 

Once the child has filled in these three boxes, their next step is to imagine that their thoughts change. Maybe this is a natural change, or maybe they are instructed to imagine their reaction if they purposefully change their thinking to something more positive.

When the child has this new thought in mind, they fill in the same three boxes, except these are on the right side.

This exercise can help the child compare how they think, feel, and behave when they are struggling with an emotion to how they might think, feel, and behave if their thinking changed. It can help children to understand the value of modifying their thinking to make it more positive, in addition to helping parents and other family members understand what the child is going through.

You can find this worksheet at this or this link.

Know Me More

This activity is most effective with a group of five or more members.

Come to the group session with a list of questions prepared. These questions should be fun and interesting questions that will help the members get more comfortable talking about themselves.

Potential questions could include:

  • Where would you be now if you were not in this group?
  • What motivates you to come here?
  • What is one thing about yourself that makes you proud and happy?
  • What is one thing about yourself that you are not proud of?

 

Nominate one member to be the questioner, or the therapist can act as the questioner.

Ask each member one of these questions, or all of these questions if time permits, and encourage them to give it some thought and answer it honestly and in a meaningful way.

These questions will help group members to become more comfortable talking and sharing with others, as well as helping members learn about one another. They can be found at this link along with other ideas for teen therapy group activities.

4 Group Therapy Exercises and Worksheets for Depression and Anxiety

Group therapy is commonly used in the treatment of people with depression and anxiety. A group setting is a perfect place for people suffering from depression or anxiety to connect with others, practice important social skills, and learn healthy coping strategies from each other.

While many of the activities and exercises mentioned above can be applied to individuals with any diagnosis or issue that brings them to therapy, there are some that can be especially effective for those with depression or anxiety. A few of these exercises and worksheets are listed below.

Coping with Stress

While the experience of stress is not exclusive to those with a diagnosis of depression or anxiety, those suffering from these disorders often have the most trouble coping with stress. Many of those struggling with depression or anxiety will turn to unhealthy, unhelpful, or even harmful ways to cope. This activity can help them find new, healthy ways to cope.

This exercise requires only a poster board and a marker, as well as enough group members to split into smaller groups of two to four members each.

Instruct the group to nominate one person to write and another to present to the larger group.

Tell the group that they will be discussing healthy ways to cope with stress, and encourage them to come up with at least 10 ways to cope in a healthy manner. For groups of teens or children, it is helpful to provide a few examples to get them going. Providing two examples of ways you personally cope should be enough to get the ball rolling.

Give the groups a set amount of time to brainstorm and discuss. Once each group has come up with a list of at least 10 coping mechanisms, have the presenter in each group share the group’s mechanisms out to the larger group.

This activity can spark a great discussion about coping, what is healthy and what is not, and identify new strategies for coping.

To extend this discussion, you can instruct members to identify a situation in which they would use each technique.

For more information on this activity, click here.

Setting Goals

Setting and striving towards goals can be tough for us all, but for those struggling with depression, even setting a realistic goal can seem like a monumental task. To help group members set and work towards their goals, this activity can help.

This activity can be applied in each group meeting and discussed in the next group meeting.

The therapist should preface the first practice of this activity with a discussion on the importance of setting small, realistic, and measurable goals.

Once each group member has an understanding of how to set good goals, end the session by giving each group member a piece of paper and a pen and instructing them to set one small, measurable goal for that week (or until the next session). Collect the papers once the members are done.At the beginning of the next session, hand out the papers and tell members to think about what they have done to achieve those goals since the last session. This can be done individually or in a group, although it may be best to save the group version for later sessions to allow members to get comfortable with one another.

This activity will help group members learn how to set small, realistic goals and, hopefully, give them the experience of meeting these small, realistic goals.

Click here to read about this activity.

Schema Activation Formulation

This cognitive therapy worksheet can help clients trace the development of a particular schema and understand the subsequent reactions, sensations, and choices he or she makes.

On the left side of the worksheet is a box labeled “Event.” The clients should think hard about when they first developed a particular schema and trace it back to the event that created it. For example, if a client feels they will never be good enough, perhaps this schema came from a parent who gave no praise for a big accomplishment or told the child they didn’t do well enough.

Next, this box leads to a triangle labeled “Schema.” This is where the clients should write down the schema they hold, such as “I am not good enough.”

This schema leads to a set of four interrelated and interacting consequences of the schema: bodily sensations, emotions, thoughts, and behaviors. The clients should fill in each box with the corresponding descriptions of how this schema makes them feel, think, and behave.

Completing this worksheet in a group setting can help clients connect with each other and realize that they are not alone in their negative thoughts and beliefs. It can be far too easy to believe that we are the only ones struggling and suffering with mental health or emotional problems, but this is far from the truth. Working in a group will help relieve clients of this false belief and encourage them to share and connect with others.

This worksheet will be available for download soon.

Cracking the NUTS and Eliminating the ANTS

This fun activity is based on the work of renowned psychologists Elisha Goldstein, Aaron Beck, and David Burns.

NUTS refers to Negative Unconscious Thoughts, an acronym created by Goldstein and described in his book Uncovering Happiness. He believed that identifying and bringing awareness to these thoughts was the first and most important step in ridding ourselves of our negative, unhelpful, or harmful beliefs.

ANTS refers to Automatic Negative Thoughts, an acronym coined by David Burns in his groundbreaking book Feeling Good. Burns finds that these ANTS can cause depression and anxiety and lead to low self-esteem, self-doubt, and a host of other problems.

For this activity, the therapist should lead the group through a discussion of NUTS and ANTS, terms which can be used interchangeably when talking about the self-sabotaging habits we have.

To begin, have each group member write down five phrases that put the NUTS and ANTS into words, such as “I’m not good enough,” “There’s something wrong with me,” or “I don’t deserve to be loved.” Have group members reflect on these NUTS and ANTS, and identify any themes or patterns that connect them. Encourage members to discuss them as a group or in mini-groups.

Next, tell group members to think about how certain they are that their ANTS and NUTS are true. Have they ever challenged these thoughts? Can they find evidence for or against the ANTS and NUTS? Considering the evidence, which possibility is more likely: that they are true, or that they are false? Help them think of more factual ways to reframe these beliefs, such as “I am not perfect, but I don’t need to be,” or “I am a good person who sometimes makes mistakes.”

Finally, help group members see how much these NUTS and ANTS infiltrate their thoughts. Give group member s a few minutes to identify their NUTS and ANTS and count how many they can identify within a certain period of time. When they are done, they can share their counts and their NUTS and ANTS with the group, if they are comfortable doing so.

To learn more about this exercise and to see a companion worksheet to go with it, click here or here. This activity is a sample from Judith Belmont’s book 150 More Group Therapy Activities & TIPS, which will be described in more detail below.

Best Books, YouTube Videos, and Podcasts on Group Therapy

The following books, videos, and podcasts are packed full of information on group therapy. Whether you’re a therapist who already facilitates group therapy, a mental health professional who is looking to incorporate group sessions, or simply curious about group therapy, you will find value in these resources.

Theory and Practice of Group Psychotherapy by Irvin D. Yalom and Molyn Leszcz

This book is an excellent book for those who wish to learn about Yalom’s signature group psychotherapy model. It can also be used as a textbook for therapy students or a resource for practicing therapists who wish to add group therapy to their practice.

Not only does this book cover the basics and the foundational assumptions and theories behind this group therapy model, it was also recently updated to include new developments in the field. Added topics include online therapy, specialized groups, ethnocultural diversity, trauma, managed care, and more.

This book enjoys a very positive 4.4 rating on Amazon, and boasts a litany of appreciative reviews. Click here to check out some of these reviews or purchase the book for yourself.

150 More Group Activities and TIPS (Treatment Ideas & Practical Strategies) by Judith Belmont

This book is a valuable addition to the therapist’s toolbox. It includes 150 activities, handouts, and strategies that can be used in group therapy. For each exercise or handout, the author breaks it down into the theory behind it, how to implement it, and how to understand and apply the results.

The author draws upon Dialectical Behavior Therapy, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and positive psychology to provide effective and engaging activities that will have a positive impact on clients’ treatment experience.

150 More Group Activities and TIPS builds off of the author’s previous book, 103 Group Activities and TIPS (Treatment Ideas & Practical Strategies). You can find the original book here and the new book here.

YouTube Video: Essential Skills for Effective Interpersonal Group Facilitation

In this YouTube video, psychologist June Lake discusses the Yalom model of group psychotherapy. You will learn about the foundations of this model, the necessary skills required to facilitate this type of therapy, and a brief overview of the approach. In addition, June discusses some of the most common mistakes new group therapy facilitators make and how to avoid them.

YouTube Video: Leading Therapy Groups with Adolescents

If you’re curious to see an actual group therapy session unfold, this video can sate that curiosity! In the video, two group therapists facilitate a group therapy session with high schoolers. You will get an idea of the atmosphere of a group therapy session with adolescents and a model of effective facilitation from the two therapists. In the video description, there is a link to the full video if you’re hungry for more.

Podcast: Using Groups to Fill Your Private Practice

This podcast from Jennifer Sneeden and Katie K. May is a great resource for therapists who are considering the addition of group therapy sessions or workshops into their practice. Katie is a counselor in Philadelphia who runs a successful private practice, and in this podcast she shares some of the keys to her success.

Click here to check out the podcast.

Podcast: Benefits of Group Therapy

In this podcast, Krstine Hitchens, the Director of Family Programs at the Father Martin’s Ashley addiction treatment center, discusses the importance of group therapy in the treatment of addiction and outlines the many potential benefits.

You will find this podcast here.

You can download the printable version of the infographic here.

Group Therapy and Group Counseling Near Me

If you are interested in taking advantage of group therapy or counseling, the options available will depend on your location. A quick Google search for “group therapy near me” should turn up some helpful information.

However, if Google isn’t delivering on this search, there are a few helpful websites you may want to check out:

  • The Mental Health America website can help Americans struggling with mental illness find groups to support or supplement their treatment.
  • NAMI (National Alliance on Mental Illness) is another great resource for people in America.
  • MeetUp is usually used for finding like-minded friends to share a hobby with, but it can also be used to find an informal support group.
  • This website can also help match you with informal support groups for anxiety, depression, and related issues. Its results are generally within the United States, but there are some listings for groups in Australia, South Africa, and remote support groups.

A Take Home Message

This article is chock full of activities, exercises, worksheets, and techniques that can be put to effective use in group therapy. Most of these activities and exercises can be applied in a wide range of group therapy situations.

I hope you have found this article as informative and useful as I found researching it. Whether you’re a therapist or other mental health professional, or just curious about how group therapy can benefit you, you should find at least a few things in this piece that add to your knowledge or set of tools for group facilitation.

Let us know what you learned or found especially interesting in the comments below. Would you use any of these activities in your practice? Do you have any tips or advice on how to implement these activities and techniques?

As always, thank you for reading!

  • References

    • APA. (2017). Psychotherapy: Understanding group therapy. American Psychological Association. Retrieved from http://www.apa.org/helpcenter/group-therapy.aspx http://www.belmontwellness.com/
    • Cherry, K. (2017, May 20). What is group therapy and how does it work? Very Well. Retrieved from https://www.verywell.com/what-is-group-therapy-2795760 Counselling Connection. (2010, September 8). Types of therapuetic groups. Counselling Connection. Retrieved from http://www.counsellingconnection.com/index.php/2010/09/08/types-of-therapeutic-groups/
    • www.counselor-license.com
    • Fenton, A. (2014, April 12). Check-in question ideas. Amanda Fenton. Retrieved from http://amandafenton.com/2014/04/check-in-question-ideas/
    • Flannery, B. (2014, August 11). Group therapy topics: Mental health educational activities. Hub Pages. Retrieved from https://hubpages.com/health/Group-Topics-for-the-Mentally-Ill
    • Good Therapy. (2013, December 18). Group therapy. GoodTherapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/modes/group-therapy
    • www.goodtherapy.org
    • www.livestrong.com
    • Orenstein, B. W. (2014, November 25). 6 benefits of group therapy for mental health treatment. Everyday Health. Retrieved from http://www.everydayhealth.com/news/benefits-group-therapy-mental-health-treatment/
    • SimplePractice. (2017, January 11). 8 substance abuse group topics for addiction treatment counselors. SimplePractice. Retrieved from https://www.simplepractice.com/blog/substance-abuse-group-topics-addiction-treatment-counselors/
    • www.therapistaid.com
About the Author
Courtney Ackerman is a graduate of the positive organizational psychology and evaluation program at Claremont Graduate University. She is currently working as a researcher for the State of California and her professional interests include survey research, well-being in the workplace, and compassion. When she’s not gleefully crafting survey reminders, she loves spending time with her dogs, visiting wine country, and curling up in front of the fireplace with a good book or video game.

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