Behavior Therapy in Groups - Essay Example

Behavior Therapy in Groups Group Therapy Over 50 Years Old Group psychotherapies include psychoanalytic, interpersonal, gestalt, transactional, crisis, supportive, cognitive-behavior, family and other types such as self help and recovery groups. The common goal of group therapies is to relieve symptoms, change perceptions, improve communication modify behavior and alter family dynamics. The term group therapy came up in 1931 and J.L. Moreno is usually credited with the name and the idea. Of course, many others also were working with the idea. World War I provided for a lot of growth in groups methods because of the large amount of psychiatric casualties in the was. The American military in World War II also used group methods to treat large numbers of psychiatric causalities. Behavioral theory or behavior modification is the treatment of human behavioral disorders through reinforcement of the desired behaviors and suppression of undesirable behavior. This therapy has its roots with Pavlov but became a developed technique in the United States by B. F. Skinner. He used positive or negative re-enforcers to encourage desirable behavior and punishments to deter undesirable behavior. Originally, behavioral therapy groups worked with anger management and addiction (Ockrnik 2003). One of the specific types of Behavioral group therapy that came out in the 1960s was originally written by Marsha Linehan. This may be the most well known kind of behavioral therapy today. Originally, she developed a program, Dialectical Behavioral Therapy (DBT), for patients diagnosed with Borderline Personality Disorder. In the beginning, it appeared to be quite effective and it was adapted to many other type of diagnosis. This writer will look at how effective this therapy turned out to be over the long term as well as the effectiveness of several other new innovations in group therapy. Behavioral Therapy Behavior therapy in groups can be recognized by its emphasis on specifying problems and goals in concrete behavioral terms and in using principles of learning to facilitate behavioral change. Since it is generally assumed that therapy is a learning process, then there are some advantages in group therapy. Much of our learning comes through imitation also there are others to imitate. It is also known that learning takes place more quickly when the individual has something in common with the people around him/her. A group of peers would then be ideal for that purpose. Also adaptive behavior is strengthened when reinforced by peers. Finally, the stimulus situation is closer to natural social situations than is individual therapy (Ockrnik 2003). There are two types of Behavioral Group Therapy. The earliest Behavioralists maintained formats where the leader was strongly directive. A goal was established for each participant and a plan to reach the coal was constructed between the therapist and the client. Spontaneous and fee-flowing group interactions were discouraged. There was then role rehearsal within the group. In the 1980s, these groups showed improved interpersonal functioning, higher self-esteem levels and lower drop-out rates than other groups (Ockrnik,2003). Some Behavioral group methods were more conventional. There was little interference form these therapists. The therapist rewarded behaviors by giving verbal acknowledgement or approval. Such things have been tried as providing a noxious sound every time the group was silent thereby training group members to keep talking. This was often used with groups of depressed individuals. Outcome research has shown that group members progress the fastest when praised by the therapist for positive behaviors. These reinforcement measures have been applied to children’s play groups as well with positive results. In all, behavioral group therapy the process of social skills training involves this series of steps: Identify and specify problems Target interpersonal goals involving emotional expression Stimulate the problem situation using role playing Use modeling and shaping Give positive feedback Give assignments to practice in “real life” (Ockrnik 2003) Present research on Behavioral Group Therapy Medical Setting Some or the most recent uses for behavioral group therapy is in the medical field. Behavioral therapy has been used to support patients while helping them change their life style to adjust to medical conditions. In a very recent study, women with breast cancer were divided into two groups, one for behavioral therapy and the other for relaxation and guided imagery and a third control group. Four months later distress was significantly reduced in both therapy groups compared to the control group. The relaxation group was more effective in reducing fatigue and sleep difficulties where as the behavioral group was more effective in reducing external health locus of control. Their illness was virtually unchanged in both groups. Adherence to self-practice at home was very much related to outcomes. This study supports using both forms of group therapy for the best results. One of the factors discussed in the results regarding behavioral therapy is that it allowed patients to remain more active in their life away from treatment and these individual seemed more capable of dealing with everyday life demand (Cohan 2007). Another attempt at using behavioral therapy in a group in a medical setting is with early Alzheimer’s patients. These patients and their family member, called the care partner, have the goal of planning what the patient would like in treatment and living conditions at the illness progresses. This is done at this time while the patient is able to make decisions. At the completion of the ten week memory group, patients felt secure that their wishes were doable and would be carried out. The appreciated the support from others in the same situation in making their decision. Family members appreciated knowing what was expected of them by their loved one and stated they felt stronger in facing what may be a difficult future. All rated the memory club experience very favorably (Zarit, etal.2004) Weight loss Behavioral groups are being tried for weight loss with out much success. The outcome of these groups is little weight loss but much higher levels of self esteem as measured by the Rosenberg Self-esteem and Eating Disorders Examination. The initial study showed not weight loss but a significant rise in self-esteem levels. The second group which lasted longer showed a similar change in self esteem plus a 5% of body weight loss. Further study may show the change in self esteem comes first and the weight loss needs a longer period of time (Bkroyd, Roth, Stott 2006). Elementary School From a very different perspective behavioral group therapy is being tried as a way to teach elementary school students in Los Angles adaptive and appropriate social skill. An eight session protocol addressing dealing with the incarceration of a parent and well as appropriate social skills that will protect the child from such a fate is being used. These groups appear to give the child adult acknowledgement for appropriate behaviors as well as guidance in understanding why the parent is gone. School official report more positive behaviors in the school from graduates of the program (Lopez &SunitBaht 2007). Dialectical behavioral therapy (DBT) Dialectical behavioral therapy is a skills training program developed originally for Borderline personality disorder. This program attempts to teach psychosocial skills to individuals who have learned maladaptive ways of dealing with those around them and the pressures of life. It is done in group therapy both inpatient and out patient. The first reviews of the outcome were so promising that the program has been adapted to several other disorders. A brief explanation of the skills that need to be acquired are listed below. It is easy to see how this becomes a very behavioral plan. This writer finds this to be an excellent example of behavioral group goals . States of Mind. Mindfulness is the main idea in DBT. It includes three major states of mind: reasonable mind, emotional mind, and wise mind. The reasonable mind is taking the time to stau calm, gather facts, and use rational problem solving. Emotional mind is internal thinking and external behavior based on clients emotions. Wise mind is putting together the reasonable mind and emotional mind. Wise mind is finding the truth about by logically thinking things through. Effective problem-solving abilities are needed for the client to take charge of difficult life events. “What Skills” There are three mindfulness "what skills" they are learning to observe, describing the situation, and participating with awareness. Participating in life without awareness means being driven by mood and impulsivity. "How Skills." There are three "how skills" first looking at things nonjudgmentally, second, acting in the moment, and finally doing what is effective. Interpersonal Effectiveness The goal of interpersonal effectiveness is to learn skills for interpersonal problem solving. The focus is on conflicts, such as problems with relationships, anxiety, and issues of abandonment. Social skills and assertiveness skills are used. They include asking for what one needs, saying no, coping with conflict, maintaining a relationship with another person, and maintaining self-respect. Emotion Regulation The third essential skill is emotion regulation. This is to focus on increasing control of emotions, and actually feeling and naming emotions. Distress Tolerance aims at just getting through and surviving crisis situations. One goal of DBT is to learn to accept distress as a part of life and tolerate it. Crisis survival skills include distraction from distress; improving the moment through prayer, imagery, or relaxation; self-soothing through the five senses; and thinking of the pros and cons of tolerating the distress (Journal of Psychosocial Nursing and Mental Health 2006). Effectiveness of DBT Inpatient Inpatient nurses state that Dialectical behavior therapy is easy to use, offers immediate symptom management and it is cost effective. Empirical evidence indicates that DBT is and effective treatment for Borderline Personality Disorder (Journal of Psychosocial Nursing and Mental Health 2006). Obsessive Compulsive Personality Disorder The skills have been used in groups of people with Obsessive Compulsive Personality Disorder. The objective of the group was to work with issues in the work place. The greatest change reported was in the perspectives of the clients work cohorts. They found the experience of working with the group members to be a more pleasant experience and recommended that the employer continue to employ individuals with this disorder (Miller & Krause 2007). Outcome Study Another very recent study looked at three different kinds of group therapy for Borderline Personality Disorder, dialectical behavioral therapy, transference-focused psychotherapy and dynamic supportive treatment. Ninety patients were involved in the study for a one year period of time. Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning and social adjustment. Only transference-focused psychotherapy and supportive treatment was associated with improvement in anger. Transference-focused psychotherapy and supportive treatment both were associated with improvements in impulsivity. Only transference-focused psychotherapy was predictive of change in irritability and verbal and direct assault (Clarken, Levy, Lenzenweger 2007). This study claims to be the first study to compare DBT to other methods. All three methods were significantly effective but transference-focus and supportive treatment did have some areas where they did better than the others. There were no such areas with DBT. Elderly It is interesting to see that DBT skills are taught to elderly Borderline patients in nursing homes. These are patients who generally have not been exposed to these skills in the past. Caregivers report much more self control and stability in individuals who are taught these skills making for a more pleasant environment on the nursing home wards. This was a case study review so statistics were not available. Finally, this 2006 study reports that women with borderline personality disorder wo receive DBT were half as likely to attempt suicide as those treated by expert therapist. This study involved 101 patients over one years period of time. Half were given DBT and half were given what ever treatment their therapist recommended. The DBT group had six less suicide attempts in that year than did the other group. Only one DBT patient attempted suicide and was not successful. Three in the other group were successful in their attempt (Hunt 2007). Discussion Behavioral Group therapy is a type of therapy that sets forth specific goals to be achieved during the period of group work. The goals generally are known by all and all are working toward the achievement of the same goals. This writer chose to look into this type of therapy to see if something so sensible is therapeutically effective. Clearly the research shows that it is effective. It seem like a respectful way to work with people to help them learn the skills they need to succeed in their life. This writer has also observed DBT groups and found them to appear to be successful. It appears now after much time has gone by therapist and institutions are still finding it to be a successful treatment for borderline personality disorder but it is also being applied to other disorders such as obsessive-compulsive personality disorders. It appears that the highly organized goals and skills to achieve those goals as put forth by the DBT program is an excellent example of how behavioral therapy should work. Therapist need to be extremely clear in their goals and the ways the client must meet those goals. Putting that into a group setting also provides the member with additional support that may not always be available in behavioral therapy. The negative aspect to such structured group therapy may be that other needs of individuals will not be addressed as the format is so structured. It would also appear that considerable time must be put into building a successful structure. Further it would seem that special training may be involved. In looking at the DBT structure, this is a new language to learn and follow. The structure needs to be followed exactly to be effective so these would definitely need to be training of the leaders to make it effective. All the group behavioral therapy was effective and appears to be helpful across numerous needs and disorders. In the poorest, showing it came in as good as two other kinds of therapy. It appears to this writer that behavioral group therapy should be considered when setting up a group therapy group. References Bkroyd, J., Rother, S., & Stott, D. (2006). Weight loss as a Primary Objective of Therapeutic Groups for Obese Women: two Preliminary Studies. British Journal of Guidance and Counseling. 34(2;) 254-261. Clarkin, J.F, Levy, K. N., Lenzenweger, M. F.& Kernberg, O. F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. American Journal of Psychiatry. 16496); 922-929. Cohan, M. (2007). Comparing Relaxation Training and Behavioral Group Therapy for Women with Breast Cancer. Research on Social Work Practice, 17(3); 313-326. Dialectical Behavior Therapy Reduces Suicide in Women with Borderline Personality Disorder. (2006). Journal of Psychosocial Nursing and Mental Health Services. 44(9); 8-10. Hunt, M. (2007). Borderline Personality Disorder across a Lifespan. Journal of Women and aging. 19(1/2). 178-181. Lopez, C. & SunitiBaht, C. (2007). Supporting Students With Incarcerated Parents in Schools: A Group Intervention. Journal of Specialists in Group Work. 32(2); 139-147. Miller, T.W. & Krause, R.F. (2007). Modified Dialectical Behavior Therapy and Problem Solving for Obsessive-Compulsive Personality Disorder. Journal of Contemporary Psychology. 37(2); 79-86. Osborne, L.L. & McComish, J.F. (2006). Working With Borderline Personality Disorder: Nursing Interventions Using Dialectical Behavioral Therapy. Journal of Psychosocial Nursing & Mental Health Services. 44)6); 40-48. Ozkrnik, D. (2003). Group Therapy Passes Centennial. Psychiatric News. 38(15); 36-39. Zarit, S.H., Femia, E. E., Watson, J., Rice-Oeschger, L. & Kakos, B. (2004). Memory Club:A Group Intervention for People With Early-Stage Dementia and Their Care Partners. The Gerontologist. 44(2); 262-269. Read More