About Group Therapy
While not essential for the treatment success of most anxiety disorders, groups can be an important adjunct, or even replacement, for individual therapy. Because Cognitive Behavioral Therapy (CBT) is psycho-educational in nature, the therapist often functions as a caring teacher for the client. CBT treatment groups are therefore run almost like small, informal classes, with weekly assignments, homework review, and structured agendas. The advantages of group treatment include more time in therapy (group sessions usually run twice as long as individual ones) at a fraction of the cost, as well as multiple sources of support and feedback, and the experience of learning from others’ struggles and progress. More on this is reviewed in the opening statements of the link Group Schedules and Fees.
A brief note about confidentiality. While it is expected, and even encouraged, that you share with others outside the group about information or skills which you may have learned in group, it is also expected that specific information about other group participants will NOT be shared with others. This will be reviewed in more detail at the first session of each group.
Specific group treatment issues for the different anxiety disorders
Below are some notes about issues particular to the treatment of the different anxiety disorders. Much of the information about these anxiety disorders has been well documented elsewhere on the Internet. One of the most comprehensive is The Anxiety Network. For additional information about any of these groups which may be running at SAS of NJ, go to the link Group Schedules an Fees.
Obsessive Compulsive Disorder (OCD)
For general information about this disorder go to the International OCD Foundation. More than any other anxiety disorder, medication is often recommended, although many of these medications are aimed at the obsessive compulsive symptoms themselves, and not necessarily the anxiety symptoms that go along with them. Relaxation and cognitive restructuring are less emphasized for OCD- the heart of the treatment is “Exposure with Response Prevention.” In ERP, OCD clients go through a heirchy of exposure situations, each time refraining from avoiding, escaping, or ritualizing. While these exposures most often are done in real life situations, exposure in one’s imagination, or “imaginal exposure” is also frequently used. Designing the specifics for each exposure can get tricky, especially when there are obsessions with little or no compulsions. Really understanding how the OCD “thinks” is essential to its weakening or defeat. Sometimes “paradoxical” or “counter intuitive” interventions are developed, which essentially diffuse the anxiety around the obsessions.
The Group Treatment protocol is based mostly on the model developed by Drs. Edna Foa and Michael Kozak at the Center for the Treatment and Study of Anxiety at Allegheny University. Weekly homework ERP “challenges” are tailored to individual group members, accepted and attempted by each of them, and then reviewed in session. The group setting provides for the opportunity of constructive feedback, support, and sharing.
For more on this disorder, see the Social Phobia Homepage. Social Phobia (some prefer Social Anxiety) is estimated to be the third most common psychological difficulty, after depression and alcoholism. Exposure treatment is particularly difficult for Social Phobics, as very often the feared stimulus is chance encounters with strangers or acquaintances- situations which are difficult to control, manipulate, or prolong. Constructing exposures for individual treatment is possible, but ultimately group treatment for this disorder should be considered.
After training in the skills of CBT, the members of this group practice “simulated exposures” wherein they play out real life roles that they find anxiety provoking in the relative safety of the group. As scary as it might sound, most groups unanimously agree to allow videotaping, which is then used in the group for members to view and receive feedback about their performance.
These groups, which tend to be smaller than other CBT treatment groups, are based on the protocol developed by Dr. Richard Heimberg, now Director of the Social Phobia Program at Temple University.
Panic and Agoraphobia
CBT treatment follows the outline described in the section on Cognitive Behavioral Therapy of this web site. However, because the feared stimuli are often a person’s own body sensations, part of the exposure treatment involves the controlled, self- induced creation of low intensity specific physical panic- like symptoms.
The group protocol is mostly based on the one developed by Drs. David Barlow & Michelle Craske. Dr. Barlow was at the Center for Stress and Anxiety Disorders at the State University of New York (SUNY) at Albany when developing this program, and is now at Boston University. Dr. Craske is at UCLA.
Fears of heights, animals, elevators, etc., uses the standard CBT protocol for anxiety treatment as described in the Cognitive Behavioral Therapy section of this web site. Blood and needle phobia treatment includes some specific interventions particular to those fears.
The program relies heavily on the protocol developed by Dr. Martin Antony of the Clarke Institute at Toronto, Dr. Michelle Craske at UCLA, and Dr. David Barlow when he was at the Center for Stress and Anxiety Disorders at SUNY Albany.
General Anxiety Disorder (GAD)
CBT treatment for GAD emphasizes the relaxation and cognitive restructuring components of the treatment. There are so many kinds of stimuli that trigger anxiety in this disorder, so interventions are “tailor made” for each individual participant. Group interventions are based on the work of Dr. David Barlow when he was at the Center at Albany.
Posttraumatic Stress Disorder (PTSD)
Group treatment for this disorder, which is not always recommended, is usually done only after very extensive individual therapy has been successfully completed. CBT for this disorder is based on the different treatment protocols developed by Dr. David Meichenbaum of Waterloo University at Ontario, and Dr. Edna Foa, now at Allegheny University.
SAS of NJ is not currently offering group treatment for this anxiety disorder.