Examples of CBT based group sessions

Fieldwork Experience
My experience using Cognitive Behavioural Therapy with children was on a fieldwork placement in a Child Mental Health clinic. While on this placement I had the opportunity to co-facilitate some anxiety management group sessions. On my first day of placement, I was involved in a last group session on 'Social Skills and Anxiety'. There were approximately 5-7 children in this group. The children were between the ages of 5-7 who were involved in the clinic and having key difficulties with anxiety and social skills. Children within the unit had mental health issues including; anxiety, ADHD, depression and psychosis.
The group was run by two Occupational Therapists and was 60minutes long.
There were three children within the group that were needing extra sessions to work on anxiety management, therefore the occupational therapist's ran three more sessions with these children. These are the groups that I was involved in.

Here is an example of some group sessions using CBT;

Group One
Introduction
Warm up- cards, board game etc
Review what was covered in the previous groups the children were involved in. re anxiety.

Main Activity
Fears and worries list- children were given a worksheet where they wrote down all their fears and worries.
The children then picked an individual anxiety goal to work on.
Step ladder worksheet- The children wrote down on a piece of paper all the things they would like to do and then arranged them on the ladder. The things that feel the easiest were put at the bottom of the ladder and the most difficult ones at the top. The therapist then discussed with the children that they should start at the bottom and work their way up each step and the key was to take small steps at a time to help climb the ladder.
-Set homework tasks for the child. E.g. working on their step ladder, recording down any fears or worries that may arise between sessions.

Conclusion
Relaxation Activity- breathing exercise (child friendly)

1. Get the child to hold their left hand in a fist and imagine that they are holding their favourite pretty flower.
2. Hold their right hand in a fist, imagine it is a candle.
3. Ask the child to inhale as much as they can, sniffing the flower!
4. Then ask the child to exhale/breath out and blow their candle out.
Repeat this a few times with the child. Talk about when they might use this deep breathing activity and why it is important.

At the end of the session the parents join and the children and therapist feedback to parents and let them know what they need to work on between sessions. E.g Homework tasks.

Group Two
Introduction
Review the goal/step ladder from the previous session. See how the children are going with it.

Main Activity
-Self-talk- discussions about negative and positive self-talk, and teaching the children how negative thoughts can be disputed and changed to more positive thoughts.
-A self-talk work sheet- children write down negative self-talk and then change the statement in a positive self-talk.
-Coping Cards-these are palm-sized cards, that have positive "self-statements" that children can read these at anytime. These are a great tool for boosting confidence and 'coping' with stress and anxiety.

Conclusion
Relaxation Activity- Progressive muscle relaxation. There are different scripts that can be used for this. Here is one section of a script that I used that the children engaged in really well;

"Pretend you have a whole lemon in your hand. Now squeeze it hard. Try to squeeze all of the juice out. Feel the tightness in your hand & arm as you squeeze. Now drop the lemon. Notice how your muscles feel when relaxed. Take another lemon & squeeze. Try to squeeze harder than the first one..."

Again, at the end of the session the parents join and children and therapist feedback what happened in the session and what the homework will be in between sessions.

Group Three
Introduction
Review the step ladder and how the children's week has been since the last session.
Talk about the generalising the skills learnt over the sessions.

Main Activity
Snakes and Ladders- when child lands on a ladder they have to write down a positive self-talk statement and stick it on the board and when they land on a snake they wrote down a negative self-talk statement.

Talk to children about confidence;
- what builds it
- what makes you feel you can cope
- achievements

Conclusion
Another relaxation activity with children.
Go over everything from the last three sessions with the children and parents. Give out any worksheets for the child to use in the future.