Analyzing Depression in Adolescents Group

Depression in Adolescents Group

Curriculum overview

This group aims at aiding participants in modifying their cognitions, maladaptive schemas, and behaviors. Participants acquire a grasp of how to be more relaxed and occupied in more pleasing activities. Such changes to behavior will trigger the succeeding profounder change levels. Participating individuals will be aided in altering their depressogenic and impractical thoughts as well, to thoughts that are more practical, successively decreasing their depression levels. In order to achieve true, longer-term change, as well as to lower the possibility of recurrence of depression, one needs to modify maladaptive schemas. The group is presented with the 'schemas' idea, group members are aided in distinguishing their respective schemas, and efforts are initiated towards altering schemas. However, one must bear in mind the fact that this process of schema transformation is time-consuming and won't be achieved by the time of the group's termination. Participants in the group complete the BHS (Beck Hopelessness Scale) and BDI (Beck Depression Inventory), record their dysfunctional thoughts on a daily basis, and obtain depression-related knowledge (Corey et al., 2011).

Goals: Providing participants with depression-related information, facilitating cognitive and behavioral changes in them, and triggering the maladaptive schema change process.

Target: Students suffering from depression. It must be noted that this group isn't suitable for chronic or severe depression cases.

Length: Eight sessions of 1.5 hours each.

Facilitator training

The ASGW (Association for Specialists in Group Work) (2007) states that group counselors are required to complete a core aspect of group training. Both researchers are engaged in group process and counseling skills training, under their postgraduate counseling program. Moreover, ASGW (2007) states that individuals engaged in such group work understand that taking part in ethical practices necessitates ongoing supervision, professional training, and growth. All of this will be incorporated into the counseling group throughout its duration. Additionally, only interventions that lie within group members' skill levels will be employed.

Demographics

The adolescent group will comprise of between eight and ten female and male high-school goers between the ages of 14 and 18 years, self-identified or diagnosed as suffering from depression. A qualified woman counselor will act as facilitator for the group, whose meetings will be held every Wednesday in the lunch period. The school's counseling department will be the venue for these meetings. The adolescent depression group will be set up in the academic year's third quarter, and the last meeting will be held three weeks before school closes for the summer. Thus, roughly 8 group sessions can be incorporated into this time frame. Members of the group will receive an invitation to rejoin in the next academic year.

Membership selection

Recruitment -- Curriculum of the school can help enhance multicultural sensitivity and awareness (including gender identity), through the conducting of schoolroom guidance sessions pertaining to social and cultural tolerance and diversity. Subsequent to these discussions, the school counselor can announce an adolescent support therapy that can be availed of by depressed pupils and those who aren't clear on their status. Interested adolescents will be encouraged to approach the school's counseling office if they require any additional information. Further, school authorities will design and place written announcements across the school premises, in inconspicuous areas (like the washrooms and counseling department bulletin). The remaining school counselors, administrative staff and teachers can be informed of this group's existence by the counseling personnel involved. These professionals can identify additional potential candidates for the group (Myers et.al, 2011), who may then be invited personally to participate in the group.

Screening/Selection -- Interested candidates will be subject to a 30-minute-long process of screening, wherein they will be allowed to express what they expect from this group, including their concerns or issues relating to it. The group counselor will then explain the group's aim, his/her personal battles with depression, as well as his/her personal wish to act as facilitator for a group of depressed teens. The process of screening is vital for the counselor as well as participants. The former can, to some degree, control dynamics of the group through screening, while the latter can take an informed decision with regard to whether to participate or not. A group will be convened, comprising of members having needs that are in line with group goals, and whose welfare won't be at risk from group experience. Moreover, the counselor can look for members having diverse personalities (for instance, introverted and extroverted), and different motivation levels (i.e. identity acceptance and identity confusion). Consent will be obtaining from selected individuals prior to their joining the group. New Mexico laws allow adolescents (aged 14 years and above) to consent to personal treatment/therapy (Corey et al., 2011). Considering the sensitive character of an individual's depression status (particularly in case of teenaged students) as well as concerns pertaining to potential risks associated with seeking the consent of their parents, separate consent forms will be employed by the counselor.

Goal setting

The program will combine a number of therapeutic theories/models, such as: Adler's Individual Psychology Theory, Community Work Model, Acceptance and Commitment Therapy (ACT, a form of third wave Cognitive Behavioral Therapy), Client-Focused Expressive Art Treatments, and MBCT (Mindfulness-Based Cognitive Therapy) (Rogers, 2011). "Indivisible Self" wellness model, centered on cross-disciplinary study of healthy individuals' characteristics and Adlerian individual psychology will be utilized (Myers, et.al, 2011). This model obeys Adler's "holistic" perspective of individuals, promoting a strengths-focused psychotherapy approach which also resembles other programs impacted by Adlerian Individual Psychology in the sense that it emphasizes empowerment of self via identification and proper application of personal connections, assets, and strengths.

Change behaviors -- The depressed adolescent group's members will be taught how to be more relaxed and occupied in more pleasing activities. Such changes to behavior will trigger the succeeding profounder change levels.

Change cognitions -- Group members will be aided in altering their depressogenic and impractical thoughts to thoughts that are more practical, successively decreasing their depression levels.

Change schemas -- In order to achieve true, longer-term change, as well as to lower the possibility of recurrence of depression, one needs to modify maladaptive schemas. The group will be presented with the 'schemas' idea, group members will be aided in identifying their respective schemas, and efforts will be initiated towards altering schemas (this process of schema transformation is time-consuming and won't be achieved by the time of the group's termination).

Session outline

Session One

Materials:

Empty index cards

big sheets of paper

sentence completion forms to be handed out to every participant

copy of the BDI Instrument for individual participants

copy of the BHS Instrument for individual participants

"Cognitive-Behavioral depression therapy" handout, and "Sentence Stems" handout.

Activities:

I. Introductions (Duration: 10 minutes)

Group members will be made to introduce themselves. Leaders will then remind them of contract conditions (with emphasis given to the conditions of attendance and confidentiality).

II. Icebreaker (Duration: 10 minutes)

Aim: It enables participants to get to know one another in a way that ensures nobody feels threatened (anxious). This stage enables them to feel more at ease when taking part in group activities.

Participants, minus the leaders, form a circle, with one chair less than the number of members. The activity begins with one member occupying the center of it and stating one personal fact, for instance "I have black hair." Every member possessing this characteristic stands up and every standing individual begins scrambling for a seat (individuals previously seated might not opt for their own seat). The individual who is, at last, left standing makes a similar statement about a personal characteristic of his/hers, and the game continues.

III. Fears and Hopes Exercise (Duration: 15 minutes)

Aim: It enables group members to start sharing more personal facts with fellow group members comfortably. Furthermore, leaders can allay their fears as well as explore their idiosyncratic needs.

IV. Sentence completions relating to depression (Duration: 25 minutes)

Aim: Leaders get to know more about the depression symptoms of members. Members understand that their symptoms are experienced by other people as well, and they aren't alone. They will also understand that depression symptoms can be categorized into three groups. This activity forms the introduction to the session's subsequent stage: Cognitive-Behavioral Depression Model.

V. Cognitive-Behavioral Depression Model (Duration: 20 minutes)

Aim: Members will be educated about the present cognitive depression theory. Common language will be utilized for discussing depression. Members will be given time to mull over how this model explains their symptoms. Members will start to hope.

Leaders present the depression model (schemas or means to understand the world -- thoughts -- feelings, motivation/energy, behaviors-- depression), followed by explaining the depression spiral.

Homework

Members' homework will be the BHS scale, which they will be required to complete. Additionally, they will be urged to go through the handout, followed by reflection of how and whether it is applicable to them.

Session Two

Materials:

1. BHS (Beck Hopelessness Scale)

1. BDI (Beck Depression Inventory)

1. Daily Recording of Members' Dysfunctional Thoughts

1. Pleasant Activities Handout: (This isn't provided; group leaders will compose a list consisting of typical pleasant activities enjoyed by participants.)

1. Relaxation Exercise Handout: (This is also utilized by leaders for guiding participants in the exercise)

Activities

I. Review of the last week's session (Duration: 20 minutes)

The session will open with a discussion, and members will be invited to communicate how they felt about the foremost session, changes noticed in the course of the week, and how they felt coming back.

Individual members may wish to share the scores they obtained on their BDI, from the past week. Further, the group will briefly discuss BHS scores/interpretation.

BHS scoring levels:

1. Normal: 0-3

1. Mild: 4-8

1. Moderate: 9-15

1. Severe: 15+

II. Discussing Life's Good / Bad Times (Duration: 25 minutes)

Aim: Showing members how thoughts and emotions are interrelated, ensuring continued expression of personal feelings and thoughts, and building cohesion and trust.

Members of the group will be requested to give examples of times when they felt particularly bad and good (as long as they are comfortable with doing so).

III. Cognitive Work (Duration: 20 minutes)

Aim: Members can see how their thoughts and emotions are interlinked and, hence, emotions change by altering thoughts.

Group leaders distribute members' Daily Dysfunctional Thought Record and, using an example, explain how it must be used. Members are required to complete the form's first part (excluding the dysfunctional thought revision section) when they feel particularly sad, happy, scared, or angry (but especially the former).

IV. Letter Writing (Duration: 5 minutes)

Aim: Members become familiar with, and understand depression better, as well as get accustomed to pondering about it.

Participants' homework will be composing a letter addressed to the rest of the group, concerning their depression issues. They may outline how their life has undergone a change through depression, its impact upon their life, what the condition signifies for them, and so forth.

V. Pleasant Events (Duration: 10 minutes)

Aim: Increasing awareness of members with regard to positive activities' role in happiness and depression. This stage also aims at encouraging a growth in members' pleasant life-events.

VI. Relaxation Techniques (Duration: 15 minutes)

Aim: Members are taught to relax by themselves and understand how valuable this tool is.

Group leaders initiate basic progressive exercises for muscle relaxation by utilizing the "Relaxation Exercises" handout. If time permits, relaxation is practiced till the session's ending.

Session Three

Materials:

1. Everyday Record of members' Dysfunctional Thoughts (based on Beck's model)

1. Disputing Questions Handout

1. Cognitive Distortions Handout

1. Participant letters to the group

Activities

I. Previous session's review (Duration: 10 minutes)

Members are requested to share their progress, including latest BHS and BDI scores. They are asked whether or not they attempted the relaxation exercises and how they felt after completion.

II. Pleasant Events (Duration:10 minutes)

Group members share with the group their reactions to discussing pleasant events in the previous session.

Also, members discuss their activities in the course of the week and establish future goals.

III. Cognitive Restructuring (Duration: 40 minutes)

Aim: Facilitating members to assess their thoughts' accuracy and establishing how their feelings are impacted by their thoughts.

Participants relate their personal self-monitoring experiences. Leaders ask them how their self-monitoring went, what they noticed in connection with depression, what connection (if any) did they observe between emotions and thoughts, and what they notice about depression-linked thoughts.

IV. Homework Assignment Letters (Duration: 30 minutes)

Letters will be read out to the group and members' reactions gauged.

Aim: Processing painful emotions and building group cohesion and trust.

Session Four

Materials:

Empty index cards

Everyday Record of members' Dysfunctional Thoughts

I. Cognitive Restructuring (Duration: 25 minutes)

Members share their thoughts in connection with the self-monitoring activity (Daily Dysfunctional Thought Record), and in collaboration with the whole group, restructure these thoughts.

II. Self-Evaluation of Functioning Domains (Duration: 35 minutes)

Group leaders communicate to participants their desire to customize group work, as every depression case is unique; there are some issues which hold more relevance for different persons than others. Common areas exist, wherein individuals experience certain difficulties, as listed below (efforts have already commenced in relation to the first, second and third areas):

1. pleasant events

1. relaxation

1. troublesome thoughts

1. relatedness issues (assertion, loneliness, personal style, and isolation)

1. self-control issues -- procrastination

1. constructive approach to problems -- problem solving

1. other issues (drugs/alcohol, perfectionism, appetite/sleep, and school)

III. Self-Esteem Exercise (Duration: 30 minutes)

Aim: Participants can explore their feelings pertaining to self and how these can be related to depression. Consequently, participants can "peel back" one more layer. Every participant will receive a notecard on which to write 3 things each that they dislike (would wish to change) and like with respect to themselves, on either side.

IV. Homework - Letter Writing

Aim: Understanding self-concept origins.

Members' homework at the end of this session will be writing letters (to be, perhaps, shared with the group, but not actually posted) to a key influential personality, responsible for shaping how they currently view themselves.

Session Five

Everyday Record of members' Dysfunctional Thoughts

Schema List (Handout)

Schema Questionnaire

Activities:

I. Previous session's review (Duration: 10 minutes)

Members are requested to share their week's work in regard to their depression domains (for instance, procrastination).

II. Cognitive Restructuring (Duration: 20 minutes)

A review of homework is conducted.

III. Letters (Duration: 30 minutes)

The letters of numerous participants are read aloud to the group and participants' reactions evaluated.

IV. Schemas (Duration: 30 minutes)

Aim: Members will be educated with regard to how their experiences are organized and their impact on personal feelings and behaviors. The "schema" concept will be introduced.

One group goal is: aiding members with identification of their individual schemas and helping them discover schemas' role in their respective depression issues and life, in general. Moreover, members will start exploring schemas' origins.

Homework

Participants will be requested to compose a letter addressed to the central figure in their schema development.

Session Six

Materials:

Everyday Record of members' Dysfunctional Thoughts (Handout)

Activities:

I. Cognitive Restructuring (Duration: 20 minutes)

Participants review their homework and aid one another in challenging dysfunctional thoughts.

II. Letter Reading (Duration: 30 minutes)

Members' letters will be read out loud on a voluntary basis. They are urged by leaders to express their feelings and reactions to these letters.

III. Adapting Schemas (Duration: 40 minutes)

Members receive further schema-related education. Firstly, leaders explain how schemas work: their avoidance, compensation, and maintenance.

Session Seven

Materials:

1. Everyday Record of members' Dysfunctional Thoughts (Handout)

1. Crayons/markers and big sheets of paper

Activities:

I. Cognitive Restructuring (Duration: 15 minutes)

Members pair up and evaluate homework; subsequently, they assist one another in challenging dysfunctional thoughts.

II. Schema Modification Review/Planning of Schema Interventions (Duration: 35 minutes)

Following the acquisition of more information with regard to core schemas of participants, leaders collaborate with them for planning certain interventions targeted at failing schemas.

III. Exercise: Family Portrait (Duration: 40 minutes)

Drawing materials and paper is distributed among participants.

They are then asked to reflect on their childhood as well as adolescent years and draw an emotional and typical family scene. Participants are reassured that their drawing skills are not of any significance.