CBT Group Therapy Curriculum for Adolescent Depression

Curriculum Overview and Goals

This group aims to help participants modify their cognitions, maladaptive schemas, and behaviors. Participants learn how to be more relaxed and engaged in more pleasant activities. Such behavioral changes trigger deeper, more profound levels of change. Group members are also helped to alter depressogenic and unrealistic thoughts, replacing them with more practical ones, thereby progressively reducing their depression. To achieve genuine, longer-term change and to lower the likelihood of depression recurring, participants must work toward modifying maladaptive schemas. The group is introduced to the concept of schemas, members are helped to identify their own schemas, and efforts are begun toward altering them. It is important to note, however, that schema transformation is a time-consuming process and will not be fully achieved by the time the group concludes. Participants complete the BHS (Beck Hopelessness Scale) and BDI (Beck Depression Inventory), record their dysfunctional thoughts daily, and acquire knowledge about depression (Corey et al., 2011).

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

Target: Students suffering from depression. It should be noted that this group is not suitable for chronic or severe depression cases.

Length: Eight sessions of 1.5 hours each.

Facilitator Training, Demographics, and Membership Selection

The ASGW (Association for Specialists in Group Work) (2007) states that group counselors are required to complete a core component of group training. Both facilitators are engaged in group process and counseling skills training as part of their postgraduate counseling program. Moreover, ASGW (2007) states that individuals engaged in such group work understand that participating in ethical practice requires ongoing supervision, professional training, and growth. All of this will be incorporated throughout the counseling group's duration. Additionally, only interventions that fall within group members' skill levels will be employed.

The adolescent group will comprise between eight and ten female and male high-school students between the ages of 14 and 18 years, who are self-identified or diagnosed as experiencing depression. A qualified counselor will act as facilitator. Group meetings will be held every Wednesday during the lunch period, in the school's counseling department. The adolescent depression group will be established in the third quarter of the academic year, with the final meeting held three weeks before school closes for the summer — allowing for approximately eight group sessions. Members will be invited to rejoin in the following academic year.

The school curriculum can help enhance multicultural sensitivity and awareness — including gender identity — through classroom guidance sessions on social and cultural tolerance and diversity. Following these discussions, the school counselor can announce an adolescent support group available to students experiencing depression or those who are uncertain about their status. Interested students will be encouraged to visit the school's counseling office for additional information. Written announcements will be placed discreetly throughout the school premises, such as in washrooms and on the counseling department bulletin board. Other school counselors, administrative staff, and teachers will be informed of the group's existence and may identify additional candidates (Myers et al., 2011), who can then be personally invited to participate.

Interested candidates will undergo a 30-minute screening process, during which they may express their expectations for the group, as well as any concerns or questions. The group counselor will explain the group's purpose and goals. Screening is important for both the counselor and prospective participants: the counselor can, to some degree, manage group dynamics through this process, while participants can make an informed decision about whether to join. The group will be composed of members whose needs align with group goals and whose welfare will not be put at risk by the group experience. The counselor will also seek members with diverse personalities — for instance, introverted and extroverted individuals — and varying motivation levels.

Consent will be obtained from selected individuals prior to their joining the group. New Mexico law allows adolescents aged 14 and above to consent to their own treatment or therapy (Corey et al., 2011). Given the sensitive nature of an adolescent's depression status and concerns about the potential risks of seeking parental consent, the counselor will use separate consent forms designed for this population.

Goal Setting and Therapeutic Frameworks

The program integrates several therapeutic theories and models, including Adler's Individual Psychology, the Community Work Model, Acceptance and Commitment Therapy (ACT) — a form of third-wave Cognitive-Behavioral Therapy — Client-Focused Expressive Art Treatments, and Mindfulness-Based Cognitive Therapy (MBCT) (Rogers, 2011). The "Indivisible Self" wellness model, grounded in cross-disciplinary research on characteristics of healthy individuals and Adlerian individual psychology, will also be employed (Myers et al., 2011). This model follows Adler's holistic view of individuals and promotes a strengths-focused psychotherapy approach, emphasizing self-empowerment through the identification and application of personal connections, assets, and strengths.

Change behaviors: Group members will be taught how to be more relaxed and engaged in more pleasant activities. These behavioral changes will trigger deeper, subsequent levels of change.

Change cognitions: Group members will be helped to replace depressogenic and unrealistic thoughts with more practical alternatives, progressively decreasing their depression.

Change schemas: To achieve genuine, longer-term change and reduce the likelihood of depression recurring, participants must work toward modifying maladaptive schemas. The group will be introduced to the concept of schemas, members will be helped to identify their own, and efforts will be initiated toward schema change — with the understanding that this process is time-consuming and will not be complete by the time the group ends.

Session-by-Session Outline

Materials: Blank index cards; large sheets of paper; sentence completion forms for each participant; individual copies of the BDI and BHS instruments; "Cognitive-Behavioral Depression Therapy" handout; "Sentence Stems" handout.

I. Introductions (10 minutes)
Group members introduce themselves. Leaders remind them of the group contract, with emphasis on attendance and confidentiality.

II. Icebreaker (10 minutes)
Aim: To help participants get to know one another in a non-threatening way, so that they feel more at ease in group activities. Participants (excluding leaders) form a circle with one fewer chair than the number of members. One member stands in the center and states a personal fact — for example, "I have black hair." Every member who shares that characteristic stands up and scrambles for a seat; the person left standing makes a new statement, and the game continues.

III. Fears and Hopes Exercise (15 minutes)
Aim: To help group members begin sharing more personal information with one another comfortably, while allowing leaders to address fears and explore each member's individual needs.

IV. Sentence Completions Relating to Depression (25 minutes)
Aim: Leaders learn more about members' depression symptoms. Members recognize that others share their experiences and that they are not alone. Members also learn that depression symptoms can be grouped into three categories. This activity introduces the session's next component: the Cognitive-Behavioral Depression Model.

V. Cognitive-Behavioral Depression Model (20 minutes)
Aim: Members are educated about the current cognitive theory of depression. Common language is established for discussing depression. Members are given time to reflect on how this model relates to their own symptoms and begin to develop hope. Leaders present the depression model — schemas (ways of understanding the world) → thoughts → feelings, motivation, and energy → behaviors → depression — and explain the depression spiral.

Homework: Members will complete the BHS scale and are encouraged to read the handout and reflect on how it does or does not apply to them.

Materials: Beck Hopelessness Scale (BHS); Beck Depression Inventory (BDI); Daily Record of Members' Dysfunctional Thoughts; Pleasant Activities Handout (compiled by group leaders based on activities typical to participants); Relaxation Exercise Handout (also used by leaders to guide the relaxation exercise).

I. Review of the Previous Session (20 minutes)
The session opens with a discussion in which members share how they felt about the first session, any changes they noticed during the week, and how they feel returning to the group. Individual members may share their BDI scores. The group also briefly discusses BHS scores and their interpretation:

II. Discussing Life's Good and Bad Times (25 minutes)
Aim: To show members how thoughts and emotions are interrelated, to encourage continued expression of personal feelings and thoughts, and to build group cohesion and trust. Members are invited to share examples of times when they felt particularly bad and good, as they feel comfortable doing so.

III. Cognitive Work (20 minutes)
Aim: To help members see the connection between their thoughts and emotions, and to understand that emotions can change when thoughts change. Group leaders distribute the Daily Dysfunctional Thought Record and explain, using an example, how it is to be used. Members are asked to complete the first part of the form — excluding the thought-revision section — whenever they feel particularly sad, happy, scared, or angry.

IV. Letter Writing (5 minutes)
Aim: To help members become more familiar with their depression and practice reflecting on it. Participants are assigned the task of writing a letter to the group about their depression — describing how their life has changed, its impact, and what the condition means to them.

V. Pleasant Events (10 minutes)
Aim: To increase members' awareness of the role that positive activities play in happiness and depression, and to encourage members to engage in more pleasant activities.

VI. Relaxation Techniques (15 minutes)
Aim: To teach members how to relax independently and to demonstrate the value of this skill. Leaders guide participants through basic progressive muscle relaxation exercises using the "Relaxation Exercises" handout. If time permits, the exercise continues until the session ends.

Materials: Daily Record of Members' Dysfunctional Thoughts (Beck's model); Disputing Questions Handout; Cognitive Distortions Handout; participant letters to the group.

I. Previous Session Review (10 minutes)
Members share their progress, including their latest BHS and BDI scores, and discuss whether they tried the relaxation exercises and how they felt afterward.

II. Pleasant Events (10 minutes)
Members share their reactions to the pleasant events discussion from the previous session, discuss their activities during the week, and set goals for the coming week.

III. Cognitive Restructuring (40 minutes)
Aim: To help members assess the accuracy of their thoughts and understand how their feelings are affected by their thinking. Participants share their self-monitoring experiences. Leaders ask how the self-monitoring went, what members noticed about depression, whether they observed any connection between emotions and thoughts, and what patterns they noticed in depression-related thoughts.

IV. Homework Assignment Letters (30 minutes)
Letters are read aloud to the group and members' reactions are explored. Aim: To process painful emotions and strengthen group cohesion and trust.

Materials: Blank index cards; Daily Record of Members' Dysfunctional Thoughts.

I. Cognitive Restructuring (25 minutes)
Members share thoughts from their Daily Dysfunctional Thought Record and, in collaboration with the whole group, work to restructure these thoughts.

II. Self-Evaluation of Functioning Domains (35 minutes)
Group leaders explain their desire to tailor group work to individual needs, since each person's depression is unique and different issues hold varying degrees of relevance for different members. Common areas in which individuals experience difficulty include:

III. Self-Esteem Exercise (30 minutes)
Aim: To help participants explore their feelings about themselves and how these relate to depression. Each participant receives a notecard on which they write three things they like about themselves and three things they would like to change, one on each side.

IV. Homework — Letter Writing
Aim: To explore the origins of members' self-concept. Members write letters — to be optionally shared with the group but not actually sent — addressed to a key influential person responsible for shaping how they currently view themselves.

Materials: Daily Record of Members' Dysfunctional Thoughts; Schema List Handout; Schema Questionnaire.

I. Previous Session Review (10 minutes)
Members share their work from the week in relation to their identified depression domains, such as procrastination.

II. Cognitive Restructuring (20 minutes)
Homework is reviewed and discussed.

III. Letters (30 minutes)
Several participants' letters are read aloud to the group and participants' reactions are explored.

IV. Schemas (30 minutes)
Aim: To educate members about how their experiences are organized into schemas and how these schemas influence their feelings and behaviors. One group goal is to help members identify their individual schemas, understand the role those schemas play in their depression and broader lives, and begin exploring the origins of those schemas.

Homework: Participants are asked to write a letter addressed to the central figure in the development of their schemas.

Materials: Daily Record of Members' Dysfunctional Thoughts (Handout).

I. Cognitive Restructuring (20 minutes)
Participants review their homework and help one another challenge dysfunctional thoughts.

II. Letter Reading (30 minutes)
Members' letters are read aloud on a voluntary basis. Leaders encourage members to express their feelings and reactions.

III. Adapting Schemas (40 minutes)
Members receive further education about schemas. Leaders explain how schemas operate — including their avoidance, compensation, and maintenance — and begin working with members on strategies for adapting them.

Materials: Daily Record of Members' Dysfunctional Thoughts (Handout); crayons or markers; large sheets of paper.

I. Cognitive Restructuring (15 minutes)
Members pair up and review their homework, then help one another challenge dysfunctional thoughts.

II. Schema Modification Review and Planning of Schema Interventions (35 minutes)
Drawing on a deeper understanding of each participant's core schemas, leaders collaborate with members to plan targeted interventions aimed at modifying those schemas.

III. Exercise: Family Portrait (40 minutes)
Drawing materials and paper are distributed. Participants are asked to reflect on their childhood and adolescent years and to draw an emotionally expressive, representative family scene. They are reassured that artistic skill is not important.

I. Review of Material Covered
Members are invited to recall and briefly describe the key content and themes covered across the group sessions.

II. Continuation and Maintenance of Therapeutic Gains
Group leaders explain how members can continue their therapeutic efforts and sustain their progress. Members are encouraged to keep monitoring their depression levels and to continue examining cognitive, emotional, behavioral, and interpersonal areas where further work may be needed. They are also encouraged to make pleasant activities and relaxation a regular part of daily life.

Members are urged to remain alert to stressful events that may trigger depression — both general and specific, such as health-related issues, social losses, school- or work-related events, financial changes, and new responsibilities or adjustments. Finally, members are encouraged to continue examining and working on their evolving schemas.

III. Wrapping Up and Leave-Taking
Members are invited to share their experiences within the group and to express how they feel about the group coming to an end.