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Anxiety - Behavioral & Cognitive Strategies for Treating Anxiety
Anxiety - Behavioral & Cognitive Strategies for Treating Anxiety

Section 10
Group Cognitive-Behavioral Therapy

Question 10 | Test | Table of Contents |
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track we discussed If-Only's. Our discussion focused on the overcoming regret technique, and included the following three coping tools.  The three coping tools are making a wish I’d done it list, solving the problem before it starts, and developing the mental muscle to move on. 

On this track, we will discuss Assertiveness Training through Role Playing. 

5-Step Assertiveness Training
I use five steps in my Cognitive Behavior Therapy Assertiveness Training.  The five steps are:
1. Select an incident
2. Role-play with another group member
3. Have the client visualize the situation once more
4. Have the client role-play the situation twice with the other group member, and
5. Encourage the client. 
In the example given on this track, assertiveness training took place in a group setting.  As I describe the steps involved in Assertiveness Training, you might consider applying them to your last role play or an upcoming one.  How might you change the technique presented on this track to work in a single session with your client?  Also, could playing this track for a client of yours be productive?

Samuel, age 36, had a very demanding boss.  Samuel stated, "My boss makes me so nervous.  I’m afraid to ask for help on a project, because he’ll think I’m incapable.  And he never lets me finish a project.  He’ll approach me while I’m in the middle of something and tell me to do something else.  Then I’ll be working on the second thing and he’ll yell at me for not finishing the initial project.  But I just get so nervous when I think about talking to him about it."  Samuel’s anxiety led him to constant worry regarding confrontation with his boss and coworkers and, more recently, people he didn’t even know.  Would you agree that Samuel was an ideal candidate for assertiveness training?

Step 1 - Select an Incident
In the first step, I asked Samuel to select an incident or situation involving anger.  Samuel selected a time when his boss, Mr. Davidson, berated him for not finishing a project after assigning him another task.  Once the incident was selected, I asked Samuel to close his eyes and visualize the way the incident actually happened.  Right away this increased Samuel’s anxiety levels. 

Next, I had Samuel describe how the situation would normally play out.   First, Samuel described the incident and the personality traits of Mr. Davidson.  Samuel stated, "I was assigned to a marketing campaign for which I needed to write a financial proposal.  Shortly after beginning, Mr. Davidson requested me to begin an audit of company spending over the last six months!"  As Samuel described it, the incident consisted of Samuel being reprimanded by a pushy and overbearing Mr. Davidson.  

Step 2 - Role-Play with other Group Members
The second step involves role-playing with another group member.  In this step, Samuel observed two group members role-playing the incident in a non-hurtful, non-anger-provoking, assertive manner.  One group member from the anxiety group played Samuel asserting himself to Mr. Davidson.  To help Samuel share his reaction I asked him a few questions.  "Did the group member portray Mr. Davidson well?"  "Did he model an assertive confrontation with which you could feel comfortable?"  Samuel’s answers were positive, however if he had said no, I would have requested details.

Step 3 - Visualize the Situation Again
The third step I use in anxiety group CBT Assertiveness Training is to have the client visualize the situation once more.  The purpose here is to give the client the opportunity to incorporate the assertive techniques modeled by the other group members.  Samuel visualized the situation between himself and Mr. Davidson differently this time.  It was interesting to observe how Samuel exhibited progress in implementing assertiveness. Samuel stated, "I see that I should be calmly reminding Mr. Davidson that I have not completed the previously assigned task."

Step 4 - Role-Play the Situation Twice
The fourth step in my group assertiveness training is to have the client role play the situation twice with other group members.  The first time, Samuel played Mr. Davidson to gain insight regarding his boss’s motivation.  Samuel began to feel that Mr. Davidson actually held him in high regard.  As you probably know, this insight helped Samuel to gain a broader, more objective perspective and decrease his fear of Mr. Davidson. 

The second time through, Samuel and the other group member switched roles.  During this role play, I directed Samuel by giving him cues and suggestions.  These cues included words or actions that Samuel used to be more assertive.  For example, Samuel stated, "I am overworked."  I asked Samuel to use specify his generalization of overworked by listing the specifics of the first task assigned that were not completed.  After this role play was over, I asked both Samuel and the other group member to share what they experienced in both roles.  Also, Samuel was given feedback from the group. 

Step 5 - Encourage the Client
In addition to selecting an incident, role-playing with another therapist, having the client visualize the situation once more, and having the client role play the situation twice with the other therapist, the fifth step is encouraging the client.  I encouraged Samuel to move forward at his own pace when he felt comfortable with the assertive techniques he had learned regarding his supervisor Mr. Davidson.  If Samuel had expressed a need for more time to practice assertive confrontation skills with Mr. Davidson, another role-playing session would have taken place during this group meeting or a future one.  The main benefit I felt that Samuel derived from role-playing was an increased empathy for Mr. Davidson and improved assertive confrontation and anxiety management skills. 

On this track, we discussed CBT Assertiveness Training through Role Playing.  There are five steps in Assertiveness Training.  They are: select an incident, role-play with another group member, have the client visualize the situation once more, have the client role play the situation twice with the other group member, and encourage the client.

On the next track we will discuss watching worries come and go.  Regarding watching worries come and go, two techniques we will examine are tracking anxiety levels, and journaling and focusing on positive aspects of life.

A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder
and a Specific Phobia, Case Study

- Tsitsas, G. D. and Paschali, A. A. (2014). A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study. Health Psychology Research, 2(1603). p. 78-82.

Peer-Reviewed Journal Article References:
Bergeron, S., Khalifé, S., Dupuis, M.-J., & McDuff, P. (2016). A randomized clinical trial comparing group cognitive–behavioral therapy and a topical steroid for women with dyspareunia. Journal of Consulting and Clinical Psychology, 84(3), 259–268.

Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84(5), 427–437.

Norton, P. J., & Kazantzis, N. (2016). Dynamic relationships of therapist alliance and group cohesion in transdiagnostic group CBT for anxiety disorders. Journal of Consulting and Clinical Psychology, 84(2), 146–155.

What can be five steps in CBT Assertiveness Training through Role-Playing?
To select and enter your answer go to Test.

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