DiscoverCounselor Toolbox PodcastUsing Groups to Address Anger, Anxiety, Depression and Addiction
Using Groups to Address Anger, Anxiety, Depression and Addiction

Using Groups to Address Anger, Anxiety, Depression and Addiction

Update: 2019-06-082


Using Groups to Address

Anger, Anxiety, Depression and Addiction

Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC

Executive Director:

Host: Counselor Toolbox Podcast

Purchase CEUs at:


– Review the benefits of groups

– Identify the modalities for group

– Discuss goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression

– Explore activities that can be used to enhance group engagement

Benefits of Group

– Cost effective

– Peer feedback and support

– Development of interpersonal skills

– Reduce isolation and “uniqueness”

– Many observers

Modalities for Group

– Face-to-face

– Web-meeting

– Video with or without breakout rooms

– Chat

– Asynchronous

– Psychoeducational/skills video

– Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician

– HIPAA, HITECH and 42 CFR Part 2 all apply


– Low self esteem

– Cognitive distortions

– Emotional dysregulation

– Poor Interpersonal Skills

– Fear of isolation, rejection, failure, loss of control, the unknown

– Poor lifestyle behaviors

Awareness (2)

– Learn about anger, anxiety, depression and addiction and their symptoms

– Learn about the Mind-Body Connection (Jeopardy)

– Potential causes of symptoms

– Effects of symptoms

– Interventions for symptoms

– Have clients identify (Worksheet/Beach Ball or Jenga)

– Symptoms

– What changed which causes or worsens the symptom

– How they have dealt with the symptom in the past

– Impact of the symptom on them

Awareness (1)

– Negative Triggers

– Those things that cause or worsen the symptom

– Hungry Angry Lonely Tired (HALT)

– False Evidence Appearing Real (FEAR)

– People Places Things

– Times (of day, anniversaries, holidays)

– Small Group Activity/Presentation

– Which ones can be avoided or prevented-

– Which ones are unavoidable-

– Identify three ways to deal with the unavoidable ones to mitigate their impact.

Awareness (1)

– Positive Triggers (Flip chart stations)

– Those things that remind you to use your new tools

– Sights

– Sounds

– Smells

– Touch

– Those things that trigger positive emotions

– Sights

– Sounds

– Smells

– Touch

– How can you add those to your environment-

Awareness (1)

– Vulnerabilities

– Explain the concept of vulnerabilities

– Identify the most common vulnerabilities: What causes them and how to prevent and mitigate them

– Emotional (anger, jealousy, envy, depression, anxiety, guilt, grief)

– Mental (Poor concentration, rigid thinking, poor problem solving)

– Physical (Sleep, nutrition, pain)

– Social (lack of supportive relationships, presence of unsupportive relationships)

– Environmental

Awareness (1)

– Mindfulness and Vulnerability Prevention

– Learn about mindfulness

– Purpose

– Benefits

– Difference from meditation

– Methods

– 5 minute exercise

– 5,4,3,2,1

– Color focus: Find all the things that are blue

– What are my thoughts, urges, sensations when I feel stress, anger, fear, depression, happiness, excitement

Awareness (1)

– Goal Identification (Top 3s) What is most important to focus your energy on so you can be happy- // What does happiness/recovery look like to you- (Collage)

– What 3 things are most important to you-

– What 3 relationships are important to you and what do you want them to look like-

– What 3 personal growth goals are important to you-

– What are your values that support your goals (Top 3)

Distress Tolerance (1)

– Clients with mood or addictive disorders tend to

– Get stuck in the unpleasant emotion

– Impulsively act to eliminate/escape from distress

– Distress tolerance skills help them learn that urges and feelings:

– Come in waves

– Do not have to be acted upon

– Can be tolerated

Distress Tolerance (1)

– Distress tolerance skills help them learn that urges and feelings:

– Can help them practice the pause to make choices which will keep them using their energy to move toward their goals.

– Bee metaphor

– Rewrite the lyrics to Stop In the Name of Love by the Supremes

– Stop, step back, observe, then proceed mindfully

– Stop, step back, observe, then proceed mindfully

– Think it over

– Think it over …and so on…

Distress Tolerance (1)

– Address Distress Intolerant Thoughts using the ABCs

– Activating Event (brainstorm triggers)

– Beliefs (D.I.T) (Beach ball, hat, eggs)

– Consequences

– Dispute DITs with alternate statements

– Evaluate which outcome represents a more effective use of energy and helps get the client closer to goals.

Distress Tolerance Skills (2)

– The wave metaphor

– The cloud metaphor (Actually watch clouds)

– Discuss the concept of radical acceptance

– Differentiate from agreement or powerlessness

– Use the house metaphor

– Have clients brainstorm ways and create an action plan to:

– IMPROVE the moment (T-shirt/Water Bottle/Mug (picture))

– ACCEPT reality (Button Pins)

Cognitive Distortions (1)

– Educate about CDs and help clients learn to identify them (Game—Clients read a statement and identify which CD it is.)

– Arbitrary Inference (What is the evidence)

– Availability Heuristic (What does history say)

– Negative Mental Filter / Minimizing the Positive (Dialectics)

– Overgeneralization (Exceptions)

– Mind-Reading (Facts)

– Magnification (Probability)

– All-or-Nothing (Exceptions)

– Personalization (Alternate explanations)

– Clothes pin game

Challenging Questions (1)

– Activity: People’s Court

– Plaintiff, state your belief

– Defendant, state your belief

– Plaintiff, what are the facts supporting your belief- (Object to feelings) How reliable is the source of the evidence-

– Defendant, what are the facts against the plaintiff’s belief- How reliable is the source of the evidence-

– Judge highlights all or nothing thinking. “So I hear the plaintiff saying that this always happens. Defendant…Are there any exceptions-”

– Plaintiff, what is the evidence that [The belief] is probable-

– Defendant, what is the evidence that your belief is probable

– Plaintiff: Help me understand the big picture. Who else was/is there- What else was/is going on that is contributing-

– Defendant: What else do you have to add to what the plaintiff said-

Locus of Control (1)

– Internal: I have the ability to control everything

– External: Destiny and fate are in total control

– Serenity prayer

– Grant me the serenity to accept the things I cannot change

– The Courage to change the things I can

– The Wisdom to know the difference

Locus of Control cont…

– Explore

– How it feels/what it means to not be able to control something

– What powerlessness represents in that person’s life

– Ways to cope with those things that are out of personal control

– What stressors are within and outside of personal control (Envelope with elements:

– My relationship with… (What he says. What he thinks. What he does. How he reacts. What I say. What I think. What I do. How I react. My exposure to him.) How do you feel when you see which parts are in your control-

– Smoking (How it makes me feel. Urges. How I react. Exposure to smoking triggers. Exposure to nonsmoking triggers. Engagement in relapse prevention strategies)

Attributions (1)

– Explain what attributions are.

– You do something nice or You get a promotion

– Internal vs. External

– Stable vs. Changeable

– Global vs. Specific

– You wipe out on the sidewalk or Your new BFF comes over and your house is a disaster.

– Internal vs. External

– Stable vs. Changeable

– Global vs. Specific

– Come up with 6-10 scenarios. Have one group create an internal, stable, blobal attribution and the other create an external, changeable and specific attribution.

– Discuss how changing attributions changes how people feel about a situation-

Purposeful Action Pathway (1)

– Starting Point

– Dysphoric Feelings

– Mind-set (Distress Intolerance, Cog. Distortions)

– Physical health (Poor sleep, pain, nutrition)

– Relationships

– Self-Esteem

Self Esteem (1)

– Self esteem is the relationship with yourself

– What qualities do you look for in a friend-

– Activity: “Order a friend”

– Have participants complete their orders

– Tally up requests to identify characteristics most people are looking for

– Ask participants, which of those qualities do you have-

– How can you be your own best friend-

– Do you hold yourself to a higher standard than you hold anyone else to-

Self Esteem (1)

– Describe who you think you should be, and who you are right now.

– Similarities-

– Differences-

– Are those differences important-

– If so, make a plan to start achieving one

– If not, how can you let that go-

Interpersonal Effectiveness (3)

– Being able to ask for what you need and get it

– Asking for help and saying “no.”

– Win/Win

– Make a list of needs: Call if you are going to be late. Drop off dry cleaning. Tell me you are busy instead of just stopping responding. Help me move this weekend.

– Have group members brainstorm how to create a win-win

– Being able to set and maintain healthy boundaries

– Emotional. Handling someone who is unhappy.

– Mental. Handling someone with different points of view.

– Physical. Handling someone who invades your space.

– Skits

Interpersonal Effectiveness (3)

– Being able to develop and maintain supportive relationships.

– Communication skills

– Listen-Confirm-Respond. Practice sharing about their day. (Give prompts: So what you are saying is… It sounds like when that happened… It must have been [frustrating] when…

– Objective “I” statements (Hat with “you” or incorrectly formed “I” statements– You make me so angry when… I get so angry when you are disrespectful…)

Problem Solving (1)

– Using all skills learned thus far, have clients identify triggers or problems in a small group and choose/explain how to:

– Stay miserable and three effects

– Tolerate distress and three effects

– Change how they feel and think about the situation, and the three effects

– Change the situation and three effects


– Groups are extremely cost effective

– This series of 24 groups provides the foundation for clients to begin living a happier life.

– It is recommended to use written/visual material in addition to lecture and interactive application to help clients fully acquire knowledge and skills









Using Groups to Address Anger, Anxiety, Depression and Addiction

Using Groups to Address Anger, Anxiety, Depression and Addiction

Dr. Dawn-Elise Snipes