Mental Health Group Facilitation Curriculum

Welcome participants. Since this is the first session, establish group agreements before proceeding. Suggested norms to propose and discuss:

• Confidentiality: What is shared here stays here. What is learned here leaves here.
• Respect: One person speaks at a time. No cross-talk or unsolicited advice.
• Right to pass: Participation is encouraged but never forced.
• No substance talk glorification: We discuss recovery, not war stories.
• Safety first: If you are in crisis, let the facilitator know.

After establishing norms, conduct a brief check-in. Ask each participant to share their first name and answer: "On a scale of 1-10, how would you rate your stress level right now?"

Begin with a simple question to the group: "What does anxiety feel like in your body?" Write responses on the whiteboard. Common answers include racing heart, tight chest, sweating, stomach problems, racing thoughts, difficulty breathing.

Psychoeducation: Fight, Flight, Freeze

Explain that the body's threat response system (the amygdala) does not distinguish between a physical threat and an emotional one. In recovery, this system can be hyperactive for several reasons:

• Neurochemical recalibration: The brain is relearning how to regulate stress chemicals without substances.
• Unmasked anxiety: Many people used substances specifically to manage anxiety they did not know how to handle otherwise.
• New stressors: Recovery itself brings real-world stressors: legal issues, relationship repair, financial problems, re-entering the workforce.
• Hypervigilance: The body may remain in a heightened alert state, especially for those with trauma histories.

Normalize this: "Feeling more anxious in early recovery does not mean something is wrong with you. It often means your nervous system is doing exactly what it should be doing as it heals."

Walk the group through three grounding techniques. Practice each one together for 3-4 minutes, then debrief.

Technique 1: 5-4-3-2-1 Sensory Grounding

Guide participants to notice:

• 5 things they can see
• 4 things they can physically feel (texture of chair, feet on floor)
• 3 things they can hear
• 2 things they can smell
• 1 thing they can taste

Technique 2: Box Breathing

Inhale for 4 counts, hold for 4 counts, exhale for 4 counts, hold for 4 counts. Repeat 4 cycles. Ask participants to close their eyes or soften their gaze if they are comfortable doing so.

Technique 3: Physical Anchoring

Press both feet flat on the floor. Press palms firmly on thighs. Notice the points of contact between your body and the chair. Say silently: "I am here. I am safe. This moment will pass."

After practicing all three, ask: "Which one felt most natural to you? Which one could you realistically use in your daily life?"

Distribute index cards. Ask participants to write down:

1. One anxiety trigger they identified today
2. One grounding technique they will try this week
3. One word that describes how they are feeling right now

Invite (but do not require) volunteers to share their one-word feeling. Close with: "Anxiety is not the enemy. It is information. Our goal is not to eliminate it but to learn to move through it without reaching for something that will ultimately make it worse."

Revisit group norms briefly. Ask each participant to share: "What is one thing you did this week that was good for you, even if it was small?" This primes behavioral activation before introducing it formally.

If a participant says "nothing," gently reframe: "You showed up here today. That counts."

Start with a group question: "What is the difference between having a bad day and being depressed?" Capture responses on the whiteboard.

Psychoeducation: Sadness vs. Depression

Explain the key distinctions:

• Sadness is a normal human emotion. It comes and goes. It is usually connected to a specific event or loss. It responds to comfort, distraction, and time.
• Depression is persistent (most of the day, nearly every day, for at least two weeks). It affects sleep, appetite, energy, concentration, and motivation. It often includes feelings of worthlessness or excessive guilt. It does not improve simply with positive events.

The PAWS Factor

Explain that post-acute withdrawal syndrome can produce depressive symptoms for months after cessation of substance use. Symptoms include fatigue, emotional flatness, difficulty experiencing pleasure (anhedonia), sleep disturbance, and difficulty concentrating. This is neurobiological, not a character flaw.

"Your brain spent months or years being flooded with artificial dopamine. It takes time for your reward system to recalibrate. The flat, joyless feeling many of you experience is your brain healing, not evidence that recovery isn't working."

Behavioral Activation: The Antidepressant You Control

Introduce the concept: Depression tells us to withdraw, isolate, and stop doing things. Behavioral activation is the practice of doing the opposite, not because we feel like it, but because action often precedes motivation.

Key principles:

• Start absurdly small. Walk to the mailbox. Wash one dish. Send one text.
• Schedule activities rather than waiting to feel motivated.
• Include a mix of mastery activities (things that give a sense of accomplishment) and pleasure activities (things that feel enjoyable or soothing).
• Track what you do and rate your mood before and after. Data disrupts depressive thinking.

Distribute the behavioral activation planning worksheet. Ask participants to identify:

1. Three mastery activities they can do this week (examples: making their bed, attending a meeting, cooking a meal, completing a task at work).
2. Three pleasure activities (examples: listening to music, taking a walk, calling a friend, watching a favorite show, drawing).
3. One social connection activity (examples: texting their sponsor, attending a fellowship event, sitting in a coffee shop instead of isolating at home).

Pair participants to share their plans. Instruct partners to ask: "What might get in the way of you doing this?" and help brainstorm solutions.

Ask the group: "What is one small thing you are willing to commit to doing before our next session, regardless of how you feel?" Have each person state it aloud.

Close with: "Depression lies. It tells you nothing will help, nothing matters, and you are beyond repair. Those are symptoms, not truths. Every small action you take in defiance of that voice is recovery in motion."

Before check-in, acknowledge the topic directly: "Today we are going to talk about trauma. We are not going to ask anyone to share their trauma stories. We are going to learn about how trauma affects the brain and body, and we are going to build some practical safety tools. If at any point you need to step out, you are welcome to do so. That is not weakness. That is self-awareness."

Check-in question: "How are you arriving today? One word to describe where you are right now."

What Is Trauma?

Trauma is not defined by the event itself but by its impact on the person. An experience is traumatic when it overwhelms an individual's capacity to cope, leaves them feeling helpless, and fundamentally disrupts their sense of safety in the world.

Types of trauma relevant to recovery populations:

• Acute trauma: A single event (assault, accident, overdose, witnessing violence)
• Chronic trauma: Repeated exposure (childhood abuse/neglect, domestic violence, ongoing community violence)
• Complex/developmental trauma: Chronic interpersonal trauma that occurred during formative years, disrupting attachment, identity, and emotional regulation
• Recovery-related trauma: Traumatic experiences that occurred during active addiction (sexual exploitation, violence, overdose, incarceration, loss of children)

The Window of Tolerance

Draw the window of tolerance on the whiteboard. Explain the three zones:

• Hyperarousal (above the window): Anxiety, panic, rage, hypervigilance, racing thoughts, inability to sit still. The system is in overdrive.
• Window of Tolerance (the middle): Able to think clearly, feel emotions without being overwhelmed, engage socially, and make decisions. This is where healing happens.
• Hypoarousal (below the window): Numbness, shutdown, dissociation, exhaustion, emotional flatness, feeling "checked out." The system has collapsed.

"Substances artificially widened or narrowed this window. Stimulants pulled people up from hypoarousal. Depressants pulled people down from hyperarousal. In recovery, learning to stay inside your window without substances is one of the most important skills you will develop."

Distribute safety plan templates. Guide participants through filling in each section:

1. My warning signs that I am becoming dysregulated (physical, emotional, behavioral)
2. Things I can do on my own when I notice these signs (grounding techniques from Session 1, physical movement, changing my environment)
3. People I can contact (sponsor, sober support, counselor, crisis line)
4. Places that feel safe to me (specific locations where I feel grounded)
5. One reason to keep going today

Encourage participants to keep this plan accessible, whether in a phone, wallet, or taped to a mirror.

Lead a brief grounding exercise to close (box breathing or physical anchoring from Session 1). Then ask: "What is one thing you learned today that changes how you understand yourself?"

Close with: "You do not have to process your entire trauma history to heal. You do have to learn to keep yourself safe while you do the work. That is what today was about."

Distribute the emotions wheel handout. Ask participants: "Look at this wheel. Find the word that most closely describes how you are feeling right now. Not 'fine,' not 'good,' but the most specific word you can find."

Go around the room. Notice how difficult this is for many participants. That difficulty is the point. "Many of us grew up with a vocabulary of about four emotions: happy, sad, mad, and fine. Recovery asks us to develop a much bigger vocabulary."

Why Emotions Feel Bigger in Recovery

Explain the emotional regulation disruption that occurs in recovery:

• Substances suppress, numb, or amplify emotions artificially. Without them, the full spectrum returns.
• Emotional development may have been arrested. If someone started using at 15, they may have the emotional regulation skills of a 15-year-old in a 35-year-old body.
• The prefrontal cortex (rational brain) is still recovering. Emotional responses may be faster and more intense than logical responses for some time.

The Space Between Feeling and Acting

Write on the whiteboard: TRIGGER > EMOTION > SPACE > RESPONSE

"Recovery lives in that space. The goal is not to stop feeling. The goal is to widen the gap between what you feel and what you do about it."

The TIPP Technique

Introduce TIPP as an evidence-based crisis skill from DBT for moments of extreme emotional intensity:

• T - Temperature: Change your body temperature rapidly. Hold ice cubes, splash cold water on your face, or step outside in cold air. This triggers the dive reflex and slows heart rate.
• I - Intense Exercise: Even 5-10 minutes of vigorous movement (jumping jacks, running in place, brisk walking) metabolizes stress hormones.
• P - Paced Breathing: Exhale longer than you inhale. Try inhaling for 4 counts, exhaling for 6-8 counts. This activates the parasympathetic nervous system.
• P - Paired Muscle Relaxation: Tense muscle groups for 5-10 seconds, then release while breathing out. Work from feet to head.

Part 1: TIPP Demonstration (10 min)

Demonstrate the Temperature component by passing around ice cubes. Ask participants to hold ice in their hand for 30-60 seconds and notice what happens to their emotional state. (Most people report a shift in focus from internal distress to the physical sensation.) Then practice paced breathing together: inhale 4 counts, exhale 7 counts, for 5 rounds.

Part 2: Emotion Surfing Exercise (10 min)

Guide participants through this visualization: "Close your eyes or soften your gaze. Think of a mildly uncomfortable emotion you have experienced recently. Not the worst thing, just something mildly uncomfortable. Now imagine that emotion as a wave. Watch it build. Notice its peak. Now notice it beginning to recede. Emotions, like waves, rise and fall. They do not last forever, even when they feel like they will."

Debrief: "What did you notice? Could you observe the emotion without getting pulled under by it?"

Ask participants to write down their answer to this question: "What is one emotion I am willing to practice sitting with this week instead of running from it?"

Close with: "Emotions are not facts. They are not commands. They are information. You can feel rage without acting in rage. You can feel sadness without sinking. You can feel fear without fleeing. That is what emotional regulation is. Not the absence of feeling, but the freedom to choose your response."

Distribute small pieces of paper. Ask participants to anonymously write down one sentence that starts with "I am ashamed that..." Collect the papers, shuffle them, and read a few aloud (screen for anything too activating first).

Purpose: To demonstrate that shame thrives in secrecy and isolation. Hearing others' shame statements read aloud often produces relief: "I am not the only one who feels this way."

After reading, ask: "What did you notice hearing these? Did any of them surprise you? Did any of them sound familiar?"

Shame vs. Guilt

Write on the whiteboard:

• Guilt: "I did a bad thing." (Behavior-focused. Can motivate change. Can be resolved through amends.)
• Shame: "I am a bad person." (Identity-focused. Paralyzes. Drives isolation, secrecy, and relapse.)

"Guilt can be useful in recovery. It can motivate us to make amends, to change our behavior, to do better. Shame is almost never useful. Shame does not say 'do better.' Shame says 'why bother trying.' That is why shame is a relapse risk factor."

Where Shame Comes From

Explore common sources without requiring personal disclosure:

• Childhood messages: "You'll never amount to anything." "What's wrong with you?"
• Societal stigma around addiction: "Addicts are weak/selfish/broken."
• Consequences of addiction: Legal problems, lost relationships, harm to children, things done in active use.
• Recovery culture itself: Sometimes recovery communities inadvertently reinforce shame through labels or rigid expectations.

Cognitive Reframing

Introduce the concept: Shame produces distorted thoughts that feel like absolute truths. Cognitive reframing does not deny reality. It asks: "Is this the whole truth? Is there another way to see this?"

Example on the whiteboard:

• Shame thought: "I am a terrible parent because of my addiction."
• Reframe: "My addiction affected my parenting. I am now doing the work to be a better parent. My children deserve to see me trying, and I deserve to let myself try."

Part 1: Cognitive Reframing Practice (8 min)

Distribute the cognitive reframing worksheet. Ask participants to write down one shame-based thought they carry. Then guide them through the reframe process:

1. What is the shame thought? (Write it exactly as it sounds in your head.)
2. Is this 100% true? What evidence challenges it?
3. What would I say to a friend who told me they had this thought?
4. Write a more balanced, compassionate version of the thought.

Part 2: Self-Compassion Letter (12 min)

Ask participants to write a short letter to themselves from the perspective of someone who loves them unconditionally, or from the version of themselves they are becoming. Prompt: "Write to the version of you that is carrying all that shame. What does that person need to hear?"

This is a private exercise. No one will be asked to share, though volunteers may. Some participants may find this deeply emotional. Normalize tears and silence.

Ask participants to fold their self-compassion letter and keep it somewhere they can access it. Encourage them to read it on a hard day.

Closing round: "What is one thing you want to let go of from this session? And one thing you want to hold onto?"

Close with: "Shame cannot survive being spoken. That is why we talked about it today. Not to wallow in it, but to name it, examine it, and begin loosening its grip. You are not your worst moment. You are the person who showed up today."

Check-in question: "Think of one relationship in your life right now, any relationship. On a scale of 1-10, how healthy is it? You do not need to say who it is or explain why."

Follow up: "Did your number surprise you? Recovery often changes how we see our relationships, sometimes for the first time honestly."

Attachment Styles Overview

Briefly introduce the four attachment styles and how they show up in adult relationships:

• Secure: Comfortable with closeness and independence. Can communicate needs directly. Trusts that others will be available. (This is what we are building toward.)
• Anxious/Preoccupied: Fears abandonment. Seeks constant reassurance. May become clingy or controlling in relationships. Often hyper-attuned to others' moods.
• Avoidant/Dismissive: Uncomfortable with emotional closeness. Values independence to the point of isolation. May shut down when emotions arise. Often appears "fine" but is emotionally distant.
• Disorganized/Fearful: Wants closeness but is afraid of it. Push-pull dynamics. Often rooted in trauma where caregivers were both the source of comfort and the source of fear.

"These are not permanent categories. They are patterns, often learned in childhood, that can be changed with awareness and practice. Understanding your pattern is the first step."

Assertive Communication: The DESC Framework

Introduce DESC as a structured approach to difficult conversations:

• D - Describe the situation objectively. No judgments, no interpretations. "When you cancel plans at the last minute..."
• E - Express how it affects you using I-statements. "I feel disappointed and unimportant."
• S - Specify what you need. "I need you to let me know at least a few hours in advance if plans change."
• C - Consequences (positive). "That would help me trust that I can count on you."

Boundary Setting in Recovery

Key principles:

• Boundaries are not punishments. They are protections.
• You can set a boundary without being angry. Boundaries can be stated calmly and with compassion.
• Other people's reactions to your boundaries are not your responsibility.
• Boundaries may feel selfish if you have never had them before. They are not.

Part 1: DESC Role Play (12 min)

Pair participants. Distribute scenario cards with common recovery relationship situations:

• A family member keeps bringing up your past at every gathering.
• A friend in recovery asks to borrow money and you are uncomfortable.
• Your partner does not understand why you need to go to meetings.
• A coworker keeps inviting you to happy hour after work.
• A parent makes dismissive comments about your recovery program.

Each pair practices using DESC to address their scenario. Switch roles after 5 minutes.

Part 2: Boundary Statements (8 min)

Ask each participant to write one boundary they need to set. Then write the sentence they would say to set it. Use this template: "I care about [you/this relationship]. I need [boundary]. This is important for my recovery."

Ask: "What is one thing you want to practice in your relationships this week? It can be a boundary, a communication skill, or simply noticing your attachment pattern."

Close with: "Recovery does not happen in isolation. It happens in relationship. And relationships require skills that many of us were never taught. Learning those skills now is not a sign that something is wrong with you. It is a sign that you are finally building the life you deserve."

Content acknowledgment: "Today we are going to talk about grief and loss. For many of us, this is deeply personal. As always, you share only what you choose to share, and you are welcome to step out if you need to."

Check-in: Ask each participant to complete this sentence: "Something I have lost in this process is..." They may name a person, a relationship, a job, time, their health, their self-respect, or the substance itself. All answers are valid.

Types of Loss in Recovery

• Loss of the substance: This is real grief. The substance was a companion, a coping mechanism, a source of comfort. Acknowledging this is not glorifying use. It is being honest about the attachment.
• Loss of identity: "Who am I if I am not the party person, the tough one, the one who doesn't care?"
• Loss of relationships: Friendships that were based on using. Family members who have cut off contact. Partners who left.
• Loss of time: Years spent in active addiction. Milestones missed. Childhoods not fully present for.
• Loss of people: Friends, family, and fellow users who died from overdose, violence, or health complications.
• Ambiguous loss: Losses that are not clearly defined or socially recognized. "My family is alive but they don't trust me." "My children are here but I missed their childhood."
• Disenfranchised grief: Grief that society does not validate. People rarely send sympathy cards when you grieve your relationship with a substance, or when your using buddy dies of an overdose.

Grief Is Not Linear

Briefly address the common misconception of grief "stages." Grief does not move in a straight line from denial to acceptance. It circles, revisits, and surprises. A person may feel fine for weeks and then be leveled by a song, a smell, or a date on the calendar.

"The goal is not to get over your grief. It is to learn to carry it without letting it carry you back to using."

Meaning-Making

Introduce the concept of meaning-making: the process of finding purpose or significance in loss. This is not about saying the loss was "meant to be." It is about asking: "Given that this happened, what am I going to do with it?"

• Some people honor lost friends by staying sober in their memory.
• Some people use their experience to help others in early recovery.
• Some people channel their grief into creativity, advocacy, or service.

Distribute letter-writing paper. Ask participants to write a letter to something or someone they have lost. It can be addressed to:

• A person who has died
• A relationship that ended
• The substance itself
• The version of themselves they lost during active addiction
• The time they wish they could get back

Prompt: "Say what you need to say. You can express anger, sadness, love, regret, gratitude, or all of it. There is no wrong way to write this letter."

Allow 12-15 minutes for writing. Then invite (do not require) 2-3 volunteers to share. Respond to each share with a brief, validating statement. Do not interpret or fix. Simply witness.

After sharing, distribute a small stone or token to each participant. "This represents what you carry. You do not have to put it down. But you can hold it gently instead of gripping it."

Lead a brief moment of silence in honor of what the group has named today. Then ask: "What is one way you will honor your grief this week? Not fix it, not get over it, but honor it?"

Close with: "Grief is not a sign that you are stuck. It is a sign that you loved something, that something mattered, that you are human. Recovery asks us to feel all of it. The grief will not destroy you. Avoiding it might."

Acknowledge that this is the final session. "We have covered a lot of ground together: anxiety, depression, trauma, emotions, shame, relationships, and grief. Today we turn toward what you are building."

Check-in: "Name one strength you have discovered or rediscovered in your recovery. It does not have to be dramatic. 'I show up' is a strength. 'I am honest now' is a strength. 'I keep trying' is a strength."

What Is Resilience?

Resilience is not the absence of difficulty. It is the ability to adapt, cope, and grow through difficulty. Research identifies several key protective factors:

• Connection: At least one stable, supportive relationship. This is the single strongest predictor of resilience.
• Meaning/Purpose: A sense that your life has direction and significance.
• Self-efficacy: The belief that your actions matter and you can influence your circumstances.
• Emotional regulation: The ability to manage distress without being overwhelmed (Session 4).
• Realistic optimism: Not toxic positivity, but a genuine belief that things can improve combined with willingness to do the work.
• Flexibility: The ability to adapt when plans do not work out, to find new paths forward.

Post-Traumatic Growth

Introduce the concept: Post-traumatic growth (PTG) is the experience of positive psychological change that can emerge from the struggle with highly challenging life circumstances. It does not mean the trauma was good or necessary. It means that some people, through the process of coping, develop strengths they would not have otherwise.

Five domains of post-traumatic growth:

• Greater appreciation for life: "I do not take my days for granted anymore."
• New possibilities: "I discovered paths I never would have considered before recovery."
• Improved relationships: "My relationships are more honest and deeper than they have ever been."
• Personal strength: "If I survived that, I can handle more than I thought."
• Spiritual/existential change: "I understand what matters to me in a way I never did before."

"Post-traumatic growth is not mandatory. It is not something you should pressure yourself to achieve. But if you recognize any of these in yourself, honor them. They are real."

Distribute the resilience plan worksheet. Guide participants through each section:

1. My Support Network (5 min)

List at least three people you can turn to for support. Include at least one recovery-specific contact and one person outside of recovery. For each person, note what kind of support they provide (emotional, practical, accountability, fun).

2. My Coping Toolkit (5 min)

Drawing from everything learned in this curriculum, list your top 5 coping strategies. These should be strategies you have actually practiced, not just ones you have heard about. Be specific: not just "breathe" but "box breathing for 4 rounds."

3. My Warning Signs (3 min)

What are the early indicators that you are struggling? These might include isolation, skipping meetings, disrupted sleep, irritability, or romanticizing the past. Knowing your warning signs allows you to intervene early.

4. My Recovery Non-Negotiables (3 min)

What are the things you will not compromise on, no matter what? These are the practices, people, or principles that anchor your recovery. Examples: "I go to at least two meetings a week." "I call my sponsor before I make a big decision." "I do not keep alcohol in my home."

5. My Reason (4 min)

Write one sentence about why your recovery matters to you. Not why it matters to your family, your job, or your probation officer. Why it matters to you. This is your anchor statement.

After completing the plan, invite volunteers to share one section. Encourage participants to keep this plan visible and revisit it monthly.

Distribute index cards. Ask each participant to write their name at the top, then pass the card to the right. Each person writes one positive quality they have noticed about the person whose card they hold. Continue passing until each card has been written on by several group members. Return cards to their owners.

Final round: "What is one thing you are taking away from this group? One thing that will stay with you?"

Close with: "You came here eight weeks ago and you stayed. Some of you came scared. Some came skeptical. Some came because someone told you to. But you stayed. And in staying, you practiced every single thing we talked about: courage, honesty, vulnerability, regulation, self-worth, connection, grief, and resilience. Recovery is not something that happens to you. It is something you build, one session, one day, one next right step at a time. Thank you for trusting this process and each other."