Self-control therapy for depression

1. Introduction

Version followed: Lynn Rehm's Self-Management Therapy (SMT) for depression, the later manualised structured group programme of about 14 weekly sessions of about 90 minutes (Rehm, 2005 encyclopedia entry; Rehm, 1984), built on the three-module order (self-monitoring, then self-evaluation, then self-reinforcement) of the original six-session programme (Fuchs & Rehm, 1977). Where the 6-, 10- and 14-session versions differ, this is noted. Rehm's full manual (Rehm, 2003, PICS/TherapyAdvisor) is not drawn on; session content after Session 2 is reconstructed from the published programme descriptions and is marked [uncertain] where the exact session placement is not documented.

Self-control (self-management) therapy is a structured, didactic cognitive-behavioural course for depression derived from Frederick Kanfer's three-stage self-regulation model. Rehm's model holds that depressed people show six deficits across the three stages: they attend selectively to negative events, attend to immediate rather than delayed consequences, set stringent self-evaluative standards, make inaccurate attributions of responsibility (taking blame for failures, not credit for successes), give themselves too little reward and too much self-punishment. Change happens when the client learns and applies the opposite skills: noticing positive events and delayed outcomes, setting realistic, attainable goals, attributing outcomes accurately, and rewarding progress, which raises positive activities and positive self-statements and so lifts mood. The programme is deliberately "transparent": clients are taught the model and apply the techniques to themselves. [source: Rehm 1977 as summarised in Rehm 1976 ERIC papers; Rehm 2005 SAGE entry; APA Div 12]

2. Framework

Format. Usually a closed group of about 6–10 adults with two co-therapists; individual delivery is also documented. Each session has four parts: a didactic presentation of one self-control principle, discussion of how it applies to members' lives, in-session paper-and-pencil exercises, and a homework assignment, reviewed at the start of the next session. Daily self-monitoring starts in Session 1 and runs throughout; what is monitored shifts as each new module is added. [source: Rehm 2005 SAGE entry; Rehm 1982 ERIC paper; APA Div 12]

Versions.

Original programme: 6 weekly sessions of about 1.5 hours, in three two-session blocks (self-monitoring 1–2, self-evaluation/goal setting 3–4, self-reinforcement 5–6). [source: Fuchs & Rehm 1977, ERIC 1976 versions]
10-session/10-week version: used in the 1980s outcome and component trials; also the length listed by APA Div 12. [source: Rehm 1982 ERIC paper; APA Div 12]
14-session version: about 90 minutes weekly; the version followed here. Used with older adults, veterans and other populations. [source: Rehm 2005 SAGE entry]
Children (grades 4–6) and adolescent adaptations exist (Stark et al., 1987; Reynolds & Coats, 1986) but are not detailed here. [source: Wikipedia; APA Div 12]

Phases of the 14-session version (session placement after Session 2 [uncertain]: the three-module order is documented, the exact session split is not given in the sources):

Phase	Sessions (approx.)	Goal	Core homework
Orientation and mood awareness	1	Group formed; depression described and linked to members' symptoms; programme overview	Daily 0–10 mood rating
Self-monitoring	2 to about 4	See that mood tracks positive activities and positive self-statements; notice positive events and delayed consequences	Daily mood plus log of positive activities and positive self-statements
Self-evaluation (attributions and goal setting)	about 5 to 9	Make attributions for success and failure more accurate; set realistic, behaviourally defined goals and attainable subgoals; evaluate progress against them	Attribution exercises; goal and subgoal worksheets; continued monitoring of target behaviours
Self-reinforcement	about 10 to 13	Build a self-administered reward programme contingent on subgoal activities; increase covert self-reward (positive self-talk) and reduce self-punishment	Personal reward contract; positive self-statements practice
Consolidation	14	Review the whole model; plan continued self-management	Written plan and materials for continued use

[source: Rehm 2005 SAGE entry; Fuchs & Rehm 1977; Rehm 2010 table of contents; Wikipedia summary of Fuchs & Rehm 1977]

Criteria for moving between phases. The programme is time-structured, not criterion-driven: modules advance on the session schedule, and each module builds on the data gathered in the previous one (the activity logs supply the behaviours chosen as goals; the goals supply the targets for reward). [source: Fuchs & Rehm 1977, ERIC 1976 version] Practical readiness markers before moving on [synthesis]: the client is completing daily logs on most days; they can name at least a few activities that lift their mood; before self-reinforcement, they have at least one goal broken into subgoals they rate as achievable. If a client lacks the data, carry the previous module's homework forward rather than holding the group back.

3. Guiding principles

Transparency. Teach clients the model and why each step is used; they are learning to be their own therapist. Practical meaning: present the rationale out loud each session and link it to their own data. [source: Rehm 2005 SAGE entry]
Depression as a self-control skills deficit. Treat low mood as partly the result of how the person monitors, evaluates and rewards themselves. Practical meaning: frame problems as skills not yet learned, not as character flaws. [source: Rehm 1977, via ERIC 1976 papers]
Mood follows activities and self-statements. The programme assumes clients can change mood by changing what they do and what they say to themselves, whatever the direction of cause. Practical meaning: every intervention aims to increase positive activities or positive self-statements. [source: Rehm 2005 SAGE entry]
Data-driven self-observation. Clients' own daily records are the raw material for every later step. Practical meaning: begin each session with homework review and use the logs, not recollection. [source: Fuchs & Rehm 1977; Rehm 2005]
Look for the positive and the delayed. Correct selective attention to negative events and immediate outcomes. Practical meaning: always ask what went well and what the longer-term payoff of an activity is. [source: Rehm 1977, via ERIC 1976 papers]
Realistic standards. Goals are behavioural, specific, within the client's control and broken into attainable subgoals. Practical meaning: shrink any goal the client is unlikely to meet this week. [source: Fuchs & Rehm 1977, ERIC 1976 version]
Accurate attribution. Help clients take fair credit for successes and stop over-blaming themselves for failures. Practical meaning: when a success is reported, ask what the client did to bring it about. [source: Rehm 1977 deficit list; procedure detail [uncertain]]
Reward progress, not perfection. Self-reward should be frequent and contingent on subgoal steps; self-punishment is reduced. Practical meaning: rewards are tied to small steps the client can actually take this week. [source: Fuchs & Rehm 1977; Rehm 1977]
Structured, didactic, skills-cumulative. One principle per module, each building on the last. Practical meaning: keep to the agenda; process material is welcome but is linked back to the skill. [source: Rehm 1982 ERIC paper; Rehm 2005]
Generalisation to daily life. Skills are practised as homework in the client's real environment and handed over for continued use after the course. Practical meaning: end the course with a written self-management plan. [source: Wikipedia summary of Fuchs & Rehm 1977; Rehm 1982 ERIC paper]

4. Intervention inventory

Sources for this section: Fuchs & Rehm (1977, ERIC 1976 versions) for the three-block content; Rehm (2005 SAGE entry) for Sessions 1–2, mood rating and the four-part session format; Rehm (1982 ERIC paper) for the behavioural vs cognitive target versions; Rehm (2010) table of contents for named methods (goal setting, self-reinforcement/self-talk, assets list). All example language is illustrative. Worksheets in Rehm's manual were not seen and are not reproduced; the forms described below are generic.

4.1 Pre-group assessment and orientation

Purpose / when: Before Session 1. Confirm depression is the target, the person can work in a structured didactic group, and risk is managed. [synthesis]
Steps: (1) Standard diagnostic interview and a depression severity measure (trials used the Beck Depression Inventory and MMPI-D; use any validated measure you are licensed for). (2) Standard suicide risk assessment; agree a safety plan for anyone at elevated risk and decide whether a group-only format is enough. (3) Explain that the course is a class-like skills programme with weekly homework. (4) Get consent to the group rules (attendance, confidentiality, homework). [source for measures: Fuchs & Rehm 1977 via Wikipedia; remaining steps synthesis]
Example language (illustrative): "This group works a bit like a course. Each week we learn one skill for managing mood and you try it out between sessions."
Watch for: Active suicidality, psychosis or severe cognitive impairment, which make a didactic group a poor first-line fit [synthesis]. Rehm (1983) reported better outcomes when clients held positive attitudes toward a self-control approach, so check whether the person finds the idea credible. [source: Wikipedia summary of Rehm 1983]

4.2 Didactic presentation of the self-control model (rationale)

Purpose / when: Session 1, then a short refresh at the start of each module. Makes the programme transparent and gives clients a non-blaming explanation of their depression. [source: Rehm 2005]
Steps: (1) Introductions and programme overview. (2) Describe depression (mood, thinking, behaviour, physical symptoms) and invite members to link it to their own symptoms. (3) Present Kanfer's three stages in plain words: watching what you do, judging it against a standard, rewarding or punishing yourself. (4) Present the depression-linked patterns at each stage (noticing the negative, focusing on the short term, harsh standards, taking blame but not credit, too little self-reward, too much self-criticism). (5) Name the core premise: mood is linked to daily activities and to what you say to yourself, and changing these can change mood. (6) Preview the three modules. [source: Rehm 2005; Rehm 1977 via ERIC 1976 papers]
Example language (illustrative): "Everyone runs their life using three skills: noticing, judging and rewarding. Depression tends to bend all three. This course straightens them out one at a time."
Watch for: Members hearing "deficit" as blame. Reframe as skills that slipped under stress. Check understanding by asking a member to explain the three stages back. [synthesis]

4.3 Daily mood rating

Purpose / when: Homework from Session 1, continued throughout. Builds awareness that mood varies from day to day and familiarity with the scale. [source: Rehm 2005]
Steps: (1) Introduce a 0–10 scale anchored at 0 = the most depressed day the person has ever had and 10 = the happiest day they have ever had. (2) Ask for one average-mood rating each evening on a simple daily form. (3) In the next session, look at the week's range: highest and lowest days. (4) Ask what was different on the better days. [source: Rehm 2005]
Example language (illustrative): "Each evening, give the whole day one number. Zero is the worst day of your life, ten the best."
Watch for: Ratings that never move (check the person is using the full scale and not rating "how depressed I am in general"); missing days filled in from memory. It is working when the client notices variation and can name what was going on on better days. [synthesis]

4.4 Self-monitoring of positive activities

Purpose / when: Session 2 onward (Sessions 1–2 in the 6-session version). Counters selective attention to negative events and builds the database for goal setting. [source: Fuchs & Rehm 1977 ERIC version; Rehm 2005]
Steps: (1) Define a positive activity broadly: anything rewarding or likely to lead to rewarding effects, including small and routine ones. (2) Give a list of activity categories as prompts (for example social, physical, work/achievement, leisure, self-care). (3) Each day the client writes down every positive activity, ideally soon after it happens, alongside the daily mood rating. (4) In session, have members count daily totals. [source: Fuchs & Rehm 1977 ERIC version; Rehm 2005; category examples are synthesis]
Example language (illustrative): "Write down anything you did today that felt even a little good, or that will pay off later. Making a phone call counts. So does finishing the dishes."
Watch for: Logs with almost nothing on them, which often mean the threshold for "positive" is too high, not that nothing happened. Lower the bar and do a recall exercise of yesterday in session. Working sign: counts rise and the client starts to spot activities they had overlooked. [synthesis]

4.5 Self-monitoring of positive self-statements

Purpose / when: From Session 2, alongside activity monitoring. Targets the cognitive side of mood: what the person says to themselves. [source: Rehm 2005; Rehm 1982 ERIC paper]
Steps: (1) Explain that self-statements are the comments people make to themselves about themselves. (2) Ask clients to write down each day any positive things they thought or said about themselves. (3) Count these daily, next to the mood rating. (4) In session, ask members to share examples and note how rare or common they were. [source: Rehm 2005]
Example language (illustrative): "Notice any moment today when you thought something like 'I handled that well'. Jot it down, however small."
Watch for: Clients recording negative statements instead. Acknowledge them, then steer back to looking for positives, since the programme's aim is to increase positive self-statements. [synthesis]

4.6 Linking mood with activities and self-statements

Purpose / when: From the Session 2 homework review onward. Shows clients, from their own data, that mood tracks what they do and think. [source: Rehm 2005; Wikipedia summary of Fuchs & Rehm 1977]
Steps: (1) Ask clients to set daily mood ratings next to the daily counts of positive activities and positive self-statements. (2) Have them look for the pattern (for example, do busier or more positive days coincide with higher mood?). A simple plot of both over the week makes this visible. (3) Draw out the central premise: if mood and positive activities rise and fall together, raising activities is a lever on mood. [source: Rehm 2005; plotting is a common feature of Rehm's programme in secondary descriptions but is not confirmed in a primary source [uncertain]]
Example language (illustrative): "Look at your two best days this week. What was on your activity list those days compared with your two worst?"
Watch for: A client whose data show no link. Do not argue; widen what counts as positive and keep monitoring, or look at a longer stretch. It is working when clients spontaneously say "I feel better when I...". [synthesis]

4.7 Immediate versus delayed consequences

Purpose / when: Self-monitoring module. Counters the tendency to judge activities only by their immediate effect. [source: Fuchs & Rehm 1977 ERIC version (stated aim: increase monitoring of delayed outcomes); Wikipedia components list]
Steps: (1) Teach that many activities feel neutral or unpleasant now but bring rewards later (exercise, paying a bill, calling a friend), and that some pleasant-now activities have costs later (staying in bed). (2) Using the activity logs, ask clients to mark activities with a delayed positive effect. (3) As homework, add delayed-effect activities to the log. [source for aim: Fuchs & Rehm 1977; steps synthesis]
Example language (illustrative): "Going for that walk didn't feel great at the time. What did it do for you later in the day?"
Watch for: Clients who dismiss a delayed benefit as "nothing". Ask them to rate mood before and a few hours after a planned activity to test it. [synthesis]

4.8 Attribution training (self-evaluation module)

Purpose / when: Early self-evaluation module. Targets the model's attribution deficit: depressed people take blame for failures and give themselves little credit for successes. Attribution content is part of the later programme versions and the child adaptation; the original 1977 programme did not describe a separate attribution procedure. [source: Rehm 1977 deficit list via ERIC 1976 papers; Wikipedia on Stark et al. 1987; exact procedure in Rehm's manual not seen [uncertain]]
Steps (procedure reconstructed from the model; [uncertain] as to Rehm's exact exercise): (1) Teach that people explain why things happen by pointing to themselves or to circumstances, to lasting or temporary causes, and to broad or narrow causes. (2) Show the depressive pattern: successes put down to luck or others, failures put down to lasting, broad personal flaws. (3) In-session exercise: each member picks one recent positive event and one negative event from their logs and writes what they believe caused each. (4) For the positive event, ask what share of the outcome came from their own actions. For the negative event, list the outside and temporary factors too. (5) Homework: daily, write a fair explanation for at least one positive event that credits the client's own part. [source for model terms: Rehm 1977; steps synthesis]
Example language (illustrative): "You said the meeting went well 'because people were in a good mood'. What did you do that helped it go well?"
Watch for: Over-correction into denying any responsibility for problems. The aim is accuracy, not optimism. Working sign: clients start reporting successes with "I" as the subject. [synthesis]

4.9 Goal setting with behavioural goals and attainable subgoals

Purpose / when: Self-evaluation module. Replaces stringent, vague standards with realistic ones the client can meet and evaluate. [source: Fuchs & Rehm 1977 ERIC version; Rehm 2010 table of contents (Goal Setting)]
Steps: (1) From their activity logs, each client picks behaviours they want to increase. (2) Define the goal in behavioural terms (what, how often, when), stated positively. (3) Check that the goal is within the client's own control (not dependent on others' responses). (4) Break it into realistic, obtainable subgoals, ordered from easiest. (5) Write goals and subgoals on a goal worksheet. (6) Continue daily monitoring, now emphasising the target behaviours. [source: Fuchs & Rehm 1977 ERIC version]
Example language (illustrative): "'Be more social' is hard to score. What is one thing you could do this week that would count as a step toward it, and that doesn't depend on anyone saying yes?"
Watch for: Goals that are too large or too many; goals that rely on others ("my daughter will call"). Rule of thumb [synthesis]: if the client is not fairly confident they can do the first subgoal this week, shrink it. Working sign: subgoals are met and logged.

4.10 Self-evaluation against realistic standards

Purpose / when: Self-evaluation module, then ongoing. Teaches the client to judge their week by their own subgoals rather than by perfectionistic standards. [source: Rehm 1977 deficit list; Fuchs & Rehm 1977; procedure detail [uncertain]]
Steps: (1) At each homework review, compare what was logged with the subgoal set. (2) Ask the client to judge the result against the subgoal, not against an ideal. (3) If a subgoal was missed, treat it as information: was it too big, blocked by circumstances, or not attempted? Adjust. (4) If met, move to the next subgoal. [synthesis built on the cited aims]
Example language (illustrative): "Your target was two short walks, and you did two. By the standard you set, that's a success. How would you rate it?"
Watch for: "Yes, but" responses that discount achievements ("anyone could do that"). Point back to the agreed standard. [synthesis]

4.11 Assets list

Purpose / when: Named as a method in Rehm's 2010 treatment chapter, next to self-reinforcement/self-talk. It is a written list of the client's positive qualities and strengths that supplies material for positive self-statements. [source: Rehm 2010 table of contents; content of the section not drawn on [uncertain]]
Steps (illustrative, [uncertain] as to Rehm's exact procedure): (1) Ask the client to write a list of personal strengths, skills and good qualities. (2) Use group members to suggest items the client overlooks. (3) Keep the list to hand and add to it weekly. (4) Draw on it for positive self-statements (4.13). [synthesis]
Example language (illustrative): "Let's build a list of what you bring to the table. What would a good friend say you're good at?"
Watch for: Blank pages or dismissive items. Start with concrete behaviours from the logs ("you kept every appointment"). [synthesis]

4.12 Self-administered reward programme (overt self-reinforcement)

Purpose / when: Self-reinforcement module. Counters too little self-reward by making rewards contingent on the subgoal activities. [source: Fuchs & Rehm 1977 ERIC version; Kornblith et al. 1983 title; Rehm 2010 table of contents]
Steps: (1) Teach the principle: behaviour that is followed by reward becomes more likely, and you can supply rewards yourself rather than waiting for others. (2) Each client lists rewards that are available, affordable and genuinely enjoyable, from small everyday ones to larger ones. (3) Link specific rewards to specific subgoal activities: when the activity is done, the reward follows (some versions use points that are exchanged for rewards [uncertain]). (4) Write this as a personal contract with the target, the reward and the timing. (5) Log rewards taken alongside activities. (6) Review and adjust the contract weekly. [source for steps 1, 3: Fuchs & Rehm 1977 ("self-administered reinforcement programs with reward contingencies"); other steps synthesis]
Example language (illustrative): "When you finish the walk, what will you give yourself? Pick something you'll actually do today, not something for 'someday'."
Watch for: Rewards that are taken whether or not the activity happens (no contingency), rewards that are unhealthy or costly, and clients who feel undeserving of any reward. Working sign: target activities increase and the client reports using rewards without guilt. [synthesis]

4.13 Covert self-reinforcement: positive self-statements

Purpose / when: Self-reinforcement module (and the main target in the "cognitive target" version). Raises the frequency of positive self-statements as a form of self-reward. [source: Rehm 1982 ERIC paper; Rehm 2005; Rehm 2010 table of contents (Self-Reinforcement/Self-Talk)]
Steps: (1) Explain that praising yourself in words is a reward you can give at any time. (2) Each client writes a set of positive self-statements, drawn from the assets list and from logged successes. (3) Practise in session: after reporting a completed subgoal, the client says a positive statement about it. (4) Homework: say or think a positive self-statement after each target activity, and count positive self-statements daily. A variant attaches the statements to a frequent daily activity so they are rehearsed often; this procedure is described in a 1984 group programme as adapted from Fuchs and Rehm (1977). [source for variant: Cox 1984, secondary; steps 1–3 synthesis consistent with Rehm 1982/2005]
Example language (illustrative): "You followed through even though you were tired. Can you say that to yourself, out loud, in your own words?"
Watch for: Statements that are global and unbelievable ("I'm wonderful"). Specific, earned statements tied to behaviour work better. [synthesis]

4.14 Reducing self-punishment

Purpose / when: Self-reinforcement module. The model holds that depressed people punish themselves excessively (self-criticism, denying themselves pleasures). [source: Rehm 1977 deficit list]
Steps [synthesis: no specific procedure given in the sources [uncertain]]: (1) Ask clients to notice and count self-critical statements for a few days. (2) Identify self-punishing habits (such as cancelling pleasant activities after a setback). (3) Replace each with a neutral appraisal plus a next step, and keep the reward plan in place after a missed day.
Example language (illustrative): "When you missed Tuesday, what did you say to yourself? What would you say to a friend in the same spot?"
Watch for: Self-criticism that is chronic and intense may need more than this module (see section 5). [synthesis]

4.15 Weekly homework review

Purpose / when: The opening part of every session. Keeps the programme data-driven and holds clients to practice. [source: Rehm 2005]
Steps: (1) Each member reports the week's mood range and log totals. (2) The therapist links one observation per member to the current principle. (3) Problems with completing the homework are solved briefly before the new didactic material. [source for review placement: Rehm 2005; steps 2–3 synthesis]
Example language (illustrative): "Let's go round: your highest and lowest mood this week, and one thing you noticed on your log."
Watch for: Review that runs over the session. Time-box it. [synthesis]

4.16 Behavioural-target and cognitive-target emphases

Purpose / when: Rehm's component trials ran the full programme with three emphases: a behavioural target (raise activity level), a cognitive target (raise positive self-statements), and both combined. All the self-control procedures stay the same; only the target that is monitored and rewarded changes. Rehm reported that the specific contributions of these components were not shown independently, so the combined version is the default here. [source: Rehm 1982 ERIC paper]
Steps: Choose the emphasis at the start of the self-monitoring module and use it for logging, goals and rewards. Clinical choice [synthesis]: a cognitive emphasis for clients whose activity level is adequate but whose self-talk is harsh; a behavioural emphasis for withdrawn, inactive clients.
Watch for: Switching targets mid-course without reason. [synthesis]

4.17 Consolidation and continuation plan (final session)

Purpose / when: Last session. Summarises the content and gives clients materials to keep using the skills. [source: Wikipedia summary of Fuchs & Rehm 1977]
Steps: (1) Review the three stages and the client's own data across the course. (2) Each client writes a short plan: what to keep monitoring, the next goals and subgoals, the reward plan. (3) Identify early warning signs of mood slipping and which skill to restart first. [step 1: source; steps 2–3 synthesis]
Example language (illustrative): "If your mood starts sliding in a month, which of these tools would you pick up first?"
Watch for: Clients who see the gains as the group's, not theirs. Use attribution skills to credit their own work. [synthesis]

5. Handling problems

The primary sources say almost nothing about problem management. Rehm (1983) reported better outcomes with acute onset, many recent negative life events and positive attitudes toward self-control, and a trial in veterans with chronic combat PTSD found only a short-lived depression advantage (Dunn et al., 2007). Everything else below is [synthesis] unless tagged.

Homework not done (non-adherence). The whole programme runs on the logs. Responses: (1) Find out the barrier (forgot, form too long, "nothing to write", hopelessness). (2) Cut the task down (mood rating only, or three activities a day). (3) Tie logging to a fixed daily cue (evening meal, bedtime). (4) Fill in yesterday's log together in session so the client leaves with a model. (5) Use the programme's own tools: make "complete the log" a subgoal with a small self-reward. [synthesis]
"Nothing positive happened." Usually selective attention, the very deficit being treated. Lower the threshold, use the activity categories as prompts, and do a recall walk-through of yesterday hour by hour. [synthesis; deficit: Rehm 1977]
Stuck client: mood not shifting after the self-monitoring module. Check that goals are small enough and that the target fits (switch between behavioural and cognitive emphasis, 4.16). If there is still no movement by the reward module, review diagnosis, life stressors and the need for added or different treatment, including medication review by a prescriber. [synthesis; target versions: Rehm 1982 ERIC paper]
Chronic, severe or complex depression. Rehm's outcome data favoured acute-onset depression. For chronic depression or depression with significant comorbidity (for example chronic PTSD), expect less from SMT alone and plan for added treatment. [source: Rehm 1983 via Wikipedia; Dunn et al. 2007 abstract; recommendation synthesis]
Perfectionism re-entering through goal setting. Clients set big goals and then judge themselves as failing. Return to subgoals the client is fairly sure they can meet; explicitly rate the met subgoal as a success. [synthesis; principle from Fuchs & Rehm 1977]
Resistance to self-reward ("I don't deserve it", "it's childish"). Explain rewards as tools for building habits, not prizes for being good. Start with small, ordinary rewards already in the client's day, now made contingent. Treat the belief itself as a self-punishment pattern to monitor. [synthesis]
Resistance to the model ("my depression is caused by my situation, not my self-control"). Agree that circumstances matter; present self-management as what is still within reach. Keep goals within the client's control. If the model stays unacceptable, consider another approach, since positive attitudes toward self-control predicted better outcome. [source for predictor: Rehm 1983 via Wikipedia; rest synthesis]
Overwhelm. Too many forms at once. Phase in monitoring (mood only, then add activities), give one assignment per week, and use plain language. With older adults or clients with concentration problems, use larger print, simpler forms and more in-session practice. [synthesis]
Group process problems. Members who dominate, compare themselves unfavourably with others, or bring crises. Keep the structure (time-boxed go-rounds), stress that each person's standard is their own, and offer a brief individual contact for crises outside the group. [synthesis]
Ruptures. Signs: missed sessions, silence, "this is too simplistic". Name it directly, ask what is not working, and adjust pace or examples. A didactic format can feel impersonal; make sure each member hears their own data used in each session. [synthesis]
Missed sessions. Because modules build on each other, give a brief individual catch-up on the missed principle and homework before the next session. [synthesis]
Worsening mood or suicidal thinking during the course. Re-assess risk with standard practice, update the safety plan, include lethal-means counselling (safe storage or removal), and increase contact or step up care; the group should not be the only support for someone at elevated risk. [synthesis; standard practice]
Modality-specific pitfall: the reward plan becomes a punishment plan. Clients withhold all pleasant activities until goals are met, which reduces positive activities. Keep a floor of pleasant activities that are not contingent, and make contingent rewards extras. [synthesis]
Modality-specific pitfall: activity monitoring confirms hopelessness. A bare log can prove "I do nothing". Pair monitoring with the immediate-versus-delayed and attribution work early, and praise any logging. [synthesis]

Sources

Sources: