Importance Of Homework In Cbt
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Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz, DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.
Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.
Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression. Cognit Ther Res. 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6
Between-session interventions, or homework, are crucial to a range of psychological therapies, including cognitive behavior therapy (CBT). Therapeutic interventions often involve experiencing emotions and situations, or examining strongly held views about their problems, that clients can find distressing. Hence, the clinician faces a particular challenge in collaborating with the client to carry out these interventions between sessions. In this article, we convey how this process in CBT requires not only a consideration of the theoretically meaningful determinants of adherence behavior but also a sophisticated cognitive case conceptualization. Using case material, we illustrate the interplay between in-session design, planning, and review of between-session interventions and the conceptualization. We also include a distinction between generic elements of the therapeutic relationship and CBT-specific elements. The case material also attends to the person of the therapist, and his or her own cognitive and emotional reactions occurring throughout the process of discussing between-session interventions.
Cognitive behavioral therapy (CBT) usually involves homework, the completion of which is a known predictor of a positive outcome. The aim of the present study was to examine the session-by-session relationships between enthusiasm to complete the homework and the improvement of psychological distress in depressed people through the course of therapy.
The best fitting model suggested that, throughout the course of behavior therapy (BT), enthusiasm to complete the homework was negatively correlated with the K6 scores for the subsequent session, while the K6 score measured at the beginning of the session did not influence the enthusiasm to complete the homeworks assigned for that session.
Moreover, the extant studies of homework in CBT suffers one crucial methodological weakness. In the literature, homework compliance has usually been assessed either post-hoc after the treatment is over, thus risking the recall bias [22, 23], or only once out of the 10 or more sessions of the program, thus possibly not reflecting the overall compliance [24, 25]. Even when homework compliance was measured several times, only the average of those several values was used to predict the outcome of the treatment [26, 27]. To the best of our knowledge, no study to date has examined the session-by-session relationships between homework and an improvement through CBT.
We have previously conducted a randomized controlled trial of CBT administered via telephone among employees with subthreshold depression in a large company in Japan. This telephone CBT (tCBT) program was shown to have a large effect, in comparison with a waiting list control group, with an effect size of around 0.7 for the primary outcome of general psychological distress including depression and anxiety [28]. In this trial, we applied motivational interviewing techniques and measured the enthusiasm of the participants for completing homework at the end of each session.
The telephone CBT was a structured, manualised, eight-session program adapted from a previously established manual [34]. The participant and the therapist shared the patient manual containing all the materials for each session. A separate therapist manual was prepared specifying the procedure for each session. The participant and the therapist also shared a handbook that contained all the homework worksheets in a small notebook format.
Model 1 hypothesized that the K6 score influenced enthusiasm during the same session, both of which then influenced the K6 score of the following session. K6_2 (_3) (_4): K6 score from 2nd (3rd) (4th) session. ENTH_2 (_3) (_4): Enthusiasm for homework of the 2nd (3rd) (4th) session. Q1_2 (_3) (_4): Q1 (see text) rating from the 2nd (3rd) (4th) session. Q2_2 (_3) (_4): Q2 rating from the 2nd (3rd) (4th) session. e: Error terms of the factors
The largest strength of this research is the examination of the session-by-session relationships between the enthusiasm to complete homework and psychological distress severity. A number of preceding studies have shown that homework in CBT was associated with the improvement of depression and anxiety; in these studies, however, homework compliance was measured either as average throughout the CBT sessions or at one out of the many sessions, while depression was typically measured at the end of treatment. In this study, by contrast, we examined the session-by-session relationships between homework and distress and found that enthusiasm to complete homework did indeed lead to a reduction in distress at the time of the subsequent session.
There are several limitations in this study that should be acknowledged. First, as this research was a secondary analysis of a completed trial, the sample size was limited by the available data and was not as large as one would have preferred. This may have led to some possible type II errors (dismissing true associations). On the other hand, we were able to observe several statistically significant correlations that would be clinically meaningful. Second, as our sample consisted of employees with subthreshold depression who were not seeking clinical help and who were working, our results may not be readily generalizable to moderately or severely depressed clinical cases. Moreover, the majority of our samples were men, and this would also affect to generalizability. This limitation was primarily due to the high proportion of male employees in the company where the original RCT took place. Third, as the participants had made most of their improvement through the BT sessions alone, our session-by-session analyses of the relationships between homework enthusiasm and improvement in psychological distress were limited to the BT sessions and we could not investigate them through the CT sessions conducted in the latter half of the program. Thus our results would apply to BT homeworks but might not to CBT homeworks in general. Forth, although we estimated enthusiasm using two questions with satisfactory internal consistency reliability, as described in the Methods section, there is no standardised method to measure enthusiasm, so more refinement in this direction is desirable. Fifth, client characteristics other than enthusiasm and level of distress, such as perfectionism and fear of failure [20], and therapist characteristics were not examined in the present study. Further research is needed to examine interplay of such characteristics for homework completion and improvement of psychological distress or depression.
Treatment guidelines identify cognitive behavioral therapy (CBT) as a treatment of choice for irritable bowel syndrome (IBS). As a learning-based treatment, homework assignments are regarded as important for optimizing outcomes for CBT-treated patients. However, their actual benefit for IBS is unknown. This study examined whether homework completion corresponds with immediate and sustained treatment response in IBS patients enrolled in CBT treatment. Subjects were 358 IBS patients receiving clinic-based CBT (10 session), home-based CBT (4 session), or a 4 session, non-specific IBS education comparator as part of a large NIH trial. Homework completion was rated by clinician at each session. IBS symptom improvement was measured with the Clinician Global Improvement Scale at treatment week 5, post-treatment (week 12), and at follow-ups (weeks 22, 34, 46, 62). Homework completion rates over the 10-week acute phase corresponded with greater IBS symptom improvement and patient satisfaction at post-treatment. Early treatment homework completion did not predict early treatment response. Contrary to expectations, homework compliance rates were not greater among in-clinic session patients than home-based patients. Data lend empirical support to the clinical value of homework in teaching patients how to self-manage painful GI symptoms refractory to conventional medical and dietary therapies.
It is argued, illustrated by a case example, that homework quality and end of therapy outcomes can be positively affected when ideas of compassion and attention to individual frames of reference are considered. It is suggested that by exploring the affect experienced when completing tasks and being mindful of client learning (i.e. the zone of proximal development), engagement and emotional connection with homework increase.
Educating clients about the importance of good sleep hygiene is a core component of CBT-I. Good sleep hygiene involves increasing practices that encourage and support sleep, while decreasing or eliminating those that discourage sleep.
2. CBT is Briefer and Time-Limited.Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained. The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16. Other forms of therapy, like psychoanalysis, can take years. What enables CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments. CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end. The ending of the formal therapy is a decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending process. 153554b96e