Barriers to Cognitive Behavioral Therapy Homework Completion Scale–Depression Version: Development and Psychometric Evaluation

Abstract

We conducted a two-phase study to develop and evaluate the psychometric properties of an instrument to identify barriers to Cognitive Behavioral Therapy (CBT) homework completion in a depressed sample. In Phase I, we developed an item pool by interviewing 20 depressed patients and 20 CBT therapists. In Phase II, we created and administered a draft instrument to 56 people with depression. Exploratory Factor Analysis revealed a 2-factor oblique solution of “Patient Factors” and “Therapy/Task Factors.” Internal consistency coefficients ranged from .80 to .95. Temporal stability was demonstrated through Pearson correlations of .72 (for the therapist/task subscale) to .95 (for the patient subscale) over periods of time that ranged from 2 days to 3 weeks. The patient subscale was able to satisfactorily classify patients (75 to 79 %) with low and high adherence at both sessions. Specificity was .66 at both time points. Sensitivity was .80 at sessions B and .77 at session C. There were no consistent predictors of assignment compliance when measured by the Assignment Compliance Rating Scale (Primakoff, Epstein, & Covi, 1986). The Rating Scale and subscale scores did, however, correlate significantly with assignment non-compliance (.32 to .46).

CBT MobileWork©: User-Centered Development and Testing of a Mobile Mental Health Application for Depression

“…The scale has an overall score plus two subscales for patient centered barriers and also therapy/task related barriers. In a previous study, Cronbach's alpha ranged from .80 to .95, (Callan et al 2012).…”

“…We chose simplicity in content, navigation, and specific functionalities to address the deficits often seen in patients with depression. Understanding the barriers reported in CBT homework (Callan et al 2012) served as the framework for understanding ways to maximize the practice of CBT skills. The use of the application had to "blend in" to everyday activities and thereby reduce any stigma associated with performing therapeutic activities to address a mental health disorder (Doherty et al 2008).…”

“…There are, however, many patient, therapist, and task barriers to regular CBT skills practice that often result in homework nonadherence (Callan et al 2012;Kazantzis and Shinkfield 2007;Thase and Callan 2006). In qualitative studies of depressed patient's experience of CBT, patients viewed homework negatively for a variety of practical and emotional reasons that often lead to nonadherence (Barnes et al 2013;Callan et al 2012).…”

“…There are, however, many patient, therapist, and task barriers to regular CBT skills practice that often result in homework nonadherence (Callan et al 2012;Kazantzis and Shinkfield 2007;Thase and Callan 2006). In qualitative studies of depressed patient's experience of CBT, patients viewed homework negatively for a variety of practical and emotional reasons that often lead to nonadherence (Barnes et al 2013;Callan et al 2012). The Sequenced Treatment Alternatives to Relieve Depression (STAR-D) (Rush et al 2004;Thase et al 2007) an NIH-funded, multi-site clinical trial, was conducted to evaluate strategies to improve outcomes with treatment-resistant depression (N = 3671).…”

Problemática en Atención Primaria: tratamiento y aherencia

“…Urge modificar la relación asistencial de forma que se interactúe con las personas, familias y comunidad bajo un paradigma biopsicosocial(Téllez, 2004).Se puede afirmar que se genera un mayor impacto en la Sanidad al aumentar la efectividad sobre la adherencia al tratamiento que con cualquier mejora en los tratamientos médicos específicos(Haynes, McDonald, Garg y Montague, 2002). En consonancia, la baja adherencia al tratamiento psicológico destaca como un impedimento a la hora de implantar este tipo de tratamientos basados en la evidencia, a pesar de su efectividad para los trastornos mentales(Callan et al, 2012;Harvey y Gumport, 2015).En un principio se relacionaba únicamente al paciente con la falta de adherencia al tratamiento, posteriormente se tomó en cuenta la función del personal sanitario y, actualmente, se considera que para abordar el "problema de cumplimiento del tratamiento" se requiere un enfoque de sistemas(OMS, 2004). Deben tenerse en cuenta varios factores interrelacionados que determinan la adherencia a un tratamiento: factores derivados del paciente, así como su entorno socioeconómico y cultural; factores derivados del personal asistencial y de los servicios de salud; factores derivados del trastorno y los derivados del tratamiento(Cáceres, 2004;Holguín et al, 2006; OMS, 2004).A continuación, se presentan los factores más relevantes y las intervenciones que promueven la adherencia.Factores del pacienteEn cuanto a los factores relacionados con el paciente, destacan algunos como la relación coste-beneficio que el paciente otorga al tratamiento, y la confianza que deposita en poder seguirlo(Miller y Rollnick, 1999).…”