Compliance with homework assignments in cognitive-behavioral psychotherapy for depression: Relation to outcome and methods of enhancement

Startup, Mike; Edmonds, Jane

doi:10.1007/bf02355669

Cited by 69 publications

(57 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, Startup and Edmonds (1994) found no significant relationship between these variables and compliance and suggested that their negative findings reflected variation in patient requirements for particular therapist behaviours. For example, hopeless clients may respond adversely to attempts to involve them in identifying homework tasks but respond more positively to therapist-allocated tasks, whereas more resourceful clients may have exactly opposite reactions, welcoming choice and resisting allocated assignments.…”

Section: Introductionmentioning

confidence: 74%

Patients' experiences of homework tasks in cognitive behavioural therapy for psychosis: a qualitative analysis

Dunn

Morrison

Bentall

2002

Clin Psychology and Psychoth

View full text Add to dashboard Cite

This paper examines the experiences of individuals who agreed to undertake homework as part of cognitive behavioural therapy for psychosis. It attempts to identify factors that individuals believe influence homework compliance and thereby alert therapists to their possible impact, and, using grounded theory, dispel the myth that individuals with psychosis cannot meaningfully express their experiences and views. Ten participants, who either did (six) or did not (four) comply with homework were interviewed and a grounded theory approach was used to understand and generate theories relating to their completion of homework assignments. The factors cited as affecting homework compliance were motivation, recall of the assignment, difficulty, putting off, understanding of the rationale, perceived benefits, insight, effort and relevance. The most cited theme was insight, with four of the high compliance group accounting for 21 references and three of the low compliance group accounting for nine references. However, the high compliance group gained insight into problem development, maintenance and the use of effective strategies to realize goals whereas the low compliance group gained only an identification of their problems and an understanding of their development. Three participants in the low compliance group believed that their assignments were sometimes irrelevant to their needs but this was true of only one out of the six in the high compliance group. Further research into assessing and addressing non-acceptance of treatment rationale may be indicated. Copyright INTRODUCTIONHomework is considered an essential ingredient of cognitive behavioural therapy (CBT) for emotional disorders, and not merely an optional extra that enhances the effectiveness of face-to-face contact with a therapist (Beck, Rush, Shaw, & Emery, 1979). Between-session tasks are collaboratively designed by the therapist and the patient and may be used to gather information, test hypotheses and implement behavioural and cognitive changes. A small number of studies have found evidence that compliance with homework assignments predicts outcome in the treatment of depression. For example, Burns and Spangler (2000) reported that patients who did the most homework improved more than those who did little or no homework, confirming the findings of earlier studies (Burns & Nolen-Hoeksema, 1991;Persons, Burns, & Perloff, 1988).If homework is an essential component of effective therapy, it is important for therapists to be aware of those factors that influence compliance. Two recent studies by Bryant, Simons and Thase (1999) and Detweiler and Whisman (1999) explored patient characteristics that might affect homework compliance in depressed patients. They found no correlation between severity of depression and learned resourcefulness (positive beliefs relating to self-efficacy) but that the number of previous episodes of depression was negatively related to compliance. In the same studies, homework compliance was most strongly predicted by therapists' ge...

show abstract

Section: Introductionmentioning

confidence: 74%

Patients' experiences of homework tasks in cognitive behavioural therapy for psychosis: a qualitative analysis

Dunn

Morrison

Bentall

2002

Clin Psychology and Psychoth

View full text Add to dashboard Cite

show abstract

“…In two studies of therapist competency in delivering cognitive-behavior therapy for depression, therapists' competency in the review of homework assignments was correlated with homework compliance (e.g., Bryant et al, 1999;Shaw et al, 1999; also see Worthington, 1986). However, a study by Startup and Edmonds (1994) did not find any evidence to suggest that therapist adherence to the homework administration procedures was associated with compliance. Similarly, a study by Burns and Nolen-Hoeksema (1992) did not produce a significant relationship between therapist empathy and compliance.…”

Section: Therapist Factorsmentioning

confidence: 88%

Assessing compliance with homework assignments: Review and recommendations for clinical practice

2004

View full text Add to dashboard Cite

Despite the emphasis of homework assignments in psychotherapy research and practice, methods to assess homework compliance have been relatively neglected. This article presents a brief review of 32 studies that described the assessment of homework compliance, and evaluated homework compliance in relation to treatment outcome. More than half of the studies relied on a single source of compliance data (n = 23), eight studies involved retrospective accounts, and only four studies used the same measure of homework compliance. The vast majority of studies focused on the assessment of "homework compliance" without consideration of the "quality of homework completion" or other key factors. A more comprehensive framework for homework compliance is discussed, and a new Homework Rating Scale (HRS) is proposed as the first step towards assisting the field in a more reliable and valid assessment of homework compliance.

show abstract

“…The meta-analytic evidence of a homework-outcome relation was based on a combination of studies examining different patient populations and treatments under investigation, with these treatments differing markedly in the homework utilized. In our search for studies of homework in individual CT for depression, we identified a relatively small group of seven studies (Bryant, Simons, & Thase, 1999; Burns & Spangler, 2000; Coon & Thompson, 2003; Cowan et al, 2008; Detweiler-Bedell & Whisman, 2005; Persons et al, 1988; Startup & Edmonds, 1994). A review of these studies suggests that all but one (i.e., Detweiler-Bedell & Whisman, 2005) reported evidence of homework compliance in CT for depression being associated with positive outcomes at the end of treatment.…”

mentioning

confidence: 99%

A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits?

Conklin

Strunk

2015

Behaviour Research and Therapy

View full text Add to dashboard Cite

Homework is a key component of Cognitive Therapy (CT) for depression. Although previous research has found evidence for a positive relationship between homework compliance and treatment outcome, the methods used in previous studies have often not been optimal. In this study, we examine the relation of specific aspects of homework engagement and symptom change over successive session-to-session intervals. In a sample of 53 depressed adults participating in CT, we examined the relation of observer-rated homework engagement and session-to-session symptom change across the first five sessions. Within patient (and not between patient) variability in homework engagement was significantly related to session-to-session symptom improvements. These findings were similar when homework engagement was assessed through a measure of general engagement with homework assignments and a measure assessing engagement in specific assignments often used in CT. Secondary analyses suggested that observer ratings of the effort patients made on homework and the completion of cognitive homework were the numerically strongest predictors of depressive symptom improvements. Patient engagement with homework assignments appears to be an important predictor of early session-to-session symptom improvements. Future research is needed to identify what therapist behaviors promote homework engagement.

show abstract

Compliance with homework assignments in cognitive-behavioral psychotherapy for depression: Relation to outcome and methods of enhancement

Abstract: Despite the importance attached to homework in cognitive-

Cited by 69 publications

References 22 publications

Patients' experiences of homework tasks in cognitive behavioural therapy for psychosis: a qualitative analysis

Patients' experiences of homework tasks in cognitive behavioural therapy for psychosis: a qualitative analysis

Assessing compliance with homework assignments: Review and recommendations for clinical practice

A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits?

Contact Info

Product

Resources

About