Homework Completion, Patient Characteristics, and Symptom Change in Cognitive Processing Therapy for PTSD

Abstract

We evaluated the impact of homework completion on change in PTSD symptoms in the context of two randomized controlled trials of Cognitive Processing Therapy for PTSD (CPT). Female participants (n = 140) diagnosed with PTSD attended at least one CPT session and were assigned homework at each session. The frequency of homework completion was assessed at the beginning of each session and PTSD symptoms were assessed every other session. Piecewise growth models were used to examine the relationship between homework completion and symptom change. CPT version (with vs without the written trauma account) did not moderate associations between homework engagement and outcomes. Greater pretreatment PTSD symptoms predicted more Session 1 homework completion, but PTSD symptoms did not predict homework completion at other timepoints. More homework completion after Sessions 2 and 3 was associated with less change in PTSD from Session 2 to Session 4, but larger pre-to-post treatment changes in PTSD. Homework completion after Sessions 2 and 3 was associated with greater symptom change among patients who had fewer years of education. More homework completion after Sessions 8 and 9 was associated with larger subsequent decreases in PTSD. Average homework completion was not associated with client characteristics. In the second half of treatment, homework engagement was associated with less dropout. The results suggest that efforts to increase engagement in homework may facilitate symptom change.

A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder

“…Adherence to homework was found to be positively associated with treatment outcome in two studies (Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998 ) (Dorrepaal et al, 2012 ), but one study found no association with the amount of time spent on completing homework and treatment outcome (Spence et al., 2011 ). Completion of homework was associated with better outcomes for patients with fewer years of formal education compared to those who reported more years of education (Stirman et al, 2018 ).…”

“…Exploratory analyses to determine whether medication change during treatment modified the treatment effect for CAPS severity scores indicated that the interaction between medication change and treatment was not significant. (Spence et al, 2011 ; Stirman et al, 2018 ) USA Cognitive Processing Therapy (CPT). Internet delivered Cognitive Behavioural Therapy (I-CBT) for PTSD.…”

“…There was no significant relationship between posttreatment outcome the amount of time spent on the homework or with the amount of time spent on thought challenging. (Stapleton et al, 2006;Stirman et al, 2018) USA Prolonged Exposure (PE)Cognitive Processing Therapy (CPT).…”

Patterns of change in physical functioning and posttraumatic stress disorder with cognitive processing therapy in a randomized controlled implementation trial

“…Pain and other physical concerns can impede the cognitive functioning necessary for engaging in trauma-focused treatment and challenging maladaptive beliefs (Moriarty & Finn, 2014 ). Poor physical functioning may also interfere with homework compliance (Branch, 2012 ), which has been linked to improved treatment outcome in CPT (Stirman et al, 2018 ).…”

Predictors of change in cognitive processing therapy for veterans in a residential PTSD treatment program

“…Walter et al () reported that lower education was associated with greater improvement in PTSD symptoms during CPT in a veteran sample; however, Rizvi et al () did not detect a relationship between education and outcome. In a recent secondary analysis, education was found to be positively related to homework completion but there was evidence that individuals with less education reported more benefit from the homework (Stirman et al, ). More information is needed regarding these variables and their relationship to PTSD severity and treatment response.…”