Measuring Homework Utility in Psychotherapy: Cognitive-Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder as an Example

Abstract

Homework, or practice of skills learned in treatment, is a critical component of cognitive-behavioral therapy (CBT). However, no matter how much effort clients put into their therapy homework, this effort can only be useful if adherence to homework is related to improvement in symptoms. Although homework adherence (the extent to which clients practice skills learned in therapy outside of sessions) has been studied with respect to psychotherapy outcomes, 'homework utility', a potentially important mechanism of action in cognitive behavioral treatments, has yet to be operationally defined as a distinct construct, and it has yet to be studied with respect to psychotherapy outcome. We therefore propose an operational definition of therapy homework utility: the extent to which homework adherence is associated with parallel symptom improvement across time throughout treatment for each individual client. In this capacity, an indicator of homework utility is operationalized as the within subject correlation of sessionby-session homework adherence with session-by-session symptom change. We used a sample of clients who underwent CBT for attention-deficit hyperactivity disorder in adulthood as an example to quantify homework utility and examine its association to treatment outcome. Consistent with our hypotheses, homework utility was significantly associated with overall therapy outcome. Homework utility may be an important construct relevant to the mechanism of action of structured psychotherapies, and examining within subject sessions-by-session correlations with symptomatic change may be a useful way to examine other psychotherapy process variables.

The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis

“…A negative attitude towards homework, even if the homework is completed, could potentially limit the likelihood that the client will continue to practice the skills learned once therapy is completed. Motivation, lack of effort, and readiness to change are other variables that were not explored in the current study, which are factors that have been found to be correlated with homework compliance (Neimeyer et al 2008; Yovel and Safren 2007). Addis and Jacobson (2000) examined the relationship between clients acceptance of the treatment rationale and the degree to which clients completed homework, and concluded that the ability to provide a convincing treatment rationale may be one of the crucial skills which determines the success of CBT in real-world clinical settings.…”

Humanistic Counseling Process, Outcomes, and Research

“…Congruence/genuineness has been found to be positively associated with clients’ global assessment of functioning scores (Fuertes et al, ; Rothman, ) and client assessments of the quality of the counseling relationship (Marmarosh et al, ; Rothman, ). Finally, client–counselor goal consensus and collaboration have been found to be positively linked to positive outcomes such as global assessment of functioning (Caspar, Grossmann, Unmüssig, & Schramm, ; Yovel & Safren, ), reduced symptoms of depression (Caspar et al, ; Cowan et al, ; Zane et al, ), and stages of change readiness (Brocato & Wagner, ).…”

Specificity of Homework Compliance Effects on Treatment Outcome in CBT: Evidence from a Controlled Trial on Panic Disorder and Agoraphobia

“…A more direct approach to test the specificity of homework effects was described by Yovel and Safren (). They related the extent of homework completion after each session to the session‐by‐session symptom change.…”