Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy

Kazantzis, Nikolaos; Whittington, Craig; Zelencich, Leah M.; Kyrios, Michael; Norton, Peter J.; Hofmann, Stefan G.

doi:10.1016/j.beth.2016.05.002

Cited by 188 publications

(136 citation statements)

References 92 publications

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Section: Methodsmentioning

confidence: 99%

“…The quantity (amount) as well as the quality (appropriateness) of homework will be assessed, based on evidence that they both relate to treatment outcome [99]. Multiple sources of homework information (adolescent, therapist, data logged by the app) will be obtained to address potential differences between sources [99,100]. Adolescents will assess the quantity and quality of their homework upon arriving at the session, by rating on a 5-point scale how much of it was completed and how well it was done, using 2 items from the Homework Rating Scale II [101], an internally consistent measure of homework quantity and quality developed for use with adults [102].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

Wilansky

Eklund

Milner³

et al. 2016

JMIR Res Protoc

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BackgroundAnxiety and mood disorders are the most common mental illnesses, peaking during adolescence and affecting approximately 25% of Canadians aged 14-17 years. If not successfully treated at this age, they often persist into adulthood, exerting a great social and economic toll. Given the long-term impact, finding ways to increase the success and cost-effectiveness of mental health care is a pressing need. Cognitive behavior therapy (CBT) is an evidence-based treatment for mood and anxiety disorders throughout the lifespan. Mental health technologies can be used to make such treatments more successful by delivering them in a format that increases utilization. Young people embrace technologies, and many want to actively manage their mental health. Mobile software apps have the potential to improve youth adherence to CBT and, in turn, improve outcomes of treatment.ObjectiveThe purpose of this project is to improve homework adherence in CBT for youth anxiety and/or depression. The objectives are to (1) design and optimize the usability of a mobile app for delivering the homework component of CBT for youth with anxiety and/or depression, (2) assess the app’s impact on homework completion, and (3) implement the app in CBT programs. We hypothesize that homework adherence will be greater in the app group than in the no-app group.MethodsPhase 1: exploratory interviews will be conducted with adolescents and therapists familiar with CBT to obtain views and perspectives on the requirements and features of a usable app and the challenges involved in implementation. The information obtained will guide the design of a prototype. The prototype will be optimized via think-aloud procedures involving an iterative process of evaluation, modification, and re-evaluation, culminating in a fully functional version of the prototype that is ready for optimization in a clinical context. Phase 2: a usability study will be conducted to optimize the prototype in the context of treatment at clinics that provide CBT treatment for youth with anxiety and/or depression. This phase will result in a usable app that is ready to be tested for its effectiveness in increasing homework adherence. Phase 3: a pragmatic clinical trial will be conducted at several clinics to evaluate the impact of the app on homework adherence. Participants in the app group are expected to show greater homework completion than those in the no-app group.ResultsPhase 3 will be completed by September 2019.ConclusionsThe app will be a unique adjunct to treatment for adolescents in CBT, focusing on both anxiety and depression, developed in partnership with end users at every stage from design to implementation, customizable for different cognitive profiles, and designed with depression symptom tracking measures for youth made interoperable with electronic medical records.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

Wilansky

Eklund

Milner³

et al. 2016

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

“…Maintaining the long-term effects of these programs is another major challenge, considering the high chronicity of these patients (in our study, patients had been suffering from chronic pain for over 16 years on average). A possible moderating factor could be the quantity and quality of homework, a neglected aspect of cognitive behavioral therapy research, the importance of which has been revealed in a recent meta-analysis (Kazantzis et al, 2016). Anyway, it would be highly advisable to add some sessions after the intervention, one every 4 months, to maintain the improvements patients have obtained.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care

et al. 2017

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According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13–14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.

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“…Alternatively, examining therapeutic alliance, time spent on the modules and degree of homework adherence (cf. [58]) could also inform about treatment processes. As our previous examination of an automated version of this iCBT indicated medium effect sizes in an uncontrolled naturalistic study [59], factors related to therapistassistance are likely to be important in facilitating greater efficacy in online programs.…”

Section: Discussionmentioning

confidence: 99%

Therapist-Assisted Internet-Based Cognitive-Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial (Preprint)

Kyrios¹,

Ahern²,

Fassnacht³

et al. 2017

Preprint

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Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy

Cited by 188 publications

References 92 publications

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care

Therapist-Assisted Internet-Based Cognitive-Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial (Preprint)

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