Client Engagement with Homework: A Study of Cognitive Therapy for Depression

Homework is considered an essential component of Cognitive Therapy (CT) for depression (Beck, Rush, Shaw, & Emery, 1979), and clients who engage in more homework tend to experience greater symptom improvement over the course of treatment (Kazantzis, Deane, & Ronan, 2000). However, less is known about how therapists can increase clients’ engagement in homework, especially early in treatment. In an initial step toward addressing these issues, the primary objectives of this study were to examine whether specific therapist behaviors serve as predictors of session-to-session homework engagement and to examine the relationship between homework engagement and concurrent depressive symptom changes.This study examined the first five sessions of 66 depressed clients participating in a course of CT. A team of trained undergraduates rated therapist behaviors using the Homework-Specific Therapist Behaviors scale (HSTB), which is composed of three subscales: Specificity, Motivation, and Problem-Solving. A second team rated the homework engagement variables, which included general homework engagement (time and effort put into homework and the frequency of therapy skill use to cope with feeling sad or upset) and CT-specific homework engagement (amount of cognitive, behavioral, and self-monitoring homework). Clients and therapists also provided ratings on general homework engagement.To examine therapist behaviors as predictors of session-to-session homework engagement, repeated measures regression analyses using the SAS Proc Mixed procedure (without specification of random effects) were utilized. Controlling for previous homework engagement reported during each session, HSTB subscale scores at each session were examined as predictors of homework engagement variables at the next session. Results indicated that the Specificity subscale was the strongest and most consistent predictor of homework engagement variables (in comparison with the Motivation and Problem-Solving subscales). When rated by therapists, higher general homework engagement was significantly related to greater depressive symptom improvements, but not when engagement was rated by observers or clients. Across all three informants, the frequency with which clients used therapy skills to cope was significantly related to greater depressive symptom improvements. When examining CT-specific homework engagement, cognitive homework engagement was significantly related to greater depressive symptom improvements, whereas self-monitoring homework was unexpectedly related to a smaller magnitude of session-to-session depressive symptom change from session-to-session. The results found with the HSTB Specificity subscale suggest that therapists who devote more time to helping clients really understand homework-relevant skills and know what the assignments they are to work on may be able to enhance clients’ engagement in homework in early sessions of CT.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Psychology

Grantor dc:publisher

The Ohio State University

Year dc:date

2013

Author dc:creator

• Conklin, Laren Renee

Contributors dc:contributor

• Strunk, Daniel

• Clinical Psychology
• Homework
• Cognitive Therapy
• Depression

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=osu1365956558

OAI identifier oai:identifier

oai:etd.ohiolink.edu:osu1365956558