Congruence of Patient Takeaways and Homework Assignment Content Predicts Homework Compliance in Psychotherapy

doi:10.1016/j.beth.2019.07.005

Behavior Therapy

Volume 51, Issue 3, May 2020, Pages 424-433

https://doi.org/10.1016/j.beth.2019.07.005 Get rights and content

Highlights

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Congruence of homework content and patient takeaways predicted homework compliance
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Therapists may improve compliance by assigning homework congruent with patient takeaways
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Patient takeaways were collected during treatment on the Session Assignment and Feedback Form (SAFF)

Abstract

Homework is generally considered an essential part of psychotherapy. The present study tested the hypothesis that patients were more likely to complete homework assignments when the content of the assignments was more congruent with content the patient reported wanting to remember from the session (patient takeaways). The study relied on data collected in 541 sessions of individual naturalistic cognitive-behavioral therapy provided to 41 patients in a private practice setting and who completed a feedback form in each session that recorded the content of the homework assignments for the session, patient takeaways from the session, and homework completion. Congruence was determined by raters who evaluated the match between homework content and patient takeaways. Results of generalized linear mixed modeling showed, as predicted, that congruence between homework assignment content and takeaways was statistically significantly associated with homework compliance. This finding suggests that therapists may be able to improve homework compliance by soliciting feedback about what the client found important about the session and then assigning homework consistent with that information.

Section snippets

participants

Participants were 41 outpatients who received psychotherapy at one of three private practices in the San Francisco Bay Area. The majority of participants were female (N = 30, 73.2%), White (N = 34, 82.9%), married (N = 21, 51.2%), and employed full-time (N = 24, 58.5%). Participants averaged 39.8 years old (SD = 12.4) and had a mean of 17.4 years of education (SD = 2.1). The modal participant sought treatment for some sort of mood disorder (N = 21, 51.2%) or anxiety (N = 17, 41.5%) disorder.

descriptive analyses

Analyses were conducted on 541 SAFF forms completed by the 41 participants. Participants completed, on average, 13.2 SAFF forms that included both homework assignments and session takeaways (SD = 7.24, median = 14, max = 27, min = 1 per participant). Participants completed an average of just over 20 sessions of treatment, meaning that for about 7 sessions per participant, either no SAFF form was assigned or received by the therapist, or the returned SAFF did not include homework assignments or

Discussion

We found, as we predicted, that patients were more likely to complete homework assignments that were more congruent with content the patient reported wanting to remember from the session. This finding provides some preliminary empirical support for clinical guidelines, suggesting that matching homework assignments to the content of the therapy session can be an important factor in increasing homework compliance (Tang and Kreindler, 2017, Tompkins, 2002).

Our finding is consistent with other

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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^☆: Jacqueline B. Persons and Connie Fee are now at the Oakland Cognitive Behavior Therapy Center. Anthony L. Miles is now at the Wright Institute. The authors disclose no competing interests. A version of this study was presented at the annual convention of the Association for Behavioral and Cognitive Therapies in San Diego, California, in November 2017. We thank Polina Eidelman for contributing data, Amanda Gale-Bando for providing a case example, Michael Edge for consulting on data analytics, Janie Hong for her work developing the SAFF, and the participants who contributed data to this study.

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Congruence of Patient Takeaways and Homework Assignment Content Predicts Homework Compliance in Psychotherapy☆

Highlights

Abstract

Section snippets

participants

descriptive analyses

Discussion

Conflict of Interest Statement

Psychiatric Clinics of North America

Cognitive and Behavioral Practice

Behavior Therapy

Behaviour Research and Therapy

Behavior Therapy

A closer look at the treatment rationale and homework compliance in cognitive-behavioral therapy for depression

Cognitive Therapy and Research

Fitting linear mixed-effects models using lme4

Journal of Statistical Software

R2admb: “ADMB” to R interface functions. R Package Version 0.7.16

Therapist skill and patient variables in homework compliance: Controlling an uncontrolled variable in cognitive therapy outcome research

Cognitive Therapy and Research

Multimodel inference: Understanding AIC and BIC in model selection

Sociological Methods and Research

Practice-oriented research: Approaches and applications

Predictors of client implementation of counselor recommendations: Match with problem, difficulty level, and building on client strengths

Journal of Counseling Psychology

Apples don’t fall far from the tree: Influences on psychotherapists’ adoption and sustained use of new therapies

Psychiatric Services

Memory support strategies and bundles: A pathway to improving cognitive therapy for depression?

Journal of Consulting and Clinical Psychology

Understanding and enhancing the effects of homework in cognitive-behavioral therapy

Clinical Psychology: Science and Practice

Improvement of the working alliance in one treatment session predicts improvement of depressive symptoms by the next session

Journal of Consulting and Clinical Psychology

AD model builder: Using automatic differentiation for statistical inference of highly parameterized complex nonlinear models

Optimization Methods and Software

The R package geepack for generalized estimating equations

Journal of Statistical Software