Therapist Skill and Patient Variables in Homework Compliance: Controlling an Uncontrolled Variable in Cognitive Therapy Outcome Research
Tóm tắt
Prior research suggests therapists' assignmentof homework, and patients' compliance with it, enhancesthe efficacy of cognitive therapy (CT). However, factorscontributing to homework compliance have received scant empirical attention. This study examinedspecific demographic and clinical patient variables(age, education, number of previous depressive episodes,depression severity, and learned resourcefulness) and a variety of therapist skills (general,CT-specific, and homework-focused) as they predictedhomework compliance among 26 patients in a 20-session CTprotocol for major depression. Patients who were more compliant with homework exhibitedsignificantly greater treatment response on onedepression measure but not another. Homework compliancewas most strongly predicted by therapists' reviewinghomework assigned previously, and by general therapeuticskills. Patients' age, education, depression severity,and learned resourcefulness were unrelated tocompliance; however, number of previous episodes was negatively related to compliance.
Tài liệu tham khảo
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Burns, D. D., Adams, R. L., & Anastopoulos, A. D. (1985). The role of self-help assignments in the treatment of depression. In E. E. Beckham & W.R. Leber (Eds.), Handbook of depression treatment, assessment, and research (pp. 634–668). Homewood, IL: Dorsey Press.
Burns, D. D., & Nolen-Hoeksema, S. (1991). Coping styles, homework compliance, and the effectiveness of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 59, 305–311.
Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model. Journal of Consulting and Clinical Psychology, 60, 441–449.
Burns, D. D., Rude, S., Simons, A. D., Bates, M. A., & Thase, M. E. (1994). Does learned resourcefulness predict the response to cognitive behavioral therapy for depression? Cognitive Therapy and Research, 18, 277–291.
Burns, D. D., Shaw, B. F., & Crocker, W. (1987). Thinking styles and coping strategies of depressed women: An empirical investigation. Behaviour Research and Therapy, 25, 223–225.
Cox, D. J., Tisdelle, D. A., & Culbert, J. P. (1988). Increasing adherence to behavioral homework assignments. Journal of Behavioral Medicine, 11, 519–522.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Fennell, M. J. V., & Teasdale, J. D. (1987). Cognitive therapy for depression: Individual differences and the process of change. Cognitive Therapy and Research, 11, 253–271.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.
Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 428–466). New York: John Wiley & Sons.
Hollon, S. D., Shelton, R. C., & Loosen, P. T. (1991). Cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 59, 88–99.
Kavanagh, D. J., & Wilson, P. H. (1989). Prediction of outcome with group cognitive therapy for depression. Behaviour Research and Therapy, 27, 333–343.
Lambert, M. J., Hatch, D. R., Kingston, M. D., & Edwards, B. C. (1986). Zung, Beck, and Hamilton Rating Scales as measures of treatment outcome: A meta-analytic comparison. Journal of Consulting and Clinical Psychology, 54, 54–59.
Neimeyer, R. A., & Feixas, G. (1990). The role of homework and skill acquisition in the outcome of group cognitive therapy for depression. Behavior Therapy, 21, 281–292.
Persons, J. B., Burns, D. D., & Perloff, J. M. (1988). Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cognitive Therapy and Research, 12, 557–575.
Primakoff, L., Epstein, N., & Covi, L. (1986). Homework compliance: An uncontrolled variable in cognitive therapy outcome research. Behavior Therapy, 17, 433–446.
Robinson, L. A., Berman, J. S., & Neimeyer, R.A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30–49.
Rosenbaum, M. (1980). A schedule for assessing self-control behaviors: Preliminary findings. Behavior Therapy, 11, 109–121.
Shaw, B. F. (1984). Specification of the training and evaluation of cognitive therapists for outcome studies. In J. B. W. Williams & R. L. Spitzer (Eds.), Psychotherapy research: Where are we and where should we go? (pp. 173–188). New York: Guilford Press.
Simons, A. D., Lustman, P. J., Wetzel, R. D., & Murphy, G. E. (1985). Predicting response to cognitive therapy of depression: The role of learned resourcefulness. Cognitive Therapy and Research, 9, 79–89.
Simons, A. D., & Thase, M. E. (1992). Biological markers, treatment outcome, and 1-year follow-up in endogenous depression: Electroencephalographic sleep studies and response to cognitive therapy. Journal of Consulting and Clinical Psychology, 60, 392–401.
Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research Diagnostic Criteria: Rationale and reliability. Archives of General Psychiatry, 34, 773–782.
Worthington, E. L., Jr. (1986). Client compliance with homework directives during counseling. Journal of Counseling Psychology, 33, 124–130.
Young, J., & Beck, A. T. (1980). Cognitive therapy scale: Rating manual. Unpublished manuscript, Center for Cognitive Therapy, University of Pennsylvania, Philadelphia.