Measuring Homework Utility in Psychotherapy: Cognitive-Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder as an Example
Tóm tắt
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 session-by-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.
Tài liệu tham khảo
Addis, M. E., & Jacobson, N. S. (1996). Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies. Journal of Consulting and Clinical Psychology, 64, 1417–1424.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Barkley, R., & Murphy, K. (1998). Attention-deficit hyperactivity disorder: a clinical workbook (2nd ed.). New York: Guilford Press.
Bryant, M. J., Simons, A. D., & Thase, M. E. (1999). Therapist skill and patient variables in homework compliance: controlling an uncontrolled variable in cognitive therapy outcome research. Cognitive Therapy and Research, 23, 381–399.
Conoley, C. W., Padula, M. A., Payton, D. S., & Daniels, J. A. (1994). Predictors of client implementation of counselor recommendations: match with problem, difficulty level, and building on client strengths. Journal of Counseling Psychology, 41, 3–7.
Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alvarez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting & Clinical Psychology, 70, 1022–1028.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–61.
Kazantzis, N. (2000). Power to detect homework effects in psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 68, 166–170.
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: a meta-analysis. Clinical Psychology: Science and Practice, 7, 189–202.
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2004). Assessing compliance with homework assignments: review and recommendations for clinical practice. Journal of Clinical Psychology, 60, 627–641.
Leon, A., Solomon, D., Mueller, T., Turvey, C., Endicott, J., & Keller, M. (1999). The range of impaired functioning tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine, 29, 869–878.
Leung, A. W., & Heimberg, R. G. (1996). Homework compliance, perceptions of control, and outcome of cognitive-behavioral treatment of social phobia. Behaviour Research & Therapy, 34, 423–432.
N.I.M.H. (1985). CGI: clinical global impression scale—NIMH. Psychopharmacology Bulletin, 21, 839–844.
Primakoff, L., Epstein, N., & Covi, L. (1986). Homework compliance: an uncontrolled variable in cognitive therapy outcome research. Behavior Therapy, 17, 433–446.
Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005a). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research & Therapy, 43, 831–842.
Safren, S. A., Perlman, C., Sprich, S., & Otto, M. W. (2005b). Mastery of your adult adhd: therapist manual. New York: Oxford University Press.
Safren, S. A., Sprich, S., Chulvick, S., & Otto, M. W. (2004). Psychosocial treatments for adults with attention-deficit/hyperactivity disorder. The Psychiatric clinics of North America, 27, 349–360.
Scheel, M. J., Seaman, S., Roach, K., Mullin, T., & Mahoney, K. B. (1999). Client implementation of therapist recommendations predicted by client perception of fit, difficulty of implementation, and therapist influence. Journal of Counseling Psychology, 46, 308–316.
Shaw, B. F., Elkin, I., Yamaguchi, J., Olmsted, M., Vallis, T. M., Dobson, K. S., Lowery, A., Sotsky, S. M., Watkins, J. T., & Imber, S. D. (1999). Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 67, 837–846.
Shear, M. K., Vander Bilt, J., Rucci, P., Endicott, J., Lydiard, B., Otto, M. W., Pollack, M. H., Chandler, L., Williams, J., Ali, A., & Frank, D. M. (2001). Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depression and Anxiety, 13, 166–178.
Spencer, T., Wilens, T., Biederman, J., Faraone, S. V., Ablon, J. S., & Lapey, K. (1995). A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder. Archives of General Psychiatry, 52, 434–443.
Tang, T. Z., & DeRubeis, R. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.
Tang, T. Z., Luborsky, L., & Andrusyna, T. (2002). Sudden gains in recovering from depression: are they also found in psychotherapies other than cognitive-behavioral therapy? Journal of Consulting and Clinical Psychology, 70, 444–447.
Wilens, T., Biederman, J., Prince, J., Spencer, T., Faraone, S., Warburton, R., Schleifer, D., Harding, M., Linehan, C., & Geller, D. (1996). Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. American Journal of Psychiatry, 153, 1147–1153.
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale [see comments.]. Journal of Psychiatric Research, 22(Suppl. 1), 55–85.