The October, 2010 edition of
Advances in Cognitive Therapy (the newsletter of the Academy of Cognitive Therapy and the International Association of Cognitive Psychotherapy) is a special issue on homework in CT. Here are a few highlights:
- Homework assignments are a core feature of Beck's CBT but some studies have found weak correlations between homework compliance and treatment outcome. This has led some to question the importance of homework and even recommend that it be removed from CT. Kazantzis and Petrik (2010) discuss the available evidence and conclude a) many of the studies finding weak relationships between homework compliance and treatment outcome are hampered by small sample sizes, b) quality of homework may be more important than quantity of homework completed, and c) meta-analysis provides evidence of a medium-sized relationship (d=.48) relationship between homework compliance and treatment outcome.
- A variety of suggestions are made for improving homework compliance: Tomkins recommends giving a clear rationale for the assignment, making the assignment doable, and providing the client with written homework instructions. Callan et al., recommend using technological interventions (email reminders, alarms, apps on cell phones, etc.) to promote homework adherence. Brodman and Kendall emphasize the importance of collaboration, recommend not calling it "homework" especially with kids, responding to non-compliance with discussion and problem-solving, and rewarding compliance. Kassler et al., recommend using the principles of Motivational Interviewing and using principles of collaboration and collaborative empiricism in selecting, planning, and reviewing homework assignments.
I'd add that clients are much more likely to follow through on homework if:
- Assignments are clearly relevant to goals that are meaningful to the client.
- The therapist asks the client what is likely to interfere with their completing the assignment and then helps plan ways to overcome those impediments.
- The therapist makes a point of remembering what the assignment was, reviews it at the next appointment, and makes sure that the client recognizes how completing the assignment was useful in working towards their goals.
More on homework in CBT, can be found in the Forum archives at
http://www.behavior.net/forums/cogni...96/msg268.html.
Also, the "Action Plan" and "Behavioral Experiment" forms from
Mind over Mood can be very useful.