Integrating Homework Assignments Based on Culture: Working with Chinese Patients

Cognitive therapy as espoused by A. T. Beck (A. T. Beck, Rush, Shaw, & Emery, 1979) is increasingly used as a therapeutic modality and applied to a variety of cultural groups throughout the world. However, the majority of the literature on empirical and clinical practice has been focused on the use of cognitive therapy for Western cultures. In this article, we discuss Chinese patients’ adherence to therapy homework assignments in terms of Chinese cultural values and practices, their customary problem-solving process, and other traditional beliefs. Through the use of a case study, we illustrate how some of these culturally specific beliefs can influence the process of integrating homework assignments into the course of therapy. This resource on supervising practitioners’ treatment of Chinese patients with cognitive behavior therapy is offered as a contribution to the emerging literature on CBT for non-Western cultures.     

Critical Issues in Using Homework Assignments Within Cognitive-Behavioral Therapy for Schizophrenia

Presents an overview of the research findings to date and practical guidelines for the use of homework in cognitive-behavioral therapy for schizophrenia. In particular, the article outlines strategies to combat the common difficulties experienced when using homework with clients with schizophrenia and the types of homework assignments that may be most helpful. The empirical evidence suggests that cognitive-behavioral therapy incorporating homework assignments help clients to improve at least 60% more than those in treatment without homework. Despite that most therapy formulations incorporate homework as an integral component of treatment for schizophrenia, prior research has identified that practitioners consider homework to be less helpful for clients with delusions and hallucinations. Interventions to enhance homework compliance in the treatment of clients with schizophrenia are outlined.     

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

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.     

The Obstacle is the Path: Overcoming Blocks to Homework Assignments in a Complex Presentation of Depression

There is increasing evidence to demonstrate that clients who complete homework assignments have a better outcome in cognitive therapy (Kazantzis, Deane, & Ronan, 2000). Most clinicians recognize that enabling clients to effectively utilize homework can be a major task in itself, particularly with disorders such as depression, where individuals find even the simplest daily tasks daunting. This article begins by highlighting the problem of changing any pattern of activity, and then explores the difficulties of engaging clients in homework when they present with persistent depression with secondary anxiety features.     

Cognitive Behavioral Therapy for Chronic Pain: Strategies for the Successful Use of Homework Assignments

Presents an overview of the research findings to date, and practical guidelines for the use of homework in psychosocial treatments for patients with chronic pain. Generally, psychosocial treatments incorporating homework assignments help patients to improve more than when treatment is comprised entirely of in-session work. The article outlines common obstacles experienced when using homework with pain patients and strategies to combat these obstacles. The types of homework assignments that may be most helpful, as well as interventions that can be used to promote homework compliance and successful treatment outcome are discussed.     

The Association Between Number of Homework Assignments Completed during a Lifestyle Physical Activity Intervention and Scores on Transtheoretical Measures

An assumption of theory-based physical activity interventions is that active participation positively affects the theoretical constructs upon which the intervention is based. This assumption is rarely tested. This study assessed whether participation, defined as completion of homework, in a lifestyle physical activity intervention was associated with changes over 6 months in constructs the homework addressed: the behavioral and cognitive processes of change, self-efficacy, and decisional balance (the pros and cons). Participants were 244 sedentary adults aged 25 to 75 years. They completed an average of 12 of 20 homework assignments. Those completing at least two-thirds of the homework (n = 113) had greater changes in the theoretical constructs from pretest to posttest than those completing less (n = 90). Post-hoc analyses suggest that completing theory-based homework may impact the processes of change and self-efficacy in lifestyle physical activity interventions and, therefore, are warranted in future interventions.     

Assigning Homework to Couples and Families

Homework assignments, or “out-of-session assignments,” have gained popularity among couple and family therapists due to their potential to solidify the work achieved during the course of therapy and to help clients take responsibility for their own change. Homework assignments also serve as a testing ground in therapy to determine what works and what does not. This article provides an update on some of the empirical literature on homework assignments and its reported effectiveness in the domain of couples and family therapy. It also highlights the need for and the effectiveness of out-of-session assignments during the course of treatment.     

Homework Completion,Patient Characteristics,and Symptom Change in Cognitive Processing Therapy for PTSD

We evaluated the impact of homework completion on change in PTSD symptoms in the context of two randomized controlled trials of Cognitive Processing Therapy for PTSD (CPT). Female participants (n = 140) diagnosed with PTSD attended at least one CPT session and were assigned homework at each session. The frequency of homework completion was assessed at the beginning of each session and PTSD symptoms were assessed every other session. Piecewise growth models were used to examine the relationship between homework completion and symptom change. CPT version (with vs without the written trauma account) did not moderate associations between homework engagement and outcomes. Greater pretreatment PTSD symptoms predicted more Session 1 homework completion, but PTSD symptoms did not predict homework completion at other timepoints. More homework completion after Sessions 2 and 3 was associated with less change in PTSD from Session 2 to Session 4, but larger pre-to-post treatment changes in PTSD. Homework completion after Sessions 2 and 3 was associated with greater symptom change among patients who had fewer years of education. More homework completion after Sessions 8 and 9 was associated with larger subsequent decreases in PTSD. Average homework completion was not associated with client characteristics. In the second half of treatment, homework engagement was associated with less dropout. The results suggest that efforts to increase engagement in homework may facilitate symptom change.     

Theodore Millon's Contributions to Conceptualizing Personality Disorders

We review Theodore Millon's contributions to conceptualizing personality disorders in contemporary clinical science and practice. Millon worked tirelessly across professional domains and theoretical orientations, developing a rich integrative theory of personality and its pathology, directly and indirectly impacting the evolving iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III through DSM–5), and advocating for the personality disorders through his contributions to cofounding the International Society for the Study of Personality Disorders and the Journal of Personality Disorders. We conclude with a closer look at Millon's final major contributions to conceptualizing personality disorders as well as the strengths and limitations of his approach.     

Barriers to forgiveness

Society generally encourages individuals to forgive their transgressors because forgiveness can yield many psychological, physiological, and social benefits (Exline & Baumeister, 2000 ). Nevertheless, victims face barriers to forgiving others, and other people face obstacles that prevent them from encouraging victims to forgive. We aim to provide insight into the various barriers that deter forgiveness by examining the role of the various parties involved—victims, transgressors, and uninvolved third parties—in creating barriers to forgiveness. We contend that beliefs held by these various parties significantly reduce the likelihood that victims will forgive their transgressors. By identifying how these beliefs impede forgiveness, we can begin to understand more fully why convincing victims to forgive is often a challenge. In our discussion, we also suggest ways by which victims, transgressors, and third parties can overcome these barriers to forgiveness.     

Reducing Perceptions of Time Required to Complete Math Assignments by Adding Problems to Assignments: A Synthesis of the Additive Interspersal Research

Results from nine experiments were analyzed to evaluate the relationship between relative problem completion rates (RPCR) and judgments of time involving mathematics assignments. For each experiment, control assignments contained only target mathematics computation or word problems. Matched experimental assignments contained similar target problems with additional, briefer problems interspersed after every third target problem. After working on each assignment for the same amount of time, students selected the assignment that they judged would require the least or most amount of time to complete. Regression analysis revealed a significant linear relationship between RPCR (i.e., PCR on experimental assignments/PCR on control assignments) and time perceptions (r=.97). As RPCR increased, the percentage of students judging the experimental assignments as being less time consuming increased proportionally. Discussion focuses on application of time perception theories to educational settings.     

Governance Barriers to Sustainability

Humanity and water represent an intersection of two natural cycles: the human economy and the earth's hydrological system. Although water is vital for human survival and growth, the point where human endeavor intersects is the most variable and uncertain in the hydrological system. Significant spatial and temporal variation of evaporation and rainfall has led to a number of responses aimed at increasing certainty of access to water. However, many of the world's civilizations can attest that the very act of reducing water uncertainty by technical means (capture, storage, and irrigation) has ultimately led to greater uncertainty and civilization failure. This article explores the concept of living with water as a complex entity, inseparably connected with all three levels of existential complexity—individual, social, and ecological—rather than as a commodity, which has led to our current uncertain status.     

An Integrative Approach to Conceptualizing and Treating Complex Trauma

Complex trauma (CT) often presents with polymorphous symptoms (i.e., emotional dysregulation, dissociation, somatic distress) resulting from repeated and chronic exposure to traumatic stressors. While the public is increasingly aware of posttraumatic stress disorder (PTSD) and its accompanying symptoms, the phenomena of complex trauma is less recognized and understood. Since the trauma reactions with CT typically occur during childhood, and the symptoms go well beyond PTSD, the authors of this article assert that an integrative approach is needed that synthesizes the most effective elements of cognitive-behavioral therapy (CBT) while blending a self-psychological approach. A review of the literature addresses the definition of complex trauma, cognitive-behavioral conceptualizations and treatment approaches, self-psychological models, current theories of attachment, and advances in neuropsychoanalysis. An integrative model is then proposed, supported by clinicians in the trauma field, identifying three intertwined phases of treatment.     

Making Optimal Use of Homework to Enhance Your Therapeutic Effectiveness

Homework is a well-established yet extremely under-emphasized aspect of the Rational-Emotive/cognitive behavioral orientation. This article recognizes homework as being a very powerful tool that needs to be incorporated into treatment in order to make it more efficient and effective. The author presents numerous techniques that can be used with virtually any therapeutic approach to maximize the impact of therapy between sessions. They include audio and bibliotherapy, goal setting, SUD Scale, mood management, disputation, affirmations, mood diary, list making, guided imagery, visualization, relaxation and meditation techniques, exposure, and thought stopping techniques. The article concludes with a discussion of why clients display resistance to homework along with some approaches that can be taken to address this resistance.     

Evluation of the Homework Problem Checklist with Students with Behavior Disorders

In response to the call for educational reform, educators are beginning to review their programs and implement new instructional strategies such as homework programs to enhance the academic performance of students. Naturally, reliable and valid assessment instruments will be needed to identify students experiencing homework difficulties. The purpose of this study was to determine the inter-rater reliability and internal consistency of the Homework Problem Checklist (HPC) (Anesko, Schoiock, Ramirez, & Levine. 1987) for use with students with behavior disorders (BD). Fifty-one pairs of teachers and parents of students with BD completed the rating scale describing students' homework problems. The HPC demonstrated low to moderate levels of inter-rater reliability. Acceptable levels of internal consistency were reported for both teacher and parent ratings.     

Barriers to Adult Career Change

Adults have unique problems in making career changes. They face crucial economic, educational, and psychological barriers that require special guidance services. In this article, barriers to adult career change are identified and a five-county regional learning service using paraprofessionals is described. Results in working with more than 200 adults making career changes is reported. Suggestions for overcoming some of the problems adults face in making career changes are explained.     

Aligning Expatriate Managers’ Expectations with Complex Global Assignments

The purpose of this paper is to develop a theoretical, yet practical framework for managing unrealistic expectations of expatriate marketing managers relative to their role in complex global marketing assignments. The formation of these unrealistic expatriate marketing managers’ expectations is examined using relational contracting theory. We explore alternative HRM evaluation/support designs that can suppress the development of expatriate marketing managers’ entitlement process and thus enhance the reality of expatriate marketing managers’ expectations relative to the role in a subsidiary of the multinational enterprise.     

Learning to Drink Deeply from Books: Using Experiential Assignments to Teach Concepts

This article explores how to teach students to drink deeply from books. Drawing on the work of Peter Elbow, the article argues for incorporating experiential assignments that are structured to create a mediating realm between abstract concepts and concrete experiences. The bulk of the article explores in detail the author's use of such assignments first in a course on sexuality and religion and, second, in the standard Introduction to Religion course.