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.     

Adapting Homework for an Older Adult Client With Cognitive Impairment

There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case study describes how cognitive behavioral intervention strategies and related homework assignments were tailored and integrated to successfully treat depressive symptoms in an older African American diagnosed with probable Alzheimer’s disease. Examples of the homework strategies utilized are introduced by phase of treatment. We also discuss ways to overcome barriers to homework completion as well as methods to incorporate the client’s sociocultural context and personal history into homework.     

Suffering for science: the effects of implicit social demands on response to experimentally induced pain

In two experiments subjects rated their pain during baseline trials of cold pressor and finger pressure pain. After various instructional treatments, they were posttested with these same stimuli. As in previous studies, we found in both experiments that coping suggestions significantly reduced reported pain. Experiment 1, however, demonstrated that subjects often refrained from using available cognitive coping strategies to reduce pain unless they had been given explicit permission to do so. Experiment 2 replicated this finding and also showed that explicit permission to "do whatever you can to reduce pain" was as effective as a coping suggestion in decreasing reported pain. These findings indicate that subjects' interpretation of what is appropriate responding in the test situation determines how they choose to cope with the painful stimulation. Thus standard experimental procedures for assessing baseline levels of pain implicitly lead subjects to refrain from coping and thereby tend to underestimate their ability to control pain. Moreover, suggestions and other instructional techniques for coping with pain may produce much of their effect not by teaching subjects new coping skills but instead by giving them permission to use already available coping strategies.     

Network crisis intervention in a college setting

This article discusses the use of crisis intervention and networking principles with emotionally disturbed college students. In addition, the article demonstrates how these principles can be applied to larger systems such as entire living units or service organizations which are experiencing a crisis. Through the use of case examples the author identifies pressures experienced by college students and organizations and suggests intervention strategies emphasizing the use of available social supports. With the use of individual interviews, small and large group meetings, telephone conferences, homework assignments, and debriefing sessions, clients and their systems can be taught to cope with crises with a minimum of professional assistance.     

Do self-statements enhance the effectiveness of virtual reality exposure therapy? A comparative evaluation in acrophobia.

There is a clear need for more detailed analysis of the role of cognitive self-statements in virtual reality exposure therapy (VRET). To date, no research on this topic has been done. The primary aim of this study was to investigate whether coping self-statements would enhance the effectiveness of VRET. In a randomized crossover design, 26 patients with acrophobia (DSM-IV diagnosis of specific phobia) were randomly assigned to two sessions of VRET followed by two sessions of VRET plus coping self-statements, or the other way around: first two sessions of VRET plus coping self-statements followed by two sessions of VRET. Results showed that VRET, regardless of addition of coping self-statements, decreased anxiety of heights, decreased avoidance of height situations, and improved attitudes towards heights. However, at 6-month follow-up, most gains during treatment were not fully retained.     

Homework Use in Cognitive Therapy for Psychosis: A Case Formulation Approach

Based upon empirically supported cognitive-behavioral treatment approaches, this paper aims to outline the use of homework to enhance the therapeutic relationship, patient motivation, and skills for managing delusions, hallucinations, and negative symptoms. The nature and timing of homework is outlined for the different phases of treatment. Frequent barriers that emerge during the setting and reviewing of homework are described, followed by strategies to enhance motivation and homework compliance. The paper concludes with a demonstration of how homework is optimized within a case formulation approach for persistent symptoms of psychosis.     

When self-help materials help: Examining the effects of self-discrepancy and modes of delivery of positive self-statements

Self-help materials inculcating individuals with positive self-statements are popular in recent years, although the effectiveness of such self-statements on improving individuals’ psychological well-being has not yet been confirmed. Using a control-group pre-test/post-test design, we examined how positive self-statements may or may not benefit individuals’ mood. Individual characteristics and modes of delivery were found to moderate mood changes resulting from positive self-statements. Specifically, we found that participants experienced negative mood change after reading positive self-statements, if they have low level of need satisfaction. However, we also found that participants experienced a mood boost after listening to positive self-statements, and this effect was unrelated to self-esteem or need satisfaction. These findings suggest that self-help materials with a focus on positive self-statements should be used with caution.     

Bicultural mind, self-construal, and self- and mother-reference effects: Consequences of cultural priming on recognition memory

Two experiments showed that American (vs. Chinese) culture priming influences Beijing Chinese undergraduates’ self-construal and its attendant memory strategies. Following American culture priming (vs. Chinese culture priming or control), the participants used relatively more independent self-statements and fewer interdependent self-statements to describe the self (Experiment 1). They also performed more poorly in a delayed recognition test if they had encoded the study materials (personality adjectives) with reference to the mother (Experiment 2). These results demonstrate the activation effect of culture on self-construal and its attendant memory processes. The results also show that biculturals can access different cultural conceptions of the self and change cognitive strategies flexibly in response to cues of changing cultural demands in the immediate context.     

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.     

Treatment of a Case Example With PTSD and Chronic Pain

This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this framework, the commentary includes a focus on the treatment of PTSD with an eye toward generalizing the therapeutic strategies to chronic pain problems. Psychoeducation, imaginal exposure to the traumatic event, in vivo exposure to avoided activities, and cognitive interventions including coping self-statements, correction of logical errors, decatastrophizing and developing alternative explanations are all included in the recommendations as part of a standard cognitive behavioral treatment for PTSD. Added to this standard PTSD protocol is the suggested use of interoceptive exposure to address GH’s feared bodily sensations. In the assessment domain, standard measures for pain and PTSD assessment are suggested along with tracking of depression and anxiety sensitivity. Some recognition of more recent approaches to cognitive behavioral therapy (e.g., Acceptance and Commitment Therapy) is given in considering potential obstacles to treatment.     

English as a foreign language (EFL) homework diaries: evaluating gains and constraints for self-regulated learning and achievement

Although homework completion is said to be rather important to achievement, nowadays there is a growing concern of educators about the increasing number of students who do not engage properly on doing the homework tasks and the subsequent impact on school failure rates. Focusing on English as a Foreign Language (EFL) and using a sample of 591 Portuguese fifth and sixth graders, the present study analyses the role played by a number of homework variables on students' achievement (proximal and distal), and their mediating role on the use of self-regulated learning strategies and perceived self-efficacy in the domain. Data confirm the indirect effect of homework on school achievement, by means of the referred cognitive and motivational variables (use of self-regulated learning strategies and self-efficacy). These findings are further discussed in order to highlight the significant role homework completion can play on fighting school failure.     

家庭作业与学业成绩的关系

家庭作业不仅是一种被广泛采用的教学手段,也是学生课后最为重要的学习活动。本文从家庭作业特征、家庭作业完成过程、家庭作业中父母参与和家庭作业对学习效果影响的机制几个方面探讨了家庭作业与学业成绩的关系。最后指出了家庭作业学习效果研究的实践价值和未来研究方向。     

Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.     

Hausaufgaben in der Psychotherapie

Homework assignments represent a standard intervention in psychotherapy. Homework provides the unique opportunity to emphasize patients’ responsibility for therapeutic change and to intensify the therapeutic process. Despite these high potentials systematic homework assignment is still rare in practice. Psychotherapy research has just recently focused its attention on homework as an effective therapeutic method. Meanwhile the positive effects of homework use on therapeutic outcome have been demonstrated but little is known about therapeutic strategies to enhance these effects. The present article highlights the functions of homework within the therapeutic process and discusses its theoretical mechanisms of action. The article concludes with suggestions from both an empirical and practical point of view to further assist practitioners’ use of homework assignments.     

Coping Styles,Pain Expressiveness,and Implicit Theories of Chronic Pain

Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain.     

Effects of attentional direction, age, and coping style on cold-pressor pain in children

This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7-14 years (n = 120) were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children's pain tolerance and perceptions of pain intensity were assessed using a 10 degrees C cold-pressor task. Results showed pain intensity ratings after 1 min were lower for both intervention conditions than for the controls. Younger children (7-9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10-14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed.     

Homework

In commemoration of Dr. Aaron T. Beck’s enormous contributions to our field, I comment on the state of our knowledge regarding the role of homework in cognitive behavioral therapy. The available evidence suggests homework is a contributor to positive therapeutic outcomes in cognitive behavioral therapy. Although therapists play an important role in facilitating clients’ engagement with homework as they develop greater facility with CBT skills, little is known about the contributions of specific approaches to promoting homework engagement. I highlight some of these strategies and discuss the need for researchers to empirically evaluate them.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

The relationship among self-efficacy, negative self-referent cognitions, and social anxiety in children: a multiple mediator model

Evidence suggests that general self-efficacy, an individual's beliefs about his global abilities, and social self-efficacy, an individual's beliefs in his ability to navigate social situations, are strongly connected to levels of social anxiety. Negative self-statements, also known as negative self-referent cognitions, have also been linked with levels of social anxiety. Although self-efficacy and negative self-statements have been shown to be important variables in the phenomenology and maintenance of social anxiety in children, they have yet to be examined in conjunction with one another. The purpose of this study was to examine the relationship between negative self-referent cognitions and self-efficacy and to examine both general self-efficacy and social self-efficacy as mediator variables in the relationship between negative self-statements and social anxiety. Results were based on a sample of 126 children ages 11 to 14 years. A significant association between negative self-statements and both general self-efficacy and social self-efficacy was established. Results also indicated that general self-efficacy fully mediated the relationship between negative self-statements and social anxiety; however, contrary to hypotheses, social self-efficacy did not mediate the relationship between negative self-statements and social anxiety. Implications and future recommendations are discussed.