Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.     

Effectiveness of Cognitive Behavior Therapy for Severe Mood Disorders in an Acute Psychiatric Naturalistic Setting: A Benchmarking Study

The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, “real world” settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.     

决策评估中的结果偏差

结果偏差又称结果效应,它是发生在决策评估中的一种偏差式判断,即当决策结果与决策质量不存在实质性联系时,评估者仍根据结果信息评估决策质量.针对这一判断谬误的产生根源,研究者们提出了认知解释和申辩模型.结果偏差的影响因素主要包括动机、情境因素和评估手段等.基于先前研究存在的问题和不足,今后的研究应着眼于改进研究手段,理清与其他现象的关系并提出有效的应对策略.     

Homework Compliance Counts in Cognitive-Behavioral Therapy

Background: Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders. However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously. The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders. Methods: 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy. Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview. Participants made ratings of treatment expectancy after the first session. Homework compliance was assessed each session by the treating clinician. Results: Contrary to hypotheses, treatment expectancy and homework compliance were poorly correlated. Regression analyses revealed that homework compliance, but not treatment expectancy, predicted a significant portion of the variance in treatment outcome (10%). Conclusions: The present research suggests that although treatment expectation and homework compliance likely represent unique constructs of treatment engagement, homework compliance may be the more important treatment engagement variable for outcomes. The present research suggests that improvement of homework compliance has the potential to be a highly practical and effective way to improve clinical outcomes in CBT targeting anxiety disorders.     

The Effects of Exploration on Preschoolers' Problem-Solving Ability

Specific contributions of exploration for divergent and convergent problem-solving ability in preschool children were investigated. Participants were identified as players or nonplayers based on naturalistic observations of free-play activities, and were assigned to either an exploration or nonexploration control condition prior to administration of two divergent and two convergent problem-solving tasks. No significant differences were found between the exploration and nonexploration groups on either divergent or convergent problem-solving tasks. Subjects in the exploration group, however, spent significantly less time in the related convergent problem-solving task than in the nonrelated convergent task. The player/nonplayer distinction was also nonsignificant.     

A Data Analysis Method for Using Longitudinal Binary Outcome Data from a SMART to Compare Adaptive Interventions

Sequential multiple assignment randomized trials (SMARTs) are a useful and increasingly popular approach for gathering information to inform the construction of adaptive interventions to treat psychological and behavioral health conditions. Until recently, analysis methods for data from SMART designs considered only a single measurement of the outcome of interest when comparing the efficacy of adaptive interventions. Lu et al. proposed a method for considering repeated outcome measurements to incorporate information about the longitudinal trajectory of change. While their proposed method can be applied to many kinds of outcome variables, they focused mainly on linear models for normally distributed outcomes. Practical guidelines and extensions are required to implement this methodology with other types of repeated outcome measures common in behavioral research. In this article, we discuss implementation of this method with repeated binary outcomes. We explain how to compare adaptive interventions in terms of various summaries of repeated binary outcome measures, including average outcome (area under the curve) and delayed effects. The method is illustrated using an empirical example from a SMART study to develop an adaptive intervention for engaging alcohol- and cocaine-dependent patients in treatment. Monte Carlo simulations are provided to demonstrate the good performance of the proposed technique.     

Trauma-Related Negative Cognitions Mediate the Relationship Between Avoidant Personality Beliefs and Impeded Response to Psychotherapy for PTSD

There is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD symptoms. However, the relationship between personality pathology and TRNC in the context of PTSD is mostly unknown. In the present study, we aimed to examine whether avoidant and borderline personality beliefs (PB, indicator of personality pathology) could predict therapy outcome in PTSD, and whether the relationship between PB and therapy outcome could be mediated by TRNC. Sixty patients with PTSD were assessed for PB, TRNC and PTSD symptoms at baseline, and for PTSD symptoms at the termination of Prolonged Exposure Therapy. Baseline avoidant PB predicted significant variance in PTSD symptoms at termination over and above baseline PTSD symptoms (16% reduction in treatment effect per SD on avoidant PB). Moreover, TRNC at baseline fully mediated the relationships between baseline avoidant PB and PTSD symptoms at termination. This is the first study to show that avoidant PB predicts treatment response in PTSD, and that patients with avoidant beliefs are more vulnerable to have TRNC, which are associated with impeded therapy response. Our results highlight the importance of targeting both dysfunctional PB and TRNC in PTSD interventions.     

Approaches to evaluation

This paper offers some informal thoughts about audit and research studies in a psychotherapy or counselling context, drawing on the author's background in a difficult area of evaluation: the outcomes of psychoanalytic psychotherapy for children and adolescents. Reasons for therapists' difficulties with the idea of evaluation studies are considered, and possible designs for feasible research projects are briefly discussed. Examples of different strategies within one area are given, to illustrate the way in which different approaches can be patched together to yield important findings, and to overcome the limitations of any one approach. the place of audit in relation to research is also briefly discussed.     

Family structure and community connectedness: Their association with teenage pregnancy in South Africa

This study aimed to examine the relationships between family structure and community connectedness on the one hand, as well as risk for teenage pregnancy on the other. Data were from the South African General Household Surveys 2011, 2012, 2013; N = 279 042, female teenagers = 9.9%, age range 10 to 19; black teenagers = 81%. We applied multilevel binary logistic regression to predict risk for teenage pregnancy by family structure and community affinity variables. Findings suggest teenage female teenagers from single-headed households and with higher numbers of male relatives are at elevated risk for teenage pregnancy. Similarly, female teenagers from families with parental divorce were at higher risk for pregnancy as were those from communities with lower coherence.