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Cited by 59Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits?

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Conklin, Laren R., Strunk, Daniel R.·2015·Behaviour Research and Therapy
DOI 10.1016/j.brat.2015.06.011PMC PMC4529756
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Abstract

Homework is a key component of Cognitive Therapy (CT) for depression. Although previous research has found evidence for a positive relationship between homework compliance and treatment outcome, the methods used in previous studies have often not been optimal. In this study, we examine the relation of specific aspects of homework engagement and symptom change over successive session-to-session intervals. In a sample of 53 depressed adults participating in CT, we examined the relation of observer-rated homework engagement and session-to-session symptom change across the first five sessions. Within patient (and not between patient) variability in homework engagement was significantly related to greater session-to-session symptom improvements. These findings were similar when homework engagement was assessed through a measure of general engagement with homework assignments and a measure assessing engagement in specific assignments often used in CT. Secondary analyses suggested that observer ratings of the effort patients made on homework and the completion of cognitive homework were the numerically strongest predictors of depressive symptom improvements. Patient engagement with homework assignments appears to be an important predictor of early session-to-session symptom improvements. Future research is needed to identify what therapist behaviors promote homework engagement.

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  • Without sufficient out-of-session skills practice, clients tend to experience suboptimal outcomes, including increased likelihood of premature treatment dropout, slower symptom improvements, and ultimately worse symptoms at end of care.

    “Without sufficient out-of-session skills practice, clients tend to experience suboptimal outcomes, including increased likelihood of premature treatment dropout, slower symptom improvements (presumably due to slower skills acquisition), and ultimately worse symptoms at end of care [7,12-14].”

    From Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study (2024) · cites this paper as [13]

    The Discussion (page unavailable) reports that greater homework engagement during early cognitive-therapy sessions was associated with greater session-to-session improvement in depressive symptoms. The paper also reviews studies linking homework compliance to better end-of-treatment outcomes, while noting methodological limits. Its Methods mention early dropouts but do not link dropout risk to homework engagement; its findings also do not establish that insufficient practice causes slower improvement or worse symptoms at the end of care. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. Beck AT Steer RA Brown BK Beck depression inventory manual 1996 2th edition San Antonio, TX Psychological Corporation
  2. First MB Spitzer RL Gibbon M Williams JBW Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. (SCID- I/P) 2002 New York Biometrics Research, New York State Psychiatric Institute

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Authors
Conklin, L. R., & Strunk, D. R.
Affiliations
The Ohio State University (US)
Corresponding author
Conklin, Laren R.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2015-09
Volume
72
Pages
56-62
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2015.06.011
PMC
PMC4529756
OpenAlex
W770910149
Cited by
59
References
35
Citations by year
2026: 1 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 19 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 7 · 2015: 1
FWCI
6.20
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Research Resources (TL1RR025753)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
homework engagement, cognitive therapy, depression, homework compliance, early treatment response, intrapatient variability, observer ratings, patient effort
MeSH terms
Behavior Observation Techniques, Adult, Depression, Depressive Disorder, Female, Humans, Male, Patient Compliance, Cognitive Behavioral Therapy, Treatment Outcome

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