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BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Enthusiasm for homework and improvement of psychological distress in subthreshold depression during behavior therapy: secondary analysis of data from a randomized controlled trial

Authors: Y. Hayasaka, T. A. Furukawa, T. Sozu, H. Imai, N. Kawakami, M. Horikoshi, On behalf of the GENKI Project

Published in: BMC Psychiatry | Issue 1/2015

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Abstract

Background

Cognitive behavioral therapy (CBT) usually involves homework, the completion of which is a known predictor of a positive outcome. The aim of the present study was to examine the session-by-session relationships between enthusiasm to complete the homework and the improvement of psychological distress in depressed people through the course of therapy.

Methods

Working people with subthreshold depression were recruited to participate in the telephone CBT (tCBT) program with demonstrated effectiveness. Their enthusiasm for homework was enhanced with motivational interviewing techniques and was measured by asking two questions: “How strongly do you feel you want to do this homework?” and “How confident do you feel you can actually accomplish this homework?” at the end of each session. The outcome was the K6 score, which was administered at the start of each session. The K6 is an index of psychological distress including depression and anxiety. We used structural equation modeling (SEM) to elucidate the relationships between enthusiasm and the K6 scores from session to session.

Results

The best fitting model suggested that, throughout the course of behavior therapy (BT), enthusiasm to complete the homework was negatively correlated with the K6 scores for the subsequent session, while the K6 score measured at the beginning of the session did not influence the enthusiasm to complete the homeworks assigned for that session.

Conclusions

Empirical data now support the practitioners of BT when they try to enhance their patient’s enthusiasm for homework regardless of the participant’s distress, which then would lead to a reduction in distress in the subsequent week.

Trial Registration Number

ClinicalTrials.gov NCT00885014. April 20, 2009.
Appendix
Available only for authorised users
Literature
1.
Pincus HA, Davis WW, McQueen LE. ‘Subthreshold’ mental disorders. A review and synthesis of studies on minor depression and other ‘brand names’. Br J Psychiatry. 1999;174:288–96.CrossRefPubMed
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
3.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.CrossRef
4.
Preisig M, Merikangas KR, Angst J. Clinical significance and comorbidity of subthreshold depression and anxiety in the community. Acta Psychiatr Scand. 2001;104(2):96–103.CrossRefPubMed
5.
Kessler RC, Zhao S, Blazer DG, Swartz M. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord. 1997;45(1–2):19–30.CrossRefPubMed
6.
Rucci P, Gherardi S, Tansella M, Piccinelli M, Berardi D, Bisoffi G, et al. Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. J Affect Disord. 2003;76(1–3):171–81.CrossRefPubMed
7.
Cuijpers P, de Graaf R, van Dorsselaer S. Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disord. 2004;79(1–3):71–9.CrossRefPubMed
8.
Cuijpers P, Smit F. Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand. 2004;109(5):325–31.CrossRefPubMed
9.
Cuijpers P, Smit F, Oostenbrink J, de Graaf R, Ten Have M, Beekman A. Economic costs of minor depression: a population-based study. Acta Psychiatr Scand. 2007;115(3):229–36.CrossRefPubMed
10.
Barth J, Munder T, Gerger H, Nuesch E, Trelle S, Znoj H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10(5), e1001454.CrossRefPubMedPubMedCentral
11.
Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32.CrossRefPubMedPubMedCentral
12.
Cuijpers P, Smit F, van Straten A. Psychological treatments of subthreshold depression: a meta-analytic review. Acta Psychiatr Scand. 2007;115(6):434–41.CrossRefPubMed
13.
Kazantzis N, Lampropoulos GK, Deane FP. A national survey of practicing psychologists’ use and attitudes toward homework in psychotherapy. J Consult Clin Psychol. 2005;73(4):742.CrossRefPubMed
14.
Kazantzis N, Deane FP, Ronan KR. Homework Assignments in Cognitive and Behavioral Therapy: A Meta‐Analysis. Clin Psychol: Science and Practice. 2000;7(2):189–202.
15.
Helbig S, Fehm L. Problems with homework in CBT: Rare exception or rather frequent? Behav Cogn Psychother. 2004;32(3):291–301.CrossRef
16.
Strunk DR, Brotman MA, DeRubeis RJ. The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains. Behav Res Ther. 2010;48(7):599–606.CrossRefPubMedPubMedCentral
17.
Strunk DR, Brotman MA, DeRubeis RJ, Hollon SD. Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change. J Consult Clin Psychol. 2010;78(3):429.CrossRefPubMedPubMedCentral
18.
Webb CA, DeRubeis RJ, Dimidjian S, Hollon SD, Amsterdam JD, Shelton RC. Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance. J Consult Clin Psychol. 2012;80(3):373.CrossRefPubMedPubMedCentral
19.
Neimeyer RA, Kazantzis N, Kassler DM, Baker KD, Fletcher R. Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cogn Behav Ther. 2008;37(4):199–215.CrossRefPubMed
20.
Detweiler JB, Whisman MA. The role of homework assignments in cognitive therapy for depression: Potential methods for enhancing adherence. Clin Psychol: Science and Practice. 1999;6(3):267–82.
21.
Vanbuskirk K, Wetherell J. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2013.
22.
Persons JB, Burns DD, Perloff JM. Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cognitive Therapy and Research. 1988;12(6):557–75.CrossRef
23.
Burns DD, Spangler DL. Does psychotherapy homework lead to improvements in depression in cognitive–behavioral therapy or does improvement lead to increased homework compliance? J Consult Clin Psychol. 2000;68(1):46.CrossRefPubMed
24.
Startup M, Edmonds J. Compliance with homework assignments in cognitive-behavioral psychotherapy for depression: Relation to outcome and methods of enhancement. Cognitive Therapy and Research. 1994;18(6):567–79.CrossRef
25.
Westra HA, Dozois DJ, Marcus M. Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. J Consult Clin Psychol. 2007;75(3):363.CrossRefPubMed
26.
Coon DW, Thompson LW. The relationship between homework compliance and treatment outcomes among older adult outpatients with mild-to-moderate depression. Am J Geriatric Psych. 2003;11(1):53–61.CrossRef
27.
Rees CS, McEvoy P, Nathan PR. Relationship between homework completion and outcome in cognitive behaviour therapy. Cogn Behav Ther. 2005;34(4):242–7.CrossRefPubMed
28.
Furukawa TA, Horikoshi M, Kawakami N, Kadota M, Sasaki M, Sekiya Y, et al. Telephone Cognitive-Behavioral Therapy for Subthreshold Depression and Presenteeism in Workplace: A Randomized Controlled Trial. PLoS One. 2012;7(4):e35330.CrossRefPubMedPubMedCentral
29.
Beck A, Steer R, Brown G. BDI II. Beck depression inventory manual for the 2nd edition. New York: The Psychological Corporation/Harcourt Brace; 1996.
30.
Kessler RC, Üstün TB. The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121.CrossRefPubMed
31.
Bland JM, Altman DG. Cronbach’s alpha. BMJ (Clinical research ed). 1997;314(7080):572.CrossRef
32.
Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76.CrossRefPubMed
33.
Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, et al. The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res. 2008;17(3):152–8.CrossRefPubMed
34.
Simon G, Ludman E, Tutty S. Creating a Balance: A Step-by-Step Approach to Managing Stress and Lifting Your Mood. Victoria. British Columbia, Canada: Trafford Publishing; 2006.
35.
Lewinsohn PM, Antonuccio D, Steinmetz J, Teri L. The coping with depression course: A psychoeducational intervention for unipolar depression. Castalia Eugene, OR; 1984.
36.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
37.
Ullman JB, Bentler PM. Structural equation modeling. Handbook of Psychology, Second Edition. 2001.
38.
Hu L-t, Bentler PM. Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychol Methods. 1998;3(4):424.CrossRef
39.
Iacobucci D. Structural equations modeling: Fit indices, sample size, and advanced topics. J Consumer Psychol. 2010;20(1):90–8.CrossRef
Metadata
Title
Enthusiasm for homework and improvement of psychological distress in subthreshold depression during behavior therapy: secondary analysis of data from a randomized controlled trial
Authors
Y. Hayasaka
T. A. Furukawa
T. Sozu
H. Imai
N. Kawakami
M. Horikoshi
On behalf of the GENKI Project
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0687-3

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