Homework in psychotherapy

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Homework in psychotherapy is sometimes assigned to patients as part of their care. In this context, homework is introduced to train the skills taught in therapy, encouraging patients to apply the skills they learn in therapy to real life situations, and to correct the specific problems faced in the treatment. For example, a patient with a deficit in social skills can learn and practice appropriate social skills in one treatment session, then be asked to complete homework before the next session that applies a newly learned skill (for example, going to a social engagement or greeting five people every day).

Homework is most often used in cognitive behavioral therapy (CBT) for the treatment of mood disorders and anxiety, although other theoretical frameworks can also incorporate homework. Some types of homework used in CBT include notes of thought and behavioral experiments. Patients who use mind notes are instructed to write negative cognitions on the form of the mind record and weigh the evidence both for and against negative thoughts, with the aim to come up with new, balanced thinking in the process. Behavioral experiments are used as homework to help patients test their thoughts and beliefs directly. Research has shown that completion of homework and accuracy predict beneficial outcomes in psychotherapy and can help patients remain in remission. However, some therapists worry that providing homework makes the therapy too formal and reduces the impact of individual sessions.

Video Homework in psychotherapy

Approach

Much of the published literature on homework in psychotherapy to date focuses on the use of homework during CBT, which involves changing the mind and behavior of patients to reduce the symptoms of mental disorders they suffer. Various homework is on CBT. These tasks can range from scheduling daily exercise routines to practicing progressive muscle relaxation five times a day to monitor and record a person's negative negative thoughts throughout the day. In practice, this homework assignment is intended to help patients elevate their moods, practice and master the skills they develop in therapy, and progressively increase between treatments. Research has found that homework compliance is positively predicting successful outcomes in therapy, and therapists are now looking for better ways to do homework, so that more individuals can benefit.

CBT is not the only type of therapy to combine homework. Although each therapist makes his or her own choice of homework, some other therapies that can provide homework include exposure therapy, psychodynamic therapy, and problem-solving therapy. Homework can also be provided even if the therapist is not physically present with the treated patient. Such cases include therapy delivered by telephone, via video, or via the Internet. Treatment of some disorders, such as severe depression, can also be done without a therapist at all. Although the efficacy of self-help care is under surveillance, preliminary data suggest that completion of homework is one of the factors predicting positive treatment outcomes for patients receiving treatment over the Internet.

Maps Homework in psychotherapy

Thinking notes

Thinker notes (or mind diaries) are among the most common cognitive tasks used in CBT. They enable patients in various situations to thoroughly examine "hot thoughts" and cognitive distortions and, after doing so, arrive at newly synthesized alternative ideas that are closer to the situation. Many thought notes accomplish this task by asking for a list of patients on a regular basis: the situation they face; the emotions they feel and with the intensity of what they feel; what thoughts they have and what is meant by the "hot mind"; proof for hot thought; evidence against "hot thinking"; balanced alternative mind; and the emotion they feel after completing the thought note and the intensity of the emotion.

Example

Jane has social anxiety disorder and is only told at work that she will give presentations in front of an audience of 200 people the following week. This results in great anxiety for Jane, and she begins to fill in a mental note to try to calm herself. To begin, he filled out a column about the situation he was facing: "I was told I would give a speech in front of many audiences next week." In the next column, Jane writes what emotion she feels and with what intensity she feels: "Anxiety - 100. Fear - 90. Sad - 40." He then begins to identify some thoughts that immediately flow in his head when he hears that he will give a presentation: "Oh no, I will screw up and choke.All people will laugh at me.my boss will fire me.I will never be able to keep a job on I am worthless and failing. "Jane identifies" I'm worthless and failing "as a hot, most thought-provoking negative emotion in her situation.

After that, Jane starts writing in the next column pieces of evidence that support the thought of heat: "I have done a very bad presentation in the past, I remember sometime in high school when I had to give a speech in front of my class and I ended up crying in front of everyone I got a C on the speech and scarcely scratched in the class My high school friends and I did not say much anymore They were getting bored with me too, my co-worker did not try to talk to me either. "Jane wrote in a subsequent piece of evidence to her hot mind:" I thought my boss might be well-meaning when he gave me this presentation assignment.I did one of these presentations on a smaller scale last week and I thought I was just doing Good. Almost everyone who was there even came to me and told me afterwards.I think the audience was concerned den gan me and will be willing to support me if I ask. Also, I fill this notion of thought just as my therapist says. I think that's what he wants from me. "

In the next column, Jane writes her alternative thinking: "Presentation up front may be frightening and make me feel anxious, but I think I can handle it as long as I know that there are people who support me." After that, Jane writes the emotion she now feels and the intensity: "Anxiety - 50. Fear - 40. Sad - 10. Lega - 50."

Benefits

Both the quality and quantity of thought notes completed during therapy have been found to predict treatment outcomes for patients with depression and/or anxiety disorders. Next, Rees, McEvoy, & amp; Nathan (2005) found that mid-treatment patients' midterm care accuracy ratings correlated positively with post-treatment outcomes, and that doing homework in CBT as a whole was better than not doing homework in CBT. Accomplishing the notes accurately can also be an indication of overall acquisition of skills in care; Neimeyer and Feixas (1990) found that patients with depression who completed thought records were accurately less likely to recur six months after treatment interruption. The researchers hypothesize that this is because patients who complete accurate thinking records have acquired the skills taught in CBT, and that these skills serve as valuable coping strategies when patients are confronted with future stress and need to act as their own therapists.

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Behavioral experiments

Behavioral experiments are collaborative efforts in which therapists and patients work together to identify potential negative or dangerous beliefs, then to confirm or disprove them by designing experiments that test convictions. Like mind notes, they are most commonly used in CBT.

Example

Patients with panic disorder tend to interpret normal body sensations as signs of impending disaster. A person with panic disorder then believes that hyperventilation is a sign of an impending heart attack. A therapist who identifies this maladaptive thinking can then work with the patient to test his beliefs with behavioral experiments. To begin, the therapist and patient will agree to perform the test. In this case, it might be something like, "When I start hyperventilating, I'll have a heart attack."

Then, the therapist may start giving advice on how to test the belief. He might suggest, "Why do not you try hyperventilation into this plastic bag? If you show signs of having a heart attack, I have coached CPR and I will be able to help you while waiting for the authorities." After some initial fears, the patient may agree with the experiment and start breathing into the plastic bag while the therapist watches. Since a patient with a panic disorder is unlikely to have a heart attack during hyperventilation, he will be less likely to believe in early thinking, although he may be afraid of testing his belief initially.

Benefits

With regard to the notes of thought, behavioral experiments are considered to be better at changing individual beliefs and behaviors. To test this hypothesis, the investigators conducted an experiment comparing confidence levels and behavioral changes in participants who were given either a mind record or behavioral experimental intervention. In particular, the study tested participants who validated the commonly held belief, "If I do not wash my hands after going to the bathroom, I will be sick." Participants in mind-record conditions are notified of "normal" notes as described in the "Mind Record" section of this article and asked to come up with evidence for and against the following beliefs: "Not washing your hands after going to the toilet will make you sick." After this, they are asked to reflect on their own experiences of washing or not washing their hands after going to the toilet and to come up with a balanced alternative belief.

Under conditions of behavioral experimentation, participants worked with experiments to come up with research to test the validity of the same beliefs used in mind record conditions. For example, one study may involve making the participant void without washing his hands afterwards to see if he or she will fall ill. Participants are encouraged to concretely determine how he will say whether he is sick or not (eg, checking for fever, cough, pain, or other common symptoms of the disease) and to test his overall beliefs as possible (eg, if participants believe he is more likely to get sick after touching the toilet and not washing his hands, he is encouraged to test this hypothesis too).

The researchers found that, compared to non-treatment controls, thought records and behavioral experiments were effective in reducing the belief that not washing hands after going to the toilet would make him sick. However, behavioral experiments were found to be able to change individual beliefs immediately after the intervention, while thought records show the ability to change confidence only on follow-up one week after the intervention. On the other hand, the researchers found that neither the notes of thought nor behavioral experiments were effective in reducing how often a person actually washed their hands after using the toilet, even if they no longer believed they would be sick for not washing their hands. Since the samples under study were drawn from normal populations (compared to the individual population seeking treatment for psychological disorders), the lack of effect on these behaviors may be due to the possibility that the people being researched have no motivation to actually change their behavior.

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Issues and uncertainties

Homework is generally associated with improving patient outcomes, but it is uncertain what other factors can moderate or mediate the effects that PR has on how many patients improve. That is, some researchers have hypothesized that patients who are more motivated to complete homework are also more likely to improve; other researchers have suggested that only individuals with less severe psychopathology are even able to complete homework, so that would be effective only for a small percentage of individuals. To test this possibility, Burns and Spengler (2000) used structural equation modeling to estimate the causal relationship between homework compliance and the symptomatology of depression before and after psychotherapy. The researchers found that "the data are consistent with the hypothesis that HW compliance has a causal effect on changes in depression, and the magnitude of this effect is large" (p 46). However, there may be factors that improve home work compliance during therapy, such as the competence of general therapists and therapists' review of homework completed since the previous session.

The type of homework used in psychotherapy is not limited to the notes of thought and behavioral experimentation, which tend to be relatively structured in its implementation. In fact, although researchers have found that psychotherapy with homework is generally more effective than psychotherapy without homework, there has not been much effort to do research if certain types of homework are better at influencing positive treatment outcomes than others, or if certain environments help promote the positive effects of homework. For example, Helbig-Lang and colleagues found that, in an environment where systematic home-work procedures were rare but where overall household occupational compliance remained high, homework compliance was not positively associated with care outcomes. Another group of researchers looked at patients with depression who were in remission and undergoing maintenance therapy and found that homework compliance did not correlate with treatment outcomes in this sample. Further research can help explain the relationship between the types of homework used in psychotherapy, the environment in which they are included, and the outcomes of treatment for patients with a variety of homework assignments.

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Future direction

Both doctors and patients have difficulty in combining and complying with home care procedures through care. Factors that have been found related to home work compliance during treatment include having the therapist set concrete goals for completing homework and engaging the patient in discussions around assigned home work. If homework compliance is as important as the results of treatment as suggested by most studies, however, then there is room for improvement and future studies can focus on how to improve compliance more effectively.

Like the psychotherapy in which they are included, homework may not be effective in helping all people with different types of psychological disorders. It is therefore important to research for the disorder and where the general situation of homework will improve therapy. It will be as if helping patients treated for psychological disorders receive more individualized care and support, and hopefully improve overall treatment outcomes for all disorders.

An example of a particular situation where homework can help is the mitigation of safety seeking behaviors with behavioral experiments. Security seeking behavior is done by individuals to prevent future anticipated catastrophes, but may end up becoming more dangerous for these individuals over the long term. For example, a patient with panic disorder may avoid exercising because he believes that heavy breathing will make him experience panic attacks. Because it seems to be a preventive function of safety seeking behavior, those who carry out this behavior are unlikely to test their true effectiveness in preventing catastrophe. Thus, designing behavioral experiments in therapy to test this behavior has the potential to be a useful tool for reducing its appearance.

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See also

• Cognitive Restructuring

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References

Source of the article : Wikipedia