Lecture 9 homework in cbt

CBT comparative
Kevin Standish

 Explore the benefits of counselling clients
undertaking Behavioural Tasks / Homework
 Examining the role of Behavioural Tasks /
Homework
 Describe the skills in employing Behavioural
Tasks / Homework
 Practice the skills of employing Behavioural
Tasks / Homework

1. Brief update and mood check
2. Bridge from previous session
3. Collaborative setting of the agenda
4. Review of homework
5. Main agenda items and periodic summaries
6. Setting new homework
7. Summary and feedback

 BRIEF UPDATE AND MOOD CHECK: Very
often includes measures such as Beck
Depression Inventory (BDI). Some clients
may feel discomfort with measures but many
will feel pleased that you are taking their
symptoms seriously. It is best to regard
measures as self-reports subject to some
transference effects. Discuss client
reservations about them and amend use
accordingly.

 BRIDGING: Ask if client has any memories or
issues with the last session. Usually keep brief.
 AGENDA-SETTING: Work collaboratively:
get client’s ideas but also be prepared to put
forward ideas yourself. Can use agenda to
prioritise and manage time - for example, to
ensure time is spent both on current symptoms
and on more historical and developmental
material.

 REVIEW OF HOMEWORK: Don’t forget to do
this, as forgetting may reduce client’s motivation
to do further tasks. May be helpful for client to
keep homework in a ‘therapy notebook’.
 MAIN AGENDA ITEMS: Some trainees feel like
they are being ‘directive’ by encouraging clients
to stick to an agenda of items. This may
occasionally be true but check out with clients.
Padesky & Mooney (1998) suggest that there may
be subtle ‘therapist beliefs’ – ‘If I structure the
session, the client will experience me as a bully’,
etc.!

 SETTING NEW HOMEWORK: Try to keep it
simple and doable. Ask the client, ‘Can you see
the purpose of it?’ and ‘What might stop you
doing it?’ Try to set NO-LOSE tasks.
 FEEDBACK: Try to find out what has worked
and been learnt and what hasn’t. You need the
negative feedback as well as the positive in
order to keep the therapy on track

 Homework is recognised as a core mechanism
to promote change in cognitive behavioural
therapy.
 Weekly tasks set by the therapist provide
valuable opportunities for the client to put into
practice the different tools, skills and
techniques they have learned
 provides an excellent means of helping the
therapist to know whether such skills have
been fully understood.

 1. Classical Conditioning
 2. Operant Conditioning
 3. Generalization of Learning
 4. Shaping and maintaining changes
 Read Chapter 2 Kazantzis, Frank P. Deane,
Kevin R. Ronan and Luciano L'Abate. (2005)
Using Homework Assignments in Cognitive
Behavior Therapy (in google books)

 one cannot easily apply CBT tools when sat inside
the clinic or therapy room so it is only through
homework undertaken outside of the therapy
setting that one can apply such skills to real life.
 The idea is that at the end of therapy the patient is
able to carry on using the tools and thus become
their own therapist
 so if homework has not been a regular feature of
therapy it is highly unlikely that the patient will
continue to find CBT effective following cessation
of treatment sessions

 Homework has been viewed as a key ingredient of cognitive
therapy since its inception, and most of the research has
examined the relationships between homework completion
and therapy outcome.
 In an authoritative meta-analytic review of the literature,
Kazantzis, Whittington, and Dattilio (2010) report that the
use of homework assignments improves treatment outcome
and address a number of conceptual issues in research on
homework effects.

 Rees et al (2005) Relationship Between Homework
Completion and Outcome in Cognitive Behaviour
Therapy found that quantity and the 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.

 Fehm & Mrose (2008) researched patients
perspectives on homework and found the patients
generally had a positive attitude towards
homework and that they accomplished most of the
tasks. Results show that the vast majority of
 patients view homework positively,
 they are clearly aware of the beneficial function of
homework assignments.
 The term ‘homework’, considered problematic by
many practitioners, is accepted by the vast
majority study.
 The high rate of homework completion supports
the generally positive attitude towards homework

 As homework is central to CBT, time must be
allocated to setting them up, 5 to 10 min at the
end of the session
 Homework will often follow on directly from
major topics that have been part of the
discussion in the session
 The range of homework is boundless
 It relies on ingenuity of you and your client in
setting up suitable assignments in a
collaborative manner

 It include can include some of the following:
 Reading relevant material
 Listening to treatment tapes
 Practising new skills
 Doing a historical review of the past
 It is important that it makes sense to the client
and will be useful for subsequent treatment
sessions of a particular goal

 thought records (to help identify thinking errors and
the link between thought and behaviour), journaling
(to record/review learning outcomes),
 experiments (for example as part of a graded
exposure approach),
 surveys (to discover if others believe or the same in
specific circumstances)
 timetabling (planning time for rest, work and leisure
each day).
 Therapy homework needs to be clearly explained prior
to the end of the session and then thoroughly reviewed
during the following (ideally at the beginning) session.


 The very word or mention of homework can result in many adults
having a total mental block as it tends to bring back memories of
school. But the research shows homework is not seen as negative.

 It is absolutely crucial therefore that the therapist especially at the
beginning of therapy as well as regularly throughout treatment
highlights the key reasons why it is so effective and crucial
to CBT.
 Rather than using the word 'homework' — which may carry
negative associations — use a term like 'task' or 'practice exercise.'
 Leahy (2006) recommends the following approaches to
overcoming non-compliance:
making tasks very specific,
written instructions,
be consistent
praise the effort of undertaking each task.

 Homework should follow logically from what
happened during the session
 The assignment should be relevant to the goals set
 Bear in mind that your client has a life outside of
therapy
 It should be planned in detail
 Make sure that homework cannot be failed
 Provide relevant resources such as diaries and
reading material and should be written down
 Homework review should always be included in
the next session. Non-completion of homework
should be discussed and explore.

 http://cbt-
cognitivebehaviouraltherapy.co.uk/why-is-
homework-important-in-cbt/

 Leahy, R. (2006) Roadblocks in CBT New York:
Guilford Press.
 Kazantzis, Frank P. Deane, Kevin R. Ronan and
Luciano L'Abate. (2005) Using Homework
Assignments in Cognitive Behavior Therapy
 Chap 1 & 2 (in Google books)

Lecture 9 homework in cbt

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