Abstract
BackgroundCognitive 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.MethodsWorking 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.ResultsThe 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.ConclusionsEmpirical 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 NumberClinicalTrials.gov NCT00885014. April 20, 2009.
Highlights
Cognitive behavioral therapy (CBT) usually involves homework, the completion of which is a known predictor of a positive outcome
It has been increasingly recognized that subthreshold depression is highly prevalent in the general population [5] and in the primary care [6], is clinically relevant because it significantly affects the quality of life and functioning of the sufferers [7] and carries a high risk of developing major depressive disorder [8], and is societally important because it is associated with high economic costs [9]
Summarized briefly, the study involved an randomized controlled trials (RCTs) to compare the effectiveness of telephone CBT (tCBT) in addition to an Employee Assistance Program (EAP) and EAP alone for the treatment of subthreshold depression among workers at a large manufacturing company in Japan
Summary
Cognitive behavioral therapy (CBT) usually involves homework, the completion of which is a known predictor of a positive outcome. Subthreshold depression, sometimes called subsyndromal depression or minor depression, refers to a depressive state that does not meet the full diagnostic criteria for major depressive disorder (MDD) [1]. It would be classified as Depressive Disorder Not Otherwise Specified in DSM-IV [2] or Other Specified Depressive Disorder in DSM-5 [3]. Homework is usually assigned in every session of CBT, asking patients to practice newly learned cognitive or behavioral skills and to generalise such skills to their daily situations in which their problems occur [13]. Homework has been shown to facilitate improvement in depression, anxiety or other client problems through CBT [14] but patients often find it difficult to complete the homework [15,16,17,18,19]
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