Engagement with homework in an Internet-delivered therapy predicts reduced anxiety and depression symptoms: a latent growth curve analysis

Ram P. Sapkota, Vanessa Peynenburg, Blake F. Dear, Nickolai Titov, Heather D. Hadjistavropoulos*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    4 Citations (Scopus)

    Abstract

    Objective: Assigning homework to patients to facilitate skill development is an essential part of internet-delivered cognitive behavior therapy (ICBT). This study examined if patients’ self-ratings of homework engagement, including conceptual (e.g., understandability, difficulty, perceived usefulness) and practical (e.g., effort put into reviewing the lessons, practicing skills, continuity in use of the learned skills) engagement predicts ICBT outcomes for anxiety and depression using a subsample of data from a previously published randomized controlled trial. Method: Three hundred and one adult patients (74.56% female; 91.29% Caucasians; Mage = 36.33) randomly assigned to complete Homework Reflection Questionnaires (HWRQ) were included in this study. Patients completed the Patient Health Questionnaire (PHQ-9) and generalized anxiety disorder (GAD-7) at pretreatment, midtreatment (4 weeks), posttreatment (8 weeks), and at follow-up (12 weeks).HWRQ related to each of five lessons were completed at the beginning of the subsequent lessons or at posttreatment (e.g., Lesson 1HWRQ completed at start of Lesson 2). Latent growth curve modeling was used to test the effect of engagement with homework activities in reduction of anxiety and depression symptoms over time. Results: Patient-rated homework engagement significantly predicted rate of change in depression and anxiety symptom severity but was not significantly associated with initial levels of either outcome. Patients who reported higher engagement with assigned homework activities achieved more symptom reduction over treatment and follow-up at 12 weeks. Conclusion: The findings provide evidence of the importance of patients’ self-rated engagement with homework in ICBT as well psychometric evidence supporting use of homework ratings to assess engagement. Further studies are needed to replicate the association between homework engagement and reduction in anxiety and depression symptoms.

    Original languageEnglish
    Pages (from-to)112–117
    Number of pages6
    JournalJournal of consulting and clinical psychology
    Volume91
    Issue number2
    Early online date17 Nov 2022
    DOIs
    Publication statusPublished - Feb 2023

    Keywords

    • adherence
    • cognitive behaviour therapy
    • depression
    • homework
    • internet-delivered

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