Article2022

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

Ram P. Sapkota · Vanessa A. Peynenburg · Blake Farran Dear · Nickolai Titov · Heather D. Hadjistavropoulos

13 citations0/0 files storedJournal of Consulting and Clinical Psychology

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Digital Mental Health Interventions Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications

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: = 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 1 HWRQ 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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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2024Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking 2024AI-enabled conversational agent increases engagement with cognitive-behavioral therapy: A randomized controlled trial 2024Evaluation of additional resources used in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy 2025Feasibility trial of an unguided ultra-brief online psychological intervention within an online mental health clinic: The “things you do” intervention 2025Exploring the utility of transdiagnostic internet-delivered cognitive behavioral therapy for symptoms of adjustment disorder: A longitudinal observational study in a routine online care setting in Western Canada 2025Adaptive actions as a mechanism of change in transdiagnostic internet-delivered cognitive behavioral therapy: Comparison with homework engagement

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