Studies have shown that homework completion and accuracy predict favorable outcomes in psychotherapy and may help patients stay in remission.
[6][7] However, some therapists are concerned that assigning homework makes therapy too formal and reduces the impact of the individual sessions.
[17] Jane has social anxiety disorder and was just told at work that she would be giving a presentation in front of an audience of 200 people the following week.
This produces a large amount of anxiety for Jane, and she starts filling out a thought record to try to calm herself down.
To begin, she fills in the column about the situation she is in with: "I was told that I am going to give a speech in front of a large audience next week."
She then starts identifying some thoughts that immediately ran through her head when she heard that she would be giving the presentation: "Oh no, I'm going to mess up and choke.
After that, Jane starts writing in the next column the pieces of evidence that support the hot thought: "I've done terribly on presentations in the past.
Jane jots down in the next column pieces of evidence against her hot thought: "I think my boss might have meant well when he gave me this presentation assignment.
In the next column, Jane writes down her alternative thought: "The presentation ahead may be scary and making me feel anxious, but I think I can handle it as long as I know that there are people who support me."
Both the quality and quantity of thought records completed during therapy have been found to be predictive of treatment outcomes for patients with depression and/or an anxiety disorder.
[5] Patients with panic disorder tend to interpret normal bodily sensations as signs of impending catastrophe.
A therapist who identifies this maladaptive thought can then work with the patient to test the belief with a behavioral experiment.
After some initial apprehension, the patient may agree with the experiment and start breathing in a hyperventilating pattern while the therapist watches.
Since the patient with panic disorder most likely will not have a heart attack while hyperventilating, he will be less likely to believe in the original thought, even though he may have been scared of testing the belief at first.
Specifically, this study tested participants who endorsed the commonly held belief, "If I don't wash my hands after going to the restroom, I'll get sick.
[22] The researchers found that, compared to a no-treatment control, both thought records and behavioral experiments were effective in reducing the belief that not washing one's hands after going to the toilet would make oneself ill.
Since the sample being studied was drawn from a normal population (as opposed to the population of individuals seeking treatment for psychological disorders), this lack of an effect on behavior may be due to the possibility that the people being studied were not under any motivation to actually change their behavior.
[23] To test these possibilities, Burns and Spengler (2000) used structural equation modeling to estimate the causal relations between homework compliance and depressive symptomatology before and after psychotherapy.
[25] The types of homework used in psychotherapy are not limited to thought records and behavioral experiments, which tend to be relatively structured in their implementation.
[26] 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, either.