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    Increasing homework compliance by using the guiding model for practice : an analogue study : a thesis presented in partial fulfilment of the requirements for the Master of Arts at Massey University, Albany
    (Massey University, 2008) Connolly, Anna
    Homework assignments are considered a fundamental component of Cognitive Behavioural Therapy and are believed to be significant in assisting to produce and maintain treatment gains. However, gaining clients compliance to homework tasks remains a significant challenge. An analogue study of a single session relaxation intervention was conducted to test the guiding model for practice (Kazantzis, MacEwan & Dattilio, 2005); designed to provide therapists with a step-by-step guide of how to systematically administer homework in therapy. Forty four participants were randomly assigned to one of two conditions. The systematic condition (n = 21) was designed to administer homework following the guiding model, while the non-systematic condition (n = 23) followed standard therapy practice. Hypotheses posited that participants in the systematic group would display greater levels of engagement in homework; would have more positive beliefs in completing the homework; that greater adherence to the homework would correlate positively with reductions in anxiety; and that the systematic group would show a greater reduction in anxiety. In relation to engagement in homework the results found a statistically significant difference in the mean ranks of homework compliance between the two groups. The Mann-Whitney U result was 182 (z = -1.48) with an associated probability of .14, showing that participants in the systematic group did have higher levels of homework compliance. A MANOVA calculation was used to assess the systematic group for more positive beliefs in completing homework. The results found significant differences in two of the four Homework Rating Scale II (HRS) subscales; behaviour: F(1, 42) = 1.83, p = .184, partial eta squared - .042; and consequences/synthesis: F(1, 42) = 2.93, p = .094, partial eta squared = .065. The other two subscales of the HRS; beliefs and situation, were not administered differently between groups, providing further support for the difference of homework administration. Partial support was found for correlations between homework practice and anxiety. While three of the four correlations were significant, it was found that state anxiety actually increased as practice increased, however, trait anxiety was found to reduce as homework levels increased. No significant group differences were found in anxiety reduction. Implications of these findings are discussed.
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    The relationship between case conceptualization and homework in cognitive behavioural therapy (CBT) for depression : a thesis in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2010) Easden, Michael Haig
    Comprehensive case conceptualization is central to Cognitive Behavioural Therapy (CBT; A. T. Beck, Rush, Shaw, & Emery, 1979). Despite the importance attributed to case conceptualization there is limited empirical support for the utility of case conceptualization in CBT. In particular, there is limited research on the relationship between therapist competence in case conceptualization, in-session and between session treatment planning (i.e., homework), and outcomes. Furthermore, little is known about the evolution of case conceptualization over a course of CBT. In order to facilitate the empirical investigation of case conceptualization in CBT the primary aim of the current thesis was to develop a new method for evaluating case conceptualization, the Conceptualization Rating Scale (CRS; Easden & Kazantzis, 2008; 2009). Study 1 investigated how patients’ (n =10) written case conceptualizations change over a course of CBT for depression using 53 J. Beck Case Conceptualization Diagrams (J. Beck, 1995). Therapist’s resultant case conceptualizations became more complete over the course of therapy with an average of 33% more information being recorded in case conceptualizations from intake to session 10. Consistent with cognitive-behavioural theory, therapists tended to conceptualize core beliefs about the ‘self’ with relatively minimal reporting of beliefs about the ‘world / others’ and the ‘future’. Study 2 provided the training, development and preliminary psychometrics of the CRS. Independent observers (N = 4) rated 225 DVD recorded therapy sessions. The CRS was demonstrated to possess adequate internal consistency (α = .61) and excellent total scale interrater reliability for each of the four domains integration (k = .83), importance (k = .65), competence (ICC = .93), and fit / match (ICC = .86). Results revealed that independent observers were able to agree on different aspects of CBT therapist’s utilization of case conceptualizations during therapy sessions. In Study 3, using the total sample of 28 patients, therapist’s (N = 7) levels of competence were assessed by independent observers (N = 4) using the CRS based on 225 DVD recorded therapy sessions. A multilevel modelling (MLM) analysis revealed that after controlling for time, taken together, therapist competence in homework use and therapist competence in case conceptualization explained 40% of within patient variance and 19% of between patient variance associated with positive change on the BDI-II after controlling for patient beliefs about homework, symptom severity and personality beliefs. The results from each study contribute towards an understanding of the relationship between different domains of therapist competence and outcomes in psychotherapy. More specifically, empirical support is provided for the utility and systematic integration of case conceptualization in CBT for depression. Implications are discussed for supervision, training and clinical practice in CBT to ensure positive patient outcomes and evidenced-based interventions in CBT.
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    The impact of attributional style and homework experiences in Cognitive Behaviour Therapy for depression : a longitudinal investigation employing multilevel analysis : a dissertation presented in partial fulfillment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2010) Sachsenweger, Mieke
    This longitudinal study aimed to investigate the moderating effects of attributional style on the relationship between homework experiences and depression severity throughout the course of therapy. Through an overarching depression study at Massey University, 28 participants experiencing first-episode Major Depressive Disorder (MDD) were recruited for 20 sessions of Cognitive Behaviour Therapy (CBT) plus follow-up sessions at two months. Clients were seen by seven doctoral students, and depression severity was monitored with the Beck Depression Inventory II (BDI-II) at each session, while attributional style was measured at six time points with the Attributional Style Questionnaire (ASQ). Homework was measured with the Homework Rating Scale II (HRS-II) at each session by clients, therapists and independent observers. A three-factor structure of the HRS-II was confirmed with the current data: 'benefits and completion'; 'costs and completion' and client 'beliefs'. Following preliminary analyses, benefits of homework completion was retained as the focus in a multilevel analysis investigation which utilised sessions up to the two month follow up. Therapist competence in assigning homework, and client depression severity, gender, and age were controlled for. No overall effect was found for homework in relation to depression over the course of therapy, and therefore attributional style did not moderate this relationship. However there was a trend towards a relationship between quantity and quality of homework and depression, which was moderated by a pessimistic attributional style. No effect was found for homework in relation to attributional style independently of depression severity. Attributional style on its own was related to depression severity over the course of therapy, as predicted. Women were significantly more depressed and less optimistic at intake than men, and older age correlated with lower pessimism and depression levels. Implications for future research and clinical practice are discussed.