Action recommendations review in community-based therapy and depression and anxiety outcomes: a machine learning approach.

BACKGROUND: While the positive impact of homework completion on symptom alleviation is well-established, the pivotal role of therapists in reviewing these assignments has been under-investigated. This study examined therapists' practice of assigning and reviewing action recommendations in therapy sessions, and how it correlates with patients' depression and anxiety outcomes. METHODS: We analyzed 2,444 therapy sessions from community-based behavioral health programs. Machine learning models and natural language processing techniques were deployed to discern action recommendations and their subsequent reviews. The extent of the review was quantified by measuring the proportion of session dialogues reviewing action recommendations, a metric we refer to as "review percentage". Using Generalized Estimating Equations modeling, we evaluated the correlation between this metric and changes in clients' depression and anxiety scores. RESULTS: Our models achieved 76% precision in capturing action recommendations and 71.1% in reviewing them. Using these models, we found that therapists typically provided clients with one to eight action recommendations per session to engage in outside therapy. However, only half of the sessions included a review of previously assigned action recommendations. We identified a significant interaction between the initial depression score and the review percentage (p = 0.045). When adjusting for this relationship, the review percentage was positively and significantly associated with a reduction in depression score (p = 0.032). This suggests that more frequent review of action recommendations in therapy relates to greater improvement in depression symptoms. Further analyses highlighted this association for mild depression (p = 0.024), but not for anxiety or moderate to severe depression. CONCLUSIONS: An observed positive association exists between therapists' review of previous sessions' action recommendations and improved treatment outcomes among clients with mild depression, highlighting the possible advantages of consistently revisiting therapeutic homework in real-world therapy settings. Results underscore the importance of developing effective strategies to help therapists maintain continuity between therapy sessions, potentially enhancing the impact of therapy.

Metacognitive therapy for generalized anxiety disorders in group: A case study.

OBJECTIVES: In Metacognitive therapy (MCT), homework is used, for example, to increase awareness of thoughts and thought processes, to challenge metacognitive beliefs in real-life situations, and to practice new ways of processing thoughts, feelings, and symptoms. All MCT treatment manuals include homework assignments to be given between each session. METHOD: The following study provides a detailed description of the implementation of homework in a group-based MCT treatment for generalized anxiety disorder (GAD) at an outpatient clinic in Norway. The treatment described in this case consisted of 10 weekly group sessions (7 patients) lasting two hours. RESULTS: This case study demonstrates that group-based MCT can be used to treat GAD and describes how the use of homework can facilitate therapeutic change. CONCLUSION: Overall, the effectiveness of MCT was found to be high. Homework gives patients the opportunity to take charge of their therapy and develop a sense of responsibility for their own progress, both during and after treatment.

Homework as a driver of change in psychotherapy.

BACKGROUND AND OBJECTIVES: The utilization of Between-Session Homework (BSH) holds a longstanding tradition in the field of psychotherapy. Significantly, it serves as a pivotal catalyst for change within behavioral and cognitive-behavioral therapies, and has also garnered endorsement within psychodynamic and humanistic-experiential therapies. While our current conceptualization of BSH is characterized by assimilation and integration, diversity prevails in how BSH is incorporated into the treatment plan, spanning various therapy stages, thus necessitating a customized therapist-client interpersonal dynamic. Far from being a panacea, the employment of BSH emerges as a highly sophisticated and intricate clinical methodology, demanding a high degree of therapist proficiency and competence to facilitate client engagement. METHODS: In this introductory paper, we present an issue of the Journal of Clinical Psychology: In Session that exemplifies the diverse modalities through which BSH can be integrated into clinical practice across various client demographics and within distinct psychotherapeutic paradigms. We place specific emphasis on the pivotal role of BSH and its interplay with proposed mechanisms of change throughout the course of treatment. RESULTS: Initially, we provide an overarching view of the subject and expound on empirical research substantiating the efficacy of BSH in psychotherapy. Subsequently, we delve into strategies for adeptly integrating and monitoring BSH within clinical practice. CONCLUSIONS: Our primary objectives encompass affording readers a more lucid comprehension of (1) the content and nature of homework; (2) the influence of BSH on treatment outcomes; and (3) the ways through which therapists can foster client engagement with BSH. Finally, we introduce the six papers comprising this issue.

Promoting skill use in skill enhanced cognitive behavioral therapy: A case example.

Cognitive behavioral therapy (CBT) appears to achieve its effects at least in part by fostering the development of CBT skills. In an effort to leverage CBT skill development, our group developed and tested a skill-enhanced version of CBT (CBT-SE) in a recent trial. In this paper, we describe our work with a client who participated in a 12-week course of CBT-SE as part of that trial. Although homework is a critical aspect of CBT, the greater emphasis on skill development in CBT-SE means that homework is even more central. This client's course of treatment illustrates the potential benefits of a strong focus on skill development and the use of specific homework assignments to foster mastery and ongoing use of CBT skills. The client developed CBT skills at a rapid pace early in treatment and exhibited enduring symptom reductions. The experience of this client reinforces the value of a focus on CBT skills and highlights strategies for fostering skill development. Given the evidence in support of the therapeutic value of CBT skills and the well-established benefits of homework assignment, we encourage use of skill enhancing procedures, including in-session procedures and assignments that help clients develop and maintain ongoing skill use.

The use of homework in emotion-focused therapy for depression.

Emotion-focused therapy (EFT) is an empirically supported treatment of depression, and an integrative, transdiagnostic therapy approach focusing on transforming emotions that are the cause of a person's emotional pain and suffering. In-session experiential work and two-chair interventions are consolidated and expanded by between-session homework which is viewed as a natural extension of in-session work. As the focus on emotion in EFT necessitates the provision of a safe, attuned, empathic relationship and a good collaboration on the tasks and goals of therapy the use of homework is very well-suited to this approach. An EFT case example is discussed to illustrate how homework can be an important ingredient to strengthen and facilitate change in treating a depressed client with a core underlying feeling of shame related to unresolved childhood trauma.

The role of between-session homework in cognitive-behavioral therapy for comorbid obsessive-compulsive disorder and autism: A case vignette.

OBJECTIVE: Cognitive-behavioral therapy (CBT), which includes a decided emphasis on exposure and response/ritual prevention (ERP) and between-session practice of treatment principles, has consistently demonstrated efficacy for the treatment of obsessive-compulsive disorder (OCD) and is a gold standard, recommended first-line treatment. CBT with ERP has been successfully adapted to fit the needs of autistic individuals with OCD. The present article provides a brief overview of CBT for OCD and outlines special considerations and adaptations needed when working with patients with OCD and comorbid autism, with an emphasis on the importance of between-session homework. METHOD: A case vignette is presented. RESULTS: This case study illustrates the role of homework in the exposure-based treatment of an adult autistic individual with comorbid OCD. CONCLUSION: Implications of this case vignette are discussed, and recommendations are offered for clinicians working with autistic individuals with OCD, especially in regard to bolstering completion of between-session ERP homework.

The use of practice assignments in cognitive processing therapy to promote cognitive and emotional change: A case study.

Cognitive processing therapy (CPT) is a first-line treatment for posttraumatic stress disorder (PTSD). The primary goals of CPT are to identify and challenge dysfunctional cognitions resulting from the trauma to promote a more balanced set of beliefs and reduce manufactured emotions; encouraging expression of natural emotions further promotes symptom improvement. Between-session assignments (homework) are an integral part of learning and practicing the skills developed during CPT, and these assignments are theorized to reinforce the proposed mechanisms of symptom change. This article begins with a brief description of the theoretical foundations of CPT and an overview of the session content of the CPT protocol, followed by a case study illustrating the use of CPT with the written account (CPT + A) with a survivor of childhood sexual assault. Although the client demonstrated some avoidance, her successful completion of practice assignments throughout treatment allowed her to identify and examine thoughts contributing to feelings of guilt and self-blame as well as negative beliefs about the world. She was able to reduce her assimilated and overaccommodated stuck points to form a more balanced view of the trauma, and also process her natural emotions, resulting in a significant reduction of PTSD symptoms. The role of homework at each session and how the assignments addressed the proposed mechanisms of change in CPT are discussed, and recommendations to increase clients' engagement in practice assignments in CPT are provided.

Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial.

OBJECTIVE: Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients' homework completion and only rarely have considered the role of therapist competence. METHODS: The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale - Revised (HRS-II); (c) pre-post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (Mage = 19.61, SD = 2.60). RESULTS: Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship. CONCLUSIONS: The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.

The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder.

OBJECTIVE: Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD: There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS: Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION: The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.

Predictors of homework engagement in group CBT for social anxiety: client beliefs about homework, its consequences, group cohesion, and working alliance.

OBJECTIVE: Group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) is effective, but little data exist on generic relational components of the therapeutic process, such as group cohesion and therapy alliance, and central CBT-specific components such as homework engagement, beliefs, and perceived consequences. The aim of this study was to investigate the relationships between homework, group cohesion, and working alliance during group CBT for social anxiety disorder. METHOD: Participants (N = 105) with SAD engaged in 12 sessions of group CBT. Measures of homework, working alliance, and group cohesion were completed at multiple points throughout treatment. Random-intercept cross-lagged panel models were used to evaluate the prospective relationships between measures. RESULTS: Prospective relationships between the homework outcomes did not vary throughout the treatment period, with the only significant relationships seen between the random intercepts ("trait" levels). Homework beliefs were a significant negative predictor of future group cohesion, but only in mid- to late-treatment. Homework consequences and working alliance were significantly and positively predictive of each other throughout therapy. CONCLUSION: Early homework engagement is associated with higher engagement throughout therapy. Working alliance and homework engagement are important to bolster early in group CBT.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000579493..

Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning.

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental fogginess, and slowed behavior/thinking. Studies examining the association between CDS and academic functioning have reported mixed findings and have relied upon limited measures of CDS, broad ratings of academic impairment, and/or focused only on elementary-aged children. The current study examined the relationship between CDS and academic functioning in adolescents using a comprehensive, multi-informant, multi-method design. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD) recruited in the fall of their 8th grade. Above and beyond ADHD inattentive symptoms, CDS symptoms were related to poorer homework performance, lower math fluency, and lower daily academic motivation across multiple informants, and teacher-reported CDS symptoms were related to lower grades. Findings were not moderated by ADHD diagnosis, suggesting that associations between CDS and academic outcomes do not differ for adolescents with and without ADHD. Findings demonstrate that CDS symptoms are uniquely associated with daily academic difficulties as well as global indices of academic performance. These findings have implications for assessing and monitoring CDS symptoms in interventions aiming to improve the academic functioning in adolescents with and without ADHD.

Parental mentalization goes to school: a brief online mentalization-based intervention to improve parental academic support.

Parental support of children's learning contributes to children's motivation, efficacy, and academic success. Nonetheless, in the context of homework, many parents struggle to offer adequate academic support and intervene in a manner that can curtail children's academic progress. A mentalization-based online intervention was proposed for improving parental homework support. The intervention involves teaching parents to dedicate the first 5 minutes of homework preparation to observation of the child's and the parent's mental states. Thirty-seven Israeli parents of elementary school children randomly assigned to intervention or waitlist conditions participated in a pilot study assessing the feasibility and initial efficacy of the intervention. Participants completed self-report measures before and after the intervention or a 2-week waiting period and provided feedback on the intervention. Pilot findings suggest that this low-intensity online intervention can be effective in improving parenting practices in the homework supervision context. A randomized controlled trial is required to further establish the intervention's efficacy.

Staff quality of working life and turnover intentions in municipal nursing care and social welfare: a cross-sectional study.

BACKGROUND: Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic. METHODS: A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses. RESULTS: Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession 'rather often' and 'very often/always'. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34-36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, 'exercise', 'recreation and relaxation' and 'improving skills', the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used 'recreation and relaxation' more often than were reported by registered nurses. CONCLUSIONS: More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions.

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance.

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.

Empirically derived profiles of homework purposes in eleventh grade students: a latent profile analysis.

Informed by expectation-value theory and related literature, the goal of the current investigation was to identify profiles of students drawn from three purposes of homework (academic, self-regulatory, and approval-seeking). Participants were 750 eleventh-grade students in China. Results from latent profile analysis (LPA) revealed identified four different profiles of students: Very Low Profile (very low in all purposes; 5.73%), Low Profile (low in all purposes; 30.40%), Moderate Profile (moderate in all purposes; 54.40%), and High Profile (high in all purposes; 9.47%). Results further revealed that student gender was associated with profile membership. Finally, profile membership was significantly related to homework effort and completion (with a medium effect size) in that, in general, the higher the homework purposes, the higher the homework effort and homework completion.

Academic dishonesty when doing homework: How digital technologies are put to bad use in secondary schools.

The growth in digital technologies in recent decades has offered many opportunities to support students' learning and homework completion. However, it has also contributed to expanding the field of possibilities concerning homework avoidance. Although studies have investigated the factors of academic dishonesty, the focus has often been on college students and formal assessments. The present study aimed to determine what predicts homework avoidance using digital resources and whether engaging in these practices is another predictor of test performance. To address these questions, we analyzed data from the Program for International Student Assessment 2018 survey, which contained additional questionnaires addressing this issue, for the Swiss students. The results showed that about half of the students engaged in one kind or another of digitally-supported practices for homework avoidance at least once or twice a week. Students who were more likely to use digital resources to engage in dishonest practices were males who did not put much effort into their homework and were enrolled in non-higher education-oriented school programs. Further, we found that digitally-supported homework avoidance was a significant negative predictor of test performance when considering information and communication technology predictors. Thus, the present study not only expands the knowledge regarding the predictors of academic dishonesty with digital resources, but also confirms the negative impact of such practices on learning.

A "fractal" expander-compressor-supplier formative research method on array processing.

In the present research the typical triangle on formative research was extended to a double triangle for an overall career programme (here expander/ compressor) and funnel proposal was explored in a single course (as a "fractal" method). Array processing and ElectroEncephaloGram (EEG) techniques have been incorporated into a Digital Signal Processing (DSP) course and research projects. The present research question was: is it possible to insert array sensing on formative research in an undergraduate course of DSP? From over eight years, two semesters with different homework loads (homogeneous triangle vs expander-compressor-supplier distributions) were analysed in detail within the DSP evaluations and students chose between experimental applied analysis and a formative research project. Results showed that cognitive load was influenced positively in the expander-compressor-supplier distribution, showing that an increase of the efficiency undertook more undergraduate research on array processing and the decrease of the number of formative applied projects. Over a longer term (48 months) students undertook more undergraduate research works on array processing and DSP techniques. Supplementary Information: The online version contains supplementary material available at 10.1007/s10639-023-11837-y.

Economics at the FCC 2021-22: 5G Spectrum Auctions, Affordable Connectivity, Broadband Data Collection, and Merger Review.

The Federal Communications Commission (FCC) is responsible for regulation in the communications marketplace and for management of the nation's non-federal radio spectrum. During the past year, FCC economists continued to work on auctions so as to repurpose mid-band spectrum for advanced wireless services - including 5G - as well as initiatives to close the connectivity gap and make broadband more affordable. FCC economists also evaluated the likely competitive effects of Verizon's proposed acquisition of prepaid competitor TracFone Wireless. Finally, FCC economists helped in setting up the novel Broadband Data Collection.

Racial and Ethnic Differences in Homework Time among U.S. Teens.

Along with intensified competition for college admissions, U.S. teens increasingly spend more time on educational activities. Homework can be a particularly important component of educational time for economically disadvantaged and racial/ethnic minority students who have limited access to private sources of learning beyond the classroom. This study uses data from the American Time Use Survey and the Programme for International Student Assessment to compare homework time by race/ethnicity and examine the factors that explain these differences. We extend existing literature to consider explanations beyond demographic and family background. Our ordinary least squares (OLS) results show that family background accounts for the difference in homework time between Hispanic and White students and partially explains the difference between Black and White students, with students' academic characteristics or school fixed effects explaining the remaining gap. While these factors partially account for Asian students' greater time spent on homework than their White peers, a substantial gap remains.

The experimental effect of social media use, treadmill walking, studying, and a control condition on positive and negative affect in college students.

Using a within-subjects design, this study assessed the experimental effect of common activities upon positive and negative affect scores in a college student sample. All participants completed the following 30-minute activity conditions: treadmill walking, self-selected schoolwork (i.e., studying), social media use, and a control condition where participants sat in a quiet room (i.e., do nothing). Positive and negative affect scores were assessed at baseline, mid-, and post-condition. Positive affect scores increased by 26% and 10% during the treadmill and studying conditions, respectively. Conversely, positive affect decreased by 20% and 24% during the social media and "do nothing" conditions, respectively. Furthermore, negative affect was decreased by 8% in the studying condition. These changes were statistically significant (p ≤ 0.04). This suggests that college students' everyday activities can significantly impact affect, for better and for worse. As demonstrated, studying and walking may improve affect, whereas social media use may negatively impact affect.