Enthusiasm for homework and improvement of psychological distress in subthreshold depression during behavior therapy: secondary analysis of data from a randomized controlled trial

Y Hayasaka, T A Furukawa, T Sozu, H Imai, N Kawakami, M Horikoshi, GENKI Project, Toshiaki A Furukawa, Masaru Horikoshi, Norito Kawakami, Masayo Kadota, Megumi Sasaki, Yuki Sekiya, Hiroki Hosogoshi, Masami Kashimura, Kenichi Asano, Hitomi Terashima, Kazunori Iwasa, Minoru Nagasaku, Takaki Fukumori, Madoka Niwa, Yuki Oe, Maki Shibata, Hiroko Fujisato, Junko Ito, Chiori Hirota, Naoki Kawasaki, Issei Shinmei, Yuriko Takagishi, Shihori Yamada, Masato Hattori, Saori Kitagawa, Kanako Nakazawa, Kyoko Shimada, Haruki Shimoda, Masao Tsuchiya, Maki Umeda, Ayano Yamagishi, Louis C Grothaus, Y Hayasaka, T A Furukawa, T Sozu, H Imai, N Kawakami, M Horikoshi, GENKI Project, Toshiaki A Furukawa, Masaru Horikoshi, Norito Kawakami, Masayo Kadota, Megumi Sasaki, Yuki Sekiya, Hiroki Hosogoshi, Masami Kashimura, Kenichi Asano, Hitomi Terashima, Kazunori Iwasa, Minoru Nagasaku, Takaki Fukumori, Madoka Niwa, Yuki Oe, Maki Shibata, Hiroko Fujisato, Junko Ito, Chiori Hirota, Naoki Kawasaki, Issei Shinmei, Yuriko Takagishi, Shihori Yamada, Masato Hattori, Saori Kitagawa, Kanako Nakazawa, Kyoko Shimada, Haruki Shimoda, Masao Tsuchiya, Maki Umeda, Ayano Yamagishi, Louis C Grothaus

Abstract

Background: Cognitive behavioral therapy (CBT) usually involves homework, the completion of which is a known predictor of a positive outcome. The aim of the present study was to examine the session-by-session relationships between enthusiasm to complete the homework and the improvement of psychological distress in depressed people through the course of therapy.

Methods: Working people with subthreshold depression were recruited to participate in the telephone CBT (tCBT) program with demonstrated effectiveness. Their enthusiasm for homework was enhanced with motivational interviewing techniques and was measured by asking two questions: "How strongly do you feel you want to do this homework?" and "How confident do you feel you can actually accomplish this homework?" at the end of each session. The outcome was the K6 score, which was administered at the start of each session. The K6 is an index of psychological distress including depression and anxiety. We used structural equation modeling (SEM) to elucidate the relationships between enthusiasm and the K6 scores from session to session.

Results: The best fitting model suggested that, throughout the course of behavior therapy (BT), enthusiasm to complete the homework was negatively correlated with the K6 scores for the subsequent session, while the K6 score measured at the beginning of the session did not influence the enthusiasm to complete the homeworks assigned for that session.

Conclusions: Empirical data now support the practitioners of BT when they try to enhance their patient's enthusiasm for homework regardless of the participant's distress, which then would lead to a reduction in distress in the subsequent week.

Trial registration number: ClinicalTrials.gov NCT00885014 . April 20, 2009.

Figures

Fig. 1
Fig. 1
Session-by-session changes of mean K6 scores. The error bars represent the standard error
Fig. 2
Fig. 2
Model 1 hypothesized that the K6 score influenced enthusiasm during the same session, both of which then influenced the K6 score of the following session. K6_2 (_3) (_4): K6 score from 2nd (3rd) (4th) session. ENTH_2 (_3) (_4): Enthusiasm for homework of the 2nd (3rd) (4th) session. Q1_2 (_3) (_4): Q1 (see text) rating from the 2nd (3rd) (4th) session. Q2_2 (_3) (_4): Q2 rating from the 2nd (3rd) (4th) session. e: Error terms of the factors
Fig. 3
Fig. 3
Model 2 further hypothesized that enthusiasm for the preceding session was correlated with enthusiasm for the following session
Fig. 4
Fig. 4
Standardized coefficients of the best-fitting model, Model 2, with constraints

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