Search

Objectives: Although homework assignments are an integral component of cognitive-behavioral therapy (CBT) and relate to positive therapy outcomes, it is unclear whether specific homework types and their completion have specific effects on outcome. Method: Data from N = 292 patients (75% female, mean age 36 years) with panic disorder and agoraphobia and treated with standardized CBT were analyzed with homework compliance quality and quantity for different types of homework serving as predictors for different outcome variables. Results: Quality ratings of homework completion were stronger outcome predictors than quantitative compliance ratings. Exposure homework was a better outcome predictor than homework relating to psychoeducation and self-monitoring. Conclusion: Different aspects of homework compliance and specific homework types might differentially relate to CBT outcome.

Beesdo-Baum K, Knappe S, Fehm L, Hofler M, Lieb R, Hofmann SG, Wittchen H-U. The natural course of social anxiety disorder among adolescents and young adults. Objective: To examine the natural course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long-term outcomes. Method: A community sample of N = 3021 subjects aged 14–24 was followed-up over 10 years using the DSM-IV/M-CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow-up. Results: SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow-up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow-up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co-occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and – less impressively – diagnostic stability. Conclusion: A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.

Homework assignments are an indispensable part of cognitive-behavioural therapy. During the past two decades, a growing number of studies have shed light on its characteristics and effects. However, most studies primarily consider the therapists' view, and little is known about the use of supportive strategies to implement homework assignments in psychotherapy and about patients' attitudes towards regular assignments. To fill this gap, we assessed the attitudes towards homework assignments of 80 outpatients. In addition, those who had received a task during the past session (75%) were asked to report characteristics of their task as well as therapists' behaviour strategies during the assignment of the task. One week later, therapists rated the extent of completion of the task. Results showed that the patients generally had a positive attitude towards homework and that they accomplished most of the tasks. With regard to the therapists' behaviour during the assignment of the task, there seems to be room for improvement.

Journalists frequently report on disasters. There is a growing evidence that they are subsequently at higher risk of post-traumatic and depressive symptoms. We conducted an internet-based study with 61 journalists who had covered the tsunami disaster in December 2004 from the affected region. The extent of trauma exposure, symptoms and social variables were assessed. About 8 months after the event, indications of post-traumatic stress disorder were found in 6.6 per cent of the sample. Post-traumatic and depressive symptoms were related to the extent of traumatic exposure and to several social variables, most importantly, a low degree of social acknowledgment by supervisor and colleagues. Copyright © 2007 John Wiley & Sons, Ltd.

There has been continued empirical research on the role of homework assignments in psychotherapy, but little is known about their use in clinical practice. Although attitudes are an important factor in determining whether practitioners use homework assignments, existing data is limited to the frequency and types of assignments used in therapy. One hundred and forty German psychologists were surveyed regarding their use of and attitudes towards homework assignments. Practitioners reported a variety of attitudes regarding the effects of homework on treatment outcome, the process of integrating homework into therapy and patient compliance with homework. We suggest that consideration should be given to therapist attitudes (or beliefs) in future conceptual or empirical work designed to examine homework effects in psychotherapy. Copyright © 2004 John Wiley & Sons, Ltd.

Objective: To summarize epidemiological studies providing data on prevalence, incidence, comorbidity, natural course, risk factors and consequences of social phobia (SP). Method: Data from cross-sectional studies and prospective longitudinal studies in particular are considered. Results: These studies portray SP as a frequent mental disorder, which begins typically in early adolescence, and is highly comorbid with other anxiety disorders, as well as secondary depression and substance abuse disorders. Several possible risk factors have already been identified for the onset and unfavorable course of SP; some of them have been tested in prospective longitudinal studies. SP is a chronic disorder when compared with other mental disorders and when subclinical symptomatic levels are considered. Impairment caused by SP is considerable and increases over a patient's life span. The negative impact of SP is not only reflected in subjective well-being and reduced quality of life but also in social role functioning, and it impacts negatively on career progression. Conclusion: Prospective longitudinal studies in representative samples drawn from the general population provide information that allows the overall direct and indirect costs of the disorder (treatment costs, disability, social welfare) to be determined, and enables an improvement in long-term care strategies as well as preventive efforts to be established.