May 14, 2024
Dear Colleagues,
The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by John Montopoli, LMFT, LPCC, A-CBT, representing NSAC – San Francisco, and examines research conducted by McEvoy, Johnson, Kazantzis, and Egan (2024) looking at the predictors of homework engagement in Cognitive Behavioral Group Therapy (CBGT) for Social Anxiety Disorder (SAD).
Both individual and group CBT are well established treatments for social anxiety disorder. Both treatment modalities achieve similar success in reducing symptoms. [1,2,3]. The current study investigates how elements of the therapeutic relationship, specifically group cohesion and working alliance, are associated with homework engagement during group CBT for social anxiety. Increased homework engagement (quality and quantity adherence) has been linked to improved outcomes in CBGT for SAD (Leung & Heimberg, 1996).
In this randomized controlled trial (RCT), 105 participants completed a 12-session group treatment. The findings revealed that group cohesion and working alliance were not directly associated with homework engagement. However, a previous study by Kazantzis and Miller (2022) emphasized the role of appraisals of homework as correlates of engagement.
The authors propose several useful implications, despite the negative associations between the treatment variables. Namely, individuals who have a clear understanding of the value of homework tasks and derive benefits from them are more likely to engage in homework tasks. Specifically, the importance of the client having a clear rationale for homework, that homework tasks closely align with their treatment goals, and tasks are collaboratively designed and implemented as early as possible in treatment. They also suggest that successful engagement in homework is associated with stronger therapeutic alliance, which, in turn, is associated with higher homework mastery over problems and progress. Additionally, the clients who had less clarity over homework tasks tended to report stronger group cohesion.
For clinicians: Homework engagement shows to improve outcomes. What strategies do you use, both in individual and group CBT, to increase homework engagement?
McEvoy, Peter M; Johnson, Andrew R; Nikolaos Kazantzis; and Egan Sarah J. (2024). Predictors of homework engagement in group CBT for social anxiety: client beliefs about homework, its consequences, group cohesion, and working alliance. Psychotherapy Research, 34(1), 68–80.
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John Montopoli, LMFT, LPCC, A-CBT
Representing NSAC San Francisco
(Pacific CBT)
Citations:
1. Colhoun H, Kannis-Dymand L, Rudge M, et al. (2021). Effectiveness of group cognitive therapy for social anxiety disorder in routine care. Behaviour Change. 38(2), 60-72.
2. Guo T, Su J, Hu J, Aalberg M, Zhu Y, Teng T, Zhou X. (2021). Individual versus group cognitive behavioral therapy for anxiety disorders in children and adolescents: A meta-analysis of randomized control trials. Frontiers in Psychiatry, Oct. 20.
3. Wersebe H, Sijbrandij M, & Cuijpers P. (2013). Psychological group-treatments of social anxiety disorder: a meta-analysis. PLoS ONE, 8(12).