title: Enthusiasm for homework and improvement of psychological distress in subthreshold depression during behavior therapy: secondary analysis of data from a randomized controlled trial.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00885014 . April 20, 2009.
authors.affiliation: Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. y.hy.hh.y3@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Hayasaka
authors.affiliation: Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. furukawa@kuhp.kyoto-u.ac.jp.
authors.forename: T A
authors.initials: TA
authors.lastname: Furukawa
authors.affiliation: Department of Management Science, Faculty of Engineering, Tokyo University of Science, 1-3 Kagurazaka, Shinjyuku-ku, Tokyo, 162-8601, Japan. sozu@ms.kagu.tus.ac.jp.
authors.forename: T
authors.initials: T
authors.lastname: Sozu
authors.affiliation: Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. ihits@hotmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Imai
authors.affiliation: Department of Mental Health, University of Tokyo Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. norito@m.u-tokyo.ac.jp.
authors.forename: N
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8551, Japan. mhorikoshi335@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Horikoshi
mesh_terms: D000124:Achievement; D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods; D010349:Patient Compliance / Q000523:psychology*; D013315:Stress, Psychological / Q000628:therapy*; D013689:Telephone; D014937:Work / Q000523:psychology; D055815:Young Adult