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How to keep your patient motivated to perform assignments in CBT

Updated 19th of March 2023

The purpose of homework in Cognitive Behavioral Therapy (CBT) is for patients to have the opportunity to practice skills presented in the therapy room, and is an important part of the therapeutic process. Research shows that doing homework is associated with better outcomes. Despite this, many patients experience difficulties in carrying out their assignments Here are some simple steps you can take to keep your patient motivated to complete their tasks.

What are homework assignments in CBT?

A homework assignment in CBT can be described as a specific therapeutic activity that is discussed in a session, and  is assigned to be performed and documented by the patient before the next session. Within the framework of this definition, psychologists can work in different ways in designing tasks. The assignment can be relatively standardized as part of a treatment protocol. Assignments can also be created as verbal agreements. The broad definition of what homework can be, makes it flexible and adaptable. But it can also make it difficult for both patient and psychologist to create recurring good assignments to perform.

How to create good homework assignments in CBT

1. Take an experimental approach

Patients can sometimes have low confidence in their own ability to change their behavior pattern. After all, that's why they've sought help. To ensure that the patient experiences other behavioral patterns, it is important that tasks always contribute to learning - regardless of whether they have been performed or not. When the tasks are explained, you can therefore formulate these with a focus on learning something new, and to test something to perform. This then makes it easier to follow up with feedback. If for some reason the task was not carried out, then one can explore what was learned from it, which contributes to the therapeutic process and the patient's understanding of their own problems.

2. Formulate assignments with the SMART- Methodology

Once you give a patient a task, you can use the SMART method to explain it. A SMART task is:

  • Specific. It describes a concrete action.​

  • Measurable. It is possible to verify whether the task has been completed.

  • Achievable. The task should be seen as possible to perform.

  • Relevant. The task is associated with the patient's problem.

  • Time bound. The task has an end at a particular criterion.

3. Create assignments that contribute to a sense of mastery

At the beginning of therapy, it is likely that the patient has low confidence in changing their behavior pattern. Therefore, it may be timely to give patients tasks that they have a high probability of succeeding with, while being associated with the patient's problem. Early success with a task can contribute to a feeling of mastery, which can keep the patient engaged in performing progressively more difficult tasks later in the course of therapy. It also provides an excellent opportunity to give the patient positive feedback on behaviors during the early phase of the change process.

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