The Association Between Homework Engagement in Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder and Therapeutic Change

Background: Therapeutic homework, defined as planned assignments given to patients between therapy sessions (Beck, 1995), has long been a central tool in various therapeutic methods, particularly in cognitive-behavioral therapies (Dozois, 2010). Empirical studies have consistently shown that homework engagement significantly enhances CBT's treatment outcomes (Kazantzis et al., 2010). However, limited research has explored the implications of homework engagement (HE)—the extent to which patients complete assigned tasks (Rodríguez et al., 2020)—within cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD).

Objective: In light of the central place of homework in CBCT for PTSD and its potential to impact treatment, this study aims to examine how HE influences treatment outcomes in CBCT for PTSD, focusing on the association between PTSD symptom severity, dyadic satisfaction, and HE. Additionally, the study explores the role of pre-treatment motivation in HE and compares individual versus conjoint HE.

Method: The sample comprised 32 couples with one partner having posttraumatic symptoms, seeking CBCT for PTSD. Data were collected from the identified patient (IP)––the partner with posttraumatic symptoms––at multiple time-points (before and during treatment). Data were analyzed using generalized estimating equations (GEE) to explore the relationships between pre-treatment motivation, posttraumatic symptom severity, dyadic satisfaction, and HE.

Results: Strong positive associations were found between individual and conjoint HE, indicating that these two forms of engagement are closely related. A significant positive relationship was observed between pre-treatment motivation and HE. Weekly HE was linked to improvements in treatment outcomes, with higher levels of homework completion associated with a reduction in PTSD symptoms and increased dyadic satisfaction.

Discussion: These findings suggest that HE plays a crucial role in improving clinical outcomes in CBCT for PTSD. Engagement with homework tasks is associated with reductions in PTSD symptoms as well as improvements in dyadic satisfaction. The study highlights the contribution of pre-treatment motivation as a predictor of HE, underscoring the need to foster patient motivation prior to treatment. Furthermore, the relationship between individual and conjoint HE provides valuable insights into the role of the therapeutic environment in supporting individual progress and contributing to overall treatment efficacy, suggesting that the treatment protocol succeeds in fostering a team dynamic between partners. This study paves the way for future research into the role of homework in enhancing both individual and dyadic recovery in PTSD treatment.