The Treatment of Depression and Substance Abuse - Dissertation Example

They state that “integrated supportive group therapy in a randomized trial has shown a differential effect on treatment retention in subjects with severe mental disorders and substance use disorders”, and homework compliance is the adherence that comes as one positive outcome of group therapy sessions for such patients.

Reinecke (2010, p.54) maintains the idea that clients with depression are less likely to adhere to the “in-session exposure” which makes them non-comply with homework completion. He states that the cause for this is that the in-session exposure of a depressive client or one suffering from anxiety involves others observing him doing homework, which he is already anxious about, thus enhancing his anxiety into a social anxiety disorder. However, Reinecke affirms that homework compliance is an important bridge between the in-session activities and change of client’s attitude toward life, especially for patients with depression, anxiety and substance abuse.

He suggests that the client’s behaviour of homework non-compliance should be addressed very early in the therapy. Cruess et al. (2010) found that the patients reported that they non-comply with the between-session homework because of a “lack of receptivity to details regarding their medical illness”. Lien et al. (2010) studied in their research the relationship between the substance abuse group therapy sessions and patient compliance. They found that what motivates the patients to comply with the completion of between-session homework is the clinical outcome which they want to see as their health benefits.

According to them, “patients balance expected benefits and costs during a treatment episode when deciding on compliance” and hence comply with the standards if they seem to be benefitting from the treatment since the Lien et al. observed that those patients who were progressing were less likely to not complete homework, not show at or drop out of the sessions. Similar conclusions have been approached by Guardiano, Weinstock and Miller (2011) who have found that patients of substance abuse are at high risk of non-compliance with homework completion or attendance at group therapy sessions due to which they have to suffer from negative consequences.

They have proposed an adjunctive psychosocial intervention that will reduce non-compliance in substance abusers. According to them, “The intervention involves brief in-person sessions and follow-up phone contacts with the patient and a significant other/family member.” They state that this intervention will improve the effects of group therapy on substance abusers by helping enhance the relationship between them and the provider thus motivating them to attend the group therapy sessions while adhering to the homework completion.

Abramowitz et al. (2009, p.104) have suggested that patients can be motivated to comply with homework completion in group therapy sessions by encouraging “self-controlled exposure” so that patients are motivated “to perform more exposure exercises”. Mausbach et al. (2010) studied the relationship between depressive clients’ homework compliance and group therapy outcomes and found that a combined approach of client and therapist homework rating is necessary for the therapist to be able to motivate homework compliance in patients. Meyer et al. (2010) found in their research that “adding motivational interviewing + thought mapping to cognitive-behavioural group therapy” is very helpful in motivating patients with disorders like depression and substance abuse for homework compliance.