The graded homework assignment technique for treating depression.

A technique used in the early stages of cognitive therapy for depression.

Within cognitive therapy for the treatment of depression, a variety of emotional, cognitive, and behavioral techniques aimed at decreasing depressive symptoms are included. In this article we will talk about graded homework assignmenta technique indicated especially in the early stages of psychological treatment.

The graded homework assignment is focused on reducing the patient's apathy and promoting his behavioral activation, so that little by little his mood improves. We are going to know in detail how this is achieved by means of the above mentioned technique.

The behavioral techniques

Cognitive therapy of depression includes different components or techniques grouped into 3 main areas: behavioral, cognitive and emotional techniques. Within the behavioral techniques, we find the assignment of graded tasks.

Behavioral techniques are used to promote behavioral changes and to alleviate motivational and affective motivational and affective symptoms, especially in very depressed patients.. They also help to detect and modify maladaptive cognitions used as small experiments.

Among them, we can distinguish:

• Mastery and/or satisfaction techniques.
• Cognitive rehearsal or practice.
• Role-playing.
• Coping techniques.
• Programming of activities.
• Assignment of graded tasks.

Let's see what the latter, the graded homework assignment, consists of.

Graded homework assignments: characteristics

Graded homework assignment is a behavioral technique widely used in Aaron Beck's cognitive therapy for the treatment of depressive disorders.

Graded homework assignment is used mostly in the early stages of therapy, and/or when the patient is very depressedIt is used when the patient is very depressed, in order to bring him/her out of this state of apathy and absolute abulia. The therapist's goal will be to restore the patient's previous level of functioning before the depression.

The application of graded tasks will allow the incorporation of more cognitive techniques in more advanced stages of treatment, when the patient's mood is better.

The technique consists of assigning the patient tasks with different degrees of difficulty, that are challenging for the patient but with a high probability of success.. The tasks will be graded, that is, their level of difficulty will go from less to more, and each time they will be more complex for the patient.

The therapist should record the patient's expectations of difficulty and efficacy about the different tasks or activities, as well as the degree of realism regarding these expectations.

It will also be important, as the therapy progresses, to compare the patient's evaluations of his or her performance with the patient's own..

Theoretical foundations of graded homework assignments

The theoretical basis of this method is based on the clinical observation that the patient in a severe depressive state believes that he/she is no longer capable of performing the functions "expected of him/her" as a student, worker, mother or father, etc. In the same way, his significant others sometimes begin to think so as well.

In addition, the patient may no longer have any hope of deriving gratification from the activities he once enjoyed. That is why the assignment of graded tasks is also considered a behavioral experimentIn the same way, the therapist, by helping the patient to modify certain behaviors, will be able to show him that his negative and overly general conclusions were incorrect.

In the same way, the therapist, by helping the patient to modify certain behaviors, will be able to show him that his negative and overly general conclusions were incorrect.

When to use the technique?

As already mentioned, graded homework is usually used at the beginning of psychotherapy, in the early stages of treatment. Concretely, we can distinguish three phases of cognitive therapy:

• Phase 1: Behavioral activation techniques.
• Phase 2: Questioning of automatic thoughts.
• Phase 3: Questioning of basic assumptions and beliefs.

Phase 1 includes the assignment of graded tasks. In this phase, a series of graded activities or tasks will be planned with the patient, which he/she will develop that the patient will develop.

First, he/she should record his/her daily activities and mood.

Then the therapist will schedule with him activities aimed at increasing his activity level, satisfaction and sense of accomplishment (the goal is for the patient to feel "useful" even if it is for simple tasks).

Finally, the activities will be broken down into smaller steps when necessary..

Additional benefit of the technique

This first phase of therapy, as well as the assignment of graded tasks, has an additional benefit for the patient, as it will help to avoid or control the tendency to ruminate.

Thus, by increasing the level of activity activity level, attention and energy will be focused on aspects other than will be focused on aspects other than one's own thoughts (they will be directed to the outside world, and not so much to the inside).

Thus, when the patient focuses his interest and attention on specific activities, the therapist will induce him/her to counteract his/her flight into ruminative or depressive thoughts and allow him to engage in more constructive activities.

On the other hand, as we have already seen, there are other techniques similar to graded homework assignment. Specifically, a very similar one is activity scheduling. Let's see the differences between them, since they are concepts that are sometimes used interchangeably (although they are slightly different techniques).

Differences between activity scheduling and graded assignments

Activity scheduling is more demanding and structured than graded homework assignment, and graded homework assignment, on the other hand, is focused on activities of the patient's daily life. of the patient's daily life.

In addition, activity scheduling should include a diary of the patient where he/she writes down the scheduled tasks together with the therapist.

Bibliographical references:

• Feixas, G; Miró, T. (1993). Approaches to psychotherapy. An introduction to psychological treatments. Barcelona: Ed. Paidós
• Labrador, F.J. et al. (2001). Manual de técnicas de modificación y terapia de conducta. Madrid: Pirámide