Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors

Leah M. Zelencich, Nikolaos Kazantzis, Dana Wong, Dean P. McKenzie, Marina Downing, Jennie L. Ponsford

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)


Traumatic Brain Injury (TBI) associated cognitive impairments may pose an obstacle to homework engagement in Cognitive Behavior Therapy (CBT) for depression and anxiety. The current study examined the association of demographic, injury-related and CBT process variables with homework engagement in CBT adapted for TBI -related cognitive impairments (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions, representing 31 therapist-client dyads, were assessed from the independent observer perspective. Client homework engagement, therapist competence in assigning and reviewing homework, and working alliance strength, were measured. Multi-level mixed model regressions showed that older client age, more time since injury, stronger working alliance and greater therapist competence in homework review, were significantly associated with higher levels of homework engagement. The findings highlight how CBT-ABI therapists can possibly enhance homework engagement for clients with TBI.

Original languageEnglish
Pages (from-to)40-51
Number of pages12
JournalCognitive Therapy and Research
Publication statusPublished - 1 Feb 2020


  • Anxiety
  • Brain injury
  • Cognitive behavior therapy
  • Depression
  • Homework
  • Therapist competence
  • Working alliance

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