How to Send Out Online Exercises and Homework in Therapy

No matter the branch of psychology you apply, most clients will benefit from homework or take-home exercises during the therapeutic relationship.

In fact, in some treatments, homework is the primary means by which clients see changes and progress toward their goals (Kazantzis & L’Abate, 2005). Therefore, it’s essential to make the process of completing homework simple and intuitive.

Thankfully, there is a range of modern technologies that can help.

In this article, we’ll outline some scientifically demonstrated benefits of homework in therapy, explore the advantages of designing homework digitally, and give you eight useful templates you can use to start designing and sending out digital homework today.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with a detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.

Importance of Exercises and Homework in Therapy

Homework has repeatedly been shown to be an effective way to facilitate therapeutic change (Addis & Jacobson, 2000; Mausbach, Moore, Roesch, Cardenas, & Patterson, 2010). Importantly, the benefits of homework also apply to a range of different psychological challenges.

For instance, in a study of homework compliance among a sample of older adult outpatients experiencing depression, completion of homework contributed significantly to positive post-treatment outcomes (Coon & Thompson, 2003).

Likewise, CBT homework, particularly when administered using digital technologies, relates significantly to positive outcomes in populations being treated for substance abuse (Carroll, Nich, & Ball, 2005; Carroll et al., 2008).

Trends within the broader practice of therapy delivery have also increased homework’s centrality and importance.

For instance, with the rise of time-limited and brief forms of therapy, such as Solution-Focused Brief Therapy and certain CBT treatments, therapists must find ways to amplify the impact of counseling when working within short timeframes.

Further, therapists have become increasingly reliant on homework and exercises to ensure psychoeducational interventions can be effective despite minimal face-to-face contact with clients.

How Can Online Exercises Upgrade Your Care?

Making use of the online and digital technologies already at your clients’ fingertips can help ensure they have easy access to the benefits of treatments involving homework.

Therapists are increasingly moving online to deliver not only real-time therapy sessions via videoconferencing, but homework, too.

Using online platforms and tools to deliver therapeutic care affords many benefits to both practitioners and clients, including:

• Increased convenience for clients, who can use their own device to access materials
• Therapists’ access to pre-made and customizable digital activities that can be administered to multiple clients with the push of a button
• The ability for therapists to follow up with clients via instant messaging
• Digital reporting features that allow therapists to track clients’ progress
• Advanced security features (e.g., HIPAA and GDPR compliance)

Next, let’s look more closely at the advantages of providing care using online technologies. To do this, we’ll present several examples of exercises designed using the online psychotherapy platform Quenza, which features a growing number of pre-developed activities you can assign to your clients as homework.

If any of these examples pique your interest, consider trying out the platform for yourself by taking advantage of the 30-day trial for just one dollar. The founders of PositivePsychology.com developed Quenza, with the help of the wider positive psychology community, to provide a vital online platform for therapists.

The platform is constantly evolving, with a comprehensive roadmap for more functionality to be added on a monthly basis.

3 Examples of Online Therapy Exercises

Let’s now look at three examples of online therapy exercises that illustrate the breadth of opportunities available through online homework delivery. As mentioned before, you can access these using the Quenza trial.

1. Self-Acceptance Meditation

Many clients who undergo therapy do so because of challenges with self-image or a harsh inner critic.

Meditation and other practices associated with Eastern philosophy have been shown to be powerful for cultivating greater self-acceptance (Brach, 2005; David, Lynn, & Das, 2013).

In Quenza’s Self-Acceptance Meditation activity, clients are invited to take 20 minutes to relate to themselves in the same way they would with someone they love and care for deeply.

The meditation begins by inviting clients to explore their conditions for self-worth, such as power, wealth, or intelligence. It then progresses to help clients uncouple their ability to accept themselves from these conditions by inviting them to extend unconditional love to a visualization of themselves as a young child.

2. A Mindful Goal Focus

Depending on their presenting symptoms, clients may vary substantially in their motivation and focus on goals. For instance, some clients may possess insufficient goal focus, leaning toward avoidance or impulsivity, while others might strive so hard for goals that they cannot savor the present moment.

Using the Mindful Goal Focus reflection exercise, you can help your clients identify their dominant goal focus and realign it to facilitate greater balance of attention and wellbeing.

In particular, the reflection invites your clients to reflect on whether they possess insufficient or excessive goal focus and consider the disadvantages of these tendencies. They are then invited to explore actionable strategies to help set more mindful goals.

3. The Outcome Rating Scale

Finally, online tools can be useful for administering assessments to help judge the efficacy of a therapeutic intervention. As with meditations and psychoeducational materials, these assessments can also be administered online.

As an example, the Outcome Rating Scale is a useful assessment you can send clients to help gauge their feelings and functioning across four domains in the lead-up to an upcoming therapy session:

• Overall (general sense of wellbeing)
• Individual (personal wellbeing)
• Interpersonal (family, close relationships)
• Social (work, school, friendships)

As with all tools on Quenza, these scales can be easily customized to assess functioning across domains that particularly interest your clients.

How to Send Out Online Exercises the Right Way

Working via an online platform such as Quenza allows therapists to adapt digital homework exercises from pre-existing libraries and share them directly to clients’ devices. This workflow leads to greater convenience for both the client and the therapist.

Clients can complete exercises at their convenience using the devices already in their pockets and are spared the hassle of working with hard-copy documents. Therapists can track clients’ progress through assigned activities using these platforms’ dashboards and reporting features.

Users providing feedback about Quenza point to many advantages associated with sending out exercises digitally:

• Automated follow-ups for outstanding activities, which may help clinical populations experiencing memory deficits.
• The ability to design micro-teachings and bite-sized activities allows therapists to be present for clients between sessions.
• The ability to engage with homework using their own device increases clients’ self-belief that they can successfully complete assigned activities.

Onboarding your clients with digital technologies

To reap the myriad benefits of online therapy exercises and homework, it’s important to carefully onboard your clients with the requisite technologies.

All clients should receive the same information, and your explanation should begin with the basics to account for different levels of digital literacy.

To help, consider the following three tips to help minimize digital overwhelm when starting your clients out with a new online therapy platform (Markidan, n.d.):

• Break down the process into small steps.
  For instance, rather than sending your clients several activities in quick succession, start with a single activity, and invite them to test it out on different devices.
• Call attention to the most important features of the platform.
  For instance, in Quenza, your clients will spend much of their time in the “To do” menu, which lists their unfinished activities, so draw attention to this menu first. Assume that clients will explore the remaining features of the platform later once they’ve gotten their feet wet.
• Create a short digital instruction guide.
  Consider recording a short video (2–3 minutes) that illustrates the features of the platform you’ll be using most with your clients. In Quenza, you might even design a “Welcome” activity that illustrates your workflow on the platform using screenshots.

By taking the time to design a systematic onboarding process, you will save time for both yourself and your clients, who will get their questions about the platform answered at the beginning of the therapeutic relationship.

Likewise, setting aside an opportunity for clients to familiarize themselves with your chosen platform will ensure they are wholly focused on assigned materials, rather than worrying about the technology, when starting their first homework activity.

5 Ways to Craft Online Exercises in Quenza

If you’re a do-it-yourself type, you may find Quenza’s intuitive Activity Builder particularly useful. It enables therapists to design homework activities entirely from scratch.

The Activity Builder includes many question and response types, ranging from open-ended, free-text responses to questions with multiple answer options that proceed sequentially.

To illustrate, let’s look at five ways you might craft online homework activities using some of these features.

1. Standardized psychological assessments

A common starting point for practitioners using the platform is to administer questionnaires as part of an initial or ongoing psychological assessment.

For instance, therapists looking to screen for markers of common psychological conditions, such as depression and anxiety, can easily recreate their preferred assessment tool (e.g., the Beck Depression Inventory, DASS-42) within the platform using the multiple-choice and linear-scale question formats.

Once created, the therapist can then send the assessment directly to the client’s Quenza account. Likewise, this assessment can be saved and sent to future clients just as conveniently, with client names and identifying details automatically swapped out as needed.

2. Short reflections

You may also find Quenza useful for tracking your clients’ wellbeing and mental health in short reflection exercises or check-ins.

Such reflections can tap into a range of clinically relevant foci, including:

• Present emotional states
• Needs and drives
• Challenging events (and subsequent coping strategies)
• Beliefs and thoughts
• Goal pursuits

For instance, using the free-text response options, you might invite your client to begin each day by writing one goal they’d like to achieve that day. Practitioners can automatically program the activity prompting this goal-setting exercise to be sent to the client’s device each morning right before they wake up.

Following this, you might then invite clients to respond to a series of rating scales probing the strength of their motivation to pursue this goal or ask them to reflect on strategies they could use to achieve it.

For an example of a reflection such as this, look at the Brief Needs Check-In activity, which you can access via Quenza’s Expansion Library.

3. Meditations and visualizations

One advantage of using an online platform like Quenza is the ability to design homework activities that leverage the full capabilities of clients’ devices by incorporating multimedia, such as images, audio, and video.

By incorporating multimedia into designed activities, your options for providing resources to clients increase exponentially. A common approach is to source or pre-record guided meditations and visualizations that clients can complete between sessions.

Depending on your clients’ needs, these can center on helping your client self-soothe during times of crisis, explore memories from their past, or better manage stress.

For an in-depth look at the benefits and different applications of guided meditations and visualizations, be sure to look at our dedicated blog posts.

And for a range of useful templates to get you started, look at the following pre-loaded meditations and visualizations available through Quenza’s Expansion Library:

• S.O.B.E.R. Stress Interruption Technique
• The Private Garden: A Visualization for Stress Reduction
• Visualizing a Compassionate Self
• Personal Needs Meditation

4. Psychoeducation and lessons

Given that there is limited time during face-to-face sessions with clients, you may find value in getting your clients to engage with readings and other educational materials as homework.

With Quenza, you can design engaging lessons with visuals and other multimedia that clients can complete at their own pace.

Further, you can design lessons that form one part of a sequence via Quenza’s Pathway function. This function allows practitioners to prepare sets of activities that are automatically sent to clients’ devices according to a schedule.

A few days later, practitioners can follow up material from lessons with activities or reflections that encourage clients to apply the taught principles and lessons in their own context or in several stages.

For some useful examples, be sure to look at Learning to Say “No” and 20 Guidelines for Developing a Growth Mindset, available via Quenza’s Expansion Library.

5. Metaphors

Metaphors can be powerful tools to help clients understand key psychoeducational principles through likeness or analogy. They are also a cognitively engaging way to teach using visual imagery.

Using Quenza, you can design bite-sized homework lessons that center on a single metaphor. These can help clients understand distinctions between psychological concepts, the difference between adaptive and maladaptive behaviors, or practices they may wish to implement in their own lives.

Again, for some inspiration, consider looking at the following activities available through Quenza’s Expansion Library.

• Resolving Jealousy Using the Camera Lens Metaphor
• The Scoreboard Metaphor
• Pushing the Ball Underwater Metaphor

A Take-Home Message

With the many conveniences technology now affords us, it’s a great time to ‘go digital’ when assigning your clients therapy homework and exercises.

Indeed, by doing so, you may increase your clients’ odds of seeing positive benefits from treatment, and you allow yourself to draw on pre-made materials that were designed with best practice in mind.

We hope this article has inspired you with ideas to take the hassle out of assigning homework. And if you’ve found any of these materials useful or have your own strategies for improving your workflow with clients between sessions, be sure to let us know in the comments. We’d love to hear from you.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.