Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Abstract

Homework or between-session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10-week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post-treatment and at 1-month follow-up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.

A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits?

“…Looking beyond studies of treatments for depression specifically, some research has addressed this issue. While Rees and colleagues (2005) failed to find that quality of thought record completion predicted outcomes for depression or anxiety symptoms above and beyond homework quantity, Schmidt and Woolaway-Bickel (2000) found quality of homework was a stronger predictor of outcomes than percentage of homework completed in their study of CBT for panic disorder. Additional research is needed to clarify whether it is the quality or quantity of homework that better predicts therapeutic outcomes.…”

“…Similarly, a low score could reflect either little work on the patient’s part or a large amount of work, if the therapist had assigned an even larger amount. An alternative way of examining homework is to assess the extent to which patients engage in homework activities between sessions—without a comparison to what was assigned in the preceding session (e.g., Rees, McEvoy, & Nathan, 2005). As we noted, these approaches can lead to important differences in the assessment of homework.…”

“…To our knowledge, only two previous studies have examined patients’ homework engagement on multiple specific assignments within a given treatment (Cammin-Nowak et al, 2013; Rees et al, 2005). Rees and colleagues examined several different homework types (relaxation, reading, thought diaries, and behavioral tasks) as predictors of post-treatment symptoms in a mixed anxious and depressed sample participating in group cognitive-behavioral therapy.…”

A Pilot Study Disseminating Cognitive Behavioral Therapy for Depression: Therapist Factors and Perceptions of Barriers to Implementation

“…For instance, the trainers highlighted the work of Shaw and colleagues suggesting that the structure items on the CTRS were most related to client outcomes (Shaw et al 1999). In addition, the trainers discussed the findings of Bryant et al (1999) that suggested therapist review of homework was critical to client homework compliance and that homework completion appears to be a critical component leading to successful response to CBT (e.g., Rees et al 2005;Simons et al, under review). Therefore, it is possible that therapists were motivated by the research to incorporate these effective components into clinical practice.…”

Do Therapeutic Homework Assignments Address Areas of Need for Individuals with Severe Mental Illness?

“…Homework serves a number of important functions in clinical practice. These include increasing the amount of time that the person spends engaged in therapeutic activities (Beck, Rush, Shaw, & Emery, 1979;Nelson, Castonguay, & Barwick, 2007), promoting the generalization of skills to the individuals living environment (Shelton & Levy, 1981) and encouraging the active involvement of the person in the treatment process (Rees, McEvoy, & Nathan, 2005).…”