Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder
Abstract
Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.
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Without sufficient out-of-session skills practice, clients tend to experience suboptimal outcomes, including increased likelihood of premature treatment dropout, slower symptom improvements, and ultimately worse symptoms at end of care.
“Without sufficient out-of-session skills practice, clients tend to experience suboptimal outcomes, including increased likelihood of premature treatment dropout, slower symptom improvements (presumably due to slower skills acquisition), and ultimately worse symptoms at end of care [7,12-14].”
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Psychotherapy and behavioral interventions
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- Authors
- Conklin, L. R., Curreri, A. J., Farchione, T. J., & Barlow, D. H.
- Affiliations
- Boston University (US)
- Corresponding author
- Conklin, Laren R.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 52
- Issue
- 4
- Pages
- 1008-1018
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W3121485639
- Cited by
- 23
- References
- 49
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 1 · 2021: 2
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01 MH090053)
- Agency for Healthcare Research and Quality
- Mayo Clinic
- Chinese University of Hong Kong
- U.S. Department of Defense
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- homework compliance, homework quality, cognitive behavioral therapy, anxiety disorders, obsessive-compulsive disorder, Unified Protocol, treatment discontinuation, treatment retention, generalized anxiety disorder, panic disorder, social anxiety disorder, depressive symptoms, clinical severity
- MeSH terms
- Phobia, Social, Anxiety Disorders, Humans, Obsessive-Compulsive Disorder, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome
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