The use of homework in behavior therapy for anxiety disorders
Abstract
In this article, the authors discuss the role of homework in behavior therapyfor the anxiety disorders. First, the authors describe the essential componentsof behavior therapy that include exposure to feared consequences andcessation of all avoidance behaviors. Then, the authors briesy review theliterature on the relationship between homework compliance and treatmentoutcome. Next, the authors discuss the way that homework is used in termsof self-monitoring and exposure exercises during the course of treatment.Finally, the authors discuss the practicalities of encouraging homeworkcompliance and managing noncompliance.Behavior therapy is an empirically based treatment approach that hasdemonstrated efÞcacy across the anxiety disorders (see Hersen & Bellack,1999, for discussions of behavior therapy in panic disorder, obsessiveÐcompulsive disorder, social phobia and posttraumatic stress disorder, or forspeciÞc treatment manuals including suggestions for homework assign-ments see Oxford University Press/Graywind Publications manuals). Inaddition to the empirical stance taken by researchers of behavior therapy,clinicians and patients are also encouraged to take the stance of scientistsin the context of treatment. SpeciÞcally, treatment involves testing beliefsthat they have about particular situations during treatment sessions and ontheir own through the use of homework assignments.Behavior therapy for the anxiety disorders focuses primarily on havingpatients confront situations that that they are avoiding. Avoidance can beovert (e.g., a person with social phobia who refuses to do any public
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An individual with strong homework adherence has had more exposure to the fear memory, possibly affecting how much habituation occurs between sessions and ultimately treatment outcome.
“An individual with strong homework adherence has had more exposure to the fear memory, possibly affecting how much habituation occurs between sessions and ultimately affecting treatment outcome (Huppert, Roth, Ledley, & Foa, 2006).”
From Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD (2014) · cites this paper as Huppert, Roth, Ledley, & Foa, 2006
Cites
(1997) · Medical Entomology and Zoology · Cited by 1,043 · see citing works
Self-citationTreating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD
Ellis, E. M. (1999) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1999.53.1.126 · Cited by 734 · see citing works
Homework assignments in cognitive and behavioral therapy: a meta-analysis
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.7.2.189 · Cited by 412 · see citing works
Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder
Kozak, M. J., & Foa, E. B. (1994) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)90132-5 · Cited by 369 · see citing works
Self-citationAntony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00083-7 · Cited by 327 · see citing works
Mastery of Your Anxiety and Panic: Workbook
Barlow, D. H., & Craske, M. G. (2006) · doi:10.1093/med:psych/9780195311358.001.0001 · Cited by 230 · see citing works
Bryant, M. J., Simons, A. D., & Thase, M. E. (1999) · Cognitive Therapy and Research · doi:10.1023/a:1018703901116 · Cited by 183 · see citing works
Schmidt, N. B., & Woolaway-Bickel, K. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.1.13 · Cited by 169 · see citing works
Leung, A. W., & Heimberg, R. G. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(96)00014-9 · Cited by 168 · see citing works
Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia
Edelman, R. E., & Chambless, D. L. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00068-u · Cited by 137 · see citing works
Schmidt, N. B., & Woolaway-Bickel, K. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.1.13 · Cited by 128 · see citing works
Homework Assignments in Cognitive and Behavioral Therapy: A Meta-Analysis
Kazantzis, N. (2000) · Clinical Psychology Science and Practice · doi:10.1093/clipsy/7.2.189 · Cited by 95 · see citing works
The Use of Image Habituation Training with Post-traumatic Stress Disorders
Vaughan, K., & Tarrier, N. (1992) · British Journal of Psychiatry · doi:10.1192/bjp.161.5.658 · Cited by 94 · see citing works
Mastery of Your Anxiety and Panic
Craske, M. G., & Barlow, D. H. (2006) · Oxford University Press eBooks · doi:10.1093/med/9780195311402.001.0001 · Cited by 86 · see citing works
Compliance during sessions and homework in exposure-based treatment of agoraphobia
Edelman, R. E., & Chambless, D. L. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90007-h · Cited by 85 · see citing works
Early Compliance and Other Factors Predicting Outcome of Exposure for Obsessive–Compulsive Disorder
Araujo, L. A. D., Ito, L. M., & Marks, I. M. (1996) · The British Journal of Psychiatry · doi:10.1192/bjp.169.6.747 · Cited by 82 · see citing works
Role of exposure homework in phobia reduction: A controlled study
Al-Kubaisy, T., Marks, I. M., Logsdail, S., Marks, M., Lovell, K., Sungur, M. Z., & Araya, R. (1992) · Behavior Therapy · doi:10.1016/s0005-7894(05)80224-2 · Cited by 81 · see citing works
Handbook of comparative interventions for adult disorders
Hersen, M., & Bellack, A. S. (1999) · Wiley eBooks · Cited by 36 · see citing works
Park, J., Mataix-Cols, D., Marks, I., Ngamthipwatthana, T., Marks, M., Araya, R., & Al-Kubaisy, T. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.178.6.543 · Cited by 36 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments
Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016) · JMIR Mental Health · doi:10.2196/mental.4984 · Cited by 886 · see citing works
“Self-monitoring can be used to restructure maladaptive anxiety responses [125,126], challenge perpetuating factors of depression [127], and sufficiently treat a small but significant proportion of posttraumatic stress disorder sufferers [128,129].”
Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder
Keeley, M. L., Storch, E. A., Merlo, L. J., & Geffken, G. R. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.04.003 · Cited by 261 · see citing works
Bakker, D., & Rickard, N. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.016 · Cited by 231 · see citing works
Looking beyond fear: The extinction of other emotions implicated in anxiety disorders
Mason, E. C., & Richardson, R. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.08.007 · Cited by 126 · see citing works
Treating disgust in anxiety disorders.
Mason, E. C., & Richardson, R. (2012) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2012.01282.x · Cited by 88 · see citing works
Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD
Bluett, E. J., Zoellner, L. A., & Feeny, N. C. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.09.003 · Cited by 71 · see citing works
Psychological Mechanisms of Effective Cognitive–Behavioral Treatments for PTSD
Zalta, A. K. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0560-6 · Cited by 66 · see citing works
Cooper, A. A., Kline, A. C., Graham, B., Bedard‐Gilligan, M. A., Mello, P. G., Feeny, N. C., & Zoellner, L. A. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.02.013 · Cited by 55 · see citing works
Wheaton, M. G., & Chen, S. R. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10125-0 · Cited by 47 · see citing works
“Although problems with homework completion are commonly observed in practice (Huppert et al. 2006), relatively little empirical work has specifically identified evidencebased strategies to improve ERP homework completion.”
BackgroundSeuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
“…even allow clinicians to equip patients with light-weight VR equipment, making it possible to conduct self-guided VRET outside regular therapy sessions as a homework assignment, which is crucial to anxiety and phobia treatment (Cooper et al., 2017; Heimberg et al., 1985; Huppert et al., 2006).”
A Critical Review of Multimodal-multisensor Analytics for Anxiety Assessment
Senaratne, H., Oviatt, S. L., Ellis, K., & Melvin, G. A. (2022) · ACM Transactions on Computing for Healthcare · doi:10.1145/3556980 · Cited by 28 · see citing works
“Behavioral approach tests, the other type, has more ecological validity; however, due to their time-consuming nature [102], they are often allocated as homework and clinicians get to view them through retrospective reports [112].”
BackgroundSookman, D., Phillips, K. A., Anholt, G. E., Bhar, S. S., Bream, V., Challacombe, F. L., Coughtrey, A. E., Craske, M. G., Foa, E. B., Gagné, J.-P., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113752 · Cited by 22 · see citing works
Self-citationWillner‐Reid, J., Whitaker, D., Epstein, D. H., Phillips, K. A., Pulaski, A. R., Preston, K. L., & Willner, P. (2016) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12080 · Cited by 21 · see citing works
A Case for Translation from the Clinic to the Laboratory
Kredlow, M. A., de Voogd, L. D., & Phelps, E. (2022) · Perspectives on Psychological Science · doi:10.1177/17456916211039852 · Cited by 18 · see citing works
“Exposures are conducted across multiple therapy sessions and also for homework (Huppert et al., 2006).”
BackgroundWu, M. S., Wickham, R. E., Chen, S.-Y., Chen, C., & Lungu, A. (2021) · JMIR Formative Research · doi:10.2196/33452 · Cited by 15 · see citing works
“Indeed, facing challenging situations and implementing regular out-of-session skills practices lead to long-term decreases in symptom severity and strengthen the durability of treatment gains [22,23].”
BackgroundAdvice Giving in Psychotherapy
Duan, C., Knox, S., & Hill, C. E. (2018) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190630188.013.11 · Cited by 11 · see citing works
Miragoli, S., & Milani, L. (2019) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2019-002005 · Cited by 9 · see citing works
Ronan, K. R., & Kazantzis, N. (2006) · Journal of Psychotherapy Integration · doi:10.1037/1053-0479.16.2.254 · Cited by 8 · see citing works
Walther, M., Milgram, L., Cain, G. H., Sheehan, K. G., Jones, R. N., Herren, J. A., Benito, K., Garcia, A. M., Sapyta, J. J., Franklin, M. E., et al. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100729 · Cited by 6 · see citing works
THE USE OF SELF-MONITORING AS A TREATMENT INTERVENTION
Avina, C. (2008) · Elsevier eBooks · doi:10.1016/b978-012088520-6.50011-1 · Cited by 6 · see citing works
Kazantzis, N., Dattilio, F. M., McGinn, L. K., Newman, C. F., Persons, J. B., & Radomsky, A. S. (2018) · International Journal of Cognitive Therapy · doi:10.1007/s41811-018-0014-0 · Cited by 5 · see citing works
The Basics of Exposure Therapy
Jacquart, J., Abramowitz, J. S., Arch, J. J., Margraf, J., & Smits, J. A. J. (2022) · Springer eBooks · doi:10.1007/978-3-031-04927-9_1 · Cited by 5 · see citing works
Technology's Role in Fostering Therapist-Client Collaboration and Engagement with Goals
Oewel, B., Azizan, N., Areán, P. A., & Agapie, E. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3687055 · Cited by 4 · see citing works
Refinement and examination of a brief anxiety sensitivity focused intervention
Keough, M. E. (2011) · Cited by 4 · see citing works
Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance
Nadai, A. S. D., & Karver, M. S. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6458-7_17 · Cited by 4 · see citing works
Homework Assignments in Cognitive Behavioral Therapy
Soylu, C., & Topaloğlu, C. (2014) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.5455/cap.20141029012248 · Cited by 4 · see citing works
Teckchandani, T. A., Shields, R. E., Andrews, K. L., Maguire, K. Q., Jamshidi, L., Nisbet, J., Afifi, T. O., Lix, L. M., Stewart, S. H., Sauer-Zavala, S., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1297953 · Cited by 3 · see citing works
The Role of Client Avoidance on PTSD Recovery throughout the Course of Trauma Therapy
Gloth, C. (2016) · IRL - University of Missouri, St. Louis (University of Missouri–St. Louis) · Cited by 2 · see citing works
Suen, Y. N., Yau, J. Y., Wong, P. S., Li, Y. K., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114880 · Cited by 2 · see citing works
Moscovitch, D. A., & Huppert, J. D. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-14146-1.00010-3 · Cited by 1 · see citing works
Self-citationCognitive Behavioral Therapy for Anxiety Disorders
(2021) · Cambridge University Press eBooks · doi:10.1017/9781108355605.003 · Cited by 1 · see citing works
Macklem, G. L. (2010) · Springer eBooks · doi:10.1007/978-1-4419-7907-0_9 · Cited by 1 · see citing works
Puuronen, R., & Tossavainen, S. (2013) · Jyväskylä University Digital Archive (University of Jyväskylä)
Giráldez, C. A. M., Parga, M. X. F., & Elvira, A. C. (2020) · Universitas Psychologica · doi:10.11144/javeriana.upsy19.hica
CBT for Somatic Symptom Disorder and Illness Anxiety Disorder
Reuman, L., & Abramowitz, J. S. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108355605.009
- Authors
- Huppert, J. D., Roth Ledley, D., & Foa, E. B.
- Affiliations
- University of Pennsylvania (US)
- Venue
- Journal of Psychotherapy Integration
- Published
- 2006-06
- Volume
- 16
- Issue
- 2
- Pages
- 128-139
- ISSN
- 1053-0479 (ISSN-L)
- 1573-3696
- OpenAlex
- W2022407748
- Cited by
- 36
- References
- 19
- Citations by year
- 2025: 1 · 2024: 3 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 1
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychotherapy Integration (publishedVersion)
- 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 › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- homework compliance, behavior therapy, anxiety disorders, exposure therapy, avoidance behavior, self-monitoring, treatment outcomes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
