The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis

Abstract

The current study was an updated meta-analysis of manuscripts since the year 2000 examining the effects of homework compliance on treatment outcome. A total of 23 studies encompassing 2,183 subjects were included. Results indicated a significant relationship between homework compliance and treatment outcome suggesting a small to medium effect (r = .26; 95% CI = .19–.33). Moderator analyses were conducted to determine the differential effect size of homework on treatment outcome by target symptoms (e.g., depression; anxiety), source of homework rating (e.g., client; therapist), timing of homework rating (e.g., retroactive vs. contemporaneous), and type of homework rating (e.g., Likert; total homeworks completed). Results indicated that effect sizes were robust across target symptoms, but differed by source of homework rating, timing of homework rating, and type of homework rating. Specifically, studies utilizing combined client and therapist ratings of compliance had significantly higher mean effect size relative to those using therapist only assessments and those using objective assessments. Further, studies that rated the percentage of homeworks completed had a significantly lower mean effect size compared to studies using Likert ratings, and retroactive assessments had higher effect size than contemporaneous assessments.

Does Expectancy and Homework Compliance Predict Change in CBT?

“…In a metaanalysis, Kazantzis, Whittington, and Dattilio (46 studies; n=1,072) [21] concluded that 62% of patients undergoing a therapy with homework improved significantly, whereas only 38% of patients undergoing a treatment without homework improved significantly. Mausbach, Moore, Roesch, Cardenas, and Patterson (23 studies; n=2,183) [22] reported similar results, showing a small to medium effect (r=0.26) of homework compliance on treatment outcome. Thus homework compliance can be viewed as a major process factor in treatment.…”

“…In this context, the operationalization of homework compliance plays an essential role. Although homework is an important part of cognitive behavioral therapy [57][58]21], metaanalyses clearly show that findings on the effect of homework depend strongly on how homework compliance is defined and measured [57,[21][22]. As this study implemented an improved methodology, using the mean score of homework compliance from the first five sessions, the results are based on a more representative estimator [32].…”

Introduction to the Special Issue on Processes of Cognitive Behavioral Therapy: Does “Necessary, But Not Sufficient” Still Capture It?

“…However, many of these elements of the therapeutic interaction still lack focused assessment and empirical study. For example, while studies have considered the causal benefits of including homework in CBT , correlational adherence-outcome relations (Kazantzis et al 2016;Mausbach et al 2010), and session-by-session benefits associated with homework adherence (Conklin and Strunk 2015), more research is needed on the in-session therapist behaviors that can facilitate engagement Startup and Edmonds 1994;and see;Shaw et al 1999 for evidence of competence in structuring sessions as a predictor of outcomes). Similarly, existing measures may not fully capture the definition of collaboration in CBT (Kazantzis et al 2015;Tryon and Winograd 2011), the evidence for Socratic dialogue is just emerging (Braun et al 2014), and study of feedback processes has centered on symptom assessments (Knaup et al 2009;Lambert and Shimokawa 2011).…”

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews (Preprint)

“…negative automatic thoughts, mood tracking) that do not necessarily require input from a therapist and are often covered in self-directed computerised CBT suggests that apps may in particular be a useful addition to low-intensity CBT. They may be particularly effective in facilitating engagement with CBT "homework" (which often requires recording thoughts and emotions, planning activities or tracking mood), which is a desirable outcome as regular engagement with such CBT exercises increases the effectiveness of therapy [50,51]. Moreover, the results show that apps have important advantages with regard to 'integration into practice': they are always at hand, are more private and discreet than paper worksheets, and they allow to easily share data with the therapist.…”