Top

Published in:

Open Access 01-10-2010 | Original Article

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

Authors: Brent T. Mausbach, Raeanne Moore, Scott Roesch, Veronica Cardenas, Thomas L. Patterson

Published in: Cognitive Therapy and Research | Issue 5/2010

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.

Abramowitz, J. S., Franklin, M. E., Zoellner, L. A., & DiBernardo, C. L. (2002). Treatment compliance and outcome in obsessive-compulsive disorder. Behavior Modification, 26(4), 447–463.CrossRefPubMed

Addis, M. E., & Jacobson, N. S. (2000). A closer look at the treatment rationale and homework compliance in cognitive-behavioral therapy for depression. Cognitive Therapy and Research, 24(3), 313–326.CrossRef

Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive theory of depression. New York: Guilford Press.

Bogalo, L., & Moss-Morris, R. (2006). The effectiveness of homework tasks in an irritable bowel syndrome self-management programme. New Zealand Journal of Psychology, 35(3), 120–125.

Burns, D. D., & Spangler, D. L. (2000). Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? Journal of Consulting and Clinical Psychology, 68(1), 46–56.CrossRefPubMed

Carroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., Nuro, K. F., et al. (2008). Computer-assisted delivery of cognitive-behavioral therapy for addiction: A randomized trial of CBT4CBT. The American Journal of Psychiatry, 165(7), 881–888.CrossRefPubMed

Carroll, K. M., Nich, C., & Ball, S. A. (2005). Practice makes progress? Homework assignments and outcome in treatment of cocaine dependence. Journal of Consulting and Clinical Psychology, 73(4), 749–755.CrossRefPubMed

Cash, T. F., & Hrabosky, J. I. (2003). The effects of psychoeducation and self-monitoring in a cognitive-behavioral program for body-image improvement. Eating Disorders, 11, 255–270.CrossRefPubMed

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.

Coon, D. W., & Thompson, L. W. (2003). The relationship between homework compliance and treatment outcomes among older adult outpatients with mild-to-moderate depression. [306]. The American Journal of Geriatric Psychiatry, 11(1), 53–61.PubMed

Cowan, M. J., Freedland, K. E., Burg, M. M., Saab, P. G., Youngblood, M. E., Cornell, C. E., et al. (2008). Predictors of treatment response for depression and inadquate social support: The ENRICHD randomized clinical trial. Psychotherapy and Psychosomatics, 77, 27–37.CrossRefPubMed

Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57(3), 414–419.CrossRefPubMed

Dunn, H., Morrison, A. P., & Bentall, R. P. (2006). The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clinical Psychology & Psychotherapy, 13, 145–152.CrossRef

Duttra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal of Psychiatry, 165, 179–187.CrossRef

Gonzalez, V. M., Schmitz, J. M., & DeLaune, K. A. (2006). The role of homework in cognitive-behavioral therapy for cocaine dependence. Journal of Consulting and Clinical Psychology, 74(3), 633–637.CrossRefPubMed

Granholm, E., Auslander, L. A., Gottlieb, J. D., McQuaid, J. R., & McClure, F. S. (2006). Therapeutic factors contributing to change in cognitive-behavioral group therapy for older persons with schizophrenia. Journal of Contemporary Psychotherapy, 36(1), 31–41.CrossRef

Green, C. A., Polen, M. R., Janoff, S. L., Castleton, D. K., Wisdom, J. P., Vuckovic, N., et al. (2008). Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatric Rehabilitation Journal, 32(1), 9–22.CrossRefPubMed

Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.

Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632.CrossRefPubMed

Hollon, S. D. (2003). Does cognitive therapy have an enduring effect? Cognitive Therapy & Research, 27(1), 71–75.CrossRef

Hughes, A. A., & Kendall, P. C. (2007). Prediction of cognitive behavior treatment outcome for children with anxiety disorders: Therapeutic relationship and homework compliance. Behavioural & Cognitive Psychotherapy, 35, 487–494.CrossRef

Hunter, J. E., & Schmidt, F. L. (1990). Methods of meta-analysis: Correcting error and bias in research findings. Newbury Park: Sage.

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science & Practice, 7(2), 189–202.CrossRef

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2004). Assessing compliance with homework assignments: Review and recommendations for clinical practice. [171]. Journal of Clinical Psychology, 60(6), 627–641.CrossRefPubMed

Kazantzis, N., & Lampropoulos, G. K. (2002). Reflecting on homework in psychotherapy: What can we conclude from research and experience? Journal of Clinical Psychology, 58(5), 577–585.CrossRefPubMed

Kraemer, H. C., Morgan, G. A., Leech, N. L., Gliner, J. A., Vaske, J. J., & Harmon, R. J. (2003). Measures of clinical significance. [129]. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12), 1524–1529.CrossRefPubMed

Neimeyer, R. A., Kazantzis, N., Kassler, D. M., Baker, K. D., & Fletcher, R. (2008). Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cognitive Behaviour Therapy, 37(4), 199–215.CrossRefPubMed

Otto, M. W., Smits, J. A. J., & Reese, H. (2004). Cognitive-behavioral therapy for treatment of anxiety disorders. Journal of Clinical Psychiatry, 65(Suppl 5), 34–41.PubMed

Peterson, R. A., & Brown, S. P. (2005). On the use of Beta coefficients in meta-analysis. Journal of Applied Psychology, 90, 175–181.CrossRefPubMed

Rees, C. S., McEvoy, P., & Nathan, P. R. (2005). Relationship between homework completion and outcome in cognitive behavior therapy. Cognitive Behaviour Therapy, 34(4), 242–247.CrossRefPubMed

Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86(3), 638–641.CrossRef

Schmidt, N. B., & Woolaway-Bickel, K. (2000). The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: Quality versus quantity. Journal of Consulting and Clinical Psychology, 68(1), 13–18.CrossRefPubMed

Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine, 47, 319–328.CrossRef

Tolin, D. F., Frost, R. O., & Steketee, G. (2007). An open trial of cognitive-behavioral therapy for compulsive hoarding. Behaviour Research and Therapy, 45(7), 1461–1470.CrossRefPubMed

Tompkins, M. A. (2004). Using homework in psychotherapy: Strategies, guidelines, and forms (Vol. 1). New York, NY: Guilford Press.

Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy & Research, 30, 481–498.CrossRef

Westra, H. A., Dozois, D. J. A., & Marcus, M. (2007). Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. Journal of Consulting and Clinical Psychology, 75(3), 363–373.CrossRefPubMed

Wetherell, J. L., Hopko, D. R., Diefenbach, G. J., Averill, P. M., Beck, J. G., Craske, M. G., et al. (2005). Cognitive-behavioral therapy for late-life generalized anxiety disorder: Who gets better? Behavior Therapy, 36, 147–156.CrossRef

Woods, C. M., Chambless, D. L., & Steketee, G. (2002). Homework compliance and behavior therapy outcome for panic with agoraphobia and obsessive compulsive disorder. Cognitive Behaviour Therapy, 31(2), 88–95.CrossRef

Woody, S. R., & Adessky, R. S. (2002). Therapeutic alliance, group cohesion, and homework compliance during cognitive-behavioral group treatment of social phobia. Behavior Therapy, 33, 5–27.CrossRef

Worthington, E. L. (1986). Client compliance with homework directives during counseling. Journal of Counseling Psychology, 33, 124–130.CrossRef

Yovel, I., & Safren, S. A. (2007). Measuring homework utility in psychotherapy: Cognitive-behavioral therapy for adult attention-deficit hyperactivity disorder as an example. Cognitive Therapy and Research, 31(3), 385–399.CrossRef

Title: The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis
Authors: Brent T. Mausbach
Raeanne Moore
Scott Roesch
Veronica Cardenas
Thomas L. Patterson
Publication date: 01-10-2010
Publisher: Springer US
Published in: Cognitive Therapy and Research / Issue 5/2010
Print ISSN: 0147-5916
Electronic ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-010-9297-z

2024 ASCO Annual Meeting

Springer Medicine

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

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2010

Social Anxiety and Bulimic Behaviors: The Moderating Role of Perfectionism

Cold Pressor “Augmentation” Does Not Differentially Improve Treatment Response for Spider Phobia

Disgust and Obsessive Beliefs in Contamination-Related OCD

A Tale of Two Threats: Social Anxiety and Attention to Social Threat as a Function of Social Exclusion and Non-Exclusion Threats

Exploring the Relationship Between Childhood Abuse and Analogue Generalized Anxiety Disorder: The Mediating Role of Emotion Dysregulation

The Pernicious Blend of Rumination and Fearlessness in Non-Suicidal Self-Injury