Research on The Effectiveness of Therapeutic Assignments
As the studies below suggest, therapeutic homework improves outcomes for a wide variety of clinical problems including depression, panic disorder, and schizophrenia. The research also shows that homework assignments enhance a variety of evidence-based techniques including CBT and EMDR.
Studies also reveal there are variables that can make therapy homework more effective.
When clients are more involved in choosing homework assignments, outcomes are better.
When therapists show enthusiasm for homework assignments, outcomes improve.
When clients have a positive attitude toward assignments, they have improved outcomes.
None of these variables are particularly surprising. Shared enthusiasm between the therapist and the client about any technique will result in an improved therapeutic alliance, the best predictor of positive therapy outcomes.
With this in mind, we encourage therapists to introduce therapeutic assignments early in therapy and to explain their purpose. Therapists can integrate assignments into their ongoing work, following up each week on how the assignments contributed to the client’s progress and/or what obstacles to completing the assignments were encountered by the client. We also encourage the use of multimedia and interactive assignments using our Virtual Counseling Rooms. Clients will always get more out of assignments when they are engaged in the learning process and particularly when their creativity is stimulated.
The following are just a few of the studies that underscore the efficacy of using therapeutic homework assignments:
A meta-analysis found that higher levels of homework compliance were associated with better treatment outcomes in cognitive behavior therapy, suggesting that homework assignments can be an important component of effective therapy. Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.
A study found that the quality of the therapeutic alliance was related to the patient’s engagement with homework assignments, which in turn was related to better treatment outcomes. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260.
This study found that therapist support for homework assignments was positively associated with treatment outcomes for patients with panic disorder. Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69(5), 747-755.
This study found that clients’ expectations for homework assignments were positively associated with treatment outcomes, suggesting that involving them in the selection and planning of homework assignments can increase their engagement and motivation. Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. Journal of Counseling Psychology, 58(2), 210-217.
This study found that clients who received cognitive therapy and were assigned homework had better treatment outcomes than those who received medication alone, highlighting the importance of homework assignments in cognitive therapy. MacLeod, A. K., Tata, P., Tyrer, P., Schmidt, U., Davidson, K., & Thompson, S. (2005). Cognitive therapy and pharmacotherapy for social phobia: Randomized controlled trial. The British Journal of Psychiatry, 186(2), 99-106.
This study found that computer-assisted delivery of cognitive-behavioral therapy (CBT) with homework assignments was effective in reducing anxiety symptoms in primary care settings. Craske, M. G., Rose, R. D., Lang, A., Welch, S. S., Campbell-Sills, L., Sullivan, G., … & Bystritsky, A. (2009). Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depression and Anxiety, 26(3), 235-242.
This meta-analysis found a significant relationship between homework compliance and therapy outcomes across a range of psychological interventions, suggesting that homework is an important factor in achieving positive outcomes. Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., Patterson, T. L., & The Successful Aging Evaluation Team. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429-438.
This study found that homework assignments involving exposure to anxiety-provoking stimuli were associated with greater symptom reduction in clients with posttraumatic stress disorder (PTSD) who received Eye Movement Desensitization and Reprocessing (EMDR) therapy. Lee, C. W., Taylor, G., & Drummond, P. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology & Psychotherapy, 13(2), 97-107.
This study found that clients with schizophrenia who completed homework assignments as part of cognitive-behavioral therapy showed greater improvements in symptom severity and social functioning than those who did not complete homework. Moritz, S., Veckenstedt, R., Andreou, C., Bohn, F., Hottenrott, B., Leighton, L., … & Woodward, T. S. (2014). Sustained effects of cognitive-behavioral therapy for schizophrenia: A randomized controlled trial. JAMA Psychiatry, 71(3), 304-312.
This study found that homework completion was positively associated with client progress in therapy for depression, as measured by improvements in life values and symptom severity. Lutz, W., Stulz, N., Kopta, S. M., Minami, T., Saunders, S. M., & Lysaker, P. H. (2018). Patient progress and alliance toward goals in therapy for depression using the Personal Life Value Inventory. Psychotherapy Research, 28(2), 231-242.
This study found that internet-based cognitive-behavioral therapy (CBT) with homework assignments was effective in reducing symptoms of obsessive-compulsive disorder (OCD) in a randomized controlled trial. Hoffart, A., Johnson, S. U., Himle, J. A., & Bjornstad, G. J. (2021). Internet-based cognitive behavior therapy and homework in obsessive–compulsive disorder: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 28, 100626.
This study found that a positive attitude toward homework assignments and a sense of control over completing homework were important predictors of homework completion in clients. Hall, B. J., Han, X., Hackett, R., Huang, P., & Latkin, C. (2018). Using theory of planned behavior to predict homework completion among heroin users enrolled in methadone maintenance treatment. Substance Abuse Treatment, Prevention, and Policy, 13(1), 36.
