Therapist skill and patient variables in homework compliance: Controlling an uncontrolled variable in cognitive therapy outcome research

Prior research suggests therapists' assignment of homework, and patients' compliance with it, enhances the efficacy of cognitive therapy (CT). However, factors contributing to homework compliance have received scant empirical attention. This study examined specific demographic and clinical patient variables (age, education, number of previous depressive episodes, depression severity, and learned resourcefulness) and a variety of therapist skills (general, CT-specific, and homework-focused) as they predicted homework compliance among 26 patients in a 20-session CT protocol for major depression. Patients who were more compliant with homework exhibited significantly greater treatment response on one depression measure but not another. Homework compliance was most strongly predicted by therapists' reviewing homework assigned previously, and by general therapeutic skills. Patients' age, education, depression severity, and learned resourcefulness were unrelated to compliance; however, number of previous episodes was negatively related to compliance.