Background: Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown. Aims: To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment. Method: This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases. Results: There was a significant (combined p = .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified. Conclusions: Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.

It is argued, illustrated by a case example, that homework quality and end of therapy outcomes can be positively affected when ideas of compassion and attention to individual frames of reference are considered. It is suggested that by exploring the affect experienced when completing tasks and being mindful of client learning (i.e. the zone of proximal development), engagement and emotional connection with homework increase.

Background: Homework assignments are considered an essential component for a successful outcome of cognitive behavioural therapy for youths with anxiety disorders. However, only two studies have examined the association between homework adherence and outcome of cognitive behavioural therapy for youths with anxiety disorders. Aims: The study examined the association between homework adherence and treatment outcome following a generic group cognitive behaviour treatment program (Cool Kids) for anxiety disordered youths and their parents. Method: The treatment program was completed by 98 children and adolescents (ages 7–16). Homework adherence was measured as time spent doing homework assignments between each session, reported by youths as well as parents. Outcome criteria consisted of youth-reported anxiety symptoms and clinician rated severity of primary anxiety diagnosis at posttreatment and 3-month follow-up. Results: Results did not support an association between homework adherence and treatment outcome when controlling for pretreatment severity. Conclusions: The study found no convincing evidence that homework adherence predicted outcome of cognitive behavioural therapy for youths with anxiety disorders. Reasons for divergent findings on homework adherence in cognitive behavioural therapy for youths compared to adults are discussed.

This paper reports a piece of practitioner research to explore the use of a Session Bridging Worksheet (SBW) with clients on their homework adherence, experience of their therapist, and clinical outcomes. Clients were divided into two groups randomly. One group received CBT as normal (TAU group) and the other group received CBT and used a session bridging worksheet (SBW group). The perception of the therapist's ability to address potential barriers was better when the SBW was used by the client and this seems to have had a small positive effect on homework adherence. Differences in symptom measures (BDI, BAI, BHS) between the two groups are inconclusive. The limitations of the design of the study are discussed with suggestions for future research.

This article presents a panel discussion on the integration of homework assignments into cognitive behaviour therapy sessions. The panel comprised experts in research and practice who had been invited as keynote presenters for the 32nd National Conference for the Australian Association of Cognitive and Behaviour Therapy. Experts responded to questions about the definition of homework, the mechanism by which homework produces its effects, and the relative importance of homework adherence for effective therapy. Interwoven through the discussion was an emphasis on a collaborative approach to homework, as well as specific recommendations for the integration of homework into sessions. Selected case illustrations were also discussed.

Prior research has shown that psychology-trained practitioners use homework assignments, but no prior research has sought to survey the clinical practice of other mental health professionals. Three hundred and thirty-three mental health professionals from counselling, medical, nursing, psychology, and social work training backgrounds were surveyed regarding their use of homework assignments in psychotherapy. The vast majority of the sample (83%) reported the use of homework assignments, and those practising cognitive-behavioural therapy indicated a greater frequency and degree of specificity in assigning homework. However, it was noteworthy that all theoretical and professional groups in the present study reported some use of homework assignments.

Homework assignments are an essential part of cognitive-behavioural therapy, and are included in the majority of therapy manuals and frequently used in therapeutic practice. Despite this, little is known about problems with homework completion or possible influences on homework compliance. The aim of the present practitioner survey was to provide data on problems related to homework use and compliance. Furthermore, the relationships between different variables and homework compliance were examined. Data were collected by asking 77 cognitive-behavioural therapists to recall two individual patients. Therapists described homework tasks assigned to these patients and procedures of assignment as well as problems that arose during assignment and completion. The results suggested that problems during the assignation of a task as well as during completion regularly occur. Homework compliance was positively associated both with patients' motivation for therapy, outcome at a later stage of therapy, and the provision of a written note or homework sheets on the task. Regression analyses pointed to patient variables as most crucial for homework compliance. Implications for effective homework use in clinical practice are discussed.