Although patient compliance with homework assignments is considered a major component of cognitive therapy for depression, research studies have rarely investigated homework compliance as a variable potentially influencing treatment outcome. This paper reviews the literature on outcome studies of cognitive therapy for depression and describes research design problems that result from the failure to assess and control for differential homework compliance. These design problems limit the internal validity of outcome studies and make it difficult to compare studies that included allegedly similar treatments but produced different results. Recommendations for evaluating the role of homework compliance in outcome research on cognitive therapy and other treatment approaches are described. The need for adequate measures of homework compliance and quality is stressed, and potential criteria for use in cognitive therapy homework rating scales are proposed.
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Primakoff et al. (1986) studied this question.
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