Homework (mutually agreed tasks for the patient to complete outside the therapy session) is an important component of Cognitive Behavioral Therapy (CBT). CBT homework disconfirms negative thoughts and beliefs; focuses subjective accounts to more objective detailed accounts; allows therapist and patient to review the past week’s activities; and helps the therapist to relate the session to specific tasks (Beck et al., 1979). Compliance with homework has been shown to improve the clinical results of CBT (Persons et al., 1988). At the present time there is no consensus as to the average rate of adherence in completing homework assignments (Detweiler & Whisman, 1999).

The identification and reliable measurement of barriers affecting completion of homework assignments may improve the potency of CBT, thereby producing further reductions in depressive symptoms and improvement in ultimate clinical outcome. It may also assist researchers to identify factors related to variance in treatment outcome, thereby strengthening the generalizability of investigational findings for the clinical community.

A two-phase study was conducted to develop an instrument that may assist CBT patients, therapists, and researchers to ascertain the barriers that may be preventing completion of homework assignments. Phase I involved the interview of 20 depressed patients and 20 therapists to elicit perceived barriers to homework completion in order to develop an item pool for the draft instrument. In Phase II, the draft instrument was administered to 56 subjects on 2 separate occasions.

Factor Analysis revealed a 2-factor solution of “Patient Factors” and “Therapist/Task Factors.” Internal Consistency demonstrated Alpha Coefficients of the Subscale and Entire scales that ranged from .80 to .95. Test-Re-Test correlations demonstrated Pearson correlations of .72 to .95. The only consistent demographic predictors of levels of Barriers to CBT Homework Completion Scale scores were race and marital status. The Patient subscale was able to satisfactorily classify patients (75 to 79%) with low and high adherence to homework assignments. There were no consistent predictors of assignment compliance. The Barriers to CBT Homework Completion Scale scores did correlate significantly with Assignment Compliance (.32 to .46). Sample size most likely limited the ability to fully evaluate the psychometric properties of this draft instrument. Future studies will expand upon this pilot study of the Barriers to CBT Homework Completion Scale.