A Propensity Score Analysis of Homework Adherence-Outcome Relations in Cognitive Behavioral Therapy for Depression

Judith A. Callan, Nikolaos Kazantzis, Seo Young Park, Charity G. Moore, Michael E. Thase, Abu Minhajuddin, Sander Kornblith, Greg J. Siegle

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Little is known about whether or not a consistently high level of homework adherence over the course of therapy benefits patients. This question was examined in two samples of patients who were receiving individual Cognitive Behavioral Therapy (CBT) for depression (Ns = 128 [Sequenced Treatment Alternatives to Relieve Depression: STAR-D] and 183 [Continuation Phase Cognitive Therapy Relapse Prevention: C-CT-RP]). Logistic and linear regression and propensity score models were used to identify whether or not clinician assessments of homework adherence differentiated symptom reduction and remission, as assessed by the Hamilton Depression Rating Scale-17 (HDRS-17), the Quick Inventory of Depressive Symptomatology–Self-Reported Scale (QIDS-SR), and the QIDS–Clinician Scale (QIDS-C). CBT-related response and remission were equally likely between both high and low homework adherers in both studies and in all models. But in propensity adjusted models that adjusted for session attendance, for both the STAR-D and C-CT-RP samples, greater homework adherence was significantly associated with greater response and remission from depression in the first and last 8 sessions of CBT. Our results suggest that homework adherence can account for response and remission early and late in treatment, with adequate session attendence.

Original languageEnglish (US)
Pages (from-to)285-299
Number of pages15
JournalBehavior Therapy
Issue number2
StatePublished - Mar 2019


  • cognitive behavioral therapy
  • depression
  • homework adherence
  • outcome
  • propensity score analysis

ASJC Scopus subject areas

  • Clinical Psychology


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