homework in cbt examples

How to Design Homework in CBT That Will Engage Your Clients

Take-home assignments provide the opportunity to transfer different skills and lessons learned in the therapeutic context to situations in which problems arise.

These opportunities to translate learned principles into everyday practice are fundamental for ensuring that therapeutic interventions have their intended effects.

In this article, we’ll explore why homework is so essential to CBT interventions and show you how to design CBT homework using modern technologies that will keep your clients engaged and on track to achieving their therapeutic goals.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a detailed insight into positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

Why is homework important in cbt, how to deliver engaging cbt homework, using quenza for cbt: 3 homework examples, 3 assignment ideas & worksheets in quenza, a take-home message.

Many psychotherapists and researchers agree that homework is the chief process by which clients experience behavioral and cognitive improvements from CBT (Beutler et al., 2004; Kazantzis, Deane, & Ronan, 2000).

We can find explanations as to why CBT homework is so crucial in both behaviorist and social learning/cognitive theories of psychology.

Behaviorist theory

Behaviorist models of psychology, such as classical and operant conditioning , would argue that CBT homework delivers therapeutic outcomes by helping clients to unlearn (or relearn) associations between stimuli and particular behavioral responses (Huppert, Roth Ledley, & Foa, 2006).

For instance, imagine a woman who reacts with severe fright upon hearing a car’s wheels skidding on the road because of her experience being in a car accident. This woman’s therapist might work with her to learn a new, more adaptive response to this stimulus, such as training her to apply new relaxation or breathing techniques in response to the sound of a skidding car.

Another example, drawn from the principles of operant conditioning theory (Staddon & Cerutti, 2003), would be a therapist’s invitation to a client to ‘test’ the utility of different behaviors as avenues for attaining reward or pleasure.

For instance, imagine a client who displays resistance to drawing on their support networks due to a false belief that they should handle everything independently. As homework, this client’s therapist might encourage them to ‘test’ what happens when they ask their partner to help them with a small task around the house.

In sum, CBT homework provides opportunities for clients to experiment with stimuli and responses and the utility of different behaviors in their everyday lives.

Social learning and cognitive theories

Scholars have also drawn on social learning and cognitive theories to understand how clients form expectations about the likely difficulty or discomfort involved in completing CBT homework assignments (Kazantzis & L’Abate, 2005).

A client’s expectations can be based on a range of factors, including past experience, modeling by others, present physiological and emotional states, and encouragement expressed by others (Bandura, 1989). This means it’s important for practitioners to design homework activities that clients perceive as having clear advantages by evidencing these benefits of CBT in advance.

For instance, imagine a client whose therapist tells them about another client’s myriad psychological improvements following their completion of a daily thought record . Identifying with this person, who is of similar age and presents similar psychological challenges, the focal client may subsequently exhibit an increased commitment to completing their own daily thought record as a consequence of vicarious modeling.

This is just one example of how social learning and cognitive theories may explain a client’s commitment to completing CBT homework.

Let’s now consider how we might apply these theoretical principles to design homework that is especially motivating for your clients.

In particular, we’ll be highlighting the advantages of using modern digital technologies to deliver engaging CBT homework.

Designing and delivering CBT homework in Quenza

Gone are the days of grainy printouts and crumpled paper tests.

Even before the global pandemic, new technologies have been making designing and assigning homework increasingly simple and intuitive.

In what follows, we will explore the applications of the blended care platform Quenza (pictured here) as a new and emerging way to engage your CBT clients.

Its users have noted the tool is a “game-changer” that allows practitioners to automate and scale their practice while encouraging full-fledged client engagement using the technologies already in their pocket.

To summarize its functions, Quenza serves as an all-in-one platform that allows psychology practitioners to design and administer a range of ‘activities’ relevant to their clients. Besides homework exercises, this can include self-paced psychoeducational work, assessments, and dynamic visual feedback in the form of charts.

Practitioners who sign onto the platform can enjoy the flexibility of either designing their own activities from scratch or drawing from an ever-growing library of preprogrammed activities commonly used by CBT practitioners worldwide.

Any activity drawn from the library is 100% customizable, allowing the practitioner to tailor it to clients’ specific needs and goals. Likewise, practitioners have complete flexibility to decide the sequencing and scheduling of activities by combining them into psychoeducational pathways that span several days, weeks, or even months.

Importantly, reviews of the platform show that users have seen a marked increase in client engagement since digitizing homework delivery using the platform. If we look to our aforementioned drivers of engagement with CBT homework, we might speculate several reasons why.

Implicit awareness that others are completing the same or similar activities using the platform (and have benefitted from doing so) increases clients’ belief in the efficacy of homework.
Practitioners and clients can track responses to sequences of activities and visually evidence progress and improvements using charts and reporting features.
Using their own familiar devices to engage with homework increases clients’ self-belief that they can successfully complete assigned activities.
Therapists can initiate message conversations with clients in the Quenza app to provide encouragement and positive reinforcement as needed.

The rest of this article will explore examples of engaging homework, assignments, and worksheets designed in Quenza that you might assign to your CBT clients.

Download 3 Free Positive CBT Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

Download 3 Free Positive CBT Tools Pack (PDF)

By filling out your name and email address below.

Let’s now look at three examples of predesigned homework activities available through Quenza’s Expansion Library.

Urge Surfing

Many of the problems CBT seeks to address involve changing associations between stimulus and response (Bouton, 1988). In this sense, stimuli in the environment can drive us to experience urges that we have learned to automatically act upon, even when doing so may be undesirable.

For example, a client may have developed the tendency to reach for a glass of wine or engage in risky behaviors, hoping to distract themselves from negative emotions following stressful events.

Using the Urge Surfing homework activity, you can help your clients unlearn this tendency to automatically act upon their urges. Instead, they will discover how to recognize their urges as mere physical sensations in their body that they can ‘ride out’ using a six-minute guided meditation, visual diagram, and reflection exercise.

Moving From Cognitive Fusion to Defusion

Central to CBT is the understanding that how we choose to think stands to improve or worsen our present emotional states. When we get entangled with our negative thoughts about a situation, they can seem like the absolute truth and make coping and problem solving more challenging.

The Moving From Cognitive Fusion to Defusion homework activity invites your client to recognize when they experience a negative thought and explore it in a sequence of steps that help them gain psychological distance from the thought.

Finding Silver Linings

Many clients commencing CBT admit feeling confused or regretful about past events or struggle with self-criticism and blame. In these situations, the focus of CBT may be to work with the client to reappraise an event and have them look at themselves through a kinder lens.

The Finding Silver Linings homework activity is designed to help your clients find the bright side of an otherwise grim situation. It does so by helping the user to step into a positive mindset and reflect on things they feel positively about in their life. Consequently, the activity can help your client build newfound optimism and resilience .

As noted, when you’re preparing homework activities in Quenza, you are not limited to those in the platform’s library.

Instead, you can design your own or adapt existing assignments or worksheets to meet your clients’ needs.

You can also be strategic in how you sequence and schedule activities when combining them into psychoeducational pathways.

Next, we’ll look at three examples of how a practitioner might design or adapt assignments and worksheets in Quenza to help keep them engaged and progressing toward their therapy goals.

In doing so, we’ll look at Quenza’s applications for treating three common foci of treatment: anxiety, depression, and obsessions/compulsions.

When clients present with symptoms of generalized anxiety, panic, or other anxiety-related disorders, a range of useful CBT homework assignments can help.

These activities can include the practice of anxiety management techniques , such as deep breathing, muscle relaxation, and mindfulness training. They can also involve regular monitoring of anxiety levels, challenging automatic thoughts about arousal and panic, and modifying beliefs about the control they have over their symptoms (Leahy, 2005).

Practitioners looking to support these clients using homework might start by sending their clients one or two audio meditations via Quenza, such as the Body Scan Meditation or S.O.B.E.R. Stress Interruption Mediation . That way, the client will have tools on hand to help manage their anxiety in stressful situations.

As a focal assignment, the practitioner might also design and assign the client daily reflection exercises to be completed each evening. These can invite the client to reflect on their anxiety levels during the day by responding to a series of rating scales and open-ended response questions. Patterns in these responses can then be graphed, reviewed, and used to facilitate discussion during the client’s next in-person session.

As with anxiety, there is a range of practical CBT homework activities that aid in treating depression.

It should be noted that it is common for clients experiencing symptoms of depression to report concentration and memory deficits as reasons for not completing homework assignments (Garland & Scott, 2005). It is, therefore, essential to keep this in mind when designing engaging assignments.

CBT assignments targeted at the treatment of depressive symptoms typically center around breaking cycles of negative events, thinking, emotions, and behaviors, such as through the practice of reappraisal (Garland & Scott, 2005).

Examples of assignments that facilitate this may include thought diaries , reflections that prompt cognitive reappraisal, and meditations to create distance between the individual and their negative thoughts and emotions.

To this end, a practitioner looking to support their client might design a sequence of activities that invite clients to explore their negative cognitions once per day. This exploration can center on responses to negative feedback, faced challenges, or general low mood.

A good template to base this on is the Personal Coping Mantra worksheet in Quenza’s Expansion Library, which guides clients through the process of replacing automatic negative thoughts with more adaptive coping thoughts.

The practitioner can also schedule automatic push notification reminders to pop up on the client’s device if an activity in the sequence is not completed by a particular time each day. This function of Quenza may be particularly useful for supporting clients with concentration and memory deficits, helping keep them engaged with CBT homework.

Obsessions/compulsions

Homework assignments pertaining to the treatment of obsessive-compulsive disorder typically differ depending on the stage of the therapy.

In the early stages of therapy, practitioners assigning homework will often invite clients to self-monitor their experience of compulsions, rituals, or responses (Franklin, Huppert, & Roth Ledley, 2005).

This serves two purposes. First, the information gathered through self-monitoring, such as by completing a journal entry each time compulsive thoughts arise, will help the practitioner get clearer about the nature of the client’s problem.

Second, self-monitoring allows clients to become more aware of the thoughts that drive their ritualized responses, which is important if rituals have become mostly automatic for the client (Franklin et al., 2005).

Therefore, as a focal assignment, the practitioner might assign a digital worksheet via Quenza that helps the client explore phenomena throughout their day that prompt ritualized responses. The client might then rate the intensity of their arousal in these different situations on a series of Likert scales and enter the specific thoughts that arise following exposure to their fear.

The therapist can then invite the client to complete this worksheet each day for one week by assigning it as part of a pathway of activities. A good starting point for users of Quenza may be to adapt the platform’s pre-designed Stress Diary for this purpose.

At the end of the week, the therapist and client can then reflect on the client’s responses together and begin constructing an exposure hierarchy.

This leads us to the second type of assignment, which involves exposure and response prevention. In this phase, the client will begin exploring strategies to reduce the frequency with which they practice ritualized responses (Franklin et al., 2005).

To this end, practitioners may collaboratively set a goal with their client to take a ‘first step’ toward unlearning the ritualized response. This can then be built into a customized activity in Quenza that invites the client to complete a reflection.

For instance, a client who compulsively hoards may be invited to clear one box of old belongings from their bedroom and resist the temptation to engage in ritualized responses while doing so.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

Developing and administering engaging CBT homework that caters to your client’s specific needs or concerns is becoming so much easier with online apps.

Further, best practice is becoming more accessible to more practitioners thanks to the emergence of new digital technologies.

We hope this article has inspired you to consider how you might leverage the digital tools at your disposal to create better homework that your clients want to engage with.

Likewise, let us know if you’ve found success using any of the activities we’ve explored with your own clients – we’d love to hear from you.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist , 44 (9), 1175–1184.
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., & Wong, E. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.) (pp. 227–306). Wiley.
Bouton, M. E. (1988). Context and ambiguity in the extinction of emotional learning: Implications for exposure therapy. Behaviour Research and Therapy , 26 (2), 137–149.
Franklin, M. E., Huppert, J. D., & Roth Ledley, D. (2005). Obsessions and compulsions. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 219–236). Routledge.
Garland, A., & Scott, J. (2005). Depression. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 237–261). Routledge.
Huppert, J. D., Roth Ledley, D., & Foa, E. B. (2006). The use of homework in behavior therapy for anxiety disorders. Journal of Psychotherapy Integration , 16 (2), 128–139.
Kazantzis, N. (2005). Introduction and overview. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 1–6). Routledge.
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta‐analysis. Clinical Psychology: Science and Practice , 7 (2), 189–202.
Kazantzis, N., & L’Abate, L. (2005). Theoretical foundations. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 9–34). Routledge.
Leahy, R. L. (2005). Panic, agoraphobia, and generalized anxiety. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 193–218). Routledge.
Staddon, J. E., & Cerutti, D. T. (2003). Operant conditioning. Annual Review of Psychology , 54 (1), 115–144.

Share this article:

Article feedback

Let us know your thoughts cancel reply.

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Sunk Cost Fallacy: Why We Can’t Let Go

If you’ve continued with a decision or an investment of time, money, or resources long after you should have stopped, you’ve succumbed to the ‘sunk [...]

Confirmation Bias: Seeing What We Want to Believe

Believe it or not, we can’t always trust what we see or hear. It seems our memory is influenced by our expectations (Eysenk & Keane, [...]

Behavior Therapy for Kids: 9 Fun Games and Techniques

In its many forms, behavior therapy is a powerful tool for treating a wide range of psychological disorders in children, aiming to increase their skills [...]

3 Positive CBT Exercises (PDF)

Last edited on September 9, 2020

Homework in CBT

Table of contents, why do homework in cbt, how to deliver homework, strategies to increase confidence.

Homework assignments in Cognitive Behavioural Therapy (CBT) can help your patients educate themselves further, collect thoughts, and modify their thinking.

Homework is not something that you just assign randomly. You should make sure you:

tailor the homework to the patient
provide a rationale for why the patient needs to do the homework
uncover any obstacles that might prevent homework from being done (i.e. - busy work schedule, significant neurovegetative symptoms)

Types of homework

Types of homework assignments.

You should also decide the frequency of the homework should be assigned: should it be daily, weekly?

If your patient does not do homework, that’s OK! Explore as a team, in a non-judgmental way, to explore why the homework was not done. Here are some ways to increase adherence to homework:

Tailor the assignments to the individual
Provide a rationale for how and why the assignment might help
Determine the homework collaboratively
Try to start the homework during the session. This creates some momentum to continue doing the homework
Set up systems to remember to do the assignments (phone reminders, sticky notes
It is better to start with easier homework assignments and err on the side of caution
They should be 90-100% confident they will be able to do this assignment
Covert rehearsal - running through a thought experiment on a situation
Change the assignment - It is far better to substitute an easier homework assignment that patients are likely to do than to have them establish a habit of not doing what they had agreed to in session
Intellectual/emotional role play - “I’ll be the intellectual part of you; you be the emotional part. You argue as hard as you can against me so I can see all the arguments you’re using not to read your coping cards and start studying. You start.”

The Psychology Square

a psychlogist having cbt therapy session with a client, digital illustration

Affordable Mental Wellness is Possible!

Explore The Psychology Square for Support.

December 19, 2023

20 Cognitive Behavioral Therapy (CBT) Techniques with Examples

Muhammad Sohail

Table of contents.

Cognitive Behavioral Therapy (CBT) stands as a powerful, evidence-based therapeutic approach for various mental health challenges. At its core lies a repertoire of techniques designed to reframe thoughts, alter behaviors, and alleviate emotional distress. This article explores 20 most commonly used cbt techniques. These therapy techniques are scientifcally valid, diverse in their application and effectiveness, serve as pivotal tools in helping individuals navigate and conquer their mental health obstacles.

Cognitive Restructuring or Reframing:

This is the most talked about of all cbt techniques. CBT employs cognitive restructuring to challenge and alter negative thought patterns. By examining beliefs and questioning their validity, individuals learn to perceive situations from different angles, fostering more adaptive thinking patterns.

John, feeling worthless after a rejected job application, questions his belief that he’s incompetent. He reflects on past achievements and reframes the situation, realizing the rejection doesn’t define his abilities.

Guided Discovery:

In guided discovery, therapists engage individuals in an exploration of their viewpoints. Through strategic questioning, individuals are prompted to examine evidence supporting their beliefs and consider alternate perspectives, fostering a more nuanced understanding and empowering them to choose healthier cognitive pathways.

During therapy, Sarah explores her fear of failure. Her therapist asks, “What evidence supports your belief that you’ll fail? Can we consider alternate outcomes?” Guided by these questions, Sarah acknowledges her exaggerated fears and explores more balanced perspectives.

Journaling and Thought Records:

Writing exercises like journaling and thought records aid in identifying and challenging negative thoughts. Tracking thoughts between sessions and noting positive alternatives enables individuals to monitor progress and recognize cognitive shifts.

James maintains a thought journal. Between sessions, he records negative thoughts about social situations. He then challenges these thoughts, jotting down positive alternatives and notices a shift in his mindset.

Activity Scheduling and Behavior Activation:

By scheduling avoided activities and implementing learned strategies, individuals establish healthier habits and confront avoidance tendencies, fostering behavioral change.

Emily, struggling with social anxiety, schedules coffee outings with friends. By implementing gradual exposure, she confronts her fear and eventually feels more comfortable in social settings.

Relaxation and Stress Reduction Techniques:

CBT incorporates relaxation techniques like deep breathing, muscle relaxation, and imagery to mitigate stress. These methods equip individuals with practical skills to manage phobias, social anxieties, and stressors effectively.

David practices deep breathing exercises when faced with work stress. By incorporating this technique into his routine, he manages work-related anxiety more effectively.

Successive Approximation:

Breaking overwhelming tasks into manageable steps cultivates confidence through incremental progress, enabling individuals to tackle challenges more effectively.

Maria, overwhelmed by academic tasks, breaks down her study sessions into smaller, manageable sections. As she masters each segment, her confidence grows, making the workload seem more manageable.

Interoceptive Exposure:

This technique targets panic and anxiety by exposing individuals to feared bodily sensations, allowing for a recalibration of beliefs around these sensations and reducing avoidance behaviors.

Tom, experiencing panic attacks, deliberately induces shortness of breath in a controlled setting. As he tolerates this discomfort without avoidance, he realizes that the sensation, though distressing, is not harmful.

Play the Script Until the End:

Encouraging individuals to envision worst-case scenarios helps alleviate fear by demonstrating the manageability of potential outcomes, reducing anxiety.

Facing fear of public speaking, Rachel imagines herself stumbling during a presentation. By playing out this scenario mentally, she realizes that even if it happens, it wouldn’t be catastrophic.

Shaping (Successive Approximation):

Shaping involves mastering simpler tasks akin to the challenging ones, aiding individuals in overcoming difficulties through gradual skill development.

Chris, struggling with public speaking, begins by speaking to small groups before gradually addressing larger audiences. Each step builds his confidence for the next challenge.

Contingency Management:

This method utilizes reinforcement and punishment to promote desirable behaviors, leveraging the consequences of actions to shape behavior positively.

To encourage healthier eating habits, Sarah rewards herself with a favorite activity after a week of sticking to a balanced diet.

Acting Out (Role-Playing):

Role-playing scenarios allow individuals to practice new behaviors in a safe environment, facilitating skill development and desensitization to challenging situations.

Alex, preparing for a job interview, engages in role-playing with a friend. They simulate the interview scenario, allowing Alex to practice responses and manage anxiety.

Sleep Hygiene Training:

Addressing the link between depression and sleep problems, this technique provides strategies for improving sleep quality, a critical aspect of mental well-being.

Lisa, struggling with sleep, follows sleep hygiene recommendations. She creates a calming bedtime routine and eliminates screen time before sleep, noticing improvements in her sleep quality.

Mastery and Pleasure Technique:

Encouraging engagement in enjoyable or accomplishment-driven activities serves as a mood enhancer and distraction from depressive thoughts.

After feeling low, Mark engages in gardening (a mastery activity) and then spends time painting (a pleasure activity). He finds joy in these activities, which uplifts his mood.

Behavioral Experiments:

This technique involves creating real-life experiments to test the validity of certain beliefs or assumptions. By actively exploring alternative thoughts or behaviors, individuals gather concrete evidence to challenge and modify their existing perspectives.

Laura believes people judge her negatively. She experiments by initiating conversations at social gatherings and observes that most interactions are positive, challenging her belief.

Externalizing:

Externalizing helps individuals separate themselves from their problems by giving those issues an identity or persona. This technique encourages individuals to view their problems as separate entities, facilitating a more objective approach to problem-solving.

Adam, dealing with anger issues, visualizes his anger as a separate entity named “Fury.” This helps him view his emotions objectively and manage them more effectively.

Acceptance and Commitment Therapy (ACT):

ACT combines mindfulness strategies with commitment and behavior-change techniques. It focuses on accepting difficult thoughts and emotions while committing to actions aligned with personal values, promoting psychological flexibility.

Sarah practices mindfulness exercises to accept her anxiety while committing to attend social events aligned with her values of connection and growth.

Imagery-Based Exposure:

This technique involves mentally visualizing feared or distressing situations, allowing individuals to confront and manage their anxieties in a controlled, imaginative setting.

Jack, afraid of flying, visualizes being on a plane, progressively picturing the experience in detail until he feels more comfortable with the idea of flying.

Mindfulness-Based Stress Reduction (MBSR):

MBSR incorporates mindfulness meditation and awareness techniques to help individuals manage stress, improve focus, and enhance overall well-being by staying present in the moment.

Rachel practices mindfulness meditation daily. By focusing on the present moment, she reduces work-related stress and enhances her overall well-being.

Systematic Desensitization:

Similar to exposure therapy, systematic desensitization involves pairing relaxation techniques with gradual exposure to anxiety-inducing stimuli. This process helps individuals associate relaxation with the feared stimuli, reducing anxiety responses over time.

Michael, with a fear of heights, gradually exposes himself to elevators first, then low floors in tall buildings, gradually working up to higher levels, reducing his fear response.

Narrative Therapy:

Narrative therapy focuses on separating individuals from their problems by helping them reconstruct and retell their life stories in a more empowering and positive light, emphasizing strengths and resilience.

Emily reevaluates her life story by focusing on instances where she overcame challenges, emphasizing her resilience and strength rather than her setbacks.

Each of these CBT techniques plays a unique role in helping individuals transform their thoughts, behaviors, and emotions. While some focus on cognitive restructuring, others emphasize behavioral modification or stress reduction. Together, they form a comprehensive toolkit empowering individuals to navigate their mental health challenges and foster positive change in their lives.

more insights

easily accessible information in news paper that can lead to availability heuristic

The Availability Heuristic: Cognitive Bias in Decision Making

The availability heuristic is a cognitive bias that affects decision-making based on how easily information can be recalled or accessed.

Therapist talking to a teenager about dual diagnosis in adolescents

Dual Diagnosis: Recognizing and Treating Co-Occurring Disorders

Uncover effective strategies to address dual diagnosis in adolescents, ensuring early intervention for a brighter and substance-free future.

Representativeness Heuristic in Psychology: A Complete Guide

Representativeness heuristic in psychology is a cognitive shortcut influencing decision-making by affecting our judgments about probability.

CBT Session Structure and Use of Homework

Importance of Time Management

The importance of promoting resilience and avoiding dependence makes it vital to manage time well, in terms of both individual sessions and the course of sessions as a whole. For example, many agencies that provide CBT may offer a limited number of sessions (perhaps from six to 12).

CBT Session Structure and Use of Homework

This means that careful planning is required to ensure that the client is clinically safe to leave at the end of each session and – in particular – at the end of the full course of sessions.

Having limited time can be used in a positive way to focus the client on working hard to collaborate with the therapist and to explore their own thoughts, feelings and behaviours. It is ethically appropriate to explain to the client that CBT is a gradual process that will help them take incremental steps towards changing their thoughts, emotions and behaviours.

Session Agenda

Structure is one of Bordin’s (1979) triad of elements of CBT. As well as the idiosyncratic formulation – often seen as the ‘backbone’ of CBT treatment, and displayed between therapist and client (e.g. on a table where each can see it clearly) during sessions – another key tool in structuring CBT is the session agenda.

The session agenda is agreed collaboratively at the start of each session, based on items that the therapist and client wish to include. It is helpful to relate the structure of each session to the formulation. This also has a role in supporting the client’s education in the CBT model. Key items would typically be:

following up homework completed since the previous session
briefly reviewing the client’s experience since then
practising CBT tasks.

As the BABCP emphasises, it is vital in CBT that the therapist and client work together in changing the client’s behaviours, thinking patterns or both. Because the active involvement of the client is required, it is important to set and work to an agenda, so setting out clearly the expectations of the client at every stage, making use of limited time and giving the sessions a problem-solving atmosphere.

The therapist has a responsibility to ensure that the agenda is of a manageable size, reining in client expectation if need be so that it can be achieved within the 50-minute session. As with the formulation, it is useful for both parties to be able to see the agenda during the session.

Agenda-setting also serves to strengthen the working alliance. Simmons & Griffiths (2014: 39) observe: ‘Setting the agenda together with your client underlies the general philosophy of CBT, that of active collaboration between therapist and client.’ Indeed, the therapist may even include time to obtain client feedback on the working alliance at the end of each session (by adding ‘Feedback’ to the agenda).

Use of ‘Homework’

A common feature of CBT is that the therapist sets the client ‘homework’, which is then reviewed in the next session; this aims to help clients generalise and apply their learning.

Homework in CBT refers essentially to tasks set to be completed by the client between sessions. For some clients, ‘homework’ is a word that triggers difficult memories of school days, possibly for some linked to a failure or other schema. It is therefore important to be aware of any such sensitivity in clients.

For example, if a client’s failure schema is triggered by the term ‘homework’, we might choose either to refer to it instead as ‘between-session tasks’ or to look with the client at how our use of the word is different from the way teachers used it at school – e.g. that CBT homework is always agreed (i.e. set collaboratively rather than imposed), and is about exploration and learning rather than any externally imposed expectation of outcome.

Purpose of Homework

Homework tasks are an important part of CBT practice, based on the view that client change does not come about purely as a result of in-session work – i.e. that significant effort is required by the client between sessions. In other words, there are 168 hours in the client’s week and only one of them is spent with the therapist.

Introducing the concept of homework early in therapy is also useful in getting the message across to the client that the working alliance requires significant effort and commitment from them – i.e. in promoting the understanding that the responsibility for change lies very much with them, guided by the therapist as professional facilitator.

Homework can also help enhance client autonomy, showing them they can become their own therapist using the CBT model.

Tailoring Homework to Client Needs

Homework tasks should be tailored to the client’s idiosyncratic formulation. Key points to consider are how challenging it will be for the individual client – and also how specific, practical and measurable.

When negotiating homework, we must therefore always use the core conditions and put ourselves in the client’s frame of reference. For example, we might see a small change in activity levels as perfectly manageable but this may seem huge for a depressed client.

Homework tasks should be just enough to challenge a client to extend themselves but not so much that it feels overwhelming. In the latter case, the likelihood is that the client will then simply not attempt it at all, so negating the point of the homework entirely.

It is also important to bear in mind the client’s schemas when setting homework. For example, a client with a failure schema would need very manageable tasks in the early days (with less challenge built in), while a client with a subjugation schema might agree to homework they knew to be unsuitable just to please the therapist.

Checking Homework

It is important that the therapist remembers to check homework during the next session – otherwise, the client may feel frustrated that they have invested time and energy in doing this with no apparent interest or follow-up from their counsellor.

This could detrimentally affect the bond and also lead to non-compliance with homework tasks in future. Sufficient time should be allowed in the session agenda to discuss the client’s experience of their homework tasks and learning from these.

Again, the therapist should hold in mind when evaluating homework any client schemas that may affect this. For example, a client with an unrelenting standards schema might be harsh on themselves in evaluating their achievements.

In this case, the therapist would need to tease out the client’s successes, and could use the work to help challenge the related negative automatic thoughts (e.g. filtering, all-or-nothing thinking or discounting the positive).

Free Handout Download

Non-compliance with homework.

There are many possible reasons for non-compliance with homework tasks, and exploring these is an important part of therapy. Homework non-compliance may link with schema avoidance.

For example, a client may use avoidance to protect themselves from the difficult feelings associated with a failure schema. In other words, they may think that if they don’t attempt the homework task, then at least they can’t fail at it.

Offering the client the core conditions is important in exploring the reasons for non-completion of homework tasks. Clients may initially say they have not had time, and the therapist needs to take the time to discuss their real reasons for not doing the homework. This provides a valuable opportunity for new learning about – and hence understanding of – the client’s patterns of thinking, feeling and behaving.

Bordin E (1979) ‘The generalizability of the psychoanalytic concept of the working alliance’, Psychotherapy: Theory, Research and Practice , 16, 252–260.

Simmons J & Griffiths R (2014) CBT for Beginners , Sage

Spotted out-of-date info or broken links? Kindly let us know the page where you found them. Email: [email protected]

Bipolar Disorder
Therapy Center
When To See a Therapist
Types of Therapy
Best Online Therapy
Best Couples Therapy
Best Family Therapy
Managing Stress
Sleep and Dreaming
Understanding Emotions
Self-Improvement
Healthy Relationships
Student Resources
Personality Types
Guided Meditations
Verywell Mind Insights
2023 Verywell Mind 25
Mental Health in the Classroom
Editorial Process
Meet Our Review Board
Crisis Support

What Is Therapy Homework?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Astrakan Images / Getty Images

Types of Therapy That Involve Homework

If you’ve recently started going to therapy , you may find yourself being assigned therapy homework. You may wonder what exactly it entails and what purpose it serves. Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz , DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.

Homework can be given in any form of therapy, and it may come as a worksheet, a task to complete, or a thought/piece of knowledge you are requested to keep with you throughout the week, Dr. Erkfitz explains.

This article explores the role of homework in certain forms of therapy, the benefits therapy homework can offer, and some tips to help you comply with your homework assignments.

Therapy homework can be assigned as part of any type of therapy. However, some therapists and forms of therapy may utilize it more than others.

For instance, a 2019-study notes that therapy homework is an integral part of cognitive-behavioral therapy (CBT) . According to Dr. Erkfitz, therapy homework is built into the protocol and framework of CBT, as well as dialectical behavior therapy (DBT) , which is a sub-type of CBT.

Therefore, if you’re seeing a therapist who practices CBT or DBT, chances are you’ll regularly have homework to do.

On the other hand, an example of a type of therapy that doesn’t generally involve homework is eye movement desensitization and reprocessing (EMDR) therapy. EMDR is a type of therapy that generally relies on the relationship between the therapist and client during sessions and is a modality that specifically doesn’t rely on homework, says Dr. Erkfitz.

However, she explains that if the client is feeling rejuvenated and well after their processing session, for instance, their therapist may ask them to write down a list of times that their positive cognition came up for them over the next week.

"Regardless of the type of therapy, the best kind of homework is when you don’t even realize you were assigned homework," says Erkfitz.

Benefits of Therapy Homework

Below, Dr. Erkfitz explains the benefits of therapy homework.

It Helps Your Therapist Review Your Progress

The most important part of therapy homework is the follow-up discussion at the next session. The time you spend reviewing with your therapist how the past week went, if you completed your homework, or if you didn’t and why, gives your therapist valuable feedback on your progress and insight on how they can better support you.

It Gives Your Therapist More Insight

Therapy can be tricky because by the time you are committed to showing up and putting in the work, you are already bringing a better and stronger version of yourself than what you have been experiencing in your day-to-day life that led you to seek therapy.

Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.

It Helps Empower You

The sense of empowerment you can gain from utilizing your new skills, setting new boundaries , and redirecting your own cognitive distortions is something a therapist can’t give you in the therapy session. This is something you give yourself. Therapy homework is how you come to the realization that you got this and that you can do it.

"The main benefit of therapy homework is that it builds your skills as well as the understanding that you can do this on your own," says Erkfitz.

Tips for Your Therapy Homework

Below, Dr. Erkfitz shares some tips that can help with therapy homework:

Set aside time for your homework: Create a designated time to complete your therapy homework. The aim of therapy homework is to keep you thinking and working on your goals between sessions. Use your designated time as a sacred space to invest in yourself and pour your thoughts and emotions into your homework, just as you would in a therapy session .
Be honest: As therapists, we are not looking for you to write down what you think we want to read or what you think you should write down. It’s important to be honest with us, and yourself, about what you are truly feeling and thinking.
Practice your skills: Completing the worksheet or log are important, but you also have to be willing to put your skills and learnings into practice. Allow yourself to be vulnerable and open to trying new things so that you can report back to your therapist about whether what you’re trying is working for you or not.
Remember that it’s intended to help you: Therapy homework helps you maximize the benefits of therapy and get the most value out of the process. A 2013-study notes that better homework compliance is linked to better treatment outcomes.
Talk to your therapist if you’re struggling: Therapy homework shouldn’t feel like work. If you find that you’re doing homework as a monotonous task, talk to your therapist and let them know that your heart isn’t in it and that you’re not finding it beneficial. They can explain the importance of the tasks to you, tailor your assignments to your preferences, or change their course of treatment if need be.

"When the therapy homework starts 'hitting home' for you, that’s when you know you’re on the right track and doing the work you need to be doing," says Erkfitz.

A Word From Verywell

Similar to how school involves classwork and homework, therapy can also involve in-person sessions and homework assignments.

If your therapist has assigned you homework, try to make time to do it. Completing it honestly can help you and your therapist gain insights into your emotional processes and overall progress. Most importantly, it can help you develop coping skills and practice them, which can boost your confidence, empower you, and make your therapeutic process more effective.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression . Cognit Ther Res . 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6

Lebeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy . Cogn Behav Ther . 2013;42(3):171-179. doi:10.1080/16506073.2013.763286

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Psychol Res Behav Manag

Homework in Cognitive Behavioral Supervision: Theoretical Background and Clinical Application

1 Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic

2 Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic

3 Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic

4 Jessenia Inc. - Rehabilitation Hospital Beroun, Akeso Holding, Beroun, The Czech Republic

Ilona Krone

5 Riga`s Stradins University, Riga, Latvia

Julius Burkauskas

6 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania

Jakub Vanek

Marija abeltina.

7 University of Latvia, Latvian Association of CBT, Riga, Latvia

Alicja Juskiene

Tomas sollar, milos slepecky, marie ociskova.

The homework aims to generalize the patient’s knowledge and encourage practicing skills learned during therapy sessions. Encouraging and facilitating homework is an important part of supervisees in their supervision, and problems with using homework in therapy are a common supervision agenda. Supervisees are encouraged to conceptualize the patient’s lack of homework and promote awareness of their own beliefs and responses to non-cooperation. The supervision focuses on homework twice – first as a part of the supervised therapy and second as a part of the supervision itself. Homework assigned in supervision usually deals with mapping problems, monitoring certain behaviors (mostly communication with the patient), or implementing new behaviors in therapy.

Introduction

The development of competent clinical supervision is crucial to effectively training new CBT therapists and supervisors and maintaining high therapy standards throughout their careers. 1 Clinical supervision is a basis for CBT training, but there are only a few empirical evaluations on the effect of supervision on therapists’ competencies. Wilson et al 2 in their systematic review and meta-analysis, synthesized the experience and impact of supervision for trainee therapists from 15 qualitative studies. Although supervision leads to feelings of distress and self-doubts, it can effectively support supervisees in personal and professional development. It could similarly harm supervisees’ well-being, clinical work and clients’ experiences. Alfonsson et al 3 published a study to evaluate the effects of standardized supervision on rater-assessed competency in six CBT therapists under protocol-based clinical supervision. This is one of the first investigations showing that supervision affects cognitive behavioral competencies. Although several works have studied the effectiveness of supervision on the therapist’s competence and for the therapist’s work with patients in qualitative studies, 3–7 there is still a lack of studies that dealt with the importance of homework in supervision.

Homework is a vital element of cognitive behavioral therapy (CBT) which distinguishes it from many other psychotherapeutic approaches. 8–10 Patients usually participate in therapy by completing homework assignments and taking responsibility for their course.

Assigning and discussing homework is one of the basic competencies of a cognitive-behavioral therapist and a supervisor in the context of counselling, psychology, therapy, and social work. The manuscript aims to refer to homework in several settings: homework in therapy, supervision of homework in therapy, using the homework by the supervisor for the supervisee, and homework in the training of supervisors.

Homework in Therapy

While specific recommendations for the practical usage of homework have been clearly articulated since the early days of CBT, 11 , 12 practitioners state that they do not follow these recommendations. 13–15 For example, many physicians admit that they forget homework or do not focus on standard specifications when, where, how often, and how long the task should last. Often reported non-cooperation in homework assignments may be due to the practice recommendations being too strict or because students think the amount of homework they can assign is limited. 16

The Sense of Homework in the Therapy

Patients verify methods and skills they learned during the session in real situations and the natural environment. 9 , 17 Through homework, patients also test hypotheses that emerged during the session with the therapist (for example, “If I went out on the street alone, I would be so weak that I would pass out or lose control completely”). Homework help that the important part of the therapy takes place between sessions and allows the patients to become independent and manage their problems even after the end of therapy. 10 , 18 Patients learn how to raise hypotheses and test them in real-life situations. Through completing homework persistently during the therapy, patients gain skills on how to plan their activities and gain new skills, and they also collect a rich source of therapeutic diaries. The investigations advocate that adding homework to CBT increases its efficacy and that patients who constantly complete homework have better outcomes. The outcomes of four meta-analyses highlight the value of homework in CBT:

Kazantzis et al 10 inspected 14 studies that compared results for patients allocated to CBT without or with homework. The average patient in the homework group reported better results than about 70% of controls.
Outcomes from 16 studies 17 and an updated analysis of 23 studies 19 discovered that higher compliance led to better treatment results among patients who received homework projects during therapy.
Kazantzis et al 20 studied the relationships between quantity (15 studies) and quality (3 studies) of the homework to treatment results. The effect sizes were medium to large, and these effects remained fairly constant in a 12-month follow-up.

Therapists strategically create homework to reduce patients’ psychopathology and encourage them to practice skills learned during therapy sessions; nevertheless, non-adherence (between 20% and 50%) remains one of the most cited reasons for decreased CBT efficacy. 21 Several reasons for non-adherence to homework might be pointed out –the therapist does not regularly discuss homework with the patient, the patient no longer considers it important and stop doing it. 9 , 22 Discussing homework also allows the therapist to strengthen the patient’s belief in their ability to achieve certain goals. 23 The fact that the patient has completed the assignment must be properly acknowledged, and then therapists discuss the quality of homework separately. 24 Good questions might be, “How did you do your homework? Were there any difficulties in fulfilling them? What kind?” Furthermore: “How can you handle these problems next time? What did you learn while completing your homework? Can it help you cope with other issues?”

How to Increase the Effectiveness of Homework in the Therapy

Homework is the most effective, and it is most likely to succeed if: 19 , 25

Follows logically from the topics discussed during the session and uses the methods that the patient learned during the session;
they are clearly and concretely defined, so it is easy to determine whether or to what extent the patient has been successful in fulfilling them (eg, “Leaving the house alone for at least 30 minutes every day”, not “Starting to go out alone”);
the patient clearly understands their meaning (“To verify your belief that you will faint on the street” or “See for yourself whether your anxiety will continue to rise, remain the same or subside after a certain time”), and they believe they can achieve the goals;
homework is formulated so that failure is impossible because, in any case, the patient will learn something useful that will help them in therapy;
the therapist anticipates and discusses obstacles that could hinder the fulfilment of homework and plans procedures to overcome them.

An important aspect of CBT is the patient’s independence. 10 , 18 Homework is typically determined by consensus. To increase the likelihood that the patient will complete the homework, the patient and the therapist should document their assignments in writing. Additionally, it is very convenient for the patient to record the homework, typically pre-prepared. 24 These records serve as a basis for discussing homework in the next session and also allow the therapist to assess the changes achieved during therapy (“A month ago, you were able to go out alone for only half an hour and your anxiety level previously reached level ‘9’, while now you were alone outside for more than an hour and your anxiety do not exceed ‘5’ rated subjectively”).

Because the goal of therapy is to help the patient experience success, the patient’s assigned homework must be feasible. 18 , 26 On the other hand, patients should improve their ability to cope with problems and unpleasant conditions during therapy, they need to exert significant effort to overcome certain unpleasant feelings and emotions. 19 , 20

Even if therapists follow all these rules, they will unavoidably find that sometimes the patient does not complete assigned homework. 20 , 23 In this case, it is required to find out why this happened:

whether the patient understood what the task was and what it meant
whether mastering this exercise is important and motivated
whether unforeseen circumstances prevented them from fulfilling it
whether the assigned exercise was not very demanding for them in their current mental state

Therefore, therapists do not consider the non-fulfilment of homework a priori as a manifestation of resistance or lack of moral qualities on the patient’s part, then as a problem that must be solved together.

However, if, despite a thorough discussion of homework and agreement on its completion, the patient repeatedly does not even attempt to complete it, does not bring records and fails to justify non-compliance, it is necessary to return to the problem analysis and goal-setting. We need to clarify with the patient whether the problem they are currently dealing with in therapy is really the most important for them, whether the goal they seek to achieve is sufficiently desirable, and whether the therapist offers to achieve is acceptable. 9 , 20

Most practicing CBT therapists report that they use homework and consider homework important for many problems 14 and believe in the role of homework in improving therapeutic outcomes. 24 , 27 Encouraging and facilitating homework is a basic skill of a CBT therapist; therefore, it is an important part of supervision. 19 , 20 , 26 Homework needs to be carefully assigned and discussed ( Box 1 ).

Case Vignette – Discussion About Not Completing Homework with an Anxious Patient

Kazantzis et al 28 advise examining the therapeutic relationship, which significantly impacts therapy adherence, to better comprehend non-cooperation with homework assignments. Data illustrating the therapist’s homework competence and the therapy outcome 29 , 30 show that the therapist is primarily responsible for their patients’ adhering to or failing to do homework. CBT therapists exhibit many interrelated automatic thoughts, assumptions, and behaviors during sessions that affect homework use in therapy. 8 , 15 In training, common negative attitudes for therapists include: “Homework will make patients feel like school and resent!” “They will feel too controlled and limited!”; “Homework will increase some ps’ sense of vulnerability!”; or “Homework will be even more stressful for stressed patients!” Another widespread belief is that the “structure” of CBT, whose homework is important, reduces spontaneity and worsens the therapeutic relationship. 15

In addition, there is some scientific support for these views of therapists’ attitudes toward homework concerning the therapeutic process. 31 The result of these attitudes is either a complete avoidance of homework assignments in a way that is not effective and consequently maintains these beliefs. 8 For example, common behaviors require supervision, such as rapidly discussing directions at the end of a session, neglecting to repeat homework, or failing to justify while designing homework. 9 The CBT Homework Project proposed a practice model 29 that emphasizes the importance of therapist beliefs, therapist empowerment, cognitive conceptualization, and the therapeutic relationship in enhancing homework practice. 23

Theoretical and empirical support for homework assignments in CBT leads most practicing CBT therapists to at least accept in principle that regular and systematic homework assignments will benefit their patients. 8 As a result, CBT therapists favour assigning homework in therapy. However, many beginning therapists encounter problems when they start designing homework (ie, selecting tasks and discussing them with the patient), assigning homework (ie, collaborating on practical aspects of completing homework), and repeating homework in sessions. 32 Incorporating homework into therapy is often superficial, hasty, poorly done, or forgotten. 16 Therefore, problems with using homework in therapy are a common supervision agenda of practicing CBT therapists.

Personal Training and Self-Reflection of the Therapist as a Supervision Intervention

CBT training students are encouraged to conceptualize the patient’s lack of homework and promote awareness of their own beliefs and responses to non-cooperation in the CBT conceptual framework. 8 Suppose the therapist fails to develop this awareness. In that case, errors in clinical judgment may occur, adversely affecting the therapeutic relationship and course of therapy. 33 Self-exercise (practicing CBT techniques and interventions as a therapist) and self-reflection (ie, process reflection) are concepts developed by Bennett-Levy et al, 34 to operationalize a useful understanding of own processes in working with patients. CBT training students are asked to become accustomed to using self-exercise and self-reflection. In a few qualitative studies, self-exercise and self-reflection have proven to improve the therapist’s self-concept, ie, self-confidence, perceived competence in one’s abilities and belief in the effectiveness of the CBT model. 34–36 Calvert et al 37 study checked the use of meta-communication in supervision from supervisees’ perspectives using the Metacommunication in Supervision Questionnaire (MSQ). There were differences in the reported frequency with which the different types of meta-communication were used. It appears that meta-communication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of meta-communication. 1

Below are examples of self-exercise and self-reflective exercises. The following self-assessment is developed to shape thinking before a preliminary meeting with a supervisor. Earlier knowledge has shown that supervisees and supervisors do not always share common ideas about supervision. Therefore, the supervisee could finish this self-assessment as a homework exercise before supervision. A supervisee might want to identify conversation matters that may enable a supervisor to better comprehend their requirements and needs.

Before Starting

Questions regarding previous and desired experience in supervision.

What background information do you think your supervisor requires to understand you at the start? (This may include a curriculum vitae noting appropriate previous experience). What would be the best method to convey these details? Is there any distinction between what you desire from this placement and what you feel you need? What background details about this placement and this supervisor do you have? How does this make you feel? Exists any more information that you need? What do you want and expect your supervisor to concentrate on during supervision? What roles do you want your supervisor to play with respect to you and your work? What supervisory media do you want to experience (for example, taped, “live”, or reported)? What do you intend to do about your feelings? Consider how you feel about your supervisor evaluating your work at the end of the positioning process.

Reflection on the Strengths

What are the top three strengths you want your supervisor to uncover as you enter this supervisory relationship?

List 3 points for your development that may or might not be obvious to your supervisor.

Reflection on Difficulties

Therapists regularly discover face-to-face contact with people labelled by society as coming from a specific sub-group.

Which sub-groups make you feel uneasy for whatever reason? Do you want to address this during supervision? 38

Examples of Self-Assessment in the Supervision Process

Exploring sources of stress from clinical work.

Check all that resonate for you. 39

❑ Perfectionism ❑ Fear of failure ❑ Self-doubt ❑ Need for approval ❑ Emotional depletion ❑ Unhealthy lifestyle

Which of them seems to have the greatest impact on your stress levels?

What supervisor has most regularly identified as weak points in your clinical work?

Processing Mistakes

When mistakes are processed in ways that lead to reflection, flexibility, and adjustments in how you function, it can result in learning and growth.

Consider a patient you are now working with (or have recently worked with) with whom you have experienced a therapeutic failure.

Answer the following questions while keeping this experience in mind:

What are the signs of a therapeutic failure? How can you be certain that what you are doing is not beneficial on some level? What benefits might your patient derive from failure? When did things begin to deteriorate? Which initiatives have been most effective so far, and which have been least effective? How have you been careless?
Examine your intervention choices as well as how they were carried out:
What concerns or considerations did you overlook? What is impeding your ability to be more effective? How has your empathy and compassion for this individual been harmed? How can you use this experience to help you grow?

Reflection of Therapeutics Mastery Skills

Favorite techniques.

Explain three things you have put off in your career or life because they appear risky—you have something to lose and gain.
Which therapeutic strategies or interventions stimulate you the most?
What would you call your “hidden weapon”?
What kind of patients or presenting difficulties interest you the most?
What would it take to incorporate more of the pleasure and satisfaction you receive when applying the strategies mentioned earlier into other aspects of your work? 39

The following examples from clinical supervision demonstrate how self-exercise and self-reflection can help participants understand their belief system’s impact on homework in CBT.

Supervision of Homework in Therapy

Supervision is classically mandatory for students in cognitive behavioral training and plays a crucial part in therapist development. 2 The typical structure of continuous supervision of one patient includes discussing questionnaires or scales used to measure the severity of the problem (like the Beck depression inventory), homework, events in therapy since the last session, and then discussing the agenda of the current supervision meeting (what will be done in the session, which problem will be addressed), work on a selected issue or problems, homework assignment, session summary and its evaluation by the supervisor. The supervision focuses on homework twice – first as a part of the supervised therapy and second as a part of the supervision itself ( Box 2 ).

Case Vignette – Discussion About Patient´s Homework During Supervision

Whether and how the patient completes homework is a common supervisory issue ( Box 3 ). The therapist often complains that the patient refuses to do homework or rarely does it. 8 , 16

Recording of Paul’s Automatic Thoughts

An external file that holds a picture, illustration, etc.
Object name is PRBM-15-3809-g0001.jpg

The picture describes the vicious circle of countertransference reaction, where automatic thoughts lead to developing negative emotions, bodily reactions and behaviors. Any vicious circle components can alert the therapists that their countertransference reaction is taking place.

Case Vignette –Discussion of Setting Homework During Supervision

Homework in Supervision

Homework assignments are a common part of supervisory work. These may involve the patient’s management (eg noticing on their recording how often the therapist strengthens the patient and how and if it is rare to clarify where reinforcement would be appropriate), working on oneself (eg clarifying experiences and attitudes that lead to countertransference in a particular patient, awareness of which other patients may also occur) and theoretical study (the supervisor may advise the therapist to read a professional text that can help better understand and work with the patient). 40

The supervisor helps define a specific engagement, discusses specific therapeutic methods, touches on what methods the therapist has used and what else they may consider the role, for the most part, the implementation of strategies whose ability to use in therapy under supervision will be planned, as part of homework.

Homework assigned in supervision usually deals with mapping problems (supplementing the conceptualization of the case, evaluation, vicious circle of the problem with the patient, etc.), monitoring certain behaviors (mostly communication with the patient), or implementing new, behaviors in therapy (usually using therapeutic strategies). 12 Homework teaches the supervisee to work on self-reflection outside the supervision meetings. 41 Discussing the homework properly at the beginning of the session is important. The mentioned home exercises usually concern the work with the supervised case report of the patient. The basic questions concern homework results, discussing the obstacles in solving them and what the supervisee learned in homework. 8 The discussion gives the supervisor case management information and can point to important practice moments.

Homework Assignment

Before the end of the session, the supervisor and the supervisee agree on a homework assignment. It is optimal when homework arises from a problem addressed in the session’s main part. 8 At the beginning of supervision, proposals for homework assignments usually come from the supervisor and are discussed and recorded in writing. 40 During supervision, the supervisee creates homework assignments, and the content is discussed with the supervisee.

The Meaning of Homework

Homework must make sense for the supervisee; otherwise, he will have no motivation to do it. However, it is also important to make sense of the patient or patients and develop the therapist’s skills and competencies. It is desirable to discuss the meaning of homework in supervision.

Possible Difficulties When Completing Homework

It is advantageous to discuss the anticipated difficulties in completing homework. This has the advantage that the supervisee can prepare for possible difficulties, consider overcoming them and consult with the supervisor. Discussing difficulties helps the supervisee model and later develops the skill to discuss the patient’s homework difficulties.

The Impact of the Therapist’s Belief System

In some therapists, there can be reasons for a more complex level of conceptualization. 42 That is important when the therapist repeats certain mistakes even though they have repeatedly discussed them with the supervisor. At a directly accessible level, the situation with the patient can be described using a vicious circle. The deeper “hidden” level refers to the core beliefs and conditional rules activated in a specific situation with the patient. 40 , 43 A supervisor can use the “falling arrow” technique to map core beliefs and conditional assumptions. 43

One such way is the Therapeutic Belief System (TBS). 44 TBS is a theoretical model useful for understanding the specific beliefs, assumptions, and behaviors that therapists and patients commonly experience that could potentially affect the course of therapy. In line with the cognitive model, TBS provides a framework for identifying therapists’ and patients’ beliefs about themselves, each other, the treatment process, the emotions these beliefs can evoke, and typical behavioral reactions. For example, a therapist may see a patient as an “aggressor”, a “helpless victim”, or a “collaborator”. The participant’s own beliefs may supplement these beliefs about himself, such as “victim”, “co-worker”, “carer”, or “rescuer”. Homework assignments may be perceived by both the therapist and the patient as “hopeless”, “productive”, or simply maintaining the status quo and lead to a different emotional and behavioral response. 8 Thus, TBS can be introduced into supervision to guide the supervisee to consider whether he or she identifies with any of the therapists’ typical beliefs and behaviors outlined in the model. A simple awareness of such patterns can be a useful orientation when considering the role of attitudes and beliefs in integrating homework ( Box 4 ).

Case Vignette – Discussion About Supervisee Homework

The scheme broadly refers to mental structures that integrate and give meaning to events. 45 Schemes can be positive, negative or neutral. In CBT as a treatment for psychological disorders, we focus on dysfunctional patterns often associated with specific diagnostic presentations (for example, emotional vulnerability patterns are common in anxiety disorders). Schema is generally defined as a ubiquitous topic of cognitive functions, emotions, physiological feelings about oneself, and relations with others. 33

Therapists’ schemes run in specific therapies and do not usually signal mental health problems. 8 Therapists’ schemes are influenced by the following factors: training experiences, such as supervision and training phase, therapy model, peer group, clinical experience, and personal experience. 13 , 40 Once identified, the therapist’s scheme can be used in supervision as a starting point to discuss some of the practitioner’s views that may interfere with therapy. 8 Completing structured questionnaires can identify participants’ schemes, basic beliefs, and assumptions. Some examples of useful questionnaires are the Dysfunctional Attitudes Scale, 46 the Personal Faith Questionnaire, 47 the Young Schema Questionnaire 48 and the Therapists’ Schema Questionnaire. 49 Leahy’s Therapists’ Scheme Questionnaire is a relatively straightforward screening technique for identifying therapeutic patterns that could affect a therapeutic relationship. It consists of 46 assumptions related to the 14 most common therapeutic regimens.

Certain schemes are particularly common in CBT supervisees. These include “demanding standards”, “excessive self-sacrifice”, and “special superior person”. 49 Training therapists who identify with the “demanding standards” scheme have a somewhat obsessive, perfectionist, and controlling approach to therapy. These therapists usually have high expectations for keeping a patient’s homework and may not realize that non-compliance with homework is often part of the learning process. Therapists may expect that there is a “right” way to complete a homework assignment, leading to feelings of frustration when assignments produce different results. This may signify insecurity and a notion that if things break from the planned structure, the therapist will be exposed as “incompetent”. Many therapists identify with the “excessive self-sacrifice” pattern, the most commonly observed pattern in both novice and experienced therapists. 33 Leahy 49 proposes that these therapists overstate the importance of their patient relationships. They may fear leaving or feel guilty that they are or feel better than the patient. As a result, the therapist may engage in therapy-defeating behaviors, such as making the homework assignment to the patient’s various needs, having difficulty with appropriate assertiveness in discussing persistent patient non-cooperation, and having a tendency to avoid techniques. Such as exposure or opening of painful memories for fear that the patient will be upset.

Novice therapists who identify with the “special superior person” scheme see the therapeutic situation as an opportunity to achieve excellent results and have high-performance expectations. There may be a tendency for the patient to idealize or, conversely, to devalue or distance himself from patients who do not improve or do their homework. The presence of a “special superior” scheme can be seen as overcompensation in response to “demanding standards” and “excessive self-sacrifice”, which have the thematic connotations of “not being good enough”. The supervision session sets the supervisee in a situation where the supervisor supervises homework through videotaped therapeutic sessions utilizing a cognitive therapy scale (CTS). 50 Feelings of superiority and exceptionality can, in some cases, be a way of dealing with the feelings of inferiority that they experience, that their use of homework is judged in this way.

In addition to recognizing the general responses to the scheme that most training students encounter, the supervisor should help the supervisor become aware of his or her idiosyncratic beliefs and coping styles, which some patients may trigger ( Box 5 ). The supervisor should encourage the supervisee to pay special attention to the “overlapping patterns” in which the therapist’s scheme and the patient’s scheme overlap, leading to the over-identification of the therapist with the patient. 33

Case Vignette – The Supervisor Advises the Therapist to Work with Core Beliefs and Conditional Rules

Homework in Supervisor Training

For supervisors, their supervisors’ training is important. An important part of this training is the practice of self-reflection, which should be requested directly in the meeting and as homework. It can be a task to capture situations in supervision in which they do not feel comfortable using the vicious circle, cognitive restructuring of automatic negative thoughts in these situations, capturing thoughts, emotions, bodily sensations and behaviors in situations where they are aware that they are experiencing countertransference reactions to the supervised therapist. It is also important that in their homework, they reflect on their concentration level during supervision sessions and consider what supervision skills they have used or what they have learned for the next session. A typical complex homework in supervision training is a video recording of supervision sessions and their analysis. The recorded supervision and analysis are then analyzed in the next supervision training meeting.

This article is designed as an overview of views and experiences. Its important element is work samples. This is also a limitation of this article. Assignment of homework in supervision and therapist and supervisor training lacks scientific information about its effectiveness. Nevertheless, assigning homework is an important part of cognitive behavioral therapy. We know quite well about its meaning in prescribing for patients. Less is known about their meaning and effectiveness in supervision. The supervisee encounters problems completing homework assignments for her patients that she brings to the supervisee. Why the patient does not complete the homework may be his problem, but his therapist may also have a part in it his requirements, which include how the homework is assigned, its suitability for the given patient, timing, and complexity. Homework can also belong to the training of supervisors and the supervision of supervision. Here, we do not know any research evidence about their effectiveness in using the most important part of supervision, the patient; however, they are experienced by supervisors and supervisees as useful and meaningful.

Homework in supervision and supervision requires further reflection on their meaning and subsequent research, which should examine their significance for the supervisee’s competence (supervisee) and the ultimate impact on the patient himself.

Homework presents one of the cornerstones of cognitive-behavioral therapy, CB supervision and the training of CBT supervisors. If applied consistently and collaboratively, homework enhances therapeutic outcomes and increases the patient’s self-confidence. Setting and maintaining a fruitful working alliance for homework can be challenging – issues with homework present one of the common reasons to seek a supervisory consultation. Supervision then focuses on examining the specific case and experienced problems, factors in the interaction between the therapist and their patient, and the therapist’s automatic thoughts, schemas, and behaviors that might maintain the issue. There are several ways to address this topic in supervision. Homework is usually part of supervision because of its usefulness. The supervised therapist may be given similar tasks as the patient receives in therapy: to describe the automatic thoughts that occur to him while guiding the patient, to test them and look for a more rational response, to conduct behavioral experiments, to clarify the core beliefs and conditioned assumptions that influence the formation of the therapeutic relationship, experiments with adequate communication with the patient and others. A therapist’s self-experience through practice can help them improve their therapeutic work.

Acknowledgments

This paper was supported by the research grant VEGA no. APVV-15-0502 Psychological, psychophysiological and anthropometric correlates of cardiovascular diseases.

The authors report no conflicts of interest in this work.

Empowering Progress: Effective Therapy Homework for Depression

The role of therapy homework.

Therapy homework plays a vital role in the treatment of depression, providing individuals with an opportunity to actively engage in their healing process. By completing assignments outside of therapy sessions, individuals can reinforce the concepts learned in therapy, apply new skills, and make progress towards their treatment goals. In this section, we will explore the importance of therapy homework and how it can specifically help with depression.

Understanding the Importance of Homework in Therapy

Homework assignments serve as an extension of therapy and allow individuals to continue their progress beyond the confines of the therapy room. It provides an opportunity for individuals to practice and integrate new insights, coping strategies, and techniques into their daily lives. Through regular engagement with therapy homework, individuals can reinforce the therapeutic work, develop new habits, and enhance their overall well-being.

Therapy homework offers several benefits for individuals with depression. It allows for increased self-awareness, as individuals are encouraged to reflect on their thoughts, emotions, and behaviors. This self-reflection promotes a deeper understanding of oneself and the factors contributing to their depression, enabling individuals to identify patterns and make positive changes.

Additionally, therapy homework empowers individuals by giving them a sense of control and agency in their recovery journey. It fosters a sense of ownership and responsibility for one’s mental health, promoting active participation and engagement in the therapeutic process.

How Therapy Homework Can Help with Depression

Therapy homework can be particularly effective in addressing various aspects of depression. It can help individuals challenge negative thought patterns and develop more adaptive and positive thinking. Cognitive Behavioral Therapy (CBT) worksheets, for example, provide structured exercises to identify and reframe negative thoughts. These worksheets, along with journaling and thought records, allow individuals to track their thoughts and emotions, identify cognitive distortions, and develop healthier thinking patterns.

Behavioral activation exercises are another valuable component of therapy homework for depression. They involve engaging in activities that provide a sense of accomplishment, pleasure, or mastery, even when motivation is low. By gradually increasing participation in enjoyable and fulfilling activities, individuals can combat the inertia often associated with depression and experience an improvement in mood.

By consistently engaging in therapy homework, individuals with depression can experience a sense of progress, growth, and empowerment. However, it’s essential to collaborate with a therapist to develop a personalized homework plan that aligns with individual goals, needs, and preferences. This collaboration ensures that the homework assignments are tailored to the specific challenges and circumstances faced by each individual.

In the following sections, we will explore different types of therapy homework for depression and provide tips for developing a personalized homework plan that maximizes the benefits of therapy.

Types of Therapy Homework for Depression

When it comes to managing depression through therapy, various types of homework assignments can be incorporated to enhance the therapeutic process. These assignments aim to reinforce the skills and techniques learned in therapy sessions and provide individuals with opportunities for self-reflection and growth. Here are three common types of therapy homework for depression:

Cognitive Behavioral Therapy (CBT) Worksheets

Cognitive Behavioral Therapy (CBT) is a widely used approach for treating depression. CBT worksheets are valuable homework tools that help individuals identify and challenge negative thought patterns and beliefs. These worksheets typically involve exercises such as identifying automatic negative thoughts, examining evidence for and against these thoughts, and developing more balanced and realistic thinking patterns. CBT worksheets can be used to address distorted thinking commonly associated with depression, such as overgeneralization, personalization, and catastrophizing.

Journaling and Thought Records

Journaling and thought records are effective homework assignments for promoting self-awareness and monitoring thoughts and emotions related to depression. By encouraging individuals to write down their thoughts and feelings, these assignments provide an opportunity to identify negative thinking patterns and emotions that contribute to depressive symptoms. Thought records, in particular, involve documenting a specific negative thought, examining evidence for and against it, and generating alternative, more positive thoughts. Journaling and thought records can be powerful tools for increasing self-reflection and challenging negative self-perceptions.

Behavior Activation Exercises

Behavior activation is a key component of therapy for depression . Homework assignments focused on behavior activation aim to increase engagement in pleasurable and meaningful activities, even when motivation is low. These assignments may involve creating a schedule of daily activities, setting achievable goals, and gradually increasing involvement in enjoyable activities. By actively participating in positive experiences, individuals with depression can counteract the cycle of withdrawal and isolation often associated with the condition.

By incorporating these types of therapy homework into the treatment plan, individuals with depression can actively engage in their own healing process. It is important for therapists to collaborate with their clients, identifying specific goals and areas of focus, to tailor the homework assignments to each individual’s needs and preferences. Consistency, tracking progress, and seeking support are essential for making therapy homework a meaningful and effective part of the journey towards overcoming depression.

For more information on therapy homework assignments and ideas for other areas of focus, visit our articles on therapy homework assignments and therapy homework ideas .

Developing a Personalized Homework Plan

To make the most out of therapy homework for depression, it’s essential to collaborate with your therapist and develop a personalized plan. This plan should be tailored to your specific needs, goals, and areas of focus. By working together with your therapist, you can create a realistic and manageable homework plan that complements your therapy sessions.

Collaborating with Your Therapist

The first step in developing a personalized homework plan is to collaborate with your therapist. Through open and honest communication, express your goals, challenges, and preferences. Your therapist will use their expertise to guide you in selecting appropriate homework assignments that align with your therapy objectives.

Your therapist may suggest specific therapy techniques or resources that can be incorporated into your homework plan. These may include cognitive behavioral therapy (CBT) worksheets , journaling , thought records , behavior activation exercises , or other relevant tools. By discussing your preferences and comfort level, you can ensure that the chosen homework assignments resonate with you.

Identifying Goals and Areas of Focus

During therapy sessions, you and your therapist will identify specific goals and areas of focus. These goals may include developing coping skills, challenging negative thought patterns, improving self-esteem, or enhancing communication skills. By identifying these goals, you can create homework assignments that directly address the areas you want to work on.

For example, if one of your goals is to challenge negative thought patterns, your therapist may suggest completing CBT worksheets that help you identify and reframe negative thoughts. By integrating these worksheets into your homework plan, you can reinforce the skills learned during therapy sessions and continue working on them independently.

Creating a Realistic and Manageable Plan

When creating your homework plan, it’s crucial to ensure that it is realistic and manageable. Your therapist will help you set realistic expectations and establish a schedule that fits your lifestyle. It’s important to strike a balance between challenging yourself and avoiding overwhelming tasks.

By breaking down larger goals into smaller, achievable tasks, you can maintain motivation and progress steadily. Your therapist may also suggest incorporating self-care activities, relaxation exercises, or mindfulness practices into your homework plan to foster emotional well-being and resilience.

To help you stay organized and track your progress, consider using a journal or a digital tool specifically designed for therapy homework. These tools can help you monitor your assignments, record your thoughts and emotions, and reflect on your progress over time.

Remember, the success of your therapy homework plan depends on your consistency, commitment, and willingness to actively engage in the process. By collaborating with your therapist, identifying goals, and creating a realistic plan, you can maximize the benefits of therapy homework for depression.

Tips for Effective Therapy Homework

To make the most out of therapy homework and enhance the effectiveness of your treatment for depression , it’s important to keep a few key tips in mind. These tips will help you stay on track and maximize the benefits of your therapy sessions.

Consistency and Commitment

Consistency is key when it comes to therapy homework. Make a commitment to regularly engage in your assigned exercises or activities. Set aside dedicated time each day or week to work on your homework. Treat it as a priority and integrate it into your routine. By being consistent and committed, you’ll reinforce the therapeutic progress and build momentum towards achieving your goals.

Tracking Progress and Making Adjustments

Keep track of your progress as you engage in therapy homework. Maintain a record of your experiences, observations, and any changes you notice. This tracking will help you identify patterns and trends, providing valuable insights into your journey. It can be helpful to use a journal or a tracking app to record your thoughts and progress. Regularly review your records with your therapist to assess your growth, make adjustments, and refine your homework plan if necessary.

Seeking Support and Accountability

Seek support and accountability to stay motivated and committed to your therapy homework. Share your goals and progress with a trusted friend, family member, or support group. Consider joining a therapy or coaching community where you can connect with others who are also working on their mental health. Engaging in discussions, sharing experiences, and receiving encouragement from others can provide a sense of support and accountability that keeps you motivated and engaged.

Remember, therapy homework is an integral part of the treatment process for depression. By following these tips for effective therapy homework, you can enhance your progress and experience the full benefits of your therapeutic journey. Stay consistent, track your progress, and seek support to make the most out of your therapy experience.

For more information and resources on therapy homework for various topics, visit our therapy homework assignments page.

Overcoming Challenges with Therapy Homework

While therapy homework can be an effective tool for managing depression, it’s important to acknowledge and address the challenges that may arise during the process. Here are some common challenges individuals may encounter when completing therapy homework and strategies for overcoming them.

Addressing Resistance and Motivation Issues

Resistance and lack of motivation can hinder progress when it comes to therapy homework. It’s not uncommon to feel resistant or unmotivated, especially when dealing with the symptoms of depression. However, it’s important to remember that therapy homework plays a significant role in your overall treatment and recovery.

To address resistance and motivation issues, consider the following strategies:

Explore the underlying reasons : Reflect on why you may be resistant or lacking motivation. Are there specific barriers or fears that need to be addressed? Share your concerns with your therapist to gain a deeper understanding and explore possible solutions.
Break tasks into smaller steps : Overwhelming tasks can lead to resistance. Break down your therapy homework into smaller, more manageable steps. This can help make the tasks feel less daunting and increase motivation.
Find intrinsic motivation : Connect with the deeper reasons behind why you want to engage in therapy homework. Remind yourself of the potential benefits, such as improved coping skills or increased self-awareness. Focusing on these intrinsic motivations can help reignite your motivation.

Dealing with Time Constraints

Finding time to complete therapy homework can be challenging, especially when juggling other responsibilities and commitments. However, dedicating time to your therapy homework is essential for making progress in your treatment.

To overcome time constraints, consider the following strategies:

Prioritize and schedule : Prioritize your therapy homework by scheduling specific times in your daily or weekly routine dedicated solely to completing the tasks. Treat these scheduled times as non-negotiable commitments to yourself and your well-being.
Break tasks into shorter sessions : If the length of the tasks feels overwhelming, break them into shorter sessions spread out over several days. This can help you fit therapy homework into your schedule more easily.
Utilize downtime : Identify pockets of time throughout your day that can be used to complete smaller tasks. For example, you can work on journaling exercises during your morning commute or listen to guided meditation during your lunch break.

Modifying Homework to Fit Individual Needs

Therapy homework is not one-size-fits-all, and it’s important to tailor it to your individual needs and preferences. If you find that certain exercises or assignments are not resonating with you or are not producing the desired outcomes, it may be necessary to modify them.

Consider the following strategies for modifying therapy homework:

Communicate with your therapist : Discuss any challenges or concerns you have with your therapist. They can help modify the homework assignments to better suit your needs and provide alternative options if necessary.
Explore alternative techniques or activities : If a particular exercise is not effective for you, discuss alternative techniques or activities with your therapist. They may be able to suggest different approaches that align better with your preferences and goals.
Experiment and adapt : Be open to experimenting with different approaches and techniques. Therapy homework is a collaborative process, and it may take some trial and error to find what works best for you. With the guidance of your therapist, adapt and modify the homework assignments to suit your unique circumstances.

By addressing resistance and motivation issues, managing time constraints, and modifying therapy homework to fit your individual needs, you can overcome challenges and make the most of your treatment. Remember to communicate openly with your therapist, as they are there to support you in your journey toward healing and recovery.

Download free guide (PDF)

Discover how to engage your clients on autopilot while radically scaling your coaching practice.

Coach, This Changes Everything (Free PDF)

How Much Does Homework Matter in Therapy?

What research reveals about the work you do outside of therapy sessions..

Posted April 16, 2017 | Reviewed by Ekua Hagan

What Is Therapy?
Find a therapist near me

Homework is an important component of cognitive behavior therapy (CBT) and other evidence-based treatments for psychological symptoms. Developed collaboratively during therapy sessions, homework assignments may be used by clients to rehearse new skills, practice coping strategies, and restructure destructive beliefs.

Although some clients believe that the effectiveness of psychotherapy depends on the quality of in-session work, consistent homework during the rest of the week may be even more important. Without homework, the insights, plans, and good intentions that emerge during a therapy session are at risk of being buried by patterns of negative thinking and behavior that have been strengthened through years of inadvertent rehearsal. Is an hour (or less) of therapeutic work enough to create change during the other 167 hours in a week?

Research on homework in therapy

Research on homework in therapy has revealed some meaningful results that can be understood collectively through a procedure called meta-analysis. A meta-analysis is a statistical summary of a body of research. It can be used to identify the average impact of psychotherapy homework on treatment outcomes across numerous studies. The results of four meta-analyses listed below highlight the value of homework in therapy:

Kazantzis and colleagues (2010) examined 14 controlled studies that directly compared treatment outcomes for clients assigned to psychotherapy with or without homework. The data favored the homework conditions, with the average client in the homework group reporting better outcomes than about 70% of those in the no-homework conditions.
Results from 16 studies (Kazantzis et al., 2000) and an updated analysis of 23 studies (Mausbach et al., 2010) found that, among those who received homework assignments during therapy, greater compliance led to better treatment outcomes. The effect sizes were small to medium, depending on the method used to measure compliance.
Kazantzis et al. (2016) examined the relations of both quantity (15 studies) and quality (3 studies) of homework to treatment outcome. The effect sizes were medium to large, and these effects remained relatively stable when follow-up data were collected 1-12 months later.

Taken together, the research suggests that the addition of homework to psychotherapy enhances its effectiveness and that clients who consistently complete homework assignments tend to have better mental health outcomes. Finally, although there is less research on this issue, the quality of homework may matter as much as the amount of homework completed.

To enhance the quality of homework, homework assignments should relate directly to a specific goal, the process should be explained with clarity by the therapist, its method should be rehearsed in session, and opportunities for thoughtful out-of-session practice should be scheduled with ideas about how to eliminate obstacles to completion.

To find a therapist, please visit the Psychology Today Therapy Directory .

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in Cognitive and Behavioral Therapy: A meta‐analysis. Clinical Psychology: Science and Practice, 7(2), 189-202.

Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta‐analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156.

Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.

Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429-438.

Joel Minden, Ph.D., is a clinical psychologist, author of Show Your Anxiety Who’s Boss , director of the Chico Center for Cognitive Behavior Therapy, and lecturer in the Department of Psychology at California State University, Chico.

Find a Therapist
Find a Treatment Center
Find a Psychiatrist
Find a Support Group
Find Teletherapy
United States
Brooklyn, NY
Chicago, IL
Houston, TX
Los Angeles, CA
New York, NY
Portland, OR
San Diego, CA
San Francisco, CA
Seattle, WA
Washington, DC
Asperger's
Bipolar Disorder
Chronic Pain
Eating Disorders
Passive Aggression
Personality
Goal Setting
Positive Psychology
Stopping Smoking
Low Sexual Desire
Relationships
Child Development
Therapy Center NEW
Diagnosis Dictionary
Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

Coronavirus Disease 2019
Affective Forecasting
Neuroscience

Types of Homework in CBT

Cindy brown.

November 5, 2021
No Comments

What is Homework in Psychotherapy

Psychotherapy homework is often allocated to patients as part of their therapy. Homework activities are incorporated in this way to practice techniques taught in therapy, to enable people to adapt the skills they have gained in therapy to real-life circumstances, and to strengthen the particular issues experienced in therapy. For example, in one therapy session, a patient with social skills deficits might practice and rehearse acceptable social skills, and be expected to complete homework assignments before the next session applying those newly acquired skills (e.g., going to a social engagement or greeting five people each day). In this article, we will talk about Homework Types in CBT .

Thought and Behavior Rating Scales

Such homework is essential in the treatment of patients with cognitive distortions. These tests, which provide clinical information and are for self-report (self-rating) scales, also work as a self-report criterion to observe the patient’s mood changes during post-session homework or sessions. The use of such scales helps provide feedback from the patient during or towards the end of therapy. Beck Depression Inventory and Beck Anxiety Inventory are among the scales frequently used in this type of homework. The Beck Depression Inventory can work either as a group or as an individual by grading oneself or verbally, while the Beck Anxiety Inventory can be administered individually by grading one’s self.

Self-Monitoring

In the self-monitoring homework, patients keep records of their cognitive and behavioral status related to their main problems. This homework technique helps the therapist to get a clearer idea about the nature of the patient’s problem. This may also be useful for patients whose symptoms have spread throughout the day, have become habitual, and have difficulty describing these symptoms. However, therapists should be aware that self-monitoring in anxious patients can provoke anxiety. During this activity, the therapist asks the patient to concentrate on automatic thoughts and beliefs during the interaction with the family members.

Event Planning Phases

With this technique, patients first make a list of what they have to do. Then select one of them to determine which steps they should take to achieve this. . The therapist should ensure that these steps are large enough for the patient to cope with. After identifying the steps, the patient can rehearse the subject and write down the possible difficulties he may face. And think about what he can do about these steps. In this process, the therapist tells the patient: “Start the practice from the first step and ignore the other steps. Focus on what you’ve accomplished, not the things you have to do waiting for you.”

Confrontation

For the CBT to be effective, the client should apply confrontation exercises as an assignment at home, on the street, or in public transport. The confrontation treatment evaluation consists of three stages; explaining the rational treatment-making the graded confrontation list and determining the reaction prevention rules.

Last Updated on December 10, 2022 by Lucas Berg

Your email address will not be published. Required fields are marked *

Related post, what is pmdd and how does it affect mental health, the myth of napoleon complex in women and 9 most successful short women celebrities, family counseling services: everything you should know, privacy overview.

IMAGES

CBT Worksheets Printable/instant Download Cognitive Behavioural Therapy
What is CBT? The Complete Guide to Cognitive Behavioral Therapy
Cognitive Behavioral Therapy Worksheet Template & Example
10++ Cbt Abc Worksheet
How the CBT Triangle Connects Thoughts, Feelings, and Behaviors
CBT: Example and Practice Sheet Counseling Activities, Therapy

VIDEO

The Homework of CBT Cognitive Behavioral Therapy
CBT Homework done, Junk Journaling is more fun
CBT Session Demo
Getting Clients To Do Homework
Better Therapy Homework: Evidence-Based Practices for Better Outcomes
CBT Delivers!

COMMENTS

How to Design Homework in CBT That Will Engage Your Clients
Using Quenza for CBT: 3 Homework Examples. Let's now look at three examples of predesigned homework activities available through Quenza's Expansion Library. Urge Surfing. Many of the problems CBT seeks to address involve changing associations between stimulus and response (Bouton, 1988). In this sense, stimuli in the environment can drive ...
Homework in CBT
Here are some ways to increase adherence to homework: Tailor the assignments to the individual. Provide a rationale for how and why the assignment might help. Determine the homework collaboratively. Try to start the homework during the session. This creates some momentum to continue doing the homework.
20 Cognitive Behavioral Therapy (CBT) Techniques with Examples
Cognitive Behavioral Therapy (CBT) stands as a powerful, evidence-based therapeutic approach for various mental health challenges. At its core lies a repertoire of techniques designed to reframe thoughts, alter behaviors, and alleviate emotional distress. This article explores 20 most commonly used cbt techniques.
Assigning Homework in Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is known to be a highly effective approach to mental health treatment. One factor underlying its success is the homework component of treatment. It's certainly ...
The New "Homework" in Cognitive Behavior Therapy
By Judith S. Beck, Ph.D., and Francine R. Broder, Psy.D. Judith S. Beck, Ph.D. We've stopped using the word "homework" in CBT. Too many clients take exception to that term. It reminds them of the drudgery of assignments they had to do at home when they were at school. So in recent times, we've switched. "Homework" is now called the ...
CBT WORKSHEET PACKET
A more detailed description and further examples of each worksheet can be found in Beck, J. S. Cognitive Behavior Therapy: Basics and Beyond, 3rd ed. (2020), and Beck, J. S. Cognitive Therapy for Challenging ... Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org ...
CBT Session Structure and Use of Homework
For example, many agencies that provide CBT may offer a limited number of sessions (perhaps from six to 12). ... Homework in CBT refers essentially to tasks set to be completed by the client between sessions. For some clients, 'homework' is a word that triggers difficult memories of school days, possibly for some linked to a failure or ...
What is the Status of "Homework" in Cognitive Behavior Therapy, 50
Fortunately, the research underpinning CBT homework is moving towards more clinically meaningful studies. Therapist skill in using homework has been shown to predict outcomes 9-10, and recently a study found that greater consistency of homework with the therapy session resulted in more adherence. 11 Our Cognitive Behavior Therapy Research Lab (currently based at the Turner Institute for Brain ...
Therapy Homework: Purpose, Benefits, and Tips
This article explores the purpose of therapy homework, the benefits it can offer, and some tips to help you comply with your homework assignments. ... an example of a type of therapy that doesn't generally involve homework is eye movement desensitization and reprocessing ... Homework compliance counts in cognitive-behavioral therapy. Cogn ...
Homework Assignments in CBT: A Close Look with Therapy Now SF
Cognitive Behavioral Therapy (CBT) is a transformative approach that intertwines our thoughts, emotions, and behaviors. At Therapy Now SF, we're firm advocates of CBT's efficacy, and an essential ingredient in this process is the use of homework assignments. ... In Cognitive Behavioral Therapy, homework assignments aren't merely tasks to ...
Supporting Homework Compliance in Cognitive Behavioural Therapy
Homework Non-Compliance in CBT. Cognitive behavioral therapy (CBT) is an evidence-based psychotherapy that has gained significant acceptance and influence in the treatment of depressive and anxiety disorders and is recommended as a first-line treatment for both of these [1,2].It has also been shown to be as effective as medications in the treatment of a number of psychiatric illnesses [3-6].
Homework in Cognitive Behavioral Supervision: Theoretical Background
Homework in Therapy. While specific recommendations for the practical usage of homework have been clearly articulated since the early days of CBT, 11, 12 practitioners state that they do not follow these recommendations. 13-15 For example, many physicians admit that they forget homework or do not focus on standard specifications when, where, how often, and how long the task should last.
The CBT Model: Psychoeducation
The CBT Model Info Sheet is a one-page worksheet designed to explain the cognitive model through accessible writing and examples. Your clients will learn how their thoughts, emotions, and behaviors interact, and the value of changing their negative thinking patterns. While we've done our best to make this worksheet as accessible as possible, we ...
CBT Worksheets
The Cognitive Triangle. worksheet. The cognitive triangle illustrates how thoughts, emotions, and behaviors affect one another. This idea forms the basis of cognitive behavior therapy (CBT). Perhaps most important to CBT, when a person changes their thoughts, they will also change their emotions and behaviors.
Empower Your Clients: Effective Therapy Homework Ideas Unveiled
For example, if a client is working towards improving their self-esteem, therapy homework could involve engaging in self-affirmation exercises or creating a self-compassion journal. ... In this section, we will explore therapy homework ideas for different needs, including Cognitive Behavioral Therapy (CBT) techniques, mindfulness and meditation ...
Empowering Progress: Effective Therapy Homework for Depression
Cognitive Behavioral Therapy (CBT) worksheets, for example, provide structured exercises to identify and reframe negative thoughts. These worksheets, along with journaling and thought records, allow individuals to track their thoughts and emotions, identify cognitive distortions, and develop healthier thinking patterns.
How Much Does Homework Matter in Therapy?
Homework is an important component of cognitive behavior therapy (CBT) and other evidence-based treatments for psychological symptoms. Developed collaboratively during therapy sessions, homework ...
The Use of Homework in Cognitive Behavior Therapy ...
Finally, effective homework helps to build therapeutic collaboration and afford the patient the opportunity for building self-efficacy. Using several case examples, this paper describes the functions and impediments to using homework in CBT.
Homework In Cognitive Behavioral Supervision
Most practicing CBT therapists report that they use homework and consider homework important for many problems 14 and believe in the role of homework in improving therapeutic outcomes. 24,27 Encouraging and facilitating homework is a basic skill of a CBT therapist; therefore, it is an important part of supervision. 19,20,26 Homework needs to be ...
Types of Homework in CBT
Psychotherapy homework is often allocated to patients as part of their care. Homework activities are incorporated in this way to practice techniques taught in therapy, enable people to adapt the skills they have gained in therapy to real-life circumstances, and to strengthen the particular issues experienced in therapy. For example, in one therapy session, a patient with social skills deficits ...