Why clients do not engage with homework in CBT therapy

When Dr. Aaron Beck developed Cognitive Behavioral Therapy, he was inspired by the other theories at the time. Influenced by the educational component of the behavioral therapy, “homework” was introduced as an integral part of the Cognitive Behavioral Therapy. Homework was a structured therapeutic tasks to be carried out in between sessions, designed collaboratively by the therapist and client, aimed to not only introduce behavioral changes but to inflict a shift in key cognitions. 

Many studies have looked at the importance of homework and its relation to better treatment outcomes. Studies have shown that clients who engage with homework show better progress and better treatment outcomes than those who do not. The research community also focused on non-engagement in an attempt to understand, solve and prevent this in therapy sessions. Reasons for non-engagement  include client’s lack of motivation to change, inability to access and recognize negative automatic thoughts, lack of understanding of the importance and purpose of homework.  Other factors refer to the format of homework (pen and paper, docs and pdfs), inconvenience due to the amount of time needed, forgetting etc. In clinical work, although clients might show up in every session, it is not uncommon for them to do so without having completed the homework, no matter the collaboration and the rationale provided at the time of its assignment.  While a therapist can emphasize and urge clients to adhere to their homework there is little they can do in between sessions.  

Current studies discuss tackling the non-engagement issues either by renaming therapeutic tasks as ”action plans” rather than homework, as suggested by Dr. Judith Beck or using mobile apps and the advances in technology to address many obstacles associated with homework engagement. 

Wei Tang and David Kreindler (2017) have recommended that mobile apps addressing homework engagement such as CBTapp should be science-based, compatible with therapy provided, promote learning, provide guidance, foster connections and promote motivation for completion of tasks. These apps should also consider the different populations they cater to taking into account education background, cognitive abilities etc. 

 “It’s up to therapists to help clients carefully design meaningful assignments with a good likelihood of success and to motivate clients to follow through” - Dr Judith Beck

At CBTapp we are creating a solution that reflects the above directions from research and are focusing on providing the therapists with tools to better engage their clients and improve therapy outcomes.

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