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Updated: May 7, 2026

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Published on: April 26, 2024

"Barriers to Cognitive Behavioral Therapy Homework Completion Scale- Depression Version": Development and

Judith A Callan¹, Jacqueline Dunbar-Jacob, Susan M Sereika

¹University of Pittsburgh School of Nursing, Pittsburgh, PA ; University of Pittsburgh Medical Center, Pittsburgh, PA.

International Journal of Cognitive Therapy

|September 20, 2013

Summary

Identifying barriers to Cognitive Behavioral Therapy (CBT) homework completion is crucial for depressed patients. A new instrument effectively distinguishes patient and therapy factors influencing CBT adherence.

Keywords:

Adherence Cognitive Behavioral Therapy Compliance Homework reliability validity

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Last Updated: May 7, 2026

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Published on: April 26, 2024

Area of Science:

Psychology
Clinical Psychology
Psychiatry

Background:

Cognitive Behavioral Therapy (CBT) is a common treatment for depression.
Homework completion is a critical component of CBT effectiveness.
Barriers to CBT homework completion can impede treatment success.

Purpose of the Study:

To develop and psychometrically evaluate an instrument to identify barriers to CBT homework completion.
To assess the reliability and validity of the new instrument in a depressed sample.

Main Methods:

A two-phase study involving interviews with depressed patients and CBT therapists to create an item pool.
Administration of a draft instrument to 56 individuals with depression.
Exploratory Factor Analysis to determine the instrument's factor structure.
Internal consistency, temporal stability, sensitivity, and specificity analyses were conducted.

Main Results:

Exploratory Factor Analysis identified two factors: "Patient Factors" and "Therapy/Task Factors."
The instrument demonstrated strong internal consistency (coefficients .80–.95) and temporal stability (correlations .72–.95).
The patient subscale accurately classified patients with low and high adherence (75–79%), with good sensitivity and specificity.

Conclusions:

The developed instrument is a reliable and valid tool for identifying barriers to CBT homework completion in depressed individuals.
Understanding patient and therapy/task factors can inform interventions to improve CBT adherence.
The instrument shows promise for clinical application in optimizing depression treatment outcomes.