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Therapeutic Homework and Treatment Outcomes in Youth Cognitive-Behavioral Therapy for Internalizing Disorders: A
Abigail E Pine1, Mary A Gum2, Michelle M Liu2
1Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 North Broadway Suite 206, Baltimore, MD, 21205, USA. apine1@jh.edu.
Clinical Child and Family Psychology Review
|July 17, 2026
Summary
Improving adherence to cognitive behavioral therapy (CBT) homework in youth is crucial for better treatment outcomes. Greater homework completion is linked to reduced symptoms, especially in pediatric obsessive-compulsive disorder (OCD).
Area of Science:
- Child and Adolescent Psychiatry
- Clinical Psychology
- Behavioral Therapy Research
Background:
- Homework adherence is a key factor in cognitive behavioral therapy (CBT) effectiveness for pediatric internalizing disorders.
- Previous research on youth has yielded mixed results regarding the impact of homework adherence on CBT outcomes.
- This study systematically reviews and meta-analyzes existing clinical trials to clarify this relationship.
Purpose of the Study:
- To examine the association between homework adherence and CBT outcomes in youth with internalizing disorders.
- To determine if disorder type influences the strength of this association.
- To highlight the role of homework adherence as a mechanism for CBT efficacy in pediatric populations.
Main Methods:
- A systematic review and meta-analysis of 14 clinical trials involving 1179 participants (mean age 11.33 years).
- Inclusion criteria focused on youth internalizing disorders treated with CBT.
- Random-effects meta-analytic models were used to assess the association between homework adherence and symptom reduction.
Main Results:
- A small-to-moderate negative correlation was found between homework adherence and post-treatment symptoms (r = -0.23, p < 0.001).
- Disorder type significantly moderated the association.
- The link between adherence and outcomes was strongest for obsessive-compulsive disorder (OCD) (r = -0.42).
Conclusions:
- Homework adherence is an important mechanism for CBT effectiveness in youth, particularly for OCD.
- The association between homework adherence and CBT outcomes varies by disorder type.
- Strategies to enhance homework adherence may improve CBT outcomes for children and adolescents with internalizing disorders.
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