Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia

The relationship between adherence to group cognitive-behavioral treatment instructions and outcome was examined for 52 social phobic clients. Less symptomatic clients were no more likely to adhere to treatment instructions than more highly symptomatic clients. Clients were less likely to participate during group treatment sessions if they were higher on avoidant personality traits, and were less likely to complete self-directed exposures if they were more paranoid. Dependent clients tended to complete homework assignments more than less dependant clients. With one exception, adherence to treatment instructions for between session homework was not related to any of the outcome measures at the completion of treatment. However, at the 6-month follow-up, clients who adhered more to homework instructions reported less anxiety during the speech, and also tended to report greater decrements in anxiety and larger changes in their avoidant behavior. These data suggest that homework may be more important in the long-run, when the therapist is no longer present to prompt exposure.