Client Factors Influencing Adherence to Homework in Psychotherapy: Findings from a Tertiary Care Setting in India

Homework adherence (HWA) plays a crucial role in predicting psychotherapy outcomes. However, there is limited research on factors that impact homework adherence. This study employs a social cognitive framework to examine client variables and predictors impacting homework adherence among individuals undergoing individual psychotherapy.

Using a cross-sectional design, 94 adults (aged 18–60 years) seeking treatment from an outpatient clinical services unit at a mental health center, were recruited. Participants completed the Short Self-Regulation Questionnaire (SSRQ), Generalized Self-Efficacy Scale (GSE), Barriers to CBT Homework Completion Scale, and Multidimensional Health Locus of Control (MHLC). Therapists rated Homework Compliance Scale (HCS). Correlations between self-regulation, self-efficacy, perceived barriers, locus of control, and homework adherence were examined. Median regression (MR) analysis was utilized to identify predictors of homework adherence.

Homework adherence was positively correlated with both self-efficacy (p < 0.01) and self-regulation (p < 0.05). There was no significant relationship between the subscales of the locus of control measure and homework adherence. Patient-related perceived barriers and overall barriers were significantly negatively correlated with HWA (p < 0.01). Patient-related and therapy/task-related perceived barriers to HWA were negatively correlated with self-efficacy (p < 0.01) and self-regulation ((p < 0.01). Self-efficacy was a significant predictor of homework adherence.

Social cognitive factors linked to homework adherence are often overlooked in psychotherapy research. Our findings highlight the role of addressing self-efficacy beliefs and self-regulation and addressing perceived barriers to improve homework adherence and engagement, and thereby treatment outcomes.