Does Therapy Homework Help? What the Research Shows

Research suggests that therapy homework is linked with better outcomes, especially in cognitive behavioural therapy (CBT), but the link is modest and does not prove that homework alone causes improvement. A 2010 meta-analysis by Mausbach and colleagues found a small to medium association between doing homework and treatment results. A 2016 meta-analysis by Kazantzis and colleagues found larger associations, with caveats. How well you practise a skill seems to matter, not just whether you tick the task off.

What "therapy homework" actually means

Therapy homework is anything your therapist suggests you do between sessions. In CBT it is a standard part of the approach. The NHS page on CBT says you will usually be asked to practise what you have learned between sessions, and that you may be asked to record your progress in a worksheet or diary.

Common examples include:

• Writing down a stressful situation and the thoughts that came with it.
• Trying a behaviour you have been avoiding, in small steps.
• Practising a breathing or grounding skill.
• Noticing and rating your mood or anxiety through the week.

If you want more ideas, see therapy homework ideas for clients or the therapy homework page. Homework does not have to be a worksheet. It can be a small experiment, a note, or a conversation.

What the research says

Most of the research below is about CBT. Other therapies use between-session tasks too, but the evidence base is thinner, so it is wise not to assume the same findings apply everywhere.

Mausbach and colleagues, 2010

Mausbach, Moore, Roesch, Cardenas and Patterson published an updated meta-analysis in Cognitive Therapy and Research. It pooled 23 studies with 2,183 participants. The authors reported an overall correlation of about r = .26 between homework compliance and treatment outcome, which they described as a small to medium relationship. The pattern was similar across the problems studied, including depression, anxiety and substance use.

In plain terms: people who did more of their homework tended to do somewhat better. That is an association. It does not tell us that homework made the difference, because people who are feeling better, more motivated or less overwhelmed may simply find it easier to do the tasks.

Kazantzis and colleagues, 2016

Kazantzis, Whittington, Zelencich, Kyrios, Norton and Hofmann reviewed 17 studies with 2,312 clients in Behavior Therapy. They looked at two things: the quantity of homework completed, and its quality, meaning how well clients acquired the targeted skill. Both were related to outcomes after treatment and at follow-up, with effect sizes in the moderate to large range.

The authors were careful about limits. Only three studies measured quality, the confidence intervals around those estimates were wide, and they said the findings need confirming by further research. The takeaway many clinicians draw is that doing a task thoughtfully may count for more than doing a lot of tasks.

Callan and colleagues, 2018

A propensity score analysis by Callan, Kazantzis and colleagues in Behavior Therapy tried to get closer to the causation question using data from two CBT for depression samples. Overall, response and remission rates did not differ between high and low adherers. When the researchers adjusted for session attendance, greater adherence was associated with better response and remission at some points in treatment. The authors described the associations as small but consistent and the findings as preliminary, and they noted limits such as reliance on therapist ratings and modest sample sizes.

What this adds up to

• Doing homework tends to go along with better outcomes, mostly in CBT studies.
• The size of the link is typically described as small to moderate in the earlier work, and larger but less certain in the 2016 review.
• Most studies are observational, so they cannot prove cause and effect.
• Quality may matter as much as quantity, though the evidence on that is still limited.
• Nobody has shown that skipping a task ruins therapy. The research is about averages across groups, not what will happen to you.

Why homework might help

The research does not settle why homework is associated with better results, so these are reasonable ideas rather than proven mechanisms. A therapy hour is short, and most of your life happens outside it. Practising a skill in the situations where you need it gives you something concrete to review in the next session. Noticing your thoughts, moods or behaviours between sessions also gives you and your therapist real examples instead of vague memories. The Mental Health Foundation, in its overview of CBT, notes that you review how tasks went at the start of each session, and that if you could not finish them, you can discuss what got in the way.

That last point is important. A skipped task is information, not a failure.

How to make homework doable

If homework feels like one more thing on a long list, these changes can help:

1. Shrink it. Ask whether you can do a five-minute version. A two-line thought record counts more than a perfect one you never write.
2. Attach it to a habit. Do it after your morning coffee, on the bus, or before you brush your teeth at night.
3. Write it down before you leave the session. Ask your therapist to repeat the task and write it in your phone or notebook while you are still in the room.
4. Know the point. If the purpose of a task is unclear, ask. Tasks you understand are easier to start.
5. Set a trigger, not a time. "When I notice I am avoiding something, I will write what I am telling myself" is often easier than "I will journal at 7 p.m."

For more on making sessions count, see how to get more out of therapy.

What to do when you skip it

Most people skip homework at some point. It does not mean you are resistant or doing therapy wrong.

• Do not wait for the session to catch up. Ten minutes the day before is better than a guilty cram that leaves you dreading the next appointment.
• Do a rough version. Even a few notes from memory give you something to discuss.
• Work out what got in the way. Was the task too big, unclear, badly timed, or emotionally heavy? Each of those has a different fix.
• Tell your therapist plainly. Therapists expect this and can adjust the task. Hiding it usually makes the work less useful.

How to talk to your therapist about homework

Some phrases you can borrow:

• "I did not manage the task. Can we look at why?"
• "That felt like too much for one week. Could we try a smaller version?"
• "I do not see how this connects to my goal. Can you explain it?"
• "I do better with writing or voice notes than worksheets. Can we try that?"

If you are unsure how to open that conversation, what to say to your therapist has more wording ideas. If you are wondering whether therapy as a whole is on track, how to know if therapy is working covers the signs to look for.

How to track your homework

Tracking does not need to be elaborate. A simple log helps you see what you practised, how it went and what to bring up. For each task, you might note:

• The task and the date.
• What happened, in a sentence or two.
• What was hard or surprising.
• One question for your therapist.

Over several weeks, a log can show patterns, such as which tasks you tend to do and which you avoid. A therapy tracker can keep this together, and it also makes it easy to share the points you choose with your therapist.

When to get support

Therapy homework should be manageable. If a task makes you feel unsafe, much worse, or overwhelmed, stop and tell your therapist before the next session if you can. If you are in crisis or thinking about harming yourself, contact a licensed professional, your local emergency services or a crisis line in your country right away. This article is general information and not medical advice.

Sources and further reading

• The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis - Mausbach and colleagues, 2010, on the small to medium link between compliance and outcome.
• Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy - Kazantzis and colleagues, 2016, on quantity and quality of homework.
• A Propensity Score Analysis of Homework Adherence-Outcome Relations in Cognitive Behavioral Therapy for Depression - Callan and colleagues, 2018, on small, preliminary associations in depression.
• Overview: Cognitive behavioural therapy (CBT) - NHS description of CBT and practising between sessions.
• Cognitive behavioural therapy (CBT) - Mental Health Foundation on reviewing tasks in sessions.

Where Symplia fits

Symplia is a private mental health app that can sit alongside therapy. Its Therapy Work feature gives you a place to keep the tasks your therapist suggests, record how they went, and bring your notes to your next session, while Session Prep helps you decide what to raise. You choose what to share with your therapist. Symplia is not therapy and does not replace a licensed professional.

Try Symplia free at app.symplia.app. Monthly and Annual plans include a 7-day free trial.

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