[2026-01-26] Factors Associated With Homework Adherence in Cognitive Behavioral Therapy

Paniccha Chaikawin; Komsan Kiatrungrit; Nuttorn Pityaratstian; Sirichai Hongsanguansri

doi:10.33165/rmj.2026.e275833

Authors

Paniccha Chaikawin Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand / Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand / National Institute for Child and Family Development, Mahidol University, Nakhon Pathom, Thailand https://orcid.org/0009-0004-7994-3825
Komsan Kiatrungrit Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0002-6975-114X
Nuttorn Pityaratstian Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Sirichai Hongsanguansri Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2026.e275833

Keywords:

Homework adherence, Cognitive behavioral therapy, Therapeutic alliance, Intrinsic motivation, Identified regulation

Abstract

Background:Homework is a central component of cognitive behavioral therapy (CBT), promoting the application of therapeutic skills in daily life. However, adherence to homework varies and may be influenced by multiple factors, particularly among young people.

Objectives: To identify factors associated with homework adherence in CBT, and to examine these factors specifically in young people.

Methods: A cross-sectional descriptive study was conducted with 79 clients receiving CBT through the “Therapist Volunteers” project or the outpatient psychiatry clinic at Ramathibodi Hospital, along with 47 therapists. Data were collected from January 2024 to September 2024. Measures included the Working Alliance Inventory - Short Revised (WAI-SR), the Situational Motivation Scale (SIMS), SCORE-15, Homework Rating Scale II (HRS-II), Homework Compliance Scale (HCS), and Clinical Global Impression - Improvement Scale (CGI-I). Descriptive and inferential statistics, including multiple regression analysis, were used.

Results: The mean age of participants was 26.06 years; 82.3% were female. Therapeutic alliance, intrinsic motivation, and identified regulation were significantly associated with homework adherence (P < .05). Among young people, therapeutic alliance, identified regulation, and therapist experience were positively associated with homework adherence. Both self-reported homework adherence and therapist-rated completion were significantly correlated with clinical improvement (P < .01).

Conclusions: A strong therapeutic alliance, along with intrinsic motivation and identified regulation, play crucial roles in enhancing homework adherence and clinical outcomes in CBT. For young people, therapist experience and tailored support strategies may further strengthen treatment engagement.

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