Therapeutic Homework and Treatment Outcomes in Youth Cognitive-Behavioral Therapy for Internalizing Disorders: A Meta-Analysis.

Homework adherence represents a salient, modifiable target for improving cognitive behavioral therapy (CBT) outcomes for pediatric internalizing disorders. While the adult literature has found a clear connection between CBT homework adherence and treatment outcomes, the evidence among youth have been mixed regarding the extent to which between-session homework adherence predicts CBT outcomes. The present study conducted a systematic review and meta-analysis that examines the association between homework adherence and CBT outcomes in clinical trials of internalizing disorders for youth. Fourteen studies met prespecified inclusion criteria, comprising a total sample of 1179 participants (M age = 11.33 years, 53.79% female). Random-effects meta-analytic models identified a small-to-moderate association between greater homework adherence and lower post-treatment symptoms (r = -0.23, p < 0.001). Interestingly, disorder type significantly moderated this association, such that the association between homework adherence and CBT outcomes was strongest in obsessive-compulsive disorder (OCD) samples (r = -0.42), compared to anxiety (r = -0.14) and depression (r = -0.06). Findings underscore the importance of homework adherence as a mechanism of youth CBT, particularly for OCD. Enhancing homework adherence may help optimize CBT outcomes in pediatric populations.