The use of homework in cognitive behavior therapy: Working with complex anxiety and insomnia

Homework, or self-help, is an essential and required part of cognitive behavioral treatment. It offers several opportunities for the therapist to extend and increase therapy contact by having the patient "live" the therapy outside of the consulting room. It can also serve as a measure of the patient's motivation for therapy or for change. Homework offers the patient an opportunity to practice what has been developed and discussed in the therapy session. By trying out new behaviors, new ideas, or new emotional responses, the patient can make "real" what has been an abstraction in the therapeutic dialogue,. The homework becomes an opportunity for gathering data. Inasmuch as the homework grows "organically" from the session content, it is relevant and timely. Homework provides continuity between sessions. Rather than sessions being discrete moments in time, they are chained together by the homework from the previous session being included in the agenda for the subsequent session. The homework can be structured to involve signficant others. This is essential in many therapeutic situations, and having the significant others involved can substantially aid in relapse prevention. Finally, effective homework helps to build therapeutic collaboration and afford the patient the opportunity for building self-efficacy. Using several case examples, this paper describes the functions and impediments to using homework in CBT.