Cognitive Therapy and Research

, Volume 24, Issue 3, pp 313–326

A Closer Look at the Treatment Rationale and Homework Compliance in Cognitive-Behavioral Therapy for Depression

  • Michael E. Addis
  • Neil S. Jacobson

DOI: 10.1023/A:1005563304265

Cite this article as:
Addis, M.E. & Jacobson, N.S. Cognitive Therapy and Research (2000) 24: 313. doi:10.1023/A:1005563304265


This study examined the relationships between acceptance of the treatment rationale (ATR), homework compliance, and change during cognitive-behavioral therapy (CBT) for depression. By evaluating the associations between these variables over time it was possible to compare competing theories of change in CBT. Clients meeting criteria for major depression (N = 150) were assessed longitudinally for their reaction to the treatment rationale and homework compliance over the course of a 20-session treatment. The results suggest that both ATR and homework compliance make independent contributions to predicting within-treatment change and treatment outcome. There was no evidence that compliance mediates the effect of ATR on treatment outcome. These findings support a multiprocess model of change in CBT. Acceptance of the treatment rationale may facilitate involvement in treatment and nonspecific change processes, while compliance with homework assignments contributes to additional change. We discuss these findings in regard to alternative theories of change and the dissemination of CBT to real-world clinical settings.

cognitive-behavioral therapy depression treatment rationale homework compliance process of change 

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Michael E. Addis
    • 1
  • Neil S. Jacobson
    • 2
  1. 1.Department of PsychologyClark UniversityWorcester
  2. 2.Center for Clinical ResearchUniversity of WashingtonSeattle

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