Critical Issues in Using Homework Assignments Within Cognitive-Behavioral Therapy for Schizophrenia

  • Natalie M. Glaser
  • Nikolaos Kazantzis
  • Frank P. Deane
  • Lindsay G. Oades


Presents an overview of the research findings to date and practical guidelines for the use of homework in cognitive-behavioral therapy for schizophrenia. In particular, the article outlines strategies to combat the common difficulties experienced when using homework with clients with schizophrenia and the types of homework assignments that may be most helpful. The empirical evidence suggests that cognitive-behavioral therapy incorporating homework assignments help clients to improve at least 60% more than those in treatment without homework. Despite that most therapy formulations incorporate homework as an integral component of treatment for schizophrenia, prior research has identified that practitioners consider homework to be less helpful for clients with delusions and hallucinations. Interventions to enhance homework compliance in the treatment of clients with schizophrenia are outlined.


Public Health Schizophrenia Empirical Evidence Research Finding Critical Issue 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anderson, C. M., Reiss, D. J., & Hogarty, G. E. (1986). Schizophrenia and the family: A practitioner's guide to psychoeducation and management. New York: Guilford Press.Google Scholar
  2. Andrews, G., Crino, R., Hunt, C., Lampe, L., & Page, A. (1994). The treatment of anxiety disorders. New York: Cambridge University Press.Google Scholar
  3. Barrowclough, C., & Tarrier, N. (1992). Families of schizophrenic patients: Cognitive behavioural interventions. London: Chapman & Hall.Google Scholar
  4. Beck, A. T., Rush, A, J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
  5. Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: Guilford Press.Google Scholar
  6. Bellack, A. S. (1986). Schizophrenia: Behaviour therapy's forgotten child. Behaviour Therapy, 17, 199–214.Google Scholar
  7. Birchwood, M., Shepherd, G. (1992). Controversies and growing points in cognitive behavioural interventions for people with schizophrenia. Behavioural Psychotherapy, 20, 305–342.Google Scholar
  8. Blanchard, E. B., Nicholson, N. L., Radnitz, C. L., Steffek, B. D., Appelbaum, K. A., & Dentinger, M. P. (1991a). The role of home practice in thermal biofeedback. Journal of Consulting and Clinical Psychology, 59, 507–512.Google Scholar
  9. Blanchard, E. B., Nicholson, N. L., Taylor, A. E., Steffek, B. D., Radnitz, C. L., & Appelbaum, K. A. (1991b). The role of regular home practice in the relaxation treatment of tension headache. Journal of Consulting and Clinical Psychology, 59, 467–470.Google Scholar
  10. Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapist empathy and recovery from depression in cognitive behavioral therapy: A structural equation model. Journal of Consulting and Clinical Psychology, 60, 441–449.Google Scholar
  11. Chadwick, P., Birchwood, M., & Trower, P. (1996). Cognitive therapy for delusions, voices and paranoia. Chichester, England: Wiley.Google Scholar
  12. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  13. Cox, D. J., Tisdelle, D. A., & Culbert, J. P. (1988). Increasing adherence to behavioral homework assignments. Journal of Behavioral Medicine, 11, 519–522.Google Scholar
  14. Dattilio, F. M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota, FL. Professional Resource Exchange.Google Scholar
  15. Falloon, I. R., Boyd, J. L., & McGill, C. W. (1984). Family care of schizophrenia: A problem solving approach to the treatment of mental illness. New York: The Guilford Press.Google Scholar
  16. Finch, B. E., & Wallace, C. J. (1977). Successful interpersonal skills training with schizophrenic inpatients. Journal of Consulting and Clinical Psychology, 45, 885–890.Google Scholar
  17. Fowler, D., Garety, P., & Kuipers, E. (1995). Cognitive behaviour therapy for psychosis: Theory and practice. London: Wiley.Google Scholar
  18. Garner, D. M., & Bemis, K. M. (1985). Cognitive therapy of anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia (pp. 107–146). New York: Guilford Press.Google Scholar
  19. Glass, G. V., McGaw, B., & Smith, M. L. (1981). Meta-analysis in social research. Beverly Hills, CA: Sage.Google Scholar
  20. Haddock, G., & Slade, P. D. (1996). Cognitive behavioural interventions with psychotic disorders. London: Routledge.Google Scholar
  21. Natalie M. Glaser, Nikolaos Kazantzis, Frank P. Deane, and Lindsay G. Oades 259</del>Google Scholar
  22. Halford, W. K., & Hayes, R. (1991). Psychological rehabilitation of chronic schizophrenic patients: Recent findings on social skills training and family psychoeducation. Clinical Psychology Review, 11, 23–44.Google Scholar
  23. Harmon, T. M., Nelson, R. O., & Hayes, S. C. (1980). Self-monitoring of mood versus activity by depressed clients. Journal of Counseling and Clinical Psychology, 48, 30–38.Google Scholar
  24. Hogg, L. (1996). Psychological treatments for negative symptoms. In G. Haddock, & P. D. Slade (Eds.), Cognitive behavioural interventions with psychotic disorders (pp. 151–167) London: Routledge.Google Scholar
  25. Hogg, L., & Hall, J. (1992). Management of long term impairments and challenging behaviour. In M. Birchwood & N. Tarrier (Eds.), Innovations in the psychological management of schizophrenia: Assessment, treatment and services (pp. 171–203). London: Wiley.Google Scholar
  26. Kazantzis, N. (2000). Power to detect homework effects in psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 68, 166–170.Google Scholar
  27. Kazantzis, N., & Deane, F. P. (1999). Psychologist's use of homework assignments in clinical practice. Professional Psychology: Research and Practice, 30, 581–585.Google Scholar
  28. Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7, 189–202.Google Scholar
  29. Kazdin, A. E., & Mascitelli, S. (1982). Covert and overt rehearsal and homework practice in developing assertiveness. Journal of Consulting and Clinical Psychology, 50, 250–258.Google Scholar
  30. Kopelowicz, A., & Liberman, R. P. (1998). Psychosocial treatments for schizophrenia. In P. E. Norman, & J. M. Gorman (Eds.), A guide to treatment that works (pp. 190–211). New York: Oxford University Press.Google Scholar
  31. Kornblith, S. J., Rehm, L. P., O'Hara, M. W., & Lamparski, D. M. (1983). The contribution of self-reinforcement training and behavioral assignments to the efficacy of self-control therapy for depression. Cognitive Therapy and Research, 7, 499–528.Google Scholar
  32. Kuehnel, T. G., & Liberman, R. P. (1988). Functional assessment. In R. P. Liberman (Ed.), Psychiatric rehabilitation of chronic mental patients (pp. 59–116). Washington, DC: American Psychiatric Press, Inc.Google Scholar
  33. Kuipers, E., Garety, P., & Fowler, D. (1996). An outcome study of cognitive behavioural treatment for psychosis. In G. Haddock, & P. D. Slade (Eds.), Cognitive Behavioural interventions with psychotic disorders. (pp. 151–167) London: Routledge.Google Scholar
  34. Leung, A. W., & Heimberg, R. G. (1996). Homework compliance, perceptions of control, and outcome of cognitive-behavioural treatment of social phobia. Behaviour Research and Therapy, 34, 423–432.Google Scholar
  35. Liberman, R. P. (1988). Psychiatric rehabilitation of chronic mental patients. Washington, DC: American Psychiatric Press, Inc.Google Scholar
  36. Liberman, R. P., DeRisi, W. J., & Mueser, K. T. (1989). Social skills training for psychiatric patients. New York: Pergamon.Google Scholar
  37. Lipsey, M., & Wilson, D. (1993). The efficacy of psychological, educational, 260 Journal of Rational-Emotive & Cognitive-Behavior Therapy and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181–1209.Google Scholar
  38. Macaskill, N. D. (1996). Improving clinical outcomes in REBT/CBT: The therapeutic uses of tape recording. Journal of Rational Emotive and Cognitive Behaviour Therapy, 14, 199–207.Google Scholar
  39. Marks, I. M., Lelliott, P., Basoglu, M., Noshirvani, H., Monteiro, W., Cohen, D., & Kasvikis, Y. (1988). Clomipramine, self-exposure, and therapistaided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522–534.Google Scholar
  40. Mazzulo, S. M., Lasagna, L., & Griner, P. F. (1974). Variations in interpretation of prescription assignments. Journal of the American Medical Association, 227, 929–931.Google Scholar
  41. Morrison, R. L., & Wixted, J. L. (1989). Social skills training. In A. S. Bellack (Ed.), A clinical guide for the treatment of schizophrenia (pp. 237–261). New York: Plenum Press.Google Scholar
  42. Neimeyer, R. A., & Feixas, G. (1990). The role of homework and skill acquisition in the outcome of group cognitive therapy for depression. Behaviour Therapy, 21, 281–292.Google Scholar
  43. Nelson, H. E. (1997). Cognitive behavioural therapy with schizophrenia: A practice manual. Cheltenham, England: Stanley Thorne.Google Scholar
  44. Nichols, M. P., & Schwartz, R. C. (1998). Family therapy: Concepts and methods (4th ed.). Needham Heights, MA: Allyn & Bacon.Google Scholar
  45. Onyett, S. (1992). Case management in mental health. London: Chapman & Hall.Google Scholar
  46. Perris, C. (1989). Cognitive therapy with schizophrenic patients. London: Guilford Press.Google Scholar
  47. Rosenthal, R. (1994). Parametric measures of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 231–243). New York: Russell Sage Foundation.Google Scholar
  48. Scogin, F., Jamison, C., Floyd, M., & Chaplin, W. F. (1998). Measuring learning in depression treatment: A cognitive bibliotherapy test. Cognitive Therapy and Research, 22, 475–483.Google Scholar
  49. Shelton, J. L., & Ackerman, J. M. (1974). Homework in counselling and psychotherapy: Examples of systematic assignments for therapeutic use by mental health professionals. Springfield, IL: Charles C. Thomas.Google Scholar
  50. Shelton, J. L., & Levy, R. L. (1981). Behavioural assignments and treatment compliance: A handbook of clinical strategies. Champaign, IL: Research Press.Google Scholar
  51. Startup, M., & Edmonds, J. (1994). Compliance with homework assignments in cognitive behavioural psychotherapy for depression: Relation to outcome and methods of enhancement. Cognitive Therapy and Research, 18, 567–579.Google Scholar
  52. Stuart, R. B. (1975). Behavioral remedies for marital ills: A guide to the use of operant-interpersonal techniques. In T. Thompson, & W. Docken (Eds.), International symposium on behavior modification (pp. 245–257). New York: Appelton.Google Scholar
  53. Watson, J. E., & Singh, N. (1985). Social skills training for schizophrenic patients. Behaviour Change, 2, 94–101.Google Scholar
  54. Natalie M. Glaser, Nikolaos Kazantzis, Frank P. Deane, and Lindsay G. Oades 261</del>Google Scholar
  55. Wixted, J. T., Morrison, R. L., & Bellack, A. S. (1988). Social skills training in the treatment of negative symptoms. International Journal of Mental Health, 17, 3–21.Google Scholar
  56. Wright, J. H., Thase, M. E., Beck, A. T., & Ludgate, J. W. (1993). Cognitive therapy with inpatients: Developing a cognitive milieu. New York: The Guilford Press.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2000

Authors and Affiliations

  • Natalie M. Glaser
    • 1
  • Nikolaos Kazantzis
    • 2
  • Frank P. Deane
    • 3
  • Lindsay G. Oades
    • 4
  1. 1.University of WollongongAustralia
  2. 2.Massey UniversityNew Zealand
  3. 3.Department of Psychology, Illawarra Institute for Mental HealthUniversity of WollongongWollongongAustralia
  4. 4.University of WollongongAustralia

Personalised recommendations