The effect of homework compliance on smoking cessation and anxiety management

Homework assignments have been a key component of cognitive behavioral therapy (CBT) for decades, but few studies examined the effect of compliance on outcome within smoking cessation samples. Those that did so reached inconsistent conclusions. Also, compliance studies have seldom controlled for other factors known to differentiate outcome and rarely considered the quality of assigned work relative to quantity. This study examined homework compliance in a combined CBT and pharmacological, four session, integrated smoking cessation and anxiety management treatment program. Compliance was assessed via a composite measure capturing six homework tasks. Outcome was assessed by percent reduced from baseline rate, amount of cigarettes consumed, and abstinence. Better overall homework compliance predicted greater smoking reduction and abstinence at the week 1 and month 1 follow ups, and did so independent of anxiety sensitivity, motivation, nicotine dependence severity, attendance problems, and in-session participation. Quantity and quality did not differ in predicting outcome when both were measured by ideal compliance. When quantity was assessed by ideal compliance and quality by actual performance, however, quantity outperformed quality. The number of rescheduled sessions and level of in-session participation partially mediated the association between homework compliance and treatment outcome.