Homework is a task that is mutually agreed upon by the CBT therapist and patient to be completed in the time period after a session and before the subsequent session. Homework is 13 considered a vehicle from which data may disconfirm negative thought and beliefs. It is uniquely tailored to each patient’s goals and the content of the session.

Thus, across patients, homework assignments varied each session (except session one). Session one, however, characteristically included reading the brochure “Coping with Depression” (Essay Lab). Variations included type of assignment, how much time is required to prepare and complete the assignment, and general difficulty (some assignments are inherently more difficult). Homework assignments were broadly characterized as educative (bibliotherapy), affective (mood management techniques), cognitive (recording automatic thoughts), behavioral (response prevention), or organizational (constructing activity schedules).

The care and treatment of major depression occurs at various venues including inpatient, outpatient and primary care settings. CBT, both in Beck’s (1979) classic paradigm and in modified versions and applications, is one of the most prominent and efficacious treatments for major depression.

Nurses deliver CBT as advanced professionals and as primary nurses on inpatient settings. 14 Completion with homework assignments has been demonstrated to be an important component of the overall effectiveness of CBT. The identification and reliable measurement of barriers affecting completion with homework assignments may improve the potency of CBT, thereby producing further reductions in depressive symptoms and improvement in ultimate clinical outcome.

It may also assist CBT researchers to identify factors related to variance in treatment outcome, thereby strengthening the generalizability of investigational findings for the clinical community. Findings from this study will broadly contribute to the body of knowledge on adherence with self-care assignments through further knowledge about barriers affecting CBT homework completion in a depressed population.