Improving Cognitive-Behavioral Therapy Homework Adherence with Change Talk and Commitment Language: A Cognitive Dissonance Perspective of Behavioral Change

Adherence to homework assigned during cognitive-behavioral therapy (CBT) is an important factor contributing to positive outcomes. However, rates of adherence are poor, limited evidence supporting methods to improve adherence is limited. The current study aimed to develop and test an intervention designed to promote CBT homework adherence based on cognitive dissonance theory. Patients participating in outpatient CBT were randomly assigned to either an experimental or a control condition. In the experimental condition, participants engaged in an induced-compliance procedure eliciting change talk targeting the recommended homework activity. The control condition consisted of treatment as usual. Owing to limited sample size (n = 14), statistical analysis lacked sufficient power to confirm hypotheses; however, notable effect sizes were observed trending in support of the study hypotheses predicting greater rates of homework adherence in the experimental condition. These data, in conjunction with the large body of evidence directly supporting cognitive dissonance theory as an explanation of attitude and behavioral change, invites future studies to continue to explore the use of cognitive dissonance theory in clinical settings to promote attitude and behavioral change