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Specificity of Homework Compliance Effects on Treatment Outcome in CBT: Evidence from a Controlled Trial on Panic Disorder and Agoraphobia


  • Funding/Support: This work is part of the German multicenter trial “Mechanisms of Action in CBT (MAC)”. The MAC study is funded by the German Federal Ministry of Education and Research (BMBF; project no. 01GV0615) as part of the BMBF Psychotherapy Research Funding Initiative.

  • Principal investigators (PI) with respective areas of responsibility in the MAC study are as follows: V. Arolt (Münster: Overall MAC Program Coordination); H.U. Wittchen (Dresden: Principal Investigator (PI) for the Randomized Clinical Trial and Manual Development); A. Hamm (Greifswald: PI for Psychophysiology); A.L. Gerlach (Münster: PI for Psychophysiology and Panic subtypes); A. Ströhle (Berlin: PI for Experimental Pharmacology); T. Kircher (Marburg: PI for functional neuroimaging); and J. Deckert (Würzburg: PI for Genetics). Additional site directors in the RTC component of the program are G.W. Alpers (Würzburg), T. Fydrich and L. Fehm (Berlin-Adlershof), and T. Lang (Bremen).

  • All principle investigators take responsibility for the integrity of the respective study data and their components. All authors and co-authors had full access to all study data. Data analysis and manuscript preparation were completed by the authors and co-authors of this article, who take responsibility for its accuracy and content.

  • We acknowledge the following people by site: Greifswald (coordinating site for psychophysiology): Christiane Melzig, Jan Richter, Susan Richter, Matthias von Rad; Berlin-Charite (coordinating center for experimental pharmacology): Harald Bruhn, Anja Siegmund, Meline Stoy, Andre Wittmann; Berlin-Adlershof: Irene Schulz; Münster (Overall MAC Program Coordination, Genetics and Functional Neuroimaging): Andreas Behnken, Katharina Domschke, Adrianna Ewert, Carsten Konrad, Bettina Pfleiderer, Christina Sehlmeyer, Peter Zwanzger Münster (coordinating site for psychophysiology and subtyping):, Judith Eidecker, Swantje Koller, Fred Rist, Anna Vossbeck-Elsebusch; Marburg/ Aachen (coordinating center for functional neuroimaging):, Barbara Drüke, Sonja Eskens, Thomas Forkmann, Siegfried Gauggel, Susan Gruber, Andreas Jansen, Thilo Kellermann, Isabelle Reinhardt, Nina Vercamer- Fabri; Dresden (coordinating site for data collection, analysis, and the RCT): Franziska Einsle, Christine Fröhlich, Andrew T. Gloster, Christina Hauke, Simone Heinze, Michael Höfler, Ulrike Lueken, Peter Neudeck, Stephanie Preiß, Dorte Westphal; Würzburg Psychiatry Department (coordinating center for genetics): Andreas Reif; Würzburg Psychology Department: Julia Dürner, Hedwig Eisenbarth, Antje B. M. Gerdes, Harald Krebs, Paul Pauli, Silvia Schad, Nina Steinhäuser; Bremen: Veronika Bamann, Sylvia Helbig-Lang, Anne Kordt, Pia Ley, Franz Petermann, Eva-Maria Schröder. Additional support was provided by the coordinating center for clinical studies in Dresden (KKS Dresden): Xina Grählert and Marko Käppler.

  • The RTC project was approved by the Ethics Committee of the Medical Faculty of the Technical University of Dresden (EK 164082006). The neuroimaging components were approved by the Ethics Committee of the Medical Faculty of the Rheinisch-Westfälische Hochschule University Aachen (EK 073/07). The experimental pharmacology study was approved by the Ethics Committee of the state of Berlin (EudraCT: 2006-00-4860-29).

  • The study was registered with the ISRCTN: ISRCTN80046034.

Please address correspondence to: Sandra Cammin-Nowak, Center for Clinical Psychology and Rehabilitation, University of Bremen, Grazer Str. 2b, 28359 Bremen, Germany, E-mail:



Although homework assignments are an integral component of cognitive-behavioral therapy (CBT) and relate to positive therapy outcomes, it is unclear whether specific homework types and their completion have specific effects on outcome.


Data from N = 292 patients (75% female, mean age 36 years) with panic disorder and agoraphobia and treated with standardized CBT were analyzed with homework compliance quality and quantity for different types of homework serving as predictors for different outcome variables.


Quality ratings of homework completion were stronger outcome predictors than quantitative compliance ratings. Exposure homework was a better outcome predictor than homework relating to psychoeducation and self-monitoring.


Different aspects of homework compliance and specific homework types might differentially relate to CBT outcome.