Homework Completion in Treating Obsessive–Compulsive Disorder with Exposure and Ritual Prevention: A Review of the Empirical Literature

Background Homework is an integral part of treating obsessive–compulsive disorder (OCD) with exposure and response prevention (ERP). Between-session homework assignments are prescribed in ERP protocols, including self-monitoring, self-guided exposure practices, and ritual prevention. This review seeks to explore the empirical literature on the importance of homework completion in ERP. Method We completed a systematic review of existing studies and organized results to provide a narrative review with an emphasis on informing research and practice. Results Heterogeneous methods have been utilized to operationalize and quantify homework completion in ERP. Several studies yielded evidence showing that that patient completion of between-session homework robustly predicts to treatment outcomes across ERP delivery methods (individual outpatient, intensive residential treatment) in both adults and pediatric samples. Some factors were linked to poor patient homework completion, including OCD features (e.g., avoidance, insight), patient expectancies, and the strength of the therapeutic alliance. Relatively few studies have investigated strategies to improve homework completion. Conclusions Homework completion is an important component of treating OCD with ERP. More research is needed to improve assessment tools and test strategies to enhance homework completion. We conclude with key practice points and directions for future research.