Dose‐response patterns in low and high intensity cognitive behavioral therapy for common mental health problems

Abstract

Background Cognitive‐behavioral therapy (CBT) is effective for the treatment of common mental health problems, but the number of sessions required to maximize improvement in routine care remains unclear. Aim This study aimed to examine the dose‐response effect in low (LiCBT) and high (HiCBT) intensity CBT delivered in stepped care services. Methods A multi‐service data set included N = 102 206 patients across N = 16 services. The study included patients with case‐level depression and/or anxiety symptoms who accessed LiCBT and/or HiCBT. Patients with posttreatment reliable and clinically significant improvement in standardized outcome measures (PHQ‐9, GAD‐7) were classified as treatment responders. Survival analyses assessed the number of sessions necessary to detect 50%, 75%, and 95% of treatment responders. The 50% and 95% percentiles were used to define the lower and upper boundaries of an adequate dose of therapy that could be used to inform the timing of treatment progress reviews. Analyses were then stratified by diagnosis, and cox regression was used to identify predictors of time‐to‐remission. Results Most responders (95%) attained RCSI within 7 sessions of LiCBT and 14 sessions of HiCBT. Patients with social anxiety disorder, posttraumatic stress disorder, and obsessive‐compulsive disorder required HiCBT and lengthier treatments (6–16 sessions) to maximize improvement. Conclusions Distinctive dose‐response patterns are evident for LiCBT and HiCBT, which can be used to support treatment planning and routine outcome monitoring.

Dynamic prediction of psychological treatment outcomes: development and validation of a prediction model using routinely collected symptom data

“…36 Furthermore, dose-response studies in IAPT settings consistently show that most treatment responders show signs of symptomatic improvement during the first 2 months of treatment. 25,27 Advanced machine learning analyses did not enhance prediction accuracy. Overall, the performance of the most simple and most parsimonious model based on logistic regression was similar to that of more com putationally intensive approaches.…”

“…Separate models for low and high intensity treatments were estimated to meet the assumption of independent observations (because some patients accessed both treat ments), and previous research indicates different dose-response patterns for these types of interventions. 27 This strategy enabled us to train a dynamic prediction model using iterative logistic regressions, referred to as the Oracle algorithm hereafter, and which is mainly characterised by the inclusion of the four predictors described.…”

Neurofeedback training in major depressive disorder: A systematic review of clinical efficacy, study quality and reporting practices

“…One possible explanation for this observation is the learning process of a neurofeedback task: the feedback is initially based on unconditioned neural variability until the patient can learn, correct, and optimize the self-regulation strategies (Birbaumer et al, 2013;Ros et al, 2014). Moreover, delayed functional effects are commonly also observed in cognitive therapy: the improvement of cognitive restructuring strategies happens across sessions, and dose-response effects have been reported across psychiatric disorders (Robinson et al, 2020). Thus, from a neural as well as a cognitive perspective, an expected interval until the functional effects can be observed.…”

Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication

“…Moreover, that severely depressed patients benefitted more than moderately depressed patients also supports prior findings that psychodynamic treatment may be especially suited to address chronic depression (Town et al, 2020; Town et al, 2017). Also, patients with difficult‐to‐treat depression seem to need higher doses of treatment in terms of number of sessions to respond to psychotherapy and experience a clinically significant change (Robinson, Kellet, & Delgadillo, 2020). In light of this, the high intensity/high dose nature of the treatment programme offered here may have been especially beneficial for the more severely depressed patients in our sample.…”