How much therapy is enough? The dose–response effect and its moderators in a psychology training clinic

Abstract

Objective: The current study aims to sharpen the understanding of the psychotherapy dose-response effect and its moderators in a psychology training clinic. Method: Data were extracted from 58 client records. Weekly Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, as well as Outcomes Questionnaire-45.2, administered every fifth session, assessed whether clients achieved reliable change (RC) and clinically significant and reliable change (CSR) during treatment. Survival analyses were conducted to determine the sessions required for 50% of the sample to achieve these outcomes. Multilevel Cox frailty regressions were used to investigate client-and-therapy-based moderators. Results: The median time for 50% of the sample to achieve RC was 8-10 sessions and 11 sessions to achieve initial CSR. Past treatment history was a significant moderator of time to achieve RC. Conclusions: From a population perspective, psychotherapy is most beneficial to patients early in treatment. Sharper understanding of the number of sessions required to achieve meaningful change can inform practice in training settings.

Association between severity of symptoms and minimum mental health treatment duration in humanitarian contexts: a retrospective observational study

“… 19 Previous studies in higher income settings found that patients with higher levels of distress took eight more sessions to reach a similar recovery level than patients with lower levels of distress. 14 Some other studies found similar improvement ratios for patients with depression, namely 50% for the same range of 3–6 sessions, 34 while others reported a consensus of 25% improvement between sessions 3 and 4, and 50% between sessions 8 and 10. 33 , 35 Another study concluded that 40% of patients improved within two sessions, and up to eight sessions were necessary to achieve improvement in 60% of patients, but it did so without differentiating levels of severity.…”

Perceived helpfulness of previous therapy: A predictor of premature termination.

“…These findings suggest that clients with prior therapy may be more likely to terminate before achieving treatment goals, despite attending more sessions of therapy. Indeed, clients with prior therapy have been found to need more sessions to achieve reliable change (Chen & Keenan-Miller, 2020), therefore giving clients with prior therapy more opportunity to terminate prematurely.…”

“…Additionally, clients who perceived all previous therapy as helpful attended more sessions in this course of treatment than those who perceived all of their prior therapy as unhelpful. While this article argues that premature termination is best defined using a statistical measure of therapeutic change (i.e., RC or CSC), rather than the number of sessions attended by a client, we chose to examine how perceived helpfulness of prior therapy relates to the number of sessions attended to build upon prior work (e.g., Chen & Keenan-Miller, 2020) that has found it takes clients with prior therapy more time to achieve RC than clients with no prior therapy, and to shed light on how many sessions clinicians may have to increase engagement among clients who perceive some or all prior therapy as unhelpful.…”

“…However, no studies known to the authors of the present study have examined the relationship between premature termination and perceived helpfulness of previous therapy. Chen and Keenan-Miller (2020) found that clients who report a history of prior psychotherapy require more sessions to achieve change in symptoms, suggesting that this population may be at particularly high risk of terminating therapy before change has been achieved. Given these findings, the current article addresses whether perceptions of prior therapy predict (a) risk of termination before change is achieved on symptom measures and (b) overall duration of treatment, independent of the amount of symptom change.…”

Effectiveness of videoconferencing psychotherapy delivered by novice clinicians in a training clinic.

“…While the above findings suggest support for effective treatment in a training clinic context, data on improvement trajectory within a treatment episode is more limited. One study recently evaluated the pattern of changes in depression, anxiety, and overall distress during psychotherapy within a training clinic (Chen & Keenan-Miller, 2021). The authors found that trainee-provided care yielded clinically significant change by Session 7–11 for 50% of their client population, although approximately 20 sessions were needed for 70% of the client population to yield such change.…”