Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course; a naturalistic cohort study

Abstract

Background An adequate frequency of treatment might be a prerequisite for a favorable outcome. Unfortunately, there is a diversity of factors that interfere with an adequate frequency of sessions. This occurs especially in the first phase of treatment, while the first phase seems vital for the rest of treatment. The aim of this naturalistic study was to explore the impact of the initial frequency of treatment sessions on treatment outcome in a diverse mental health care population. Methods Anonymized data were analyzed from 2,634 patients allocated for anxiety disorders, depressive disorders, and personality disorders to outpatient treatment programs in a large general mental health care facility. Patients’ treatment outcome was routinely monitored with the Outcome Questionnaire-45 (OQ-45.2), every 12 weeks. Frequency of sessions was assessed for the first three months of treatment. Using Cox-proportional-hazard models, we explored the associations between initial frequency and improvement (reliable significant change) and recovery (reliable and clinically significant change). Results Improvement and recovery were associated with symptom severity and functional impairment at start of treatment, the year the treatment started, number of measurements, the treatment program (anxiety disorders, depressive disorders, and personality disorders) and receiving group therapy other than psychotherapy. In all diagnostic groups, both improvement and recovery were associated with a higher frequency of sessions during the first three months of treatment. For improvement, this effect diminished after three years in treatment; however, for recovery this association was sustained. Conclusions In addition to severity at start of treatment and other predictors of outcome, a low frequency of initial treatment sessions might lead to a less favorable outcome and a more chronic course of the mental disorder. This association seems not to be limited to a specific diagnostic group, but was found in a large group of patients with common mental disorders (depression and anxiety disorders) and patients with a personality disorder. Despite organizational obstacles, more effort should be made to start treatment quickly by an effective frequency of session.

The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

“…Moreover, the massed treatment leads to a faster reduction in PTSD symptoms. The findings that a higher session frequency is related to better outcomes are consistent with findings based on a meta-analysis on treatments for depression [ 22 ] and naturalistic studies across different diagnostic groups (e.g., depression, anxiety disorders, personality disorders) [ 23 , 24 ]. Furthermore, a RCT among depressive patients demonstrated that delivering treatment twice a week is more effective than delivering treatment only once a week (difference in effect size d = 0.55 [ 25 ]).…”

The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients

“…5 In an observational study, a higher session frequency was associated with improvement and recovery within the first three months of treatment. 6 However, a randomised trial on the direct effect of psychotherapy session frequency on depression is lacking. The original Beck manual for cognitive–behavioural therapy (CBT) for depression 7 prescribes that CBT should start twice weekly in the beginning of treatment, whereas interpersonal psychotherapy (IPT) should be delivered once a week, according to Klerman's manual.…”

Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy

“…Higher session frequency in the first 3 months of treatment is associated with faster improvement and recovery (Tiemens et al, 2019). Further, patients randomized to receive twice-weekly sessions experienced greater depression reductions than those offered once-weekly therapy (Bruijniks et al, 2020).…”