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The dose-response effect in routinely delivered psychological therapies: A systematic review

Robinson, Louisa, Delgadillo, Jaime, Kellett, Stephen·2020·Psychotherapy Research

DOI 10.1080/10503307.2019.1566676

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Abstract

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesize the literature on the dose-response effect in routine psychological therapies delivered to adult patients with mental health problems. Twenty-six studies were eligible for inclusion. Different methodological approaches have been used to examine the dose-response effect; including survival analysis, multilevel modelling and descriptive cluster analyses. Replicated and consistent support was found for a curvilinear (log-linear or cubic) relationship between treatment length and outcomes, with few exceptions such as eating disorders and severe psychiatric populations. Optimal doses of psychotherapy in routine settings range between 4 and 26 sessions (4-6 for low intensity guided self-help) and vary according to setting, clinical population and outcome measures. Weekly therapy appears to accelerate the rate of improvement compared to less frequent schedules. Most of the reviewed evidence is from university counselling centres and outpatient psychotherapy clinics for common mental health problems. There is scarce and inconclusive evidence in clinical samples with chronic and severe mental disorders.

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Authors: Robinson, L., Delgadillo, J., & Kellett, S.
Affiliations: University of Sheffield (GB)
Corresponding author: Delgadillo, Jaime
ORCID: Robinson, Louisa
Delgadillo, Jaime
Kellett, Stephen
Venue: Psychotherapy Research
Publisher: Informa UK Limited
Published: 2019-01-20
Volume: 30
Issue: 1
Pages: 79-96
ISSN: 1050-3307 (ISSN-L)
1468-4381
DOI: 10.1080/10503307.2019.1566676
OpenAlex: W2908544178
Cited by: 264
References: 44
Citations by year: 2026: 48 · 2025: 42 · 2024: 38 · 2023: 61 · 2022: 31 · 2021: 23 · 2020: 19 · 2019: 2
FWCI: 2.96
Type: journal article
Language: en
Open access: closed
Locations: Psychotherapy Research (publishedVersion)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: dose-response relationship, psychotherapy, treatment duration, treatment frequency, treatment outcomes, common mental disorders, outpatient psychotherapy, eating disorders, severe mental illness
MeSH terms: Mental Disorders, Humans, Psychotherapy, Outcome Assessment, Health Care

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The dose-response effect in routinely delivered psychological therapies: A systematic review

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