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The psychotherapy dose-response effect and its implications for treatment delivery services.
Abstract
To date, few studies have been published on the doseresponse relationship, but there is general consensus that between 13 and 18 sessions of therapy are required for 50% of patients to improve. Reviewing the clinical trials literature reveals that in carefully controlled and implemented treatments, between 57.6% and 67.2% of patients improve within an average of 12.7 sessions. Using naturalistic data, however, revealed that the average number of sessions received in a national database of over 6,000 patients was less than five. The rate of improvement in this sample was only about 20%. These results suggest that patients, on average, do not get adequate exposure to psychotherapy, nor do they recover from illness at rates observed in clinical trials research.
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“studies consistently show that between 3 and 10% of psychotherapy clients get worse (Crawford et al. 2016; Hansen et al. 2002; Lambert 2013; Mohr 1995; Strupp et al. 1977).”
From Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples (2021) · cites this paper as Hansen et al. 2002
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“6%) of those found in observational studies of face-to-face psychotherapy (3–14%) (Strupp et al. 1977; Mohr, 1995; Hansen et al. 2006; Lambert et al. 2006).”
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“…Discussion Although the benefits of therapy have been well-documented in the psychotherapy literature, also well-documented are the clients who terminate treatment showing little to no improvement or, who leave treatment worse-off than when they began (Lambert & Ogles, 2004; Hansen et al., 2002).”
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“Clinically significant change was evidenced by 50% of participants receiving the coping intervention, similar to observed levels of meaningful change across randomized controlled trials ( Hansen, Lambert, & Forman, 2002 ).”
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Webb, C. A., Cohen, Z. D., Beard, C., Forgeard, M. J. C., Peckham, A., & Björgvinsson, Þ. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000451 · Cited by 96
“…have reported more modest treatment effect sizes in psychotherapy delivered in naturalistic settings than in RCTs (Gibbons et al., 2010; Hans & Hiller, 2013; Hansen, Lambert, & Forman, 2002; Weisz, Weiss, & Donenberg, 1992; McEvoy & Nathan, 2007; but see Merrill et al, 2003; Lutz et al., 2016).”
BackgroundNewnham, E. A., Harwood, K. E., & Page, A. C. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.07.001 · Cited by 97
Progress monitoring and feedback in psychiatric care reduces depressive symptoms
Newnham, E. A., Hooke, G. R., & Page, A. C. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.05.003 · Cited by 104
“, 2005) and randomized controlled trials (Hansen et al., 2002).”
Lopes, R. D. C. T., Gonçalves, M. M., Machado, P. P. P., Sinai, D., Bento, T., & Salgado, J. (2014) · Psychotherapy Research · doi:10.1080/10503307.2013.874052 · Cited by 96
de Villiers, B., Lionetti, F., & Pluess, M. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1471-0 · Cited by 116
Sikkema, K. J., Hansen, N. B., Meade, C. S., Kochman, A., & Lee, R. S. (2005) · Quality of Life Research · doi:10.1007/s11136-004-2959-0 · Cited by 92
“While these rates of participant attendance are similar to those in psychotherapy practice in general [48], the impact of variable intervention exposure warrants further study.”
Self-citationMcGregor, G., Sandhu, H. K., Bruce, J., Sheehan, B., McWilliams, D. J., Yeung, J., Jones, C., Lara, B., Alleyne, S., Smith, J., et al. (2024) · BMJ · doi:10.1136/bmj-2023-076506 · Cited by 95
“29 31 The larger effect size observed in the complier average causal effect analysis may relate directly to the greater dose of physical and mental health therapies received, or, alternatively, simply to the greater exposure to other participants with similar experiences.”
BackgroundUsing clinically significant change to identify premature termination.
Swift, J., Callahan, J. L., & Levine, J. (2009) · Psychotherapy · doi:10.1037/a0017003 · Cited by 98
Side effects in internet-based interventions for social anxiety disorder
Boettcher, J., Rozental, A., Andersson, G., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.002 · Cited by 88
“For example, Hiller et al. (2012) compared critical differences for the Beck Depression Inventory (BDI-II; Beck et al.”
BackgroundMethodPremature termination in psychotherapy: Strategies for engaging clients and improving outcomes.
Swift, J. K., & Greenberg, R. P. (2014) · American Psychological Association eBooks · doi:10.1037/14469-000 · Cited by 91
Kampman, M., Keijsers, G. P. J., Hoogduin, C. A. L., & Hendriks, G.-J. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n0904 · Cited by 87
Zilcha‐Mano, S., & Errázuriz, P. (2015) · Journal of Counseling Psychology · doi:10.1037/cou0000103 · Cited by 99
Waller, G. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0679-0 · Cited by 83
Computer‐supported monitoring of patient treatment response
Percevic, R., Lambert, M. J., & Kordy, H. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.10264 · Cited by 86
Self-citationEy, S., Moffit, M., Kinzie, J. M., & Brunett, P. H. (2016) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-16-00034.1 · Cited by 84
“Unlike most employee assistance programs offering a few free sessions and then referrals to community providers, an ‘‘adequate dose’’ of treatment and subsequent ‘‘booster’’ sessions are available throughout training or employment as faculty—a model associated with greater treatment response and reduced relapse.(21) P…”
BackgroundCurran, J., Parry, G. D., Hardy, G. E., Darling, J., Mason, A.-M., & Chambers, E. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00347 · Cited by 84
Decreasing treatment dropout by addressing expectations for treatment length
Swift, J. K., & Callahan, J. L. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.541294 · Cited by 84
“The dose-effect literature has generally found that with an increased number of sessions attended there is a greater likelihood of improvement and recovery (Hansen et al, 2002 ; Howard et al, 1986 ); however, a number of researchers have found that treatment length does not always correspond to treatment success (Bald…”
BackgroundGlombiewski, J. A., Holzapfel, S., Riecke, J., Vlaeyen, J. W. S., de Jong, J., Lemmer, G., & Rief, W. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000298 · Cited by 81
The MYRIAD team, Baer, R., Crane, C., Montero-Marin, J., Phillips, A., Taylor, L., Tickell, A., & Kuyken, W. (2021) · Mindfulness · doi:10.1007/s12671-020-01547-8 · Cited by 78
Metadata
- Authors
- Hansen, N. B., Lambert, M. J., & Forman, E. M.
- Affiliations
- Yale University (US)
- Brigham Young University (US)
- Drexel University (US)
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2002
- Volume
- 9
- Issue
- 3
- Pages
- 329-343
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- OpenAlex
- W2114544903
- Semantic Scholar
- 1968734f94d02eb6e4d193bdfdd42f5931ab250d
- Cited by
- 783
- References
- 102
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 25 · 2023: 28 · 2022: 34 · 2021: 45 · 2020: 54 · 2019: 43 · 2018: 72 · 2017: 41 · 2016: 35 · 2015: 45 · 2014: 50 · 2013: 47 · 2012: 45
- FWCI
- 15.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- number of treatment sessions, treatment outcomes, naturalistic data, psychotherapy utilization
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