Cited by 788Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessDigital Mental Health Interventions

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The psychotherapy dose-response effect and its implications for treatment delivery services.

Hansen, Nathan B., Lambert, Michael J., Forman, Evan M.·2002·Clinical Psychology: Science and Practice

DOI 10.1093/clipsy.9.3.329

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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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The use of virtual reality (VR) exposure for reducing contamination fear and disgust: Can VR be an effective alternative exposure technique to in vivo?
İnözü, M., Çelikcan, U., Akın-Sarı, B., & Çıçek, N. M. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100518 · Cited by 52
Novel treatment approaches for refractory anxiety disorders
Pollack, M. H., Otto, M. W., Roy-Byrne, P. P., Coplan, J. D., Rothbaum, B. O., Simon, N. M., & Gorman, J. M. (2008) · Depression and Anxiety · doi:10.1002/da.20329 · Cited by 77
“These data join a larger literature indicating that in clinical care across the United States, few patients receive an adequate ‘‘dose’’ of psychotherapy [Hansen et al., 2002], a finding that is in concordance with the high rates of inadequate pharmacotherapy observed in primary care and specialtycare settings [Roy-By…”
Result
FIVE SESSIONS AND COUNTING: CONSIDERING ULTRA-BRIEF TREATMENT FOR PANIC DISORDER: Research Article: ultra-brief treatment for panic disorder
Otto, M. W., Tolin, D. F., Nations, K. R., Utschig, A. C., Rothbaum, B. O., Hofmann, S. G., & Smits, J. A. J. (2012) · Depression and Anxiety · doi:10.1002/da.21910 · Cited by 54
“As argued by Otto,[12] the focused brevity of treatment may be one factor explaining why treatment dropout in CBT appears to be so much lower than that for other forms of psychotherapy.[13] With a defined endpoint in sight, patients may be able to persist beyond the huge attrition rate that characterizes the first few…”
Background
Internet-Delivered Versus Face-to-Face Cognitive Behavior Therapy for Anxiety Disorders: Systematic Review and Meta-Analysis
Esfandiari, N., Mazaheri, M. A., Akbari-Zardkhaneh, S., Sadeghi-Firoozabadi, V., & Cheraghi, M. (2021) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_208_21 · Cited by 45
Exploring hope and expectations in the youth mental health online counselling environment
Dowling, M. J., & Rickwood, D. (2015) · Computers in Human Behavior · doi:10.1016/j.chb.2015.08.009 · Cited by 44
Effectiveness of a Multimodal Digital Psychotherapy Platform for Adult Depression: A Naturalistic Feasibility Study
Marcelle, E. T., Nolting, L., Hinshaw, S. P., & Aguilera, A. (2018) · JMIR mhealth and uhealth · doi:10.2196/10948 · Cited by 49
“The effect of dosage on treatment outcomes was examined using probit dose-response regression, a method used across the extant dose-response literature to predict the amount or dose of treatment needed to achieve a desired response or effect [43].”
BackgroundMethod
Mindfulness-Based Stress Reduction in Therapeutic Community Treatment: A Stage 1 Trial
Marcus, M. T., Schmitz, J. M., Moeller, G., Liehr, P. R., Cron, S. G., Swank, P. R., Bankston, S., Carroll, D. D., & Granmayeh, L. K. (2009) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990902823079 · Cited by 44
“This is consistent with the broader psychotherapy research literature in showing a positive therapy “dose” response curve (21, 22).”
Result
A meta-analysis of brief personalized feedback interventions for problematic gambling
Peter, S. C., Brett, E. I., Suda, M. T., Leavens, E. L. S., Miller, M. B., Leffingwell, T. R., Whelan, J. P., & Meyers, A. W. (2019) · Journal of Gambling Studies · doi:10.1007/s10899-018-09818-9 · Cited by 43
A scoping review of deliberate practice in the acquisition of therapeutic skills and practices
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“Hansen, Lambert, and Forman ( 2002 ), for example, reviewed the dose-response and randomized clinical trial literatures and concluded that between 13 and 18 sessions were required for 50% of patients to improve.”
Background
Walk‐In Counselling Services: Making the Most of One Hour
Slive, A. B., & Bobele, M. (2012) · Australian and New Zealand Journal of Family Therapy · doi:10.1017/aft.2012.4 · Cited by 43
Correlates of symptom reduction in treatment-seeking survivors of torture.
Raghavan, S. S., Rasmussen, A., Rosenfeld, B. D., & Keller, A. S. (2012) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0028118 · Cited by 43
Adverse events of group psychotherapy in the in‐patient setting – results of a naturalistic trial
Schneibel, R., Wilbertz, G., Scholz, C., Becker, M., Brakemeier, E.-L., Bschor, T., Zobel, I., & Schmoll, D. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12747 · Cited by 43
Complex individual pathways or standard tracks? A data‐based discussion on the trajectories of change in psychotherapy
Schiepek, G. K., Gelo, O. C. G., Viol, K., Kratzer, L., Orsucci, F. F., de Felice, G., Stöger‐Schmidinger, B., Sammet, I., Aichhorn, W., & Schöller, H. J. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12300 · Cited by 43
Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?
Unützer, J., Carlo, A. D., Arao, R. F., Vredevoogd, M. A., Fortney, J. C., Powers, D., & Russo, J. E. (2020) · Health Affairs · doi:10.1377/hlthaff.2019.01714 · Cited by 43
Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study
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When to Change the Treatment Plan: An Analysis of Diminishing Returns in VA Patients Undergoing Prolonged Exposure and Cognitive Processing Therapy
Sripada, R. K., Ready, D. J., Ganoczy, D. A., Astin, M. C., & Rauch, S. A. M. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.05.003 · Cited by 42
Barriers to and facilitators of treatment engagement for clients with personality disorder: a Delphi survey
Tetley, A., Jinks, M., Huband, N., Howells, K., & McMurran, M. (2012) · Personality and Mental Health · doi:10.1002/pmh.1176 · Cited by 49
Identifying and targeting predictors of drop-out from group cognitive behaviour therapy
Davis, S., Hooke, G. R., & Page, A. C. (2006) · Australian Journal of Psychology · doi:10.1080/00049530500504096 · Cited by 42
A delay discounting measure of great expectations and the effectiveness of psychotherapy.
Swift, J. K., & Callahan, J. L. (2008) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.39.6.581 · Cited by 42
“The dose–effect literature generally indicates that it takes somewhere between 13 and 18 (N. B. Hansen et al., 2002 ) sessions of therapy for 50% of clients to recover.”
BackgroundResultInfluential
Pathological and non-pathological features of obsessive-compulsive disorder: Revisiting basic assumptions of cognitive models
Cougle, J. R., & Lee, H. (2013) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2013.11.002 · Cited by 43
A Meta-analysis of Intervention Effects on Depression and/or Anxiety in Youth Exposed to Political Violence or Natural Disasters
Pfefferbaum, B. J., Nitiéma, P., & Newman, E. (2019) · Child & Youth Care Forum · doi:10.1007/s10566-019-09494-9 · Cited by 43
“Finally, assuming a dose–response relationship (Hansen et al. 2002), interventions with more sessions were hypothesized to have a greater effect relative to those with fewer sessions.”
Result
Treatment failures in private practice: How do psychologists proceed?
Stewart, R. E., & Chambless, D. L. (2008) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.39.2.176 · Cited by 40
Emotional intelligence and psychotherapy outcomes in the training clinic.
Rieck, T. P., & Callahan, J. L. (2013) · Training and Education in Professional Psychology · doi:10.1037/a0031659 · Cited by 40
Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis
Simmonds‐Buckley, M., Kellett, S., & Waller, G. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.01.003 · Cited by 41
“The dose-response literature suggests a negatively accelerated association between number of sessions and improved outcome, with estimates of 13-18 sessions required to achieve a 50% recovery rate (Hansen et al., 2002; Harnett, O’Donovan, & Lambert, 2010).”
Background
Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC)
Saldana, L., Bennett, I. M., Powers, D., Vredevoogd, M., Grover, T., Schaper, H., & Campbell, M. R. (2019) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-019-00944-z · Cited by 42
“Similarly, patients referred for psychotherapy often receive inadequate trials and/or ineffective therapies resulting in treatment response as low as 20% in usual specialty mental health care (Hansen et al. 2002).”
Does Phasic Trauma Treatment Make Patients With Dissociative Identity Disorder Treatment More Dissociative?
Brand, B. L., & Loewenstein, R. J. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2013.828150 · Cited by 44
“This rate of worsening is similar to or better than rates found in studies of other disorders (Hansen et al., 2002).”
Result
Real world effectiveness of digital mental health services during the COVID-19 pandemic
Prescott, M., Henson, S. J. S., Chamberlain, C. E. W., Castro, C. M., & Altman, M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0272162 · Cited by 39
Attrition in Psychotherapy
Roseborough, D., McLeod, J. T., & Wright, F. (2016) · Research on Social Work Practice · doi:10.1177/1049731515569073 · Cited by 35
“Difficulties in closing the gap between research and policy here have been widely recognized (Hansen et al., 2002; Layard & Clark, 2015).”
BackgroundMethodInfluential
The Expanding Relevance of Routinely Collected Outcome Data for Mental Health Care Decision Making
Boswell, J. F., Constantino, M. J., Kraus, D. R., Bugatti, M., & Oswald, J. M. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-015-0649-6 · Cited by 39
“Spinning one's wheels”: Nonimproved patients view their psychotherapy
Werbart, A., von Below, C., Brun, J., & Gunnarsdottir, H. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.989291 · Cited by 46

Authors: Hansen, N. B., Lambert, M. J., & Forman, E. M.
Affiliations: Yale University (US)
Brigham Young University (US)
Drexel University (US)
ORCID: Hansen, Nathan B.
Lambert, Michael J.
Forman, Evan M.
Venue: Clinical Psychology: Science and Practice
Publisher: American Psychological Association (APA)
Published: 2002
Volume: 9
Issue: 3
Pages: 329-343
ISSN: 0969-5893 (ISSN-L)
1468-2850
DOI: 10.1093/clipsy.9.3.329
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
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 4991 d)
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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The psychotherapy dose-response effect and its implications for treatment delivery services.

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