Department of Psychology, University of Sheffield, Sheffield, UK.
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
Depress Anxiety. 2020 Mar;37(3):285-294. doi: 10.1002/da.22999. Epub 2020 Feb 6.
Cognitive-behavioral therapy (CBT) is effective for the treatment of common mental health problems, but the number of sessions required to maximize improvement in routine care remains unclear.
This study aimed to examine the dose-response effect in low (LiCBT) and high (HiCBT) intensity CBT delivered in stepped care services.
A multi-service data set included N = 102 206 patients across N = 16 services. The study included patients with case-level depression and/or anxiety symptoms who accessed LiCBT and/or HiCBT. Patients with posttreatment reliable and clinically significant improvement in standardized outcome measures (PHQ-9, GAD-7) were classified as treatment responders. Survival analyses assessed the number of sessions necessary to detect 50%, 75%, and 95% of treatment responders. The 50% and 95% percentiles were used to define the lower and upper boundaries of an adequate dose of therapy that could be used to inform the timing of treatment progress reviews. Analyses were then stratified by diagnosis, and cox regression was used to identify predictors of time-to-remission.
Most responders (95%) attained RCSI within 7 sessions of LiCBT and 14 sessions of HiCBT. Patients with social anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder required HiCBT and lengthier treatments (6-16 sessions) to maximize improvement.
Distinctive dose-response patterns are evident for LiCBT and HiCBT, which can be used to support treatment planning and routine outcome monitoring.
认知行为疗法（CBT）对于治疗常见心理健康问题是有效的，但在常规护理中最大限度提高疗效所需的疗程数仍不清楚。
本研究旨在检查阶梯式护理服务中低强度认知行为疗法（LiCBT）和高强度认知行为疗法（HiCBT）的剂量反应效应。
多服务数据集包括来自 16 个服务的 N=102206 名患者。研究纳入了有病例水平抑郁和/或焦虑症状并接受 LiCBT 和/或 HiCBT 的患者。采用标准化结局测量（PHQ-9、GAD-7）评估患者治疗后是否出现可靠且具有临床意义的改善，将其定义为治疗反应者。生存分析评估了达到 50%、75%和 95%的治疗反应者所需的疗程数。50%和 95%的百分位数用于定义足够治疗剂量的下限和上限，可用于告知治疗进展审查的时间。然后根据诊断对分析进行分层，并使用 Cox 回归识别缓解时间的预测因素。
大多数反应者（95%）在 LiCBT 的 7 次疗程内和 HiCBT 的 14 次疗程内达到 RCSI。社交焦虑障碍、创伤后应激障碍和强迫症患者需要接受 HiCBT 和更长时间的治疗（6-16 次疗程）才能最大限度地提高疗效。
LiCBT 和 HiCBT 存在明显的剂量反应模式，可用于支持治疗计划和常规结局监测。
