BACKGROUND 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. AIM This study aimed to examine the dose-response effect in low (LiCBT) and high (HiCBT) intensity CBT delivered in stepped care services. METHODS 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. RESULTS 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. CONCLUSIONS Distinctive dose-response patterns are evident for LiCBT and HiCBT, which can be used to support treatment planning and routine outcome monitoring.

中文翻译：

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低强度和高强度认知行为治疗中常见精神健康问题的剂量反应模式。

背景技术认知行为疗法（CBT）对于治疗常见的精神健康问题是有效的，但是尚不清楚如何最大程度地提高常规护理水平。目的本研究旨在检查在分级护理服务中提供的低强度（LiCBT）和高强度（HiCBT）CBT的剂量反应效果。方法多服务数据集包括N = 16个服务中的N = 102 206名患者。这项研究纳入了使用LiCBT和/或HiCBT的具有病例水平的抑郁和/或焦虑症状的患者。治疗后在标准化结局指标（PHQ-9，GAD-7）方面具有可靠且临床上显着改善的患者被分类为治疗反应者。生存分析评估了发现50％，75％和95％的治疗反应者所需的治疗次数。50％和95％百分数用于定义适当剂量治疗的上下边界，该剂量可用于告知治疗进度审查的时间。然后根据诊断对分析进行分层，并使用Cox回归来确定缓解时间的预测因子。结果大多数应答者（95％）在7次LiCBT和14次HiCBT中获得了RCSI。患有社交焦虑症，创伤后应激障碍和强迫症的患者需要HiCBT和更长的治疗时间（6至16个疗程），以最大程度地改善病情。结论LiCBT和HiCBT具有明显的剂量反应模式，可用于支持治疗计划和常规结果监测。