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annabj January 27th, 2006 09:02 AM

Dosis-response studies in CBT???
Hi all!

I'm a psychologist in a pain clinic in Denmark. Me and my physician colleague want to try out an intensive CBT programme in whiplash patients with focus on returning to work. Now, my boss (physician, not psychologist) has asked if we could try the intensive programme versus a low-intensive CBT, such that if effective we could prove that CBT is effective in "higher doses". To me this sounds odd - yes we can alter the intensity (i.e no of sessions) but you can't sort of half-introduce people to the ideas of CBT, can you?
Has anyone ever seen articles on the subject? I can't find any.

Thank you so much in advance!

alexandra_k January 30th, 2006 10:31 PM

Re: Dosis-response studies in CBT???
Hmm. Mindfulness meditation has been found to be effective in the management of long term chronic pain conditions. CBT + mindfulness meditation vs CBT alone could be an interesting study (and I do believe it has been done...)

James Pretzer January 30th, 2006 10:50 PM

Re: Dose-response studies in CBT???
This is by no means exhaustive, but I was able to locate a few articles that discuss dose-response relationships in CBT to some extent. I hope this will give you a good start:
Marlowe, D. B.; Kirby, K. C.; Festinger, D. S.; Merikle, E. P.; Tran, G. Q.; Platt, J. J. (2003). Day treatment for cocaine dependence: Incremental utility over outpatient counseling and voucher incentives. Addictive Behaviors, 28, 387-398.

Otto, M. W. (2002). The dose and delivery of psychotherapy: A commentary on Hansen et al. Clinical Psychology: Science and Practice, 9, 348-349.

Freidenberg, B. M.; Blanchard, E. B.; Wulfert, E.; Malta, L. S. (2002). Changes in physiological arousal to gambling cues among participants in motivationally enhanced cognitive-behavior therapy for pathological gambling: A preliminary study. Applied Psychophysiology and Biofeedback, 27, 251-260.

Covi, L.; Hess, J. M.; Schroeder, J. R.; Preston, K. L. (2002). A dose response study of cognitive behavioral therpy in cocaine abusers. Journal of Substance Abuse Treatment, 23, 191-197.

Warner, L. K.; Herron, W. G.; Javier, R. A.; Patalano, F.; Sisenwein, F.; Primavera, L. H. (2001). A comparison of dose-response curves in cognitive-behavioral and psychodynamic psychotherapies. Journal of Clinical Psychology, 57, 63-73.

Ilardi, S. S.; Craighead, W. E. (1999). Rapid early response, cognitive modification, and nonspecific factors in cognitive behavior therapy for depression: A reply to Tang and DeRubeis. Clinical Psychology: Science and Practice, 6, 295-299.

Rosenblum, A.; Magura, S.; Foote, J.; Palij, M.; et al (1995). Treatment intensity and reduction in drug use for cocaine-dependent methadone patients: A dose-response relationship. Journal of Psychoactive Drugs, 27, 151-159.

James Pretzer February 3rd, 2006 09:59 PM

Further thoughts on dose response relationships in CBT
Your point that it wouldn't make sense to "sort of half-introduce people to the ideas of CBT" is a good one. Reducing the "dose" of CBT to the point where the ideas are presented inadequately should render the treatment ineffective. Increasing the time spent presenting the ideas of CBT beyond the point where the concepts have been communicated adequately might not increase the effectiveness of treatment very much. This makes it sound as though we wouldn't find much of a dose response relationship in CBT (i.e. once there has been enough treatment to adequately introduce the important ideas, additional treatment wouldn't do much to increase effectiveness and therefore we should just do short-term treatment).

However, there's more to effective CBT than introducing people to the ideas (otherwise, all we'd need to do is hand clients a good self-help book). Once the basic ideas have been introduced it takes time to apply them to specific problems, to complete homework assignments, to perform behavioral experiments, to learn new coping skills, to identify and modify dysfunctional beliefs, etc. With many of these interventions, I'd expect there to be a dose-response relationship. For example, a dozen behavioral experiments should accomplish more that two or three behavioral experiments, taking the time to modify all of the dysfunctional beliefs should accomplish more that just modifying one or two dysfunctional beliefs. More research is needed to know for sure, but my bet is that longer-term CBT will usually accomplish more than short-term CBT.

In practice, my preference is to apply CBT in an open-ended way where we persist until the client's goals are accomplished. Sometimes therapy is quite short-term because the client's goals are accomplished quickly, and sometimes it is quite long-term.

annabj February 14th, 2006 08:23 AM

Re: Dosis-response studies in CBT???
Thank you so much for your responses. They mirror my thoughts exactly and are what I need to convince my physician boss that he's barking up the wrong tree. We'll have to find another control group!
Many thanks yet again, your replies were very important to me.


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