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Unread February 3rd, 2006, 09:59 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default 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.
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