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How much therapy is enough? Comparing dose-effect and good-enough models in two different settings.

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Longer therapy generally leads to better outcomes, even with diminishing returns. This study supports the Good-Enough-Level model, suggesting treatment length influences symptom change, not just session count.

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Area of Science:

  • Psychology
  • Clinical Psychology
  • Health Services Research

Background:

  • The Dose-Effect model posits longer therapy yields better outcomes with diminishing returns.
  • The Good-Enough-Level (GEL) model suggests treatment ends when satisfactory outcomes are met, implying faster improvers have shorter treatments.
  • Prior research, primarily from US university centers, indicates symptom change rate depends on treatment length.

Purpose of the Study:

  • To investigate if previous findings on treatment length and symptom change hold in Swedish community-based primary and psychiatric care settings.
  • To compare the fit of the Dose-Effect model versus the GEL model in real-world clinical data.
  • To examine the moderating effect of treatment length on symptom change rate.

Main Methods:

  • Utilized two Swedish datasets: community-based primary care (n=640) and psychiatric care (n=284).
  • Patients provided session-wise ratings using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM).
  • Employed multilevel models to analyze the relationship between treatment length and symptom change.

Main Results:

  • Multilevel models favored a model where treatment length moderated symptom change rate.
  • In primary care, longer treatments resulted in greater overall symptom change, despite a slower rate of improvement.
  • Evidence supported the GEL model's core tenet and did not support a negatively accelerating Dose-Effect curve.

Conclusions:

  • Treatment length significantly moderates symptom change, supporting the GEL model over a strict Dose-Effect interpretation in these settings.
  • Patients in longer treatments may achieve greater overall improvement, challenging assumptions of diminishing returns.
  • Findings are limited to approximately 12 sessions due to data constraints for longer treatments.