The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients

Sanne J E Bruijniks*, Lotte H.J.M. Lemmens, Steven D Hollon, Frenk P.M.L. Peeters, Pim Cuijpers, Arnoud Arntz, Pieter Dingemanse, Linda Willems, Patricia van Oppen, Jos W R Twisk, Michael van den Boogaard, Jan Spijker, Judith Bosmans, Marcus J.H. Huibers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression.

AIMS: Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression.

METHOD: We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted.

RESULTS: Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18).

CONCLUSIONS: In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.

Original languageEnglish
Pages (from-to)222-230
Number of pages9
JournalBritish Journal of Psychiatry
Issue number4
Early online date7 Feb 2020
Publication statusPublished - Apr 2020


  • Depressive disorders
  • cognitive-behavioural therapies
  • individual psychotherapy
  • out-patient treatment
  • randomised controlled trial


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