In 2019 two studies looked at why clients drop out of PTSD therapy. Browne et al. (2019) examined veterans self-reported reasons for non-attendance in psychotherapy for posttraumatic stress disorder. Holder et al. (2019) looked at predictors of dropout from a randomized clinical trial of Cognitive Processing Therapy (CPT) for female veterans with military sexual trauma-related PTSD.
Browne et al. (2019) reported that greater than one five of their sample (> 20%) cited difficulty with scheduling appointments as the reason for non-attendance across treatments. Other barriers commonly cited (> 15%), included transportation (CPT), therapy taking too much time (PTSD-focused individual psychotherapy) and not being able to afford therapy (PTSD-focused group psychotherapy). Over one quarter (26%) of those scheduled to attend CPT and over one tenth (11%) of those who were scheduled to attend PTSD-focused individual psychotherapy cited treatment efficacy concerns as a reason for non-attendance.
Holder et al. (2019) study of CPT found that clients attended more sessions when they had more positive treatment belief, lower trauma-related negative cognitions about others and the world, and higher levels of negative cognitions about self-blame. They also found that no sociodemographic factors nor baseline symptoms predicted treatment dropout.
It is important to keep in mind that both these studies involved military personnel.
In an earlier study CPT and drop out related study, Rizvi et al. (2009) found that younger age, lower intelligence, and less education were associated with higher treatment dropout. In contrast, affective states (i.e., depression, trait anger, global guilt) did not predict treatment dropout.
What should I think about to help my clients attend?
While Rizvi et al. (2009) suggest that there may be some predictors of drop out that we can’t change, such as age. Their study indicates that a client’s distress (affective state) isn’t a predictor. It is worth keeping in mind that distressed clients come to change their distress, and that is what engaging in and continuing with therapy does. One of the primary tenants of CPT is engagement with emotions in order to process them and become “unstuck” from PTSD.
Both 2019 studies show that ensuring your clients believes the therapy is relevant to them might help them stay in treatment. In addition, Browne et al study indicates that discussion about scheduling appointments, might help your client stay in treatment.
References
Browne, K. C., Chen, J. A., Hundt, N. E., Hudson, T. J., Grubbs, K. M., & Fortney, J. C. (2019). Veterans self-reported reasons for non-attendance in psychotherapy for posttraumatic stress disorder. Psychological Services. Advance online publication. PTSDpubs ID: 1516900
Holder, N., Holliday, R., Wiblin, J., LePage, J. P., & Suris, A. (2019). Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD. Psychiatry Research, 276, 87-93. PTSDpubs ID: 52240 A
Rizvi, S. L., Vogt, D. S., & Resick, P. A. (2009). Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder. Behaviour Research and Therapy, 47(9), 737. doi:http://dx.doi.org/10.1016/j.brat.2009.06.003
