Managing the risk of dropout

Clinicians always like to know how to help their clients stay in therapy.  Some research has focused on demographic and pre-treatment predictors of dropout, and findings have been inconsistent. Other research has focussed on practical matters such as difficulty with scheduling appointments and these have previously been highlighted on this blog.  In an alternative to these Alpert et al, (2019) examined the content of trauma narratives written in early sessions of CPT.

They stated, “Findings suggest that patients willing to engage with negative emotions may be best able to tolerate CPT, if emotions are not over engaged to the point of physiological hyperarousal.”

While clinicians are already attending to the clients written narratives to discover assimilated and over accommodated stuck points. CPT treatment may now be further informed with a view to assist those at clients at risk of dropout.

Alpert and colleagues stated, “In the first impact statement alone, more negative emotions in the present time frame predicted lower dropout rates, but when emotional reactions had a physiological impact, dropout was higher.”  Similarly they reported that overgeneralized beliefs predicted higher rates of drop out.

By attending to the content in patients’ written narratives where they describe present-day negative physiological experiences a clinician may anticipate risk of dropout and talk with their clients about strategies for staying in treatment.

E. Alpert, A. M. Hayes, J. B. Barnes, et al., Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content, Behavior Therapy,