Objective
Many patients dropout of treatments for Post-traumatic stress
disorder (PTSD) and some clinicians believe that ‘trauma
focused’ treatments increase dropout.
Method
We conducted a meta-analysis of dropout among active treatments in
clinical trials for PTSD (42 studies; 17 direct comparisons).
Results
The average dropout rate was 18%, but it varied significantly
across studies. Group modality and greater number of sessions, but not
trauma focus, predicted increased dropout. When the meta-analysis was
restricted to direct comparisons of active treatments, there were no
differences in dropout. Differences in trauma focus between treatments in
the same study did not predict dropout. However, trauma focused treatments
resulted in higher dropout as compared to Present Centered Therapy (PCT)
– a treatment originally designed as a control, but now listed as a
research supported intervention for PTSD.
Conclusion
Dropout varies between active interventions for PTSD across studies,
but differences are primarily driven by differences between studies. There
do not appear to be systematic differences across active interventions when
they are directly compared in the same study. The degree of clinical
attention placed on the traumatic event does not appear to be a primary
cause of dropout from active treatments. However comparisons of PCT may be
an exception to this general pattern, perhaps due to a restriction of
variability in trauma focus among comparisons of active treatments. More
research is needed comparing trauma focused interventions to trauma avoidant
treatments such as PCT.
In this article, we examine the science and policy implications of the common factors perspective (CF; Frank & Frank, 1993; Wampold, 2007). As the empirically supported treatment (EST) approach, grounded in randomized controlled trials (RCTs), is the received view (see Baker, McFall, & Shoham, 2008; McHugh & Barlow, 2012), we make the case for the CF perspective as an additional evidence-based approach for understanding how therapy works, but also as a basis for improving the quality of mental health services. Finally, we argue that it is time to integrate the 2 perspectives, and we challenge the field to do so.
To examine the evidence for present-centered therapy (PCT) as a treatment for posttraumatic stress disorder (PTSD), 5 randomized clinical trials that compared PCT to an existing evidence-based treatment for PTSD were reviewed. A meta-analysis was used to estimate between-treatment differences on targeted measures, secondary measures, and dropout. PCT was found to be as efficacious as the comparison evidence-based treatment in 3 of the 5 trials, and in the 2 cases where a no-treatment condition was included, PCT was superior, with large effect sizes for targeted variables (d = 0.88, 0.74, and 1.27). When results were aggregated using meta-analysis, effects for PCT versus an evidence-based treatment for both targeted and secondary measures were small and nonsignificant (d = 0.13 and d = 0.09, respectively). As well, the dropout rate for PCT was significantly less than for the comparison evidence-based treatments (14.3% and 31.3%, respectively). It appears that PCT is an efficacious and acceptable treatment for PTSD.
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