High rates of PTSD treatment dropout: A possible red herring?

Szafranski, Derek D.; Smith, Brian N.; Grös, Daniel F.; Resick, Patricia A.

doi:10.1016/j.janxdis.2017.01.002

Cited by 81 publications

(71 citation statements)

References 41 publications

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“…The findings from the present investigation highlight interesting issues within the dropout literature, including high dropout rates, inconsistent findings across studies related to baseline PTSD severity level (Garcia et al, 2011; Gros et al, 2011), substance use frequency (McKellar et al, 2006), when dropout occurs (Mott et al, 2014) and changes in motivation to continue treatment as symptoms change over time (Szafranski et al, in press; Zandberg et al, 2016). To help reduce inconsistencies within the literature, assessment procedures should be improved surrounding treatment initiation to better understand motivations, commitment, and any resistance to treatment.…”

Section: Discussionmentioning

confidence: 72%

“…These protocol differences may explain this finding as previous studies have noted participants who are unwilling to confront trauma relevant stimuli, quickly dropout of treatment (Frye & Spates, 2012). A second possible explanation for this outcome is that motivation to continue treatment decreased as symptoms improved over the course of treatment, leading to dropout later on in treatment (Zandberg et al, 2016; Szafranski, Smith, Gros, & Resick, in press). …”

Section: Discussionmentioning

confidence: 99%

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Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Szafranski

Snead

Grös

et al. 2017

Addictive Behaviors

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High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Szafranski

Snead

Grös

et al. 2017

Addictive Behaviors

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“…In the present study, all participants completed the intensive phase and few patients (5%) left the booster phase prematurely. Again, overcoming avoidance behaviour by delivering TFT treatment within a short time frame may be the key mechanism underlying this results, considering that early dropouts are also assumed to prematurely discontinue treatment to avoid their traumatic memories (Szafranski et al, 2017). Although the low dropout rate in this study might point to the fact that intensive TFT can prevent dropout, we may also have included a select population of patients for whom intensive treatment is acceptable, which limits the generalizability of our results.…”

Section: Discussionmentioning

confidence: 97%

“…This suggests that shorter treatment durations might prove superior in retaining patients. While treatment dropout is generally considered a negative outcome, a recent study found that some patients that prematurely ended CPT or PE nevertheless showed significant PTSD symptom amelioration, although having attended more treatment sessions was associated with better treatment outcomes (Szafranski, Smith, Gros, & Resick, 2017). These findings suggest that, while it is important that treatment duration is kept as short as possible to prevent dropout and improve treatment outcome, the total number of treatment sessions should not be reduced.…”

Section: Introductionmentioning

confidence: 99%

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.

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“…If such patients were counted as completers rather than dropouts, a somewhat different pattern of findings might have emerged (Szafranski et al, 2017).…”

Section: Limitationsmentioning

confidence: 99%

In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete

Keefe

Stirman²,

Cohen

et al. 2018

Depress Anxiety

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Individual differences among patients affect the likelihood they will complete a particular treatment, and clinicians can consider these moderators in treatment planning. In the future, treatment selection models could be used to increase the percentage of patients who will receive a full course of treatment, but replication and extension of such models, and consideration of how best to integrate them into routine practice, are needed.

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High rates of PTSD treatment dropout: A possible red herring?

Cited by 81 publications

References 41 publications

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete

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