Meta-analysis of dropout in treatments for posttraumatic stress disorder.

Abstract

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.

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

“…Arguably, the lack of effect in previous treatments might (also) be associated with the high dropout rates, running up to 52% for conventional PTSD interventions (Imel et al, 2013). In the present study, all participants completed the intensive phase and few patients (5%) left the booster phase prematurely.…”

“…In addition to this suboptimal response, dropout rates in regular TFT programmes are high. A meta-analysis investigating dropout from PTSD treatment, including TFT programmes and supportive counselling (Imel, Laska, Jakupcak, & Simpson, 2013), estimated that, on average, 18% of patients drop out, with percentages varying significantly across studies and rates running up to 52%, although definitions of dropout differed among the studies.…”

“…For instance, in the meta-analysis of Imel and colleagues (2013), variability in dropout rates across studies was associated with the number of sessions delivered. That is, in treatment programmes that encompassed more (weekly) sessions, patients were more likely to drop out.…”

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

“…From this perspective, the drop-out rate in the current study of less than 4% is a remarkable finding. This is even more remarkable as regular treatment programmes for PTSD report drop-out rates of approximately 20% (Imel, Laska, Jakupcak, & Simpson, 2013), given the discussion about the need for a stabilization and emotion regulation phase (De Jongh et al, 2016) and the prevailing notion that a history of CSA renders patients more prone to attrition (Cloitre et al, 2002). However, the reason for the low drop-out rate may also be due to more practical aspects of intensive treatment, since within a short time-frame of two weeks less interfering variables may play a role.…”

A five-day inpatient EMDR treatment programme for PTSD: pilot study

“…Only 40% of military veterans lose their PTSD diagnosis after receiving trauma-focused treatment (Bradley et al, 2005; Steenkamp, Litz, Hoge, & Marmar, 2015). Imel, Laska, Jakupcak, and Simpson (2013) found an average dropout of 18% among 44 studies, yet indicated that dropout rates varied quite dramatically across studies. Schottenbauer, Glass, Arnkoff, Tendick, and Gray (2008) described a range of studies in their review, including small sample studies and non-controlled studies, and identified a broad range of dropout from 0 to 54% and non-responders ranging from 0 to 89%.…”