Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations

Schottenbauer, Michele A.; Glass, Carol R.; Arnkoff, Diane B.; Tendick, Vanessa; Gray, Sheila Hafter

doi:10.1521/psyc.2008.71.2.134

Cited by 548 publications

(438 citation statements)

References 13 publications

Supporting

Mentioning

399

Contrasting

Unclassified

Order By: Relevance

“…No significant medication side effects were reported, nor were dropouts related to medication side effects or inability to tolerate the VRE. Our treatment dropout rate of 12% is strikingly low in comparison with other PTSD treatment trials (Schottenbauer et al, 2008). Given the small number of dropouts, the fact that all dropouts were in the VRE-placebo group may be an artifact of the small sample size.…”

Section: Discussionmentioning

confidence: 56%

D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

Difede

Cukor

Wyka

et al. 2013

Neuropsychopharmacol

196

135

View full text Add to dashboard Cite

Viewing post-traumatic stress disorder (PTSD) as a disorder of emotional learning, this study used a cognitive enhancer synergistically with virtual reality exposure (VRE) therapy for the treatment of PTSD. The main objective was to determine if a novel pharmacotherapy, D-cycloserine (DCS), enhanced the efficacy of the psychotherapy. Pre-clinical studies suggest that when fear extinction occurs during DCS administration, neuroplasticity may be enhanced. VRE therapy is a particularly promising format to test the hypothesis that DCS enhances extinction learning, as sensory fear cues are standardized across patients. In a pilot randomized, double-blind, placebocontrolled trial, 100 mg of DCS or placebo was administered 90 min before each weekly VRE session, to ensure peak plasma concentrations during the sessions in 25 patients with chronic PTSD. The primary outcome measure was the Clinician Administered PTSD Scale (CAPS). Secondary outcome measures included the Beck Depression Inventory-II and the State-Trait Anger Expression Inventory-2. Assessments occurred at pre-treatment, following sessions 3, 6, 10, post-treatment, and at 6 months. The difference in CAPS between the VRE-DCS (n ¼ 13) and VRE-placebo (n ¼ 12) groups increased over time beginning at 6 weeks, with medium to large between-group effect sizes immediately post-treatment and 6 months later (d ¼ 0.68 and d ¼ 1.13, respectively). A similar pattern was observed for depression, anger expression, and sleep. PTSD remission rates were significantly greater for the VRE-DCS group (46% vs 8% at post-treatment; 69% vs 17% at 6 months). Patients in the VRE-DCS group showed earlier and greater improvement in PTSD symptoms compared with the VRE-placebo group. These results suggest a promising new treatment for PTSD.

show abstract

Section: Discussionmentioning

confidence: 56%

D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

Difede

Cukor

Wyka

et al. 2013

Neuropsychopharmacol

196

135

View full text Add to dashboard Cite

show abstract

“…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%.…”

mentioning

confidence: 99%

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

Méndez

Nijdam

Heide

et al. 2018

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout. Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD. Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated. Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen’s d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred. Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials – with longer follow up periods – are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.

show abstract

“…Also well-established is the effect PTSD has on both physical and psychological rehabilitation, such that PTSD is known to reduce treatment adherence, retention, and long-term treatment outcomes (Schottenbauer et al, 2008). Given the high prevalence of the PTSD -SUD comorbidity in various SUD treatment modalities, the question of how this relationship functions to impact treatment outcomes is important.…”

Section: Discussionmentioning

confidence: 99%

“…Attrition and low treatment adherence are common in samples with PTSD (Schottenbauer, Glass, Arnkoff, Tendick, & Gray, 2008), and PTSD is shown to be highly comorbid with SUD (Afful et al, 2010), so this combination of factors can seriously affect treatment. This is problematic as research has shown the most stable predictor of SUD treatment success is time spent in treatment (Hubbard et al, 2003).…”

Section: The Current Researchmentioning

confidence: 99%

“…Follow-up post program is difficult as individuals who utilize TCs for treatment have a higher likelihood of complex issues, and less stable residences (Wilson & Yates, 2001). To add to this difficulty, individuals with PTSD are notoriously difficult to follow (Schottenbauer et al, 2008;Weisaeth, 1989), with high rates of non-response and treatment dropout. As such, high initial samples did not equate to equivalent numbers at follow up.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Posttraumatic stress disorder in a therapeutic community for substance use disorders: an evaluation of the influence

Perryman¹

View full text Add to dashboard Cite

The purpose of this body of research is twofold. First, to investigate posttraumatic stress disorder (PTSD) in a sample of adults undergoing substance use disorder (SUD) treatment in a therapeutic community (TC) and, second, to apply major psychological theories to help understand the nature of this comorbidity in ways that inform treatment. The focal theories of this research are: emotion dysregulation (Gratz & Roemer, 2004), and revised Reinforcement Sensitivity Theory (rRST; Corr, 2008;Gray & McNaughton, 2000). Rash Impulsiveness will be included as an important dimension of rRST that has been consistently linked to substance misuse. Chapter 1 presents an overview of research related to the thesis as a whole. In Chapter .72, p < .00). Furthermore, the correlations between PTSS and two of the facets of rRST, BAS and fight-flight-freeze sensitivity (FFFS), were significantly correlated (r = -.23 and .49, p < .01, respectively). BAS sensitivity was shown to negatively correlate with PTSS, indicating that lower BAS sensitivity related to higher PTS severity. No relationship was found between the Behavioural Inhibition System (BIS) and PTSS. Finally, Rash Impulsivity significantly correlated with PTSS at intake, r = .50, p < .00. Contrary to hypotheses, and previous research, Rash Impulsivity did not significantly correlate with retention. Theoretical mechanisms linking PTSS and substance misuse were investigated further, with tests of theoretical models in which individual difference factors (facets of the rRST) were related to retention and outcomes from treatment, and facets of emotional dysregulation were tested as mediators of this relationship. Upon investigation through linear regression, no suitable variable was found the mediate the relationship between PTSS and retention.iii The final moderated mediated model, therefore, was not suitable for this population. Limited moderation, though, occurred between the two facets of rRST and retention. Specifically, investigation of the simple slopes showed that FFFS and Rash Impulsivity both moderate the relationship between PTSD and retention at high (+1 SD) and mean scores. These findings indicate that high levels of both facets do interact with PTSD to negatively influence treatment retention.The null findings for both mediation and the moderated mediation model contradict previous research, and may be due to homogeneity in scores across the population. Overall, some implications for treatment can be extrapolated. First, PTSD is highly prevalent in the TC population, and should be assessed using psychometrically valid measures, such as the PCL-C, and addressed in treatment. Second, treatment for SUD does not exacerbate PTSD; on the contrary, PTSS significantly decreased during TC treatment. Finally, as there is solid theoretical support to suggest an influence of emotion dysregulation and Rash Impulsiveness on retention and outcomes, more research needs to be conducted on the role of these two constructs with the intent of creating a better suited rehabi...

show abstract

Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations

Cited by 548 publications

References 13 publications

D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

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

Posttraumatic stress disorder in a therapeutic community for substance use disorders: an evaluation of the influence

Contact Info

Product

Resources

About