Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members

Berke, Danielle S.; Kline, Nora K.; Wachen, Jennifer Schuster; McLean, Carmen P.; Yarvis, Jeffrey S.; Mintz, Jim; Young‐McCaughan, Stacey; Peterson, Alan L.; Foa, Edna B.; Resick, Patricia A.; Litz, Brett T.

doi:10.1016/j.brat.2019.03.003

Cited by 56 publications

(42 citation statements)

References 52 publications

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“…A pooled dropout rate was calculated by summing both the total number of participants who dropped out of treatment and the total number of participants enrolled in each of the included studies and determining the proportion of participants who did not complete treatment (see Table 3). The pooled dropout rate indicated that 5.51% of participants dropped out of the intensive intervention across studies, a rate that is substantially lower than what has been reported in research on standard delivery of trauma‐focused treatment (e.g., range: 18%–39%; Berke et al., 2019; Eftekhari et al., 2019; Hembree et al., 2003; Imel et al., 2013; Steenkamp et al., 2015; Zayfert et al., 2005).…”

Section: Resultsmentioning

confidence: 67%

“…Patient dropout is a major concern in both trauma-focused EST research and clinical practice (e.g., Garcia et al, 2011;Hembree et al, 2003;Imel et al, 2013;Kehle-Forbes et al, 2016;Najavits, 2015;van Minnen et al, 2002;Zayfert et al, 2005). One meta-analysis reported an average dropout rate of 18% across trauma-focused interventions for PTSD (Imel et al, 2013); however, more recent studies have identified dropout rates of between 30% and 39% (Berke et al, 2019;Eftekhari et al, 2019;Steenkamp et al, 2015). Higher rates of dropout from ESTs for PTSD, such as PE, have been observed in clinical settings (e.g., 28%-30%; Eftekhari et al, 2019;Zayfert et al, 2005) compared to controlled study designs (e.g., 20.5%; Hembree et al, 2003).…”

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confidence: 99%

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A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

Sciarrino

Warnecke

Teng

2020

Journal of Traumatic Stress

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Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence‐based psychotherapies (EBPs)—prolonged exposure (PE) and cognitive processing therapy (CPT)—as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or “massed,” treatments for PTSD. Due to variability among intensive treatments, including treatment delivery format, fidelity to the EST, and the population studied, we conducted a systematic review to summarize and integrate the literature on the impact of intensive treatments on PTSD symptoms. A review of four major databases, with no restrictions regarding publication date, yielded 11 studies that met all inclusion criteria. The individual study findings denoted a large impact of treatment on reduction of PTSD symptoms, ds = 1.15–2.93, and random‐effects modeling revealed a large weighted mean effect of treatment, d = 1.57, 95% CI [1.24, 1.91]. Results from intensive treatments also noted high rates of treatment completion (i.e., 0%–13.6% dropout; 5.51% pooled dropout rate across studies). The findings suggest that intensive delivery of these treatments can be an effective alternative to standard delivery and contribute to improved treatment response and reduced treatment dropout.

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Section: Resultsmentioning

confidence: 67%

mentioning

confidence: 99%

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

Sciarrino

Warnecke

Teng

2020

Journal of Traumatic Stress

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“…Research has further demonstrated that treatment dropout rates for TFTs appear to be higher relative to non‐TFTs (Belsher et al., 2019; Berke et al., 2019; Imel et al., 2013; Kitchiner et al., 2019). However, first‐line evidence‐based treatments for PTSD are, almost exclusively, TFTs (U.S. Department of Veterans Affairs [VA] & Department of Defense [DoD], 2017).…”

mentioning

confidence: 99%

“…Research has further demonstrated that treatment dropout rates for TFTs appear to be higher relative to non-TFTs (Belsher et al, 2019;Berke et al, 2019;Imel et al, 2013;Kitchiner et al, 2019 [DoD], 2017). This reliance on TFTs for PTSD in military populations has been questioned due to high dropout rates, among other factors (Steenkamp et al, 2020;Straud et al, 2019).…”

mentioning

confidence: 99%

Posttraumatic Stress Disorder Treatment Dropout Among Military and Veteran Populations: A Systematic Review and Meta‐Analysis

Edwards‐Stewart

Smolenski

Bush

et al. 2021

Journal of Traumatic Stress

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High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma‐focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study‐level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence‐based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta‐analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma‐focused treatments, 16.1% for non–trauma‐focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study‐level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma‐focused treatment groups had a higher risk of dropout compared to non–trauma‐focused treatments, RR = 1.60. The statistical heterogeneity of within‐treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma‐focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study‐level covariates.

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“…Moreover, there are limits to the efficacy of first-line psychotherapies, which only work for some, especially in the military and veteran populations where clinicians acknowledge the "the inconvenient truth that first-line treatments are only partially effective" (Steenkamp, 2016, p. 758;Steenkamp et al, 2015). Dropout from first-line treatments for PTSD is a significant issue for the military and veteran population in particular (Berke et al, 2019;Goetter et al, 2015); it is increasingly recognized internationally that health care systems and the disciplines that work within them are not adequately prepared to recognize and address trauma-related health impacts (McFarlane & Bryant, 2017).…”

Section: Discussionmentioning

confidence: 99%

Developing an Occupation-Centred Framework for Trauma Intervention

Edgelow

Cramm

2020

Occupational Therapy in Mental Health

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Experiencing work-related trauma can negatively impact coping abilities and daily life participation. Occupational therapists (OTs) often provide health services to workers who have experienced trauma, including military members, veterans, and public safety personnel. The Occupational Therapy Trauma Intervention Framework (OTTIF) is a novel clinical reasoning framework that matches a client's level of readiness to engage with a spectrum of evidence-based OT approaches. Using surveys at two time points, evaluation of therapist experiences of using the OTTIF elicited positive feedback that suggests the OTTIF provides a useful occupation-centred framework for evidence-informed occupational therapy practice with clients who have experienced trauma.

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Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members

Cited by 56 publications

References 52 publications

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

Posttraumatic Stress Disorder Treatment Dropout Among Military and Veteran Populations: A Systematic Review and Meta‐Analysis

Developing an Occupation-Centred Framework for Trauma Intervention

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