The efficacy of cognitive–behavioral therapy and the problem of drop‐out

Abstract

Treatment drop-out is a common problem in the everyday practice of psychotherapy. In the cognitive-behavioral psychology literature, there are scant data on drop-out from therapy and the data available vary widely according to the definition of drop-out and the intensity of treatment. This study presents results obtained in the Behavioural Therapy Unit of the University of Barcelona. Of the 203 patients seen in the unit, 89 (43.8%) dropped out, mostly in the early stages of the intervention. The most common reasons for this were low motivation and/or dissatisfaction with the treatment or the therapist (46.7%), external difficulties (40%), and patients' feeling of improvement (13.3%). Patients who dropped out differed from those who continued; they more often presented affective or eating disorders or problems with impulse control. The observed drop-out rate is in line with figures reported for psychotherapy in general and by those studies which have considered cognitive-behavioral therapy in particular.

An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial

“…Alternatively, it could show the need to adjust Deprexis to multiple-sclerosis-speci c needs, as indicated by the retrospective appraisal of the programme in our patients. The drop-out rate in our study was just above the cuto for class-I evidence although within the range typically seen in behavioural interventions 35 and low compared with other online interventions. 36 Adherence to an online programme, though, is di cult to predict.…”

Early termination of cognitive-behavioural interventions: literature review

“…There is no robust evidence supporting an association between any particular diagnosis and early treatment discontinuation rates, 12 a finding confirmed by all the studies in that review. However, Persons et al 4 report that patients with personality disorders were more likely to drop out of treatment.…”

“…These include difficulties with transport, finances, busy timetables or time constraints, clash with other commitments, personal problems and taking time off work. Only two studies 12,19 reported significant results for those variables, one citing high scores for time and transportation. 19 Surprisingly, only one study reported dissatisfaction with treatment or therapist as a reason for terminating therapy.…”

“…The definition affects the results, but consensus has not been established. 12 Treatment discontinuation represents a significant problem in mental health, as it seems that generally the outcomes of those who dropped out of treatment are poorer than for people who stay in treatment or are equivalent to outcomes of those who were untreated, and 21-46% of those patients end up getting treated in another setting within the next year. 3,4 Furthermore, treatment discontinuation constitutes a financial loss for services in taxpayer-funded systems such as the National Health Service (NHS) in the UK and for the individual patients themselves.…”

A Preliminary, Qualitative Exploration of the Influences Associated with Drop-Out from Cognitive-Behavioural Therapy for Problem Gambling: An Australian Perspective

“…In conclusion, there is a limited amount of data regarding client numbers and reasons for withdrawal from therapy for problem gambling (as well as broader clinical practice, Bados, Balaguer, & Salaña, 2007). The figures available vary widely according to the definition of drop-out used and the treatment approach followed and there is little qualitative data available reflecting the reasons why clients drop-out.…”