Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

Abstract

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record

Public stigma and attitudes toward psychological help-seeking in the United Arab Emirates: The mediational role of self-stigma

“…Less than one‐third of individuals with a diagnosable mental health concern such as depression or anxiety receive any form of treatment, and this disparity is substantially larger in developing countries . Moreover, when individuals do seek treatment, this is often delayed and may be followed by premature termination . Consequently, much research effort has been directed toward understanding the barriers that impede treatment utilization, in an effort to facilitate greater access and uptake of services for those most in need.…”

Attitudes of Austrian psychotherapists towards process and outcome monitoring

“…Additionally, the average rate of patients who prematurely drop out of treatment was estimated at 47% in an early meta-analysis (Wierzbicki & Pekarik, 1993) and 20% in more recent ones (Swift, Greenberg, Tompkins & Parkin, 2017). As shown by Hatfield, McCullogh, Frantz & Krieger (2010), 70% of deteriorations of patients remain undocumented (and probably unnoticed), indicating that psychotherapists have great difficulties in detecting these undesirable changes.…”

Drop‐outs in psychotherapy: a change of perspective

“…In randomized controlled trials, for example, patients who unilaterally do not finish the prescribed treatment protocol are usually considered as drop‐outs. More generally, premature termination or drop‐out occurs when a patient decides to discontinue treatment before reaching a sufficient reduction of the problems that initially led him/her to seeking therapy.…”

“…Taking research findings into account, several strategies may be helpful to address the issue of drop‐outs. Most of these strategies not only apply to psychotherapy, but to pharmacotherapy as well.…”