Actuarial prediction of psychotherapy retention among Iraq–Afghanistan veterans with posttraumatic stress disorder.

Abstract

The present study aimed to identify predictors of treatment retention in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans with posttraumatic stress disorder (PTSD) who were referred for PTSD-focused treatment through completion of a Veterans Affairs (VA) specialty clinic introductory information session. A total of 124 returning veterans (89% male, 53% Caucasian, 40% African American, 2% Latino; average age = 37 years) participated in an introductory session intended to facilitate informed decision making about treatment selection for PTSD. To evaluate patient, therapist, and system characteristics that were associated with risk of prematurely dropping out of psychotherapy for PTSD, we used recursive partitioning or "classification tree" methods commonly used to derive actuarial models of risk for high or low scores on a particular outcome when the set of independent or predictor variables is large. Findings revealed interactions among predictors involving access to care, readiness for change, histories of traumatic brain injury, and previous PTSD treatment. Results from the exploratory recursive model indicated that participation in therapy was highest when veterans entered psychotherapy within 68 days of the information session, believed that they needed help, and had a history of traumatic brain injury, while participation was lowest when entry into treatment exceeded 68 days and belief in needing help was low. Effects associated with partitions in the recursive model were substantial, with Cohen's d statistics ranging from .60 to 1.75. Results of the present effectiveness study implicate the importance of access to care as well as motivation for treatment in the returning cohort of OEF/OIF/OND veterans seeking help for PTSD. (PsycINFO Database Record

Factors contributing to PTSD treatment dropout in veterans returning from the wars in Iraq and Afghanistan: A systematic review.

“…This may involve researchers more explicitly shifting their focus to examine factors that may contribute to treatment retention, rather than hypothesizing based on findings associated with treatment dropout. Recent research has highlighted a relationship between factors such as social support (Meis et al, 2010), a veteran's need for treatment (Fleming et al, 2018), and intensive treatment delivery (Zalta et al, 2018) as contributing to EBP treatment retention. However, there are few if any studies that investigate a wide-ranging, comprehensive list of factors that could enhance treatment retention in this specific and unique population of OEF/OIF/OND veterans.…”

The Psychedelic Future of Post-Traumatic Stress Disorder Treatment

“…Another factor that could affect treatment success is a patient’s readiness for PTSD treatment. In veterans with PTSD, readiness to accept treatment has been shown to be correlated with higher levels of participation [ 258 ]. Also, an increase in utilization of VA mental health care services was found to be associated with a higher level of readiness for change [ 259 ].…”

Psychosocial approaches to improving the military-to-civilian transition process.

“…While the VA has actively promoted the promulgation of evidence-based treatment for mental health concerns, more needs to be known about access and engagement in these treatment offerings for OEF/OIF/OND veterans. Fleming, Kholodkov, Dilon, Belvet, and Crawford (2018) provide keen insight into treatment participation in evidence-based psychotherapy for PTSD for returning veterans. In their study of 124 veterans enrolled in a PTSD clinic, therapy participation was found to be highest when therapy was engaged within 68 days of initial orientation session, when veterans acknowledged the need for help, and when there was a presence of traumatic brain injury.…”