Attrition in Psychotherapy

Roseborough, David J.; McLeod, Jeffrey T.; Wright, Florence I.

doi:10.1177/1049731515569073

Cited by 40 publications

(41 citation statements)

References 35 publications

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“…This rate is relatively low compared to other psychotherapy research that usually sees attrition rates closer to 50% (Roseborough et al, 2015). The ACT and control groups had similar rates of attrition, with means of 32.6% (median = 36.1) and 34.2% (median = 38.2), respectively.…”

Section: Study Characteristicsmentioning

confidence: 78%

An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders

Lee

Levin

et al. 2015

Drug and Alcohol Dependence

186

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Section: Study Characteristicsmentioning

confidence: 78%

An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders

Lee

Levin

et al. 2015

Drug and Alcohol Dependence

186

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“…This highlights the importance of finding shorter interventions for treatment of PTSD/SUD. Especially in communities with high rates of poverty and stress and with lower levels of education, the typical length of treatment in many PTSD/SUD interventions may be too long and individuals may receive inadequate “dosing” of therapy [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women

et al. 2019

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An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.

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“…In mental health research, survival analysis has been used to examine therapist turnover [e.g., Ref. ( 29 )] and client attrition/psychotherapy termination at a clinic [e.g., ( 35 )], but has yet to be harnessed to study EBP sustainment in mental health services. Administrative claims data also provide the opportunity to identify potential factors associated with a sustained EBP delivery.…”

Section: Introductionmentioning

confidence: 99%

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Brookman‐Frazee

Zhan

Stadnick

et al. 2018

Front. Public Health

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Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists’ continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child–Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan–Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists’ first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).

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Attrition in Psychotherapy

Cited by 40 publications

References 35 publications

An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders

An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders

Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

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