Personality predicts drop-out from therapist-guided internet-based cognitive behavioural therapy for eating disorders. Results from a randomized controlled trial

Abstract

Internet-based guided self-help cognitive behavioural therapy (ICBT) seems a promising way of delivering eating disorder treatment. However, treatment drop-out is a common problem and little is known about the correlates, especially in clinical settings. The study aimed to explore prediction of drop-out in the context of a randomized controlled trial within specialized eating disorder care in terms of eating disorder symptomatology, personality traits, comorbidity, and demographic characteristics. 109 outpatients diagnosed with bulimia nervosa or similar eating disorder were randomized to two types of ICBT. Participants were assessed with several clinical- and self-ratings. The average drop-out rate was 36%. Drop-out was predicted by lower scores in the personality traits Dutifulness and Assertiveness as measured by the NEO Personality Inventory Revised, and by higher scores in Self-affirm as measured by the Structural Analysis of Social Behaviour. Drop-out was also predicted by therapist factors: one therapist had significantly more drop-outs (82%) than the other three (M = 30%). Theoretical and clinical implications of the impact of the predictors are discussed.

Take charge: Personality as predictor of recovery from eating disorder

“…As expected, Conscientiousness positively predicted outcome from iCBT. A study on risk of dropout from iCBT for eating disorders supports this, as it found Dutifulness, a facet of Conscientiousness, to be protective of dropout (Högdahl, Levallius, Björck, Norring, & Birgegård, 2016). A concept that has been regarded as related to Conscientiousness is perfectionism, the latter an established risk-factor for developing an eating disorder (Culbert et al, 2015).…”

“…After minimal training in CBT, I was active as therapist in both treatments. Of the four therapists conducting iCBT, I had the highest dropout rate (Högdahl et al, 2016).…”

Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research

“…A study of internet-based guided self-help found that lower scores in the personality traits of dutifulness and assertiveness and higher scores for self-affirmation best predicted drop-out 62. However, more work is needed to establish whom bibliotherapy might best target,63 especially as self-help interventions move from the traditional book to online or combined formats, some with multimedia, discussion forum and mobile components 64–66.…”

Dropping out of a transdiagnostic online intervention: A qualitative analysis of client's experiences

“… Johansson et al, 2015 ). To date, the most common approach used in the research on IBT dropout has been based on quantitative methodologies, particularly regarding the study of predictors (e.g., Alfonsson et al, 2016 , Högdahl et al, 2016 , Karyotaki et al, 2015 , Melville et al, 2010 ).…”