Pretreatment Attrition in a Comparative Treatment Outcome Study on Panic Disorder

Hofmann, Stefan G.; Barlow, David H.; Papp, Laszlo A.; Detweiler, Michael F.; Ray, Susan; Shear, M. Katherine; Woods, Scott W.; Gorman, Jack M.

doi:10.1176/ajp.155.1.43

Cited by 85 publications

(43 citation statements)

References 13 publications

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“…Recently, it has been reported that patients with PA refuse medication at much higher rates than CT [10]. In the present study, there were no patients who refused randomization because they were unwilling to accept CT.…”

Section: Discussionmentioning

confidence: 52%

Cognitive Therapy by Allocation versus Cognitive Therapy by Preference in the Treatment of Panic Disorder

Bakker

Spinhoven

Balkom³

et al. 2000

Psychother Psychosom

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Background: Little is known about the influence of preference for a given therapy or preference against a modality of treatment on the outcome of that treatment. Results so far have been conflicting. The primary aim of this study was to investigate possible differences in outcome between panic disorder patients treated with preferred cognitive therapy and patients treated by randomization with the same intervention. Methods: A 12-week study comparing 35 patients treated by allocation with 31 patients treated by preference. Results: There were no differences at pretest between the two conditions on demographic or outcome measures. Outcome was assessed with measurements rating the panic frequency and severity of agoraphobia, general anxiety and depression. Both conditions improved significantly on nearly all ratings. There were no significant differences demonstrable between the two conditions on any of the outcome measures. Conclusion: Preference for a given therapy is not a powerful moderator of effect in the psychological treatment of panic disorder.

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Section: Discussionmentioning

confidence: 52%

Cognitive Therapy by Allocation versus Cognitive Therapy by Preference in the Treatment of Panic Disorder

Bakker

Spinhoven

Balkom³

et al. 2000

Psychother Psychosom

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“…This pattern is suggestive of a self-selection bias that may limit interpretation of study findings to those individuals in clinical practice willing to accept novel medications, and exemplifies the importance of including such information in PTSD outcome research. This potential constraint on external validity has been similarly noted in research on other Axis I disorders (Hofmann et al, 1998).…”

Section: Enrollment and Baseline Psychopathology In A Recently Complementioning

confidence: 74%

“…The impact on study validity of pretreatment attrition, or the refusal to participate by potentially eligible participants, has yet to be studied in PTSD outcome research. Efficacy research on other Axis I disorders has revealed self-selection patterns in study enrollment (e.g., differential refusal of medication vs. psychotherapy treatment conditions) that may limit generalization of study findings (Hofmann et al, 1998). Implications for the external validity of PTSD outcome research comparing pharmacotherapy to psychotherapy are addressed below in examination of pretreatment attrition data from the first randomized clinical trial (RCT) of this kind.…”

Section: Attritionmentioning

confidence: 99%

Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples?

2005

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“…If a research study enrollee is assigned to a control condition that appears to be no better than previously received services, the enrollee may enter into the assigned program halfheartedly or refuse services altogether (1,12). Likewise, if study enrollees have to relinquish a current service to participate in an experimental program, they may delay contacting the assigned program or withdraw from project participation (13,14).The present study investigates the impact of preference in experimental condition assignment on study applicants' motivation to enroll in a mental health services research project, engage in assigned services, and pursue the project's targeted outcomes. …”

mentioning

confidence: 99%

Impact of Referral Source and Study Applicants’ Preference for Randomly Assigned Service on Research Enrollment, Service Engagement, and Evaluative Outcomes

Macias¹,

Barreira²,

Hargreaves³

et al. 2005

AJP

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Objective-The inability to blind research participants to their experimental conditions is the Achilles' heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for research participants' preference for one experimental program over another to compromise the generalizability and validity of randomized controlled service evaluations as well as cross-study comparisons.Method-Three Cox regression analyses measured the impact of applicants' service assignment preference on research project enrollment, engagement in assigned services, and a service-related outcome, competitive employment.Results-A stated service preference, referral by an agency with a low level of continuity in outpatient care, and willingness to switch from current services were significant positive predictors of research enrollment. Match to service assignment preference was a significant positive predictor of service engagement, and mismatch to assignment preference was a significant negative predictor of both service engagement and employment outcome.Conclusions-Referral source type and service assignment preference should be routinely measured and statistically controlled for in all studies of mental health service effectiveness to provide a sound empirical base for evidence-based practice.Participants in research on mental health services are rarely blind to their experimental assignments, and so attrition caused by disappointment in service assignment is a wellrecognized risk. Researchers can minimize overall attrition, as well as the threat of differential attrition (1), by screening out applicants with a priori service preferences. However, some applicants may choose not to disclose their preference to ensure that they have a chance to be assigned to a favored program, or they may feel they do not have a personal preference over and above the obvious one posed by the study design. For instance, when the experimental comparison is between a new intervention and services as usual, many applicants may prefer the new program even before they learn much about it.Unfortunately, random assignment will not always equalize preexisting study enrollee characteristics across experimental groups (2), and this will always be the case when study NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript enrollees tend to prefer one service condition over another. Common sense tells us that service assignment preference must first be balanced within the total enrollee group for it to be distributed equitably across experimental conditions. For example, if 60% of enrollees have a preference for condition A and 40% have a preference for condition B, then, with true equivalence across conditions, service A would have 60% pleased and 40% disappointed assignees, while service B would have 40% pleased and 60% disappointed assignees. To the extent that pa...

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Pretreatment Attrition in a Comparative Treatment Outcome Study on Panic Disorder

Abstract: Results from comparative treatment outcome studies are limited not only to people who meet the study criteria but also to those who are willing to begin a medication treatment and discontinue their current medication.

Cited by 85 publications

References 13 publications

Cognitive Therapy by Allocation versus Cognitive Therapy by Preference in the Treatment of Panic Disorder

Cognitive Therapy by Allocation versus Cognitive Therapy by Preference in the Treatment of Panic Disorder

Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples?

Impact of Referral Source and Study Applicants’ Preference for Randomly Assigned Service on Research Enrollment, Service Engagement, and Evaluative Outcomes

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