Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans.

Abstract

Cognitive-behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts (n ϭ 79) and completers (n ϭ 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and age as unique but modest predictors of dropout.

Feasibility and Acceptability of a Brief Mindfulness Program for Veterans in Primary Care with Posttraumatic Stress Disorder

“…Fifty-six percent of participants randomized to the PC-bMP condition attended at least one session, and 80 % of this subsample completed treatment. To put this in context, historically, dropout rates from PTSD treatments are reported to be around 50 % (Schottenbauer et al 2008); one study reported that 68 % of veterans dropped out of treatment in a VA PTSD clinic (Garcia et al 2011). In one VA clinic, 151 of 365 eligible patients (41 %) who were referred to an existing MBSR orientation session attended that session (Kearney et al 2012) and 74 % of 92 veterans who enrolled in their uncontrolled study of standard MBSR subsequently met their definition of completion (attended ≥4 of 9 total group sessions).…”

Predictors of Length of Stay Among OEF/OIF/OND Veteran Inpatient PTSD Treatment Noncompleters

“…Regrettably, high rates of treatment discontinuation are found in the Veterans Affairs Medical Centers (VAMCs) outpatient (38-68%; Garcia, Kelley, Rentz, & Lee, 2011;Gros, Yoder, Tuerk, Lozano, & Acierno, 2011) and residential EBT programs targeting OEF/OIF/OND veterans with PTSD (11%; Chard et al, 2011). Attrition directly inhibits veterans' ability to refine, crystallize, and implement therapeutic skills, thus diminishing the chances of symptom reduction.…”

“…Demographic predictors of attrition from outpatient EBTs for PTSD include male gender (van Minnen Arntz, & Keijsers, 2002), younger age (Garcia et al, 2011), and African American race (Lester, Artz, Resick, & Young-Xu, 2010). Lower intelligence and less education have also been linked to early termination from outpatient EBTs (Rizvi et al, 2009).…”

“…Lower intelligence and less education have also been linked to early termination from outpatient EBTs (Rizvi et al, 2009). Higher PTSD symptom severity, problematic personality characteristics (Garcia et al, 2011), psychiatric comorbidity (Lu, Duckart, O'Malley, & Dobscha, 2011), and high alcohol use are clinical variables often related to attrition from outpatient EBTs for PTSD within veteran populations (van Minnen et al, 2002). Conversely, benzodiazepine use, although contraindicated for PTSD treatment (Abrams, Lund, Bernardy, & Friedman, 2013), is related to outpatient EBT completion, but no relationship has been found between depression and treatment discontinuation or completion (van Minnen et al, 2002).…”

Theatre as a treatment for posttraumatic stress in military veterans: Exploring the psychotherapeutic potential of mimetic induction

“…A second concerning trend involves the discouragingly high attrition rates for veterans in clinical treatment settings. The latest findings indicate that up to 68% of veterans drop out of clinical treatment for posttraumatic stress (Garcia, Kelley, Rentz, & Lee, 2011;Gros, Yoder, Tuerk, Lozano, & Acierno, 2011). There is thus a need to develop and implement innovative treatment models for THEATRE AND TRAUMATIC STRESS IN MILITARY VETERANS 4 traumatic stress that are more accessible and welcoming to a range of traumatized veterans, including those who are reluctant to adhere to conventional illness-based treatment approaches.…”