Time course of treatment dropout in cognitive–behavioral therapies for posttraumatic stress disorder.

Gutner, Cassidy A.; Gallagher, Matthew W.; Baker, Aaron S.; Sloan, Denise M.; Resick, Patricia A.

doi:10.1037/tra0000062

Cited by 116 publications

(86 citation statements)

References 27 publications

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“…To address current gaps in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Consistent with previous studies (Gutner et al, 2016; McKellar et al, 2006; McMahon et al, 1999; Szafranski et al, 2015), it was hypothesized that the majority of dropout would occur prior to mid-treatment. Younger age (Gros et al, 2011; Mertens & Weisner, 2000), African American race (Lester et al, 2010; Milligan et al, 2004), lower education (Mammo & Weinbaum, 1993; Rizvi et al, 2009), greater concurrent drug use (McKellar et al, 2006; Szafranski et al, 2014), lower income (Galovski, Blain, Mott, Elwood, & Houle, 2012) and higher pretreatment symptom severity (Garcia et al, 2011; McKellar et al, 2006) were expected to predict dropout from treatment.…”

Section: Introductionmentioning

confidence: 55%

“…Findings from previous studies indicate that the vast majority of subjects dropout from PTSD treatment (Gutner, Gallagher, Baker, Sloan, & Resick, 2016; Szafranski, Gros, Menefee, Norton, & Wanner, 2015) and SUD treatment (McKellar, Kelly, Harris, & Moos, 2006; McMahon, Kouzekanani, & Malow, 1999) early on, and before mid-treatment. Studies examining dropout from PTSD treatment show that demographic and clinical predictors of dropout include younger age (Gros, Yoder, Tuerk, Lozano, & Acierno, 2011), male gender (van Minnen Arntz, & Keijsers, 2002), African American race (Lester, Artz, Resick, & Young-Xu, 2010), lower levels of education (Rizvi et al, 2009), higher military rank (Szafranski et al, 2016), greater concurrent drug use (Szafranski, Gros, Menefee, Wanner, & Norton, 2014), lower income (Galovski, Blain, Mott, Elwood, & Houle, 2012), greater disability status and lower social support (Gros, Price, Yuen, & Acierno, 2013), and higher pretreatment symptom severity (Garcia, Kelley, Rentz, & Lee, 2011).…”

Section: Introductionmentioning

confidence: 94%

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Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Szafranski

Snead

Grös

et al. 2017

Addictive Behaviors

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High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout.

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Section: Introductionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 94%

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Szafranski

Snead

Grös

et al. 2017

Addictive Behaviors

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 90%

“…Based on prior findings (e.g., [17,37]), we expect to find significantly lower treatment dropout rates in the WET condition relative to CPT. PTSD treatment dropout remains a substantial problem for trauma-focused treatments, such as CPT and PE [17,21], with approximately one-third of participants dropping out of treatment prematurely. Recent findings indicate that the longer duration of treatment associated with PE and CPT is not the cause for the premature dropout because the majority of individuals dropout early in the course of trauma-focused treatment (e.g., [17]).…”

Section: Discussionmentioning

confidence: 90%

“…PTSD treatment dropout remains a substantial problem for trauma-focused treatments, such as CPT and PE [17,21], with approximately one-third of participants dropping out of treatment prematurely. Recent findings indicate that the longer duration of treatment associated with PE and CPT is not the cause for the premature dropout because the majority of individuals dropout early in the course of trauma-focused treatment (e.g., [17]). Consequently, it is unclear why dropout rates would be substantially lower in WET.…”

Section: Discussionmentioning

confidence: 99%

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Brief treatment for PTSD: A non-inferiority trial

Sloan

Marx

Resick

2016

Contemporary Clinical Trials

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Prior studies have identified several psychosocial treatment approaches as effective for posttraumatic stress disorder (PTSD). Unfortunately, a substantial minority of individuals who receive these treatments drop out prematurely. Moreover, a considerable number of individuals in need of PTSD treatment do not present for treatment due to time constraints and other barriers to care. Thus, there is a need to develop alternative evidence-based PTSD treatments that have lower treatment dropout rates and address current barriers to receiving care. One recently developed PTSD treatment that has demonstrated efficacy and potentially meets these criteria is Written Exposure Therapy (WET), a 5-session treatment protocol that promotes recovery through writing about the trauma event as well as one's thoughts and feelings about it without any assigned homework. In an ongoing randomized controlled trial (RCT) we are investigating whether WET is equally efficacious as Cognitive Processing Therapy (CPT), a treatment that typically requires more therapist training and more therapy sessions. The study sample consists of 126 adults diagnosed with PTSD who are randomly assigned to either WET (n = 63) or CPT (n = 63). Participants are assessed prior to treatment and 6-, 12-, 24-, 36-, and 60-weeks after the first treatment session. The primary outcome measure is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Given the prevalence of PTSD and the aforementioned limitations of currently available first-line PTSD treatments, the identification of a brief, efficacious treatment that is associated with reduced patient dropout would represent a significant public health development.

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Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder

et al. 2022

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IMPORTANCE Posttraumatic stress disorder (PTSD) occurs more commonly among military service members than among civilians; however, despite the availability of several evidence-based treatments, there is a need for more efficient evidence-based PTSD treatments to better address the needs of service members. Written exposure therapy is a brief PTSD intervention that consists of 5 sessions with no between-session assignments, has demonstrated efficacy, and is associated with low treatment dropout rates, but prior randomized clinical trials of this intervention have focused on civilian populations. OBJECTIVE To investigate whether the brief intervention, written exposure therapy, is noninferior in the treatment of PTSD vs the more time-intensive cognitive processing therapy among service members diagnosed with PTSD. DESIGN, SETTING, AND PARTICIPANTSThe study used a randomized, noninferiority design with a 1:1 randomization allocation. Recruitment for the study took place from August 2016 through October 2020. Participants were active-duty military service members diagnosed with posttraumatic stress disorder. The study was conducted in an outpatient setting for service members seeking PTSD treatment at military bases in San Antonio or Killeen, Texas.INTERVENTIONS Participants received either written exposure therapy, which consisted of 5 weekly sessions, or cognitive processing therapy, which consisted of 12 twice-weekly sessions. MAIN OUTCOMES AND MEASURESParticipants were assessed at baseline and at 10, 20, and 30 weeks after the first treatment session. The primary outcome measure was PTSD symptom severity assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Noninferiority was defined as the difference between the 2 groups being less than the upper bound of the 1-sided 95% CI-specified margin of 10 points on the CAPS-5. RESULTSOverall, 169 participants were included in the study. Participants were predominantly male (136 [80.5%]), serving in the Army (167 [98.8%]), with a mean (SD) age of 34 (8) years. Eightyfive participants were randomly assigned to written exposure therapy, with 65 (76.5%) completing all treatment sessions, and 84 to cognitive processing therapy, with 47 (54.8%) completing all treatment sessions. Findings indicated that written exposure therapy was noninferior to cognitive processing therapy, with the largest difference in change in outcome between the treatment conditions of 3.96 points on the outcome measure. The 1-sided 95% CI upper limit was less than 10 (continued) Key Points Question Is a 5-session, traumafocused written exposure therapy treatment noninferior to a more timeintensive, trauma-focused cognitive processing therapy treatment for activeduty service members diagnosed with posttraumatic stress disorder (PTSD)? Findings In this randomized noninferiority clinical trial that included 169 men and women activity-duty service members, written exposure therapy was found to be noninferior to cognitive processing therapy. Dropout rates for written exposure therapy were s...

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Time course of treatment dropout in cognitive–behavioral therapies for posttraumatic stress disorder.

Cited by 116 publications

References 27 publications

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Brief treatment for PTSD: A non-inferiority trial

Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder

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