Cited by 264Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials

Cooper, Andrew A., Conklin, Laren R.·2015·Clinical Psychology Review

DOI 10.1016/j.cpr.2015.05.001

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Abstract

Dropout from mental health treatment poses a substantial problem, but rates vary substantially across studies and diagnoses. Focused reviews are needed to provide more detailed estimates for specific areas of research. Randomized clinical trials involving individual psychotherapy for unipolar depression are ubiquitous and important, but empirical data on average dropout rates from these studies is lacking. We conducted a random-effects meta-analysis of 54 such studies (N=5852) including 80 psychotherapy conditions, and evaluated a number of predictors of treatment- and study-level dropout rates. Our overall weighted dropout estimates were 19.9% at the study level, and 17.5% for psychotherapy conditions specifically. Therapy orientation did not significantly account for variance in dropout estimates, but estimates were significantly higher in psychotherapy conditions with more patients of minority racial status or with comorbid personality disorders. Treatment duration was also positively associated with dropout rates at trend level. Studies with an inactive control comparison had higher dropout rates than those without such a condition. Limitations include the inability to test certain potential predictors (e.g., socioeconomic status) due to infrequent reporting. Overall, our findings suggest the need to consider how specific patient and study characteristics may influence dropout rates in clinical research on individual therapy for depression.

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Kvam, T.-M., Goksøyr, I. W., Rog, J., van de Vooren, I.-T. J., Stewart, L. H., Autran, I., Berthold‐Losleben, M., Mørch-Johnsen, L. E., Holst, R., Røssberg, J. I., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.11.030 · Cited by 4
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“Another study similarly reported a positive relationship between personality disorders and dropouts (Cooper & Conklin, 2015), while others have found no evidence of such an association (Goddard et al., 2015; Snoek et al., 2021).”
Who Benefits from Acute Psychiatric Home Treatment? A Systematic Review
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“…younger age, unemployment, belonging to an ethnic minority, being single, and being diagnosed with a personality disorder were associated with poorer treatment outcomes of psychological treatment in an outpatient setting (Cooper & Conklin, 2015; Delgadillo et al., 2016; Lutz et al., 2021).”
Background
KETO-MOOD: Ketogenic Diet for Microbiome Optimization and Overcoming Depression: A Protocol for a Randomized Controlled Trial
Hongler, K., Lounici, A., Maurer, E., Lanz, U., Szathmári, O., Reuter, Y., Nussbaum, S., Steinborn, I., Haedrich, A., Mölling, M. A., et al. (2024) · NeuroImmunoModulation · doi:10.1159/000542979 · Cited by 6
“Considering dropout rates, typically around 20% for behavioral interventions [72, 73], 30% for drug treatments [74 – 76], and up to 35% for short-term ( ≤ 3 months) ketogenic diet interventions [77], a ﬁ nal sample size estimation of 43 participants per treatment arm, or a total of n = 86…”
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Miles, S., Brown, G. P., Corfe, A., Hallett, C., Wingrove, J., Wheatley, J., & Veale, D. M. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.12.008 · Cited by 4
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Machado, R. D. S., Vieira, I. S., Mondin, T. C., Scaini, C. R., Molina, M. L., Jansen, K., Souza, L. D. D. M., Duarte, M. R., Simjanoski, M., & da Silva, R. A. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2693 · Cited by 4
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“More broadly, dropout rates of 26.2 % have been reported across CBT studies with child and adult populations [88], 17.5 % across RCTs of psychotherapy for depression [89], and 16 % across RCTs of psychological therapies for PTSD [90].”
Influential
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“Additionally, future longitudinal research should examine the retention of racial/ethnic minority clients in therapy with therapists of different identities, as racial/ethnic minority individuals are more likely to drop out of treatment prematurely than White individuals (Cooper & Conklin, 2015).”
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“Dropout rates from psychotherapy studies have been estimated to be at around 20% (Cooper & Conklin, 2015).”
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Schneeberger, M., Ehlert, U., Eggenberger, L., Seidler, Z. E., Wilson, M., Fisher, K., & Walther, A. (2023) · doi:10.31234/osf.io/afbd6 · Cited by 3
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“5,6 Premature treatment termination includes patients who have unilaterally decided to discontinue treatment before the problems for which they sought treatment improve, as well as patients who are unable to continue treatment due to external circumstances.”
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“More-over, many patients who obtain care discontinue pre-maturely [19–22], while those who complete treatment often receive care that falls short of adequate standards [15, 23–27].”
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Mikola, T., Lehto, S. M., Tolmunen, T., Honkalampi, K. M., Valkonen‐Korhonen, M., Laukkanen, V., Pakarinen, M., Koivumaa-Honkanen, H. T., & Ruusunen, A. A. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121709 · Cited by 2
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“Thedrop-out rate for this study was 14.2%, which is lower than previous studies in research with police of ﬁ cers at around 20% (Fitzhugh et al., 2019), and lower to clinical samples in the psychotherapy literature which are around 17% (Cooper and Conklin, 2015).”
Influential
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“Based on Cooper and Conklin, we assume a non-negligible dropout rate [40].”
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Surgenor, P. W. G., Meehan, V., & Moore, A. (2016) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2015.1134766 · Cited by 2
“The current lack of knowledge and associated risk of early therapy attrition for suicidal clients has been highlighted in recent research (Cooper & Conklin, 2015).”
BackgroundMethod
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Acosta, F. J., Ramallo‐Fariña, Y., Ruiz, L., Gómez, S., Hernández, A. N. G., Quesada, I., Lastra, C., & Calviño, M. J. (2019) · Journal of Mental Health · doi:10.1080/09638237.2019.1581346 · Cited by 3
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“Furthermore, studies indicate that there are high dropout rates from both psychological and medication treatments for depression that interfere with treatment effectiveness.(9,10) Thus, the needs of individuals suffering from depression are not being adequately met.”
Background
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Rushia, S. N., Schiff, S., Egglefield, D. A., Motter, J. N., Grinberg, A., Saldana, D. G., Shehab, A. A. S., Fan, J., & Sneed, J. R. (2020) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20200014 · Cited by 2
“05, two-tailed) with 20% attrition (a reasonable estimate based on our previous study [60] and consistent with dropout rates in psychotherapy RCTs [102]) would require a total sample of 195 or 65 per group.”
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“For example, inactive control arms are associated with significantly higher rates of attrition compared to psychological placebos (Cooper & Conklin, 2015).”
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“Given an expected attrition rate of 20% owing to dropouts and loss of data (Cooper & Conklin, 2015), a final sample of 61 participants was recruited.”
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“This expectation accords with the finding that patients with personality disorders drop out of therapy at high rates (Cooper & Conklin, 2015).”
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“Even in the most rigorously controlled research settings — with carefully selected, relatively uncomplicated patient samples — psychotherapy dropout rates average 15 – 20% (5, 6) and vary dramatically by condition, from approximately 16% for PTSD to over 50% for personality disorders (7, 8).”

Authors: Cooper, A. A., & Conklin, L. R.
Affiliations: Case Western Reserve University (US)
Boston University (US)
Corresponding author: Cooper, Andrew A.
ORCID: Cooper, Andrew A.
Conklin, Laren R.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2015-08
Volume: 40
Pages: 57-65
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2015.05.001
OpenAlex: W243214355
Cited by: 264
References: 56
Citations by year: 2026: 35 · 2025: 32 · 2024: 30 · 2023: 30 · 2022: 29 · 2021: 24 · 2020: 25 · 2019: 9 · 2018: 18 · 2017: 14 · 2016: 11 · 2015: 4
FWCI: 2.23
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Funders: Social Sciences and Humanities Research Council of Canada
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: treatment discontinuation, individual psychotherapy, major depressive disorder, predictors of dropout, personality disorders, treatment duration, psychotherapy research
MeSH terms: Major Depressive Disorder, Humans, Patient Dropouts, Psychotherapy, Randomized Controlled Trials as Topic

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Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials

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