The DOI matches its Crossref record; 56 of the 56 references it cites were found in a registry or an index.
Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“A more focused meta-analysis reviewing only individual psychotherapy for major depression found a similar drop-out rate of 19.9% (Cooper & Conklin, 2015).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Cooper & Conklin, 2015
In the citing paper
“First, Copper and Conklin found an increased attrition risk of 23.5% from trials involving an inactive control condition (which is relevant to Phases I and II of our data here).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Cooper & Conklin, 2015
Citations
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799
(2000) · Cited by 9,198
Toward the future of psychiatric diagnosis: the seven pillars of RDoC
Cuthbert, B. N., & Insel, T. R. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-126 · Cited by 3,053
Transformations Related to the Angular and the Square Root
Freeman, M. F., & Tukey, J. W. (1950) · The Annals of Mathematical Statistics · doi:10.1214/aoms/1177729756 · Cited by 2,634
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009
The Handbook of Research Synthesis.
Light, R. J., Cooper, H., & Hedges, L. V. (1994) · Journal of the American Statistical Association · doi:10.2307/2291021 · Cited by 1,880
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., et al. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.4.658 · Cited by 1,607
George, S., Duran, N., & Norris, K. (2014) · American Journal of Public Health · doi:10.2105/ajph.2013.301706 · Cited by 1,603
Jones, H. E. (2010) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2010.01108.x · Cited by 1,447
Flagged first, then by citations
Research works printed but not linked: 1
- Higgins, 2011, Chapter eight: Assessing risk of bias in included studies
Cited by
Sorted by citations
Items 201–261 of 261
Open Science and Clinical Psychology
Linthicum, K. P., Southward, M. W., & Schleider, J. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00165-5 · Cited by 2
Lee, J., Ford, C. G., McCluskey, D. L., Hopkins, P. D., McNeil, D. W., & Shook, N. J. (2021) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-021-09938-4 · Cited by 1
Terminación Prematura en Psicoterapia y Características de los Pacientes: un estudio empírico
Santángelo, P. R., Conde, K., & Mattiello, M. E. (2022) · Revista de Psicoterapia · doi:10.33898/rdp.v33i123.35623 · Cited by 1
Saulnier, K. G., Panaite, V., Ganoczy, D. A., Kim, H. M., Zivin, K., Hofer, T. P., Piette, J. D., & Pfeiffer, P. N. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.10.008 · Cited by 1
Hawighorst, A., Knight, M. J., Fourrier, C., Sampson, E., Hori, H., Cearns, M., Jörgens, S., & Baune, B. T. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115590 · Cited by 1
Nelson, B. W., Peiper, N. C., Aschbacher, K., & Forman‐Hoffman, V. L. (2024) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001319 · Cited by 1
“(19).”
Aunon, F. M., Ingram, P. F., Wolkowicz, N. R., Martino, S., Kacos, H. N., Spana, E., Honsberger, M., Rielage, J. K., Doran, N., Carretta, R. F., et al. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.70000 · Cited by 1
Short-Form Psychoeducation Videos: Process Development Study
Turtle, L., Wesson, H., Williamson, S., & Hodson, N. (2024) · JMIR Formative Research · doi:10.2196/66884
“[13,14].”
Fonzo, G. A., Doss, M. K., & Nemeroff, C. B. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20250247 · Cited by 1
Complex Cases of Comorbid Depression and Personality Disorder (PD)
Veluri, R., & Nguyen, V. P. K. H. (2018) · Springer eBooks · doi:10.1007/978-3-319-70311-4_13 · Cited by 1
Mütze, K., Witthöft, M., & Bräscher, A. (2020) · Verhaltenstherapie · doi:10.1159/000509233 · Cited by 1
Macroeconomia - capítulo II - o balanço de pagamentos
Simonsen, M. H., & Cysne, R. P. (1985) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · Cited by 1
Nelson, B. W., Peiper, N. C., Aschbacher, K., & Forman‐Hoffman, V. L. (2021) · doi:10.31219/osf.io/2nmdt · Cited by 1
Nelson, B. W., Peiper, N. C., Aschbacher, K., & Forman‐Hoffman, V. L. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3946987 · Cited by 1
Feasibility of acceptance-based health coaching targeting food cravings in pregnancy
Blau, L. E. (2021) · doi:10.54014/xev4-bzas · Cited by 1
Thompson, J. S., Kiefer, R., Diehl, J. M., & Zimmerman, M. (2020) · Annals of Clinical Psychiatry · doi:10.12788/acp.0011
Marsico, G. (2020) · Psycho-Oncologie · doi:10.3166/pson-2020-0123
Personalized treatment strategies for depression
van Bronswijk, S. C. (2020) · Research Publications (Maastricht University) · doi:10.26481/dis.20201211sb
Digital interventions to enhance readiness for psychological therapy: A scoping review (Preprint)Preprint
Jardine, J., Bowman, R., & Doherty, G. J. (2022) · doi:10.2196/preprints.37851
Tekrarlama Krizi ve Psikoterapi Etkililik Çalışmaları
Türkarslan, K. K. (2022) · Psikoloji Çalışmaları / Studies in Psychology · doi:10.26650/sp2021-959170
Paradoxical nature of narrative in analytical psychotherapy
Hatanaka, C., Kawai, T., Tanaka, Y., Konakawa, H., Suzuki, Y., & Makian, N. (2022) · Innovation The European Journal of Social Science Research · doi:10.1080/13511610.2022.2070135
“There is a growing belief that empirical research should be conducted in psychotherapy as well, and some challenging research has been conducted (Cooper and Conklin 2015; Faramarzi, Yazdani, and Barat 2015; Hamilton et al. 2000; Stamm et al. 2020).”
BackgroundSmith, E., Brooks, C. P., Clifford, E., Giles, E., Dring, J. A. E., & Startup, H. M. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000339
“These rates compare with Axis 1 drop-out rates of 17.5% in psychological therapy for depression (Cooper and Conklin, 2015) and 16.9% for generalised anxiety disorder (Gersh et al., 2017).”
ResultInfluentialJensen, I. (2022) · eDiss (Georg-August-Universität Göttingen) · doi:10.53846/goediss-9601
Talebi, M., Nemati, A., Gholami, M., & Niroumand, S. (2023) · Research Square · doi:10.21203/rs.3.rs-2557703/v1
Talebi, M., Nemati, A., Gholami, M., & Niroumand, S. (2023) · Research Square · doi:10.21203/rs.3.rs-2557703/v2
Talebi, M., Niroumand, S., Gholami, M., Samarghandi, A., & Nemati, A. (2023) · Research Square · doi:10.21203/rs.3.rs-3255221/v1
All Things Must Pass: Termination of Services in Behavior Analysis
Green, K., Lewon, M., Lewon, A. B., & Ghezzi, P. M. (2023) · Behavior Analysis in Practice · doi:10.1007/s40617-023-00854-5
“…1999; Hatchett & Park, 2003; Kazdin et al., 2006) and various consumer characteristics (e.g., attendance, reasons for seeking treatment, diagnosis; Cooper & Conklin, 2015; de Haan et al., 2013; Gersh et al., 2017; Jung et al., 2013; Linardon et al., 2018) as predictors of either continuation or…”
Budge, S. L., Tebbe, E. A., Lee, J., Dominguez, S., Matsuno, E. G., & Lindley, L. M. (2024) · doi:10.2196/preprints.64477
Digital Interventions for Bipolar Disorder
Enrique, Á., Akkol‐Solakoglu, S., Matthews, M. L., & Richards, D. (2024) · Springer eBooks · doi:10.1007/978-3-031-63349-2_10
Najera, R. C., & Benuto, L. T. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.03.001
Sowa, N. A., & Zeng, X. (2025) · Psychiatric Quarterly · doi:10.1007/s11126-025-10129-7
“Prior studies have shown that approximately 19% of patients leave psychotherapy treatment early, although there has been a wide range of rates reported [30, 31].”
Thompson, J. S., Kiefer, R., Diehl, J. M., & Zimmerman, M. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200301
Therapist Readiness To Address Perinatal Mental Health
Rizan, B. F., & Thomas, J. (2025) · Clinical Social Work Journal · doi:10.1007/s10615-025-01014-8 · Cited by 1
Laing, J., McKinnon, A. I., Creswell, C., Ehlers, A., & Wild, J. (2025) · Trials · doi:10.1186/s13063-025-09341-4
“The 15% attrition estimate was based on dropout rates of similar trials and studies reporting rates of between 10 and 20% [37, 41–47].”
Gellert, P., Beyer, A.-K., Tegeler, C., Vathke, C., Nordheim, J., Kuhlmey, A., & Kessler, E.-M. (2021) · Figshare · doi:10.6084/m9.figshare.13655302
Caydı, S., Batmaz, S., & Erdil, İ. E. G. (2026) · Current Psychology · doi:10.1007/s12144-026-09083-9 · Cited by 1
“Although this rate exceeds average dropout rates reported in psycho-therapy meta-analyses (Cooper & Conklin, 2015; Imel et al., disasters when survivors may be geographically dispersed or dealing with disrupted infrastructure.”
Kalde, J., Atik, E., Stricker, J., Schückes, M., Neudeck, P., Abel, P., Hollank, J., Pittig, A., & Pietrowsky, R. (2026) · Psychotherapy and Psychosomatics · doi:10.1159/000550820
Liu, M., Du, J., Cheng, C., Peng, D., & Mao, Q. (2026) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.70041
“…of participants in each group was pre-specified during prospective registration, the current study, like Hallford et al. (2023), conducted substantial oversampling at the baseline stage due to the high dropout rate of depression psychotherapy in randomized clinical trials (Cooper & Conklin, 2015).”
Kirk, A., King, C. S., Gallop, R., Doan, B. D., Rowe, L. S., Rivera, M., & Randa, L. E. (2026) · doi:10.2196/preprints.92448
Considerations for Counselors Working With Black Males in Career Development
Owens, D. L., Middleton, T. J., & Carter, D. (2026) · Emerald Group Publishing Limited eBooks · doi:10.1108/s2051-231720260000010002
Copeland, D. I., Giollabhui, N. M., Foster, S. L., Arnold, C., Wu, Y. ”., Raslan, H., Lind, S., Nagaswami, M. V., Streeter, C. C., Uebelacker, L. A., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121647
Li, W., Huang, J., Song, C., Jing, D., Fu, Z., & Wang, J. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100939
“%) was slightly lower than the average for self-guided interventions (Karyotaki et al., 2017a, 2017b), likely supported by brief reminders and small financial incentives, which have previously been shown to enhance adherence (Cooper and Conklin, 2015).”
Opper, F., Henges, S., Weinstein, P., Arnheim, D., Fässler, L., du Sert, O. P., Stefaniak, I., Sabé, M., Glenthøj, L. B., Thomas, N., et al. (2026) · BJPsych Open · doi:10.1192/bjo.2026.11014
“43 The criteria for having finished a treatment followed that of each study.”
Roca, P., Sanchez-Pedreño, M., Noheda, S., Ramírez-Riveros, E., Martín-Azañedo, C., Martínez‐Zaragoza, F., Zangri, R. M., del Valle, E. P. G., León‐García, M., Gravholt, D. L., et al. (2026) · APUNTES DE PSICOLOGÍA · doi:10.70478/apuntes.psi.2026.44.08
Kirk, A., King, C. S., Gallop, R., Doan, B. D., Rowe, L. S., & Randa, L. E. (2026) · JMIR Human Factors · doi:10.2196/92448
“In addition, the 100% retention rate also speaks to the acceptability and engagement of the treatment itself, given that treatment retention is often an issue both in research [65] and clinical [66] settings.”
Promoting Treatment Engagement in Cognitive Behavioral Therapy
Strunk, D. R., Brouder, L. M., & Provolo, N. (2026) · CBT: science into practice · doi:10.1007/978-3-032-05191-2_12
The Richards Trauma Process: a before-after single-arm feasibility trial of a novel psychotherapy
Barson, P., MacIsaac, P., Sanci, L., Temple-Smith, M. J., Trevena, J. A., Laughlin, A., & Chondros, P. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-026-01856-0
“We anticipated that 50% of new clients would consent to the study, and 75% of those would complete the study [53, 57–60], hence to achieve a sample size of 20 participants who complete the study we would need to approach 54 individuals, to recruit 27 who agree to the study.”
Service Parameters in Treatment of Perinatal Depression in Mothers with Low Incomes
Ammerman, R. T., Messer, E. P., Mara, C. A., Zion, C., Folger, A. T., & Frey, J. R. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10757-8
Bisby, M. A., Fisher, A. C., Jervis, N., Gandy, M., Chandra, S. S., Heriseanu, A. I., Hathway, T., Correa, A. B., Titov, N., & Dear, B. F. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2689743
Kaittila, A., Isoniemi, H., Viitasalo, K., Moisio, M., Toikka, E., Raijas, A., Tuominen, J., Kraav, S., Pursiainen, T., Kaitsaari, T., et al. (2026) · Child & Family Social Work · doi:10.1111/cfs.70225
Horton, D. M., Shi, G., Davis, M. A., Grau, P. P., & Kilbourne, A. M. (2026) · Journal of Traumatic Stress · doi:10.1002/jts.70111
“These dropout rates, while comparable to rates of psychotherapy dropout in other conditions (Cooper & Conklin, 2015; Swift & Greenberg, 2014), are a major concern in the current PTSD treatment landscape.”
Bremer-Hoeve, S., van Bronswijk, S. C., Beekman, A. T. F., Miggiels, M. F., Bruijniks, S. J. E., & van Dijk, M. K. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70320
Werneck, A. O., Stubbs, B., Schwefel, M., Henze, R., Heinzel, S., & Heißel, A. (2026) · Mental health and physical activity · doi:10.1016/j.mhpa.2026.100819
Identifying Patients at Risk for Psychotherapy Dropout in Community Settings
Giber, B., Sharma, A., Broadie, D., McCoy, T. H., Gunning, F. M., Perlis, R. H., Doshi‐Velez, F., & Solomonov, N. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.31565
The Role of Mindfulness and Contrast Avoidance in Individuals' Attitudes Toward Psychotherapy
Eken, F. O., Kahraman, S., & Balkan, İ. (2026) · Cukurova University Faculty of Education Journal · doi:10.14812/cuefd.1850737
Ghai, S., Cavallo, S., Gervais, M.-J., & Zidarov, D. (2026) · JMIR Formative Research · doi:10.2196/98632
“Third, participants in the control group may have found it challenging to adhere to the study protocol if they did not perceive direct benefits, leading them to seek alternative treatments outside the study [71].”
McGlynn, K., & Smith, E. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70219
Riper, H. M., Kleiboer, A. M., Hoogendoorn, A. W., Bosmans, J. E., Schulte, M. H. J., Mathiasen, K., Hazo, J., Holtzmann, J., Chevreul, K., Ebert, D. D., et al. (2026) · Interactive Journal of Medical Research · doi:10.2196/72866
“%) was comparable with the average dropout reported in randomized trials of individual psychotherapy for depression in routine care [72], whereas the higher attrition at 12 months is consistent with the challenges of maintaining participant engagement during long-term follow-up.”
Stefana, A., Damiani, S., Barlati, S., Bortolin, E., Cimberle, M., Cruciani, N., D'Imperio, A., Rovida, M., Stefanelli, R., & Fusar‐Poli, P. (2026) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2026.2741177
Hirschbeck, A., Kossmann, D., Scheidler, C., Khorikian–Ghazari, N., Hasan, A., & Roeh, A. (2026) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2026.2746731
Metadata
- Authors
- Cooper, A. A., & Conklin, L. R.
- Affiliations
- Case Western Reserve University (US)
- Boston University (US)
- Corresponding author
- Cooper, Andrew A.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 40
- Pages
- 57-65
- ISSN
- 0272-7358 (ISSN-L)
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
