Systematic review and meta-analysis of dropout rates in individual psychotherapy for generalized anxiety disorder
Open accessAbstract
Background Despite being a relatively prevalent and debilitating disorder, Generalized Anxiety Disorder (GAD) is the second least studied anxiety disorder and among the most difficult to treat. Dropout from psychotherapy is concerning as it is associated with poorer outcomes, leads to service inefficiencies and can disproportionately affect disadvantaged populations. No study to date has calculated a weighted mean dropout rate for GAD and explored associated correlates.Methods A systematic review was conducted using PsycINFO, Medline and Embase databases, identifying studies investigating individual psychotherapies for adults with GAD. Forty-five studies, involving 2224 participants, were identified for meta-analysis.Results The weighted mean dropout rate was 16.99% (95% confidence interval 14.42%-19.91%). The Q-statistic indicated significant heterogeneity among studies. Moderator analysis and meta-regressions indicated no statistically significant effect of client age, sex, symptom severity, comorbidity, treatment type, study type (randomized trial or not), study quality, number of sessions or therapist experience.Conclusions In research investigating psychotherapy for GAD, approximately one in six clients can be expected to drop out of treatment. Dropout rate was not significantly moderated by the client, therapist or treatment variables investigated. Future research should specify the definition of dropout, reasons for dropout and associated correlates to assist the field's progression.
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- Authors
- Gersh, E., Hallford, D. J., Rice, S. M., Kazantzis, N., Gersh, H., Gersh, B., & McCarty, C. A.
- Affiliations
- Seattle Children's Research Institute (US)
- Deakin University (AU)
- The University of Melbourne (AU)
- Monash University (AU)
- University of Washington (US)
- Corresponding author
- Gersh, Elon
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 52
- Pages
- 25-33
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W2763263127
- Cited by
- 82
- References
- 89
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 11 · 2023: 14 · 2022: 12 · 2021: 8 · 2020: 10 · 2019: 7 · 2018: 5 · 2017: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- generalized anxiety disorder, psychotherapy dropout, individual psychotherapy
- MeSH terms
- Adult, Anxiety Disorders, Female, Humans, Male, Patient Dropouts, Psychotherapy, Research Design, Comorbidity
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