Do patients drop out prematurely from exposure therapy for PTSD?

Hembree, Elizabeth A.; Foa, Edna B.; Dorfan, Nicole M.; Street, Gordon P.; Kowalski, Jeanne; Tu, Xin

doi:10.1023/b:jots.0000004078.93012.7d

Cited by 451Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

Do patients drop out prematurely from exposure therapy for PTSD?

Hembree, Elizabeth A., Foa, Edna B., Dorfan, Nicole M., Street, Gordon P., Kowalski, Jeanne, Tu, Xin·2003·Journal of Traumatic Stress

DOI 10.1023/b:jots.0000004078.93012.7d

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Abstract

Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic post-traumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and EMDR. These findings are consistent with previous research about the tolerability of exposure therapy.

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Dropout rates appear similar across PE, CPT, and trauma-focused CBT.
“One common concern with trauma-focused treatment is dropout and rates of dropout appear to be similar across PE, CPT and trauma-focused CBT (Hembree et al., 2003).”
From Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions (2018) · cites this paper as Hembree et al., 2003
Exposure therapy is effective and safe and does not produce higher dropout rates than other forms of therapy.
“it has been demonstrated that exposure therapy is effective and safe and it does not produce higher dropout rates than other forms of therapy [21]”
From In Vivo versus augmented reality exposure in the treatment of small animal phobia: A randomized controlled trial (2016) · cites this paper as [21]
Dropout rates from PE are approximately 30% across populations and treatment settings.
“Dropout rates are approximately 30% across populations and treatment settings (Bradley et al., 2005; Eftekhari et al., 2013; Hembree et al., 2003)”
From Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial (2018) · cites this paper as Hembree et al., 2003

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Authors: Hembree, E. A., Foa, E. B., Dorfan, N. M., Street, G. P., Kowalski, J., & Tu, X.
Affiliations: University of Pennsylvania (US)
Johns Hopkins University (US)
Corresponding author: Hembree, Elizabeth A.
ORCID: Hembree, Elizabeth A.
Foa, Edna B.
Dorfan, Nicole M.
Kowalski, Jeanne
Tu, Xin
Venue: Journal of Traumatic Stress
Publisher: Wiley
Published: 2003-12
Volume: 16
Issue: 6
Pages: 555-562
ISSN: 0894-9867 (ISSN-L)
1573-6598
DOI: 10.1023/b:jots.0000004078.93012.7d
OpenAlex: W1964160811
Cited by: 451
References: 56
Citations by year: 2026: 5 · 2025: 9 · 2024: 10 · 2023: 18 · 2022: 16 · 2021: 22 · 2020: 20 · 2019: 41 · 2018: 19 · 2017: 18 · 2016: 25 · 2015: 41 · 2014: 34 · 2013: 37 · 2012: 30
FWCI: 1.27
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 577 d)
Locations: Journal of Traumatic Stress (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: post-traumatic stress disorder, exposure therapy, treatment discontinuation, treatment tolerability, cognitive behavioral therapy, stress inoculation training, EMDR, cognitive therapy, psychotherapy outcome
MeSH terms: Humans, Patient Dropouts, Psychotherapy, Stress Disorders, Post-Traumatic, Treatment Outcome

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Do patients drop out prematurely from exposure therapy for PTSD?

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