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Cited by 635Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

Meta-analysis of dropout in treatments for posttraumatic stress disorder

Open access
Imel, Zac E., Laska, Kevin, Jakupcak, Matthew, Simpson, Tracy L.·2013·Journal of Consulting and Clinical Psychology
DOI 10.1037/a0031474PMC PMC3893277
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Abstract

OBJECTIVE: Many patients drop out of treatments for posttraumatic stress disorder (PTSD); some clinicians believe that trauma-focused treatments increase dropout. METHOD: We conducted a meta-analysis of dropout among active treatments in clinical trials for PTSD (42 studies; 17 direct comparisons). RESULTS: The average dropout rate was 18%, but it varied significantly across studies. Group modality and greater number of sessions, but not trauma focus, predicted increased dropout. When the meta-analysis was restricted to direct comparisons of active treatments, there were no differences in dropout. Differences in trauma focus between treatments in the same study did not predict dropout. However, trauma-focused treatments resulted in higher dropout compared with present-centered therapy (PCT), a treatment originally designed as a control but now listed as a research-supported intervention for PTSD. CONCLUSION: Dropout varies between active interventions for PTSD across studies, but variability is primarily driven by differences between studies. There do not appear to be systematic differences across active interventions when they are directly compared in the same study. The degree of clinical attention placed on the traumatic event does not appear to be a primary cause of dropout from active treatments. However, comparisons of PCT may be an exception to this general pattern, perhaps because of a restriction of variability in trauma focus among comparisons of active treatments. More research is needed comparing trauma-focused interventions to trauma-avoidant treatments such as PCT.

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  • The focus of common PTSD interventions on trauma and exposure may lead to low adherence to treatment and high dropout rates.

    “This focus may lead to low adherence to treatment and high dropout rates (Imel et al., 2013; Garcia et al., 2011).”

    From Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial (2022) · cites this paper as Imel et al., 2013

    The Abstract Results report 18% average dropout and higher dropout from trauma-focused treatments than from Present Centered Therapy, which supports the claim as a possibility. But the Abstract Conclusion and Discussion say trauma focus did not generally predict dropout among active treatments; the paper does not establish that this focus causes low adherence. Page numbers were not provided in our copy. (LLM, conf=0.84)

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  • Dropout is lower in present centered therapy (22%) compared to trauma specific treatments (36%) across three relatively large trials.

    “Imel et al. (2013) did find evidence across three relatively large trials that dropout is lower in present centered therapy (PCT; 22%) compared to trauma specific treatments (36%).”

    From Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions (2018) · cites this paper as Imel et al., 2013

  • An increase in trauma focus did not predict an increase in the dropout rate.

    “In addition, an increase in trauma focus did not predict an increase in the dropout rate.”

    From Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions (2018) · cites this paper as Imel et al., 2013

  • The aggregate proportion of dropout across all active PTSD treatments was 18.28%, with large variability across studies.

    “The aggregate proportion of dropout across all active treatments was 18.28%, however, there was a large amount of variability across studies.”

    From Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions (2018) · cites this paper as Imel et al., 2013

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Research works printed but not linked: 2

  1. Schnurr PP Friedman MJ Lavori PW Hsieh FY Design of VA Cooperative Study #420: Group treatment of PTSD Controlled Clinical Trials 2001 22 74 88 11165426
  2. Schnurr PP Friedman MJ Engel CC Foa EB Shea MT Chow BK Resick PA Cognitive behavioral therapy for posttraumatic stress disorder in women Journal of the American Medical Association 2007 297 8 820 830 17327524

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Authors
Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L.
Affiliations
  • University of Utah (US)
  • Edith Nourse Rogers Memorial Veterans Hospital (US)
  • VA Puget Sound Health Care System (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2013
Volume
81
Issue
3
Pages
394-404
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/a0031474
PMC
PMC3893277
OpenAlex
W2136341379
Cited by
633
References
76
Citations by year
2026: 40 · 2025: 53 · 2024: 59 · 2023: 52 · 2022: 60 · 2021: 60 · 2020: 86 · 2019: 61 · 2018: 51 · 2017: 30 · 2016: 34 · 2015: 28 · 2014: 15 · 2013: 2
FWCI
3.89
Type
journal article
Language
en
Update notices
correction (2016-08-15)
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (UL1RR025014)
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, treatment discontinuation, trauma-focused psychotherapy, present-centered therapy, group therapy, number of treatment sessions, medication adherence
MeSH terms
Humans, Patient Dropouts, Psychotherapy, Stress Disorders, Post-Traumatic

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