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

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Meta-analysis of dropout in treatments for posttraumatic stress disorder

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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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“S2 for CONSORT diagram), whereas exposure-based treatments often result in high dropout rates of up to 40% (Imel et al., 2013).”
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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: Imel, Zac E.
Jakupcak, Matthew
Simpson, Tracy L.
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: green
www.ncbi.nlm.nih.gov
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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