Cited by 167Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessMedication Adherence and Compliance

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

Swift, Joshua K., Greenberg, Roger P., Tompkins, Kelley A., Parkin, Susannah R.·2017·Psychotherapy

DOI 10.1037/pst0000104

Open this paper in CoChat — free account

Abstract

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record

Integrity signals

Registry

Crossref · 10.1037/pst0000104

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

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?

CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371
Crossing the Quality Chasm: A New Health System for the 21st Century
Baker, A. (2001) · BMJ · doi:10.1136/bmj.323.7322.1192 · Cited by 10,779
Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61611-6 · Cited by 6,006
Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-113 · Cited by 3,292
Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis
Walker, E. R., McGee, R. E., & Druss, B. G. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2502 · Cited by 2,976
The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014) · Psychological Science in the Public Interest · doi:10.1177/1529100614531398 · Cited by 1,642
Dropping out of treatment: A critical review.
Baekeland, F., & Lundwall, L. K. (1975) · Psychological Bulletin · doi:10.1037/h0077132 · Cited by 1,122
A meta-analysis of psychotherapy dropout
Wierzbicki, M., & Pekarik, G. (1993) · Professional Psychology: Research and Practice · doi:10.1037/0735-7028.24.2.190 · Cited by 1,118
Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.
Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0013075 · Cited by 1,050
Premature discontinuation in adult psychotherapy: A meta-analysis
Swift, J. K., & Greenberg, R. P. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028226 · Cited by 978 · cited 7×
“Providers should also make sure they are aware of situations when premature termination may be more likely, such as with younger clients, with time-unlimited interventions, and in university-based settings (Swift & Greenberg, 2012).”
BackgroundMethodResultInfluentialSelf-citation

Show all 45 references

Sorted by citations

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses
Monteleone, A. M., Pellegrino, F., Croatto, G., Carfagno, M., Hilbert, A., Treasure, J. L., Wade, T. D., Bulik, C. M., Zipfel, S., Hay, P., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104857 · Cited by 326
The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward
Lipschitz, J. M., Pike, C. K., Hogan, T. P., Murphy, S. A., & Burdick, K. E. (2023) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-023-00297-3 · Cited by 241
Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder
Merz, J., Schwarzer, G., & Gerger, H. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0951 · Cited by 178
RETRACTED ARTICLE: Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials
Jerome, L., Feduccia, A. A., Wang, J. B., Hamilton, S., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2020) · Psychopharmacology · doi:10.1007/s00213-020-05548-2 · Cited by 159
Retracted
The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline
Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C. F., Fuller, M. A., Holtzheimer, P. E., Kelly, U. A., Lang, A. J., McGraw, K., et al. (2024) · Annals of Internal Medicine · doi:10.7326/m23-2757 · Cited by 98
“Evidence was insuf ﬁ cient to recommend for or against the combination of evidence-based medications or psychotherapies to enhance treatment outcomes in PTSD (recommendation 21).”
Background
The importance of listening to patient preferences when making mental health care decisions
Swift, J. K., Mullins, R. H., Penix, E. A., Roth, K. L., & Trusty, W. T. (2021) · World Psychiatry · doi:10.1002/wps.20912 · Cited by 83
Self-citation
VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Clinician Summary
(2018) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.16408 · Cited by 77
Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis
Goldberg, S. B., Riordan, K. M., Sun, S., Kearney, D. J., & Simpson, T. L. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110232 · Cited by 69
rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches
Dalhuisen, I., van Oostrom, I., Spijker, J., Wijnen, B. F. M., van Exel, E. R., van Mierlo, H. C., de Waardt, D., Arns, M., Tendolkar, I., & van Eijndhoven, P. (2024) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230556 · Cited by 65
Predicting patients who will drop out of out-patient psychotherapy using machine learning algorithms
Bennemann, B., Schwartz, B., Giesemann, J., & Lutz, W. (2022) · The British Journal of Psychiatry · doi:10.1192/bjp.2022.17 · Cited by 62
“For an overview of patient characteristics and differences between the groups see Supplementary materials 2.”
Background
Drop‐outs in psychotherapy: a change of perspective
Leichsenring, F., Sarrar, L., & Steinert, C. (2019) · World Psychiatry · doi:10.1002/wps.20588 · Cited by 57
Toward a paradigm shift in treatment and research of mental disorders
Leichsenring, F., Steinert, C., & Ioannidis, J. P. A. (2019) · Psychological Medicine · doi:10.1017/s0033291719002265 · Cited by 55
“(6) About 20% of patients drop out of psychotherapy, even more of pharmacotherapy (Swift et al., 2017), with patients apparently experiencing the treatments as not acceptable.”
Background
Public stigma and attitudes toward psychological help-seeking in the United Arab Emirates: The mediational role of self-stigma
Vally, Z., Cody, B. L., Albloshi, M. A., & Alsheraifi, S. N. M. (2018) · Perspectives in Psychiatric Care · doi:10.1111/ppc.12282 · Cited by 45
Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder
Busmann, M., Wrege, J. S., Meyer, A. H., Ritzler, F., Schmidlin, M., Lang, U. E., Gaab, J., Walter, M., & Euler, S. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00952 · Cited by 43
“In Tufekcioglu et al. (2013), the authors have shown that alliance ruptures occur more often in the therapeutic alliance of patients with PD than in patients with non-PD.”
Background
Predictors of dropout in interdisciplinary chronic pain management programmes: A systematic review
Oosterhaven, J., Wittink, H. M., Mollema, J., Kruitwagen, C. L. J. J., & Devillé, W. L. J. M. (2018) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2502 · Cited by 42
Overall and differential attrition in mindfulness-based interventions: A meta-analysis
Lam, S. U., Kirvin-Quamme, A., & Goldberg, S. B. (2022) · Mindfulness · doi:10.1007/s12671-022-01970-z · Cited by 39
“Very similar to estimates of attrition derived from psychotherapy and pharmacotherapy generally (i.e., 19.7 to 21.9%; Swift & Greenberg, 2012; Swift et al., 2017), approximately one in five participants randomized to an MBI or control condition did not complete post-treatment assessments (19.”
MethodInfluential
The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy
Zieve, G. G., Persons, J. B., & Yu, L. A. D. (2018) · Behavior Therapy · doi:10.1016/j.beth.2018.05.004 · Cited by 44
“None of the large meta-analyses of predictors of dropout investigate outcome as a predictor of dropout (Fernandez, Salem, Swift, & Ramtahal, 2015; Swift et al., 2017; Swift et al., 2012; Wierzbicki & Pekarik, 1993).”
Background
Adverse effects of psychotherapy: protocol for a systematic review and meta-analysis
Klatte, R., Strauss, B. M., Flückiger, C., & Rosendahl, J. (2018) · Systematic Reviews · doi:10.1186/s13643-018-0802-x · Cited by 41
Addressing heterogeneity (and homogeneity) in treatment mechanisms in depression and the potential to develop diagnostic and predictive biomarkers
Fu, C. H. Y., Yong Fan, A., & Davatzikos, C. A. (2019) · NeuroImage Clinical · doi:10.1016/j.nicl.2019.101997 · Cited by 41
The Nature, Timing, and Symptom Trajectories of Dropout From Transdiagnostic and Single-Diagnosis Cognitive-Behavioral Therapy for Anxiety Disorders
Bentley, K. H., Cohen, Z. D., Kim, T., Bullis, J. R., Nauphal, M., Cassiello-Robbins, C., Sauer-Zavala, S., Sbi, S., Gallagher, M. W., Farchione, T. J., et al. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.03.007 · Cited by 37
“Given the inconsistent findings in this area (and surprisingly little research overall; e.g., Fernandez et al., 2015; Swift et al., 2017), more research is needed to better understand the relationship between symptom change during CBT and dropout.”
Background
Mechanisms of Change in Exposure Therapy for Anxiety and Related Disorders: A Research Agenda
Benito, K., Pittig, A., Abramowitz, J. S., Arch, J. J., Chavira, D. A., de Kleine, R. A., Nadai, A. S. D., Hermans, D., Hofmann, S. G., Hoyer, J., et al. (2024) · Clinical Psychological Science · doi:10.1177/21677026241240727 · Cited by 37
“The CACE modeling approach can also be used to address participants who prematurely discontinue treatment, which is common (Swift et al., 2017).”
Predicting and preventing dropout in research, assessment and treatment with refugees
Semmlinger, V., & Ehring, T. W. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2672 · Cited by 34
Enduring effects of psychotherapy, antidepressants and their combination for depression: a systematic review and meta-analysis
Voderholzer, U., Barton, B. B., Favreau, M., Zisler, E. M., Rief, W., Wilhelm, M., & Schramm, E. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1415905 · Cited by 48
Inclusion and exclusion strategies for conducting meta-analyses
Swift, J. K., & Wampold, B. E. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1405169 · Cited by 39
Self-citation
Cognitive Deficits in Patients With Depression
Richardson, L. G., & Adams, S. M. (2018) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2018.03.006 · Cited by 39
Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial
Maroti, D., Ek, J., Widlund, R.-M., Schubiner, H. H., Lumley, M. A., Lilliengren, P., Bilevičiūtė-Ljungar, I., Ljótsson, B., & Johansson, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.620359 · Cited by 32
Predicting dropout from psychological treatment using different machine learning algorithms, resampling methods, and sample sizes
Giesemann, J., Delgadillo, J., Schwartz, B., Bennemann, B., & Lutz, W. (2023) · Psychotherapy Research · doi:10.1080/10503307.2022.2161432 · Cited by 26
“The meta-analysis of Swift et al. (2017) reported an average of 21.9% of clients ending therapy prematurely.”
BackgroundInfluential
Use of a Web-Based Shared Decision-Making Program: Impact on Ongoing Treatment Engagement and Antipsychotic Adherence
Finnerty, M. T., Layman, D. M., Chen, Q., Leckman-Westin, E., Bermeo, N., Ng-Mak, D. S., Rajagopalan, K., & Hoagwood, K. E. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201800130 · Cited by 28
Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis.
Maas genannt Bermpohl, F., Kucharczyk-Bodenburg, A.-C., & Martin, A. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10254-2 · Cited by 29
Predictors of dropout among adolescents with borderline personality disorder attending mentalization-based group treatment
Jørgensen, M. S., Bo, S., Vestergaard, M., Storebø, O. J., Sharp, C., & Simonsen, E. H. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1871525 · Cited by 25
“In a meta-analysis of 186 trials on psychotherapy and pharmacotherapy, Swift et al. (2017) found that around 21.9% of clients with mixed mental disorders dropped out of treatment.”
BackgroundMethodInfluential
The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates
Simmonds‐Buckley, M., Osivwemu, E.-O., Kellett, S., & Taylor, C. A. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102187 · Cited by 29
Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy
Fruchter, E., Goldenthal, N., Adler, L. A., Gross, R., Harel, E. V., Deutsch, L., Nacasch, N., Grinapol, S., Amital, D., Voigt, J. D., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2023.115711 · Cited by 25
“…to the use of pharmacologic therapies for PTSD, patients can have a higher reluctance to initiating pharmacologic therapy vs. psychotherapy (Swift et al., 2017) and higher dropout rates vs. psychotherapy (Swift et al., 2017) based on unwanted side effects from the drugs (Williams et al., 2022).”
Background
No increase in inflammation in late-life major depression screened to exclude physical illness
Prak, E. T. L., Brooks, T. G., Makhoul, W., Beer, J. C., Zhao, L., Girelli, T., Skarke, C., & Sheline, Y. I. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-01883-4 · Cited by 29
Breathing-focused Yoga as Augmentation for Unipolar and Bipolar Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration comme traitement d’appoint pour la dépression unipolaire et bipolaire: Un essai randomisé contrôlé
Ravindran, A. V., McKay, M. S., Silva, T. D., Tindall, C., Garfinkel, T., Paric, A., & Ravindran, L. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720940535 · Cited by 22
Predictors of Dropout From Residential Treatment for Posttraumatic Stress Disorder Among Military Veterans
Smith, N. B., Sippel, L. M., Rozek, D. C., Hoff, R. A., & Harpaz‐Rotem, I. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00362 · Cited by 23
Should I stay or must I go? Predictors of dropout in an internet-based psychotherapy programme for posttraumatic stress disorder in Arabic
Vöhringer, M., Knaevelsrud, C., Wagner, B., Slotta, M., Schmidt, A., Stammel, N., & Böttche, M. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1706297 · Cited by 21
“…have been carried out with various specific focuses in recent years (Fernandez et al., 2015; Imel, Laska, Jakupcak, & Simpson, 2013; Kayrouz et al., 2018; Kuester, Niemeyer, & Knaevelsrud, 2016; Melville et al., 2010; Swift & Greenberg, 2012; Swift et al., 2017; van Ballegooijen et al., 2014).”
Background
Digital mental health treatment implementation playbook: successful practices from implementation experiences in American healthcare organizations
Mohr, D. C., Silverman, A. L., Youn, S. J., Areán, P. A., Bertagnolli, A., Carl, J. R., Carlton, T., Chaudhary, N., Cooper, D. E., DeVito, S., et al. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1509387 · Cited by 21
Selecting the optimal treatment for a depressed individual: Clinical judgment or statistical prediction?
van Bronswijk, S. C., Lemmens, L. H. J. M., Huibers, M. J. H., & Peeters, F. P. M. L. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.135 · Cited by 24
Attitudes of Austrian Psychotherapists Towards Process and Outcome Monitoring
Kaiser, T., Schmutzhart, L., & Laireiter, A. (2018) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-018-0862-1 · Cited by 19
Predicting dropout using DSM–5 Section II personality disorders, and DSM–5 Section III personality traits, in a (day)clinical sample of personality disorders.
Berghuis, H., Bandell, C. C., & Krueger, R. F. (2020) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000429 · Cited by 18
Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies
Altmann, U., Thielemann, D., Zimmermann, A. S., Steffanowski, A., Bruckmeier, E., Pfaffinger, I., Fembacher, A., & Strauss, B. M. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00748 · Cited by 18
“The discontinuation rate in pharmacotherapy is still 1.76 times higher than in psychotherapy (Swift et al., 2017).”
BackgroundInfluential
Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: A meta-review
Carpallo-González, M., Muñoz‐Navarro, R., González‐Blanch, C., & Vindel, A. C. (2023) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2023.100379 · Cited by 20
“…disorders (DR disaggregated by disorder) Individual, group and online Gersh et al. (2017) 45 2224 GAD Individual Swift, Greenberg, Tompkins, and Parkin (2017) 182 17891 Various disorders Individual and group Leeuwerik, Cavanagh and Strauss (2019) 123 5627 OCD Individual and group Lewis,…”
Background
Prevalence and prediction of dropout during depression treatment in routine outpatient care: an observational study
van Dijk, D. A., Deen, M. L., van den Boogaard, T. M., Ruhé, H. G., Spijker, J., & Peeters, F. P. M. L. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01499-1 · Cited by 16
“Second and related, this lack of information on the content of the treatment and the reasons for dropout prevents a more detailed analysis of an association between treatment type and dropout, and their potential interaction with sociodemographic variables; this would be relevant given the difference in dropout betwee…”
BackgroundResult
The Efficacy of Experiential Dynamic Therapies: A 10‐Year Systematic Review and Meta‐Analysis Update
Lilliengren, P., Mechler, J., Lindqvist, K., Maroti, D., & Johansson, R. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70086 · Cited by 19
“The average dropout rate of 13% suggests that EDT is tolerated similarly to psychotherapy in general (Swift et al. 2017), and we found no indication of differences in dropout rates compared to active control conditions.”
Treatment effects and adherence of sexually compulsive men in a randomized controlled trial of psychotherapy and medication
Scanavino, M. D. T., Guirado, A. G., Marques, J. M., do Amaral, M. L. S., Messina, B., dos Reis, S. C., Barros, V. B., Abdo, C. H. N., Tavares, H., & Parsons, J. T. (2023) · Journal of Behavioral Addictions · doi:10.1556/2006.2023.00004 · Cited by 15
Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section
Swift, J. K., Spencer, J., & Goode, J. (2018) · Psychotherapy Research · doi:10.1080/10503307.2018.1439192 · Cited by 13
Self-citation
Acceptability and Outcomes of Transdiagnostic Guided Self-help Bibliotherapy for Internalizing Disorder Symptoms in Adults: A Fully Remote Nationwide Open Trial
Lorenzo‐Luaces, L., Howard, J., Jesús-Romero, R. D., Peipert, A., Buss, J., Lind, C. M., Botts, K., & Starvaggi, I. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10338-5 · Cited by 13
“Most individuals with internalizing disorder symptoms prefer, and are more likely to adhere to (Swift et al., 2017), treatment with psychological interventions than with medications (Löwe et al.”
Background
Psychotherapy Trends in the United States
Olfson, M., McClellan, C. B., Zuvekas, S. H., Wall, M. M., & Blanco, C. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20240492 · Cited by 12
An introduction to the special issue on psychotherapy termination.
Hilsenroth, M. J. (2017) · Psychotherapy · doi:10.1037/pst0000106 · Cited by 12
Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy
Poster, K., Bennemann, B., Hofmann, S. G., & Lutz, W. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.05.001 · Cited by 10
Poor suitability for psychotherapy – a risk factor for treatment non-attendance?
Knekt, P., Grandell, L., Sares‐Jäske, L., & Lindfors, O. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.020 · Cited by 10
Psychological distress and infertility: prevalence, impact, and interventions
Clifton, J., & Domar, A. D. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-818309-0.00013-7 · Cited by 11
Beyond Pharmacology: A Narrative Review of Alternative Therapies for Anxiety Disorders
Antos, Z., Zackiewicz, K., Tomaszek, N., Modzelewski, S., & Waszkiewicz, N. (2024) · Diseases · doi:10.3390/diseases12090216 · Cited by 9
“For example, aerobic exercise, as a form of exposure therapy, allows patients to confront their fears in a controlled environment while taking advantage of the anxiolytic properties of physical activity [59].”
Background
It Is the Journey, Not the Destination: Moving From End Points to Trajectories When Assessing Chatbot Mental Health Safety
Morrin, H., Yeung, J. A., Agnew, Z. K., Østergaard, S. D., & Pollak, T. A. (2026) · JMIR Mental Health · doi:10.2196/91454 · Cited by 15
“Meta-ana-lytic syntheses report substantial dropout and show that resolving alliance ruptures relates to better trajectories [35-38].”
Predictors of Attrition in Longitudinal Neuroimaging Research: Inhibitory Control, Head Movement, and Resting-State Functional Connectivity
Stange, J. P., Jenkins, L. M., Bessette, K. L., Kling, L. R., Bark, J. S., Shepard, R., Hamlat, E. J., DelDonno, S. R., Phan, K. L., Passarotti, A. M., et al. (2018) · Brain Connectivity · doi:10.1089/brain.2018.0619 · Cited by 9
“A common challenge in conducting longitudinal studies, including those involving neuroimaging methods, is attrition, or the loss of study participants over time (Carter et al., 2008; Swift et al., 2017; Young et al., 2006).”
Background
Rapid transition from in‐person to videoconferencing psychotherapy in a counselor training clinic: A safety and feasibility study during the COVID‐19 pandemic
Hall, S. B., Bartley, A. G., Wenk, J., Connor, A., Dugger, S. M., & Casazza, K. (2022) · Journal of Counseling & Development · doi:10.1002/jcad.12439 · Cited by 11
“A high rate of TR may reflect a mismatch between client preferences and the available service or the presence of barriers including inconvenience, cost, or negative outcome expectations (Swift et al., 2017).”
Background
Psychological interventions for post-traumatic stress disorder in women survivors of intimate partner violence: A systematic review and meta-analysis
Ragucci, F., Dragan, M., Cuomo, A., Fagiolini, A. M., & Pozza, A. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100802 · Cited by 11
Client preferences, therapy activities and preference-activity match as predictors of therapy outcome
Jacobsen, C. F., Karstoft, K., Falkenström, F., Nielsen, J., Lunn, S., & Poulsen, S. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2353358 · Cited by 7
“Studies show that community and client samples alike tend to prefer psychotherapy over pharmacotherapy (Swift et al., 2017), and that laypersons tend to prefer therapy activities high on therapist directive-ness, emotional intensity and unconditional support (Cooper et al., 2019; Heinze et al.,…”
Modified Alliance-Focused Training with Doubling as an integrative approach to improve therapists’ competencies in dealing with alliance ruptures and prevent negative outcomes in psychotherapy for depression: study protocol of a randomised controlled multicentre trial
Gumz, A., Kästner, D., Reuter, L., Moura, C. M., Ehlers, K., Daubmann, A., Eubanks, C. F., Muran, J. C., Anderson, T., Stöckl, R., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-098343 · Cited by 8
Associations between therapy experiences and perceived helpfulness of treatment for people with eating disorders
Mital, R., Hay, P., Conti, J., & Mannan, H. R. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00601-1 · Cited by 8
“A further meta-analysis that utilised the data of 186 comparative trials found that both treatment refusal and premature treatment termination were linked with a non-preferred treatment modality [12].”
Method
Dropout From Exercise Interventions in Adults With Knee or Hip Osteoarthritis: A Systematic Review and Meta-analysis
Vancampfort, D., Damme, T. V., McGrath, R. L., Hemmings, L., Gillis, V., Bernar, K., dos Santos, E. B., & Schuch, F. B. (2024) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2024.02.735 · Cited by 6
The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder: Extended results of the SOPHONET-Study
Schmalbach, I., Witthöft, M., Strauss, B. M., Joraschky, P., & Petrowski, K. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02882-3 · Cited by 9
Predictors of CBT-pretreatment intervention engagement and completion: Evidence for peer support.
Nelson, C. B., Lusk, R. K., Cawood, C. D., Boore-Clor, L., Ranganathan, A., & Lyubkin, M. (2018) · Psychological Services · doi:10.1037/ser0000268 · Cited by 10
A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals
Garland, M. M., Wilson, R., Thompson, W. K., Stein, M. B., Paulus, M. P., Feinstein, J. S., & Khalsa, S. S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0286899 · Cited by 7
“Notwithstanding this limitation, these levels of adherence are broadly comparable to traditional behavioral interventions for anxiety and depression, whose treatment completion rates hover around 80% [30].”
Biofeedback: Using the power of the mind–body connection, technology, and business in psychotherapies of the future.
Austad, C. S., & Gendron, M. S. (2018) · Professional Psychology Research and Practice · doi:10.1037/pro0000197 · Cited by 9
Trainieren und Messen therapeutischer Beziehungskompetenzen
Gumz, A. (2023) · PDP – Psychodynamische Psychotherapie · doi:10.21706/pdp-22-3-204 · Cited by 6
Comparing the efficacy of electronic cognitive behavioral therapy to medication and combination therapy for generalized anxiety disorder: a quasi-experimental clinical trial
Stephenson, C., Moghimi, E., Shao, Y., Kumar, A., Yee, C. S., Miller, S., Stefatos, A., Gholamzadehmir, M., Abbaspour, Z., Jagayat, J., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1194955 · Cited by 6
Looking into the Future : How to Use Advanced Statistical Methods for Predicting Psychotherapy Outcomes in Routine Care
Uckelstam, C.-J. (2021) · Linköping studies in behavioural science · doi:10.3384/diss.diva-172754 · Cited by 6
Refusal of prescribed drug therapy (absolute non-adherence) after acute myocardial infarction/unstable angina: data from prospective observation in the LIS-3 registry
Martsevich, S. Y., Петровна, З. Н., Zagrebelnyy, A. V., Кутишенко, Н. П., Lukina, Y. V., Ginzburg, М. L., & Drapkina, O. M. (2023) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2023-2988 · Cited by 6
Participant and trial characteristics reported in predictive analyses of trial attrition: an umbrella review of systematic reviews of randomised controlled trials across multiple conditions
McChrystal, R., Lees, J. S., Gillies, K., McAllister, D., & Hanlon, P. (2025) · Trials · doi:10.1186/s13063-025-08794-x · Cited by 5
Effect of horticultural activities on reducing depressive symptoms in community-dwelling adults: A systematic review and meta-analysis
Sin, P. Y., Li, W. H. C., Fan, M. S. N., Ng, S. C., & Choi, K. C. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105081 · Cited by 6
Acupuncture therapy for Parkinson’s disease: a case report demonstrating symptomatic improvement without medication
Lei, S., Liu, Q., Leong, I., Fan, J., Tsang, Y., Liu, X., Xu, X., & Zhuang, L. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2023.1330054 · Cited by 5
Psychotherapy integration and borderline personality pathology: An examination of treatment outcomes.
Goldman, R. E., Hilsenroth, M. J., Gold, J. R., Cersosimo, B. H., Levy, S. R., & Owen, J. J. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000124 · Cited by 5
Psychotherapy for Mixed Depression and Mixed Mania
O’Brien, B., Lee, D. J., Swann, A. C., Mathew, S. J., & Lijffijt, M. (2019) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2019.10.014 · Cited by 5
The clinical effectiveness of an algorithm-guided treatment program for depression in specialized mental healthcare: A comparison with efficacy trials
Kan, K., Feenstra, T., de Vries, S. O., Visser, E., Schoevers, R. A., & Jörg, F. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.010 · Cited by 5
A cohort study of engagement in telehealth psychotherapy versus in-person services
Gibbons, M. B. C., Duong, L. A., Chiu, R. Y., Crits-Christoph, P. F., Gallop, R., Mandell, D. S., Barg, O., Newman, C. F., Brown, L. A., & Oquendo, M. A. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2375231 · Cited by 5
“An estimated 19% of individuals receiving mental health services in a nationally representative sample (Olfson et al., 2009) and 22% of individuals receiving psychotherapy as part of randomized controlled trials (Swift et al., 2017) terminate psychotherapy prematurely.”
The why, the how, and the what next: A qualitative investigation of premature termination from psychotherapy
Lipner, L. M., Katz, M., Tzor, K., Amar, A., & Yonatan‐Leus, R. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2551067 · Cited by 4
“…termination from psychotherapy ranges from 19.7% to 46.86% across different populations and treatment contexts (Sharf et al., 2010; Swift & Greenberg, 2012; Swift et al., 2017; Wierzbicki & Pekarik, 1993), representing a substantial percentage of patients whose treatment outcomes remain unclear.”
Influential
The beginning of the end: a comparison of treatment completers and early dropouts in trainee-provided time-limited cognitive behavioral therapy
Urmanche, A. A., Lipner, L. M., Bloch‐Elkouby, S., Hunter, E., Kaufmann, J., Warren, J. T., Weil, G. T., Eubanks, C. F., & Muran, J. C. (2021) · Counselling Psychology Quarterly · doi:10.1080/09515070.2021.1997916 · Cited by 4
“Based on recommendations to evaluate the session(s) preceding premature termination (Swift et al., 2017), some promising and innovative work has been conducted with Turkish students (Gülüm, Soygüt, & Safran, 2018) and adolescents (O’Keeffe, Martin, Target, & Midgley, 2019), and we hope to…”
Method
Understanding non-routine discharge: Factors that are associated with premature termination from higher levels of care in adults with anorexia nervosa
Gorrell, S., Rienecke, R. D., Duffy, A., Huston, E. M., Mehler, P. S., Johnson, C., Manwaring, J. L., McClanahan, S. F., Blalock, D. V., & Grange, D. L. (2022) · Eating Disorders · doi:10.1080/10640266.2021.2011648 · Cited by 4
“A considerable literature has examined premature termination from psychotherapy treatment across broader patient populations (Swift et al., 2017).”
Background
Associations between therapists’ verbal techniques and patient-rated therapeutic alliance, insight, and problem solving
Gumz, A., Daubmann, A., Erices, R., Berger, J., Reuter, L., & Kästner, D. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2327443 · Cited by 4
“At the same time, there are still many patients who do not adequately benefit from their psychotherapy (Barkham & Lambert, 2021; Cuijpers et al., 2021), and on average up to a quarter of all patients drop out of therapy prematurely (Fernandez et al., 2015; Swift et al., 2017).”
Neurobiological Foundations of Psychotherapies
Guina, J., Kay, J., & Yatim, F. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_168 · Cited by 3
Moments of disappointment in art therapy: patients’ perspectives
Vulcan, M., & Goldner, L. (2025) · International Journal of Art Therapy · doi:10.1080/17454832.2025.2468377 · Cited by 3
“Premature termination of psychotherapy or drop-out, i.e. a patient’s unilateral termination of services prior to completion of a recommended course of psychological treatment (Swift et al., 2012; Swift et al., 2017), is a widespread clinical phenomenon.”
Using machine learning methods to predict the outcome of psychological therapies for post-traumatic stress disorder: A systematic review
Tait, J., Kellett, S., & Delgadillo, J. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103003 · Cited by 4
A comparison of completion and recovery rates between first‐line protocol‐based cognitive behavioural therapy and non‐manualized relational therapies within a UK psychological service
Leonidaki, V., & Constantinou, M. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2669 · Cited by 3
Effectiveness of a Systems-Wide Initiative to Address Motivation and Expectations for Treatment on Initial Session Attendance to Outpatient Gambling Treatment
Pfund, R. A., Valencia, A. J., Hudson, E., Ginley, M. K., & Whelan, J. P. (2024) · Journal of Gambling Studies · doi:10.1007/s10899-024-10349-9 · Cited by 3
“The continued enhancement of engaging prospective clients yielded another 9% gain and a show rate approaching the 92% attendance rate for initial sessions for other mental health concerns (Swift et al., 2017).”
Generation of fundamental soliton in the presence of initial linear chirp
Kaczmarek, T. (2004) · Prace Naukowe Uniwersytetu Ekonomicznego we Wrocławiu · Cited by 3
Treatment preferences and their determinants among adults with depression or anxiety in out-patient mental healthcare: systematic review
Lenz, L., König, H., Leitner, M., & Hajek, A. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10849 · Cited by 3
“In their meta-analysis, Swift et al 12 found an overall treatment refusal rate of 8.2% and an overall premature termination rate of 21.9%.”
Influential
Characteristics of patients who dropped out after multidisciplinary pain management in Japan: A prospective cohort study
Takahashi, N., Takatsuki, K., Kasahara, S., & Yabuki, S. (2021) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-200292 · Cited by 2
Physiological effects of Therapeutic Body Wraps in healthy volunteers: An observational study
Korogod, N., Skuza, K., Bangerter, G., & Opsommer, E. (2022) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2022.07.020 · Cited by 2
Protocol to evaluate the effectiveness of the implementation of transdiagnostic cognitive behavioural therapy for emotional disorders in primary care and its mechanisms of change: a randomized step-wedge clinical trial (PsicAP-CV)
Muñoz‐Navarro, R., Pérez‐Jover, V., Esteller-Collado, G., Román, C. J. V.-D. H., Salgueiro, M., Llorca, A., Malonda-Vidal, E., Canet-Cortell, V., Moraga-García, M. J., Coloma‐Carmona, A., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0320857 · Cited by 2
“A meta-analysis by Swift et al. [49] found that patients on pharmacotherapy had a higher dropout rate than patients receiving psychotherapy alone.”
Modeling the Reduction of Attrition in Campus Mental Health Services: A Discrete Choice Conjoint Experiment
Cunningham, C. E., Rimas, H. L., Sivayoganathan, T., Stewart, B., Munn, C., Zipursky, R. B., Christensen, B. K., & Furimsky, I. (2020) · Emerging Adulthood · doi:10.1177/2167696820946894 · Cited by 3
“Systematic reviews conclude that patients offered medication are more likely to refuse treatment or to subsequently drop out of treatment than those offered psychotherapy (Swift et al., 2017).”
Background
Motivational Interviewing Enhances Group Cognitive Behavioral Therapy for Anxiety Disorders
Strodl, E. S., & Yang, J. (2021) · Journal of Cognitive Psychotherapy · doi:10.1891/jcpsy-d-20-00025 · Cited by 3
Treating Later-Life Depression
Steffen, A. M., Thompson, L. W., & Gallagher-Thompson, D. E. (2021) · doi:10.1093/med-psych/9780190068431.001.0001 · Cited by 2
Therapeutic collaboration in a comfort zone: a non-improved borderline patient psychotherapy case study ( Colaboración terapéutica en una zona de confort: estudio de un caso de psicoterapia de un paciente borderline que no experimentó mejoría )
Ryttinger, R., Serralta, F. B., Pires, N., Basto, I., Melo, G. R., & Ribeiro, E. (2022) · Studies in Psychology Estudios de Psicología · doi:10.1080/02109395.2022.2132750 · Cited by 2
“In the current study, dropout is defined as a premature and unilateral discontinuation after the client begins the psychotherapy, before recovering from their suffering and without the agreement of the therapist (Swift et al., 2017).”
BackgroundInfluential
Tactile Contact as a Marketing Tool for Improving an HIV/STD Education Program’s Compliance / Retention with Crack Cocaine Users
Johnson, R. J. (2020) · Psychology and Mental Health Care · doi:10.31579/2637-8892/067 · Cited by 2
Evaluating the feasibility of the Italian version of the computerized interactive remediation of cognition training for schizophrenia (CIRCuiTS)
Cascia, C. L., Ferraro, L., Seminerio, F., Scaglione, A., Maniaci, G., Matranga, D., Sideli, L., Colli, G., Sartorio, C., Paglia, F. L., et al. (2020) · Minerva Psichiatrica · doi:10.23736/s0391-1772.20.02092-0 · Cited by 2
„Talking cures“ – Sprache als Medium in Psychotherapien
Gumz, A., & Strauss, B. M. (2022) · Psychotherapeut · doi:10.1007/s00278-022-00578-x · Cited by 2
“Immerhin bis zu ein Viertel aller Patienten im Durchschnitt bricht die Therapie vorzeitig ab (Cahill et al. 2003; Fernandez et al. 2015; Swift und Greenberg 2012; Swift et al. 2017).”
Background
Preventing Dropout in Research, Assessment and Treatment with Refugees - a guidelinePreprint
Semmlinger, V., & Ehring, T. W. (2020) · doi:10.31234/osf.io/nukv3 · Cited by 2
Cognitive-Behavioral Therapies 101
Steffen, A. M., Thompson, L. W., & Gallagher-Thompson, D. E. (2021) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190068431.003.0004 · Cited by 2
Professional Development Resources
Steffen, A. M., Thompson, L. W., & Gallagher-Thompson, D. E. (2021) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190068431.005.0001 · Cited by 2

Authors: Swift, J. K., Greenberg, R. P., Tompkins, K. A., & Parkin, S. R.
Affiliations: Idaho State University (US)
SUNY Upstate Medical University (US)
University of Alaska Anchorage (US)
ORCID: Swift, Joshua K.
Venue: Psychotherapy
Publisher: American Psychological Association (APA)
Published: 2017-03
Volume: 54
Issue: 1
Pages: 47-57
ISSN: 0033-3204 (ISSN-L)
1939-1536
DOI: 10.1037/pst0000104
OpenAlex: W2593514681
Cited by: 167
References: 45
Citations by year: 2026: 11 · 2025: 16 · 2024: 22 · 2023: 10 · 2022: 21 · 2021: 44 · 2020: 13 · 2019: 9 · 2018: 17 · 2017: 3
FWCI: 1.76
Type: journal article
Language: en
Open access: closed
Locations: Psychotherapy (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords: treatment refusal, early termination, treatment discontinuation, pharmacotherapy, combined psychotherapy and pharmacotherapy, depressive disorders, panic disorder, social anxiety disorder, anorexia nervosa, bulimia nervosa, medication adherence
MeSH terms: Combined Modality Therapy, Humans, Object Attachment, Patient Dropouts, Psychotherapy, Psychotropic Drugs, Psychotherapeutic Processes, Placebo Effect, Treatment Refusal

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

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Citations

Cites

Cited by

Related

Metadata

Record

About these checks