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.
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
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“Therefore, non-adherence can have negative consequences for patients and can increase health care costs [17].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [17]
In the citing paper
“If a treatment is not acceptable to patients despite demonstrated positive outcomes, it may not be effective in practice [17].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [17]
In the citing paper
“Currently, in study reports, specific forms of drop-out rates are seldom reported [17], and a consistent definition of drop-out is lacking [28].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [17]
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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).”
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“Looking only at treatment refusal in RCTs involving psychotropic medication or psychotherapeutic treatment, findings indicate a substantially lower refusal rate of 8% (Swift et al., 2017).”
Norén, M., Lindqvist, K., Lilliengren, P., & Mechler, J. (2026) · BMC Psychology · doi:10.1186/s40359-026-04306-x · Cited by 1
“For instance, many patients report a preference for psychotherapy over medication [31].”
The combined effect of psychodynamic psychotherapy and pharmacotherapy on healthcare cost
Yonatan‐Leus, R., Abargil, M., & Cooper‐Kazaz, R. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2032861 · Cited by 1
“However, no significant difference was found between the combined therapy and each of the monotherapies (Swift et al., 2017).”
BackgroundTerminación Prematura en Psicoterapia y Características de los Pacientes: un estudio empírico
Santángelo, P. R., Conde, K., & Mattiello, M. E. (2022) · Revista de Psicoterapia · doi:10.33898/rdp.v33i123.35623 · Cited by 1
“Si bien, los resultados no son consistentes debido a las distintas maneras de ponderar y definir la terminación prematura (Santangelo, 2020a) se estima que uno de cada cinco pacientes elige terminar el tratamiento antes de la finalización programada (Swift y Greenberg, 2012; Swift et al., 2017).”
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Jalali, P., Zarani, F., Panaghi, L., & Shelby, R. (2023) · Psychodynamic Practice · doi:10.1080/14753634.2023.2295910 · Cited by 1
“%) reported in Swift and Greenberg’s meta-analysis of dropout in various psychotherapies (Swift et al., 2017), but lower than the median (47”
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“[36] Swift JK, Greenberg RP, Tompkins KA, Parkin SR.”
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“Approximately 30–60% of patients do not achieve sufficient therapeutic benefit [8], and around 20% discontinue psychotherapy early [1].”
Metadata
- 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
- Published
- 2017-03
- Volume
- 54
- Issue
- 1
- Pages
- 47-57
- ISSN
- 0033-3204 (ISSN-L)
- 1939-1536
- 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
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