Treatment dropout among veterans and their families: Quantitative and qualitative findings.
Open accessAbstract
BACKGROUND: Psychotherapy noncompletion rates for veterans and their families are high. This study sought to (a) measure noncompletion rates of such patients at a university-based treatment center, (b) compare veteran and family member attrition rates, (c) identify dropout predictors, and (d) explore clinicians' perspectives on treatment noncompletion. METHOD: Using quantitative and qualitative approaches, we analyzed demographic and clinical characteristics of 141 patients (90 military veterans; 51 family members) in a university treatment center. We defined dropout as not completing the time-limited therapy contract. Reviewing semistructured interview data assessing clinicians' perspectives on their patients' dropout, three independent raters agreed on key themes, with interrater coefficient kappa range .74 to 1. RESULTS: Patient attrition was 24%, not differing significantly between veterans and family members. Diagnosis of major depression (MDD) and exposure-based therapies predicted noncompletion, as did higher baseline Hamilton Depression Rating Scale (HDRS) total scores, severe depression (HDRS > 20), lack of Beck Depression Inventory weekly improvement, and history of military sexual trauma. Clinicians mostly attributed noncompletion to patient difficulties coping with intense emotions, especially in exposure-based therapies. CONCLUSION: Noncompletion rate at this study appeared relatively low compared to other veteran-based treatment centers, if still unfortunately substantial. Patients with comorbid MDD/PTSD and exposure-based therapies carried greater noncompletion risk due to the MDD component, and this should be considered in treatment planning. Ongoing discussion of dissatisfaction and patient discontinuation, in the context of a strong therapeutic alliance, might reduce noncompletion in this at-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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The withdrawal/dropout rate of 17.2% is in line with overall attrition rates found in adult psychotherapy across settings (19.7%), slightly lower than treatment dropout rates found among veterans and their families (24%), and substantially lower than dropout rates found among veterans in treatment for PTSD (36%).
“This rate is in line with overall attrition rates found in adult psychotherapy across settings (19.7%) [58], is slightly lower than treatment dropout rates found among veterans and their families (24%) [59], and is substantially lower than dropout rates found among veterans in treatment for PTSD (36%) [60].”
From Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans (2024) · cites this paper as [59]
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Cites
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · see citing works
(1998) · PubMed · Cited by 10,216 · see citing works
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22059 · Cited by 5,233 · see citing works
Psychometric Properties of the Life Events Checklist
Gray, M. J., Litz, B., Hsu, J. L., & Lombardo, T. W. (2004) · Assessment (Odessa, Fla.) · doi:10.1177/1073191104269954 · Cited by 1,853 · see citing works
Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M., & Marx, B. P. (2018) · Psychological Assessment · doi:10.1037/pas0000486 · Cited by 1,799 · see citing works
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 · see citing works
Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., Berger, T., Botella, C., Breton, J. M., Carlbring, P., et al. (2015) · Psychological Medicine · doi:10.1017/s0033291715000665 · Cited by 408 · see citing works
Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout
van Minnen, A., Arntz, A., & Keijsers, G. P. J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00024-9 · Cited by 393 · see citing works
Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD
Markowitz, J. C., Petkova, E., Neria, Y., Meter, P. E. V., Zhao, Y., Hembree, E. A., Lovell, K., Biyanova, T., & Marshall, R. D. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14070908 · Cited by 383 · see citing works
Self-citationLewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1709709 · Cited by 382 · see citing works
Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300307 · Cited by 368 · see citing works
Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R., & Polusny, M. A. (2016) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000065 · Cited by 322 · see citing works
Dropout From Outpatient Mental Health Care in the United States
Olfson, M., Mojtabai, R., Sampson, N. A., Hwang, I., Druss, B., Wang, P. S., Wells, K. B., Pincus, H. A., & Kessler, R. C. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.7.898 · Cited by 303 · see citing works
Cooper, A. A., & Conklin, L. R. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.05.001 · Cited by 264 · see citing works
Rizvi, S. L., Vogt, D. S., & Resick, P. A. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.06.003 · Cited by 216 · see citing works
Goetter, E. M., Bui, E., Ojserkis, R. A., Zakarian, R. J., Brendel, R. W., & Simon, N. M. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22038 · Cited by 215 · see citing works
Early Discontinuance of Borderline Patients from Psychotherapy
Gunderson, J. G., PRANK, A. F., Ronningstam, E. F., WACHTER, S., LYNCH, V. J., & WOLF, P. J. (1989) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198901000-00006 · Cited by 192 · see citing works
Schneier, F. R., Neria, Y., Pavlicová, M., Hembree, E. A., Suh, E. J., Amsel, L., & Marshall, R. D. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.11020321 · Cited by 187 · see citing works
Self-citationPredicting termination and continuation status in psychotherapy using the transtheoretical model
Brogan, M. M., Prochaska, J. O., & Prochaska, J. M. (1999) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/h0087773 · Cited by 182 · see citing works
Garcia, H. A., Kelley, L. P., Rentz, T. O., & Lee, S. (2011) · Psychological Services · doi:10.1037/a0022705 · Cited by 169 · see citing works
Substance User Treatment Dropout from Client and Clinician Perspectives: A Pilot Study
Palmer, R. S., Murphy, M. K., Piselli, A., & Ball, S. A. (2009) · Substance Use & Misuse · doi:10.1080/10826080802495237 · Cited by 137 · see citing works
The impact of deployment on U.S. military families.
Sheppard, S. C., Malatras, J. W., & Israel, A. C. (2010) · American Psychologist · doi:10.1037/a0020332 · Cited by 135 · see citing works
Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence
Steenkamp, M. M., & Litz, B. T. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.10.002 · Cited by 133 · see citing works
Hidden Heroes: America's Military Caregivers
Ramchand, R. N., Tanielian, T., Fisher, M., et al. (2014) · RAND Corporation eBooks · doi:10.7249/rr499 · Cited by 100 · see citing works
Berke, D. S., Kline, N. K., Wachen, J. S., McLean, C. P., Yarvis, J. S., Mintz, J., Young‐McCaughan, S., Peterson, A. L., Foa, E. B., Resick, P. A., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.03.003 · Cited by 96 · see citing works
Hundt, N. E., Ecker, A. H., Thompson, K. E., Helm, A., Smith, T. L., Stanley, M. A., & Cully, J. A. (2018) · Psychological Services · doi:10.1037/ser0000316 · Cited by 89 · see citing works
Why Do Eating Disorder Patients Drop Out?
Clinton, D. N. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289028 · Cited by 83 · see citing works
Predicting patient dropout in psychotherapy.
Beckham, E. E. (1992) · Psychotherapy · doi:10.1037/0033-3204.29.2.177 · Cited by 77 · see citing works
Maher, M. J., Huppert, J. D., Chen, H., Duan, N., Foa, E. B., Liebowitz, M. R., & Simpson, H. B. (2010) · Psychological Medicine · doi:10.1017/s0033291710000620 · Cited by 64 · see citing works
Bryan, C. J., Bryan, A. O., & Clemans, T. A. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.01.030 · Cited by 59 · see citing works
PREDICTORS OF COMPLETION OF EXPOSURE THERAPY IN OEF/OIF VETERANS WITH POSTTRAUMATIC STRESS DISORDER
Grös, D. F., Price, M., Yuen, E. K., & Acierno, R. E. (2013) · Depression and Anxiety · doi:10.1002/da.22207 · Cited by 58 · see citing works
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 · see citing works
Leon, A. C., Demirtaş, H., & Hedeker, D. (2007) · Clinical Trials · doi:10.1177/1740774507083871 · Cited by 54 · see citing works
Diehle, J., Brooks, S. K., & Greenberg, N. L. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1292-6 · Cited by 51 · see citing works
Sanchez-Lacay, J. A., Lewis‐Fernández, R., Goetz, D. M., Blanco, C., Salmán, E., Davies, S. O., & Liebowitz, M. R. (2001) · Depression and Anxiety · doi:10.1002/da.1027 · Cited by 49 · see citing works
Hidden Heroes: America's Military Caregivers - Executive Summary.
Ramchand, R., Tanielian, T., Fisher, M., Vaughan, C., Trail, T. E., Epley, C., Voorhies, P., Robbins, M., Robinson, E., & Ghosh‐Dastidar, B. (2014) · Europe PMC (PubMed Central) · Cited by 48 · see citing works
Young adults’ reasons for dropout from residential substance use disorder treatment
Nordheim, K., Walderhaug, E., Alstadius, S., Kern-Godal, A., Arnevik, E. A., & Duckert, F. (2016) · Qualitative Social Work · doi:10.1177/1473325016654559 · Cited by 47 · see citing works
Treatment Preferences of Psychotherapy Patients With Chronic PTSD
Markowitz, J. C., Meehan, K. B., Petkova, E., Zhao, Y., Meter, P. E. V., Neria, Y., Pessin, H., & Nazia, Y. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14m09640 · Cited by 43 · see citing works
Self-citationPredictors of Treatment Discontinuation During Prolonged Exposure for PTSD
Grös, D. F., Allan, N. P., Lancaster, C. L., Szafranski, D. D., & Acierno, R. E. (2017) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581700039x · Cited by 32 · see citing works
Secondary Traumatization in Vietnam Veterans’ Families
Yager, T. J., Gerszberg, N., & Dohrenwend, B. P. (2016) · Journal of Traumatic Stress · doi:10.1002/jts.22115 · Cited by 20 · see citing works
Do Child Abuse and Maternal Care Interact to Predict Military Sexual Trauma?
Wilson, L. C., Kimbrel, N. A., Meyer, E. C., Young, K. A., & Morissette, S. B. (2014) · Journal of Clinical Psychology · doi:10.1002/jclp.22143 · Cited by 14 · see citing works
Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.
Fischer, M. S., Bhatia, V., Baddeley, J. L., Al-Jabari, R. M., & Libet, J. M. (2018) · Family Process · doi:10.1111/famp.12308 · Cited by 14 · see citing works
Pickover, A. M., Lowell, A. M., Lazarov, A., Lopez-Yianilos, A., Sánchez-Lacay, A., Ryba, M., Such, S., Arnon, S., Amsalem, D., Neria, Y., et al. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202000355 · Cited by 10 · see citing works
Self-citationLowell, A. M., Lopez-Yianilos, A., Ryba, M., Arnon, S., Suarez‐Jimenez, B., Lazarov, A., Fisher, P. W., Markowitz, J. C., & Neria, Y. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201800356 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
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Proença, C. R., Markowitz, J. C., Coimbra, B. M., Cogo‐Moreira, H., Maciel, M. R., Mello, A. F., & Mello, M. F. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2127474 · Cited by 12 · see citing works
Self-citationVeterans’ experiences of moral injury, treatment and recommendations for future support
Bonson, A., Murphy, D., Aldridge, V., Greenberg, N. L., & Williamson, V. (2023) · BMJ Military Health · doi:10.1136/military-2022-002332 · Cited by 14 · see citing works
Schnitzer, G., Holttum, S., & Huet, V. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.049 · Cited by 12 · see citing works
Romaniuk, M., Saunders-Dow, E., Brown, K., & Batterham, P. J. (2024) · BMC Psychology · doi:10.1186/s40359-024-02097-7 · Cited by 7 · see citing works
“[59], and is substantially lower than dropout rates found among veterans in treatment for PTSD (36”
BackgroundImplementation of evidence-based psychotherapies for posttraumatic stress disorder in Azerbaijan
Ismayilova, J., Sloan, D. M., Marx, B. P., Chard, K. M., Ismayilov, F., Muradova, G., Sultanova, A., Mammadli, N., Guliyeva, G., & Ruzek, J. I. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2484063 · Cited by 5 · see citing works
Social Factors Predict Treatment Engagement in Veterans with PTSD or SUD
Fivecoat, H. C., Lookatch, S. J., Mavandadi, S., McKay, J. R., & Sayers, S. L. (2022) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-022-09823-2 · Cited by 5 · see citing works
Tillman, G. D., Morris, E. E., Rawlinson, T., Bass, C., Turner, M., Watson, K., Didehbani, N., Kozel, F. A., Kraut, M. A., Motes, M. A., et al. (2023) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2023.07.001 · Cited by 4 · see citing works
Exploring trauma-informed care in Nigerian secondary schools: The school counsellor s experiences
Adewuyi, H. O., & Dwarika, V. M. (2025) · Journal of Pedagogical Sociology and Psychology · doi:10.33902/jpsp.202533444 · Cited by 3 · see citing works
Pinto, J. V., Hunt, C. J., & O’Toole, B. I. (2022) · JMIR Research Protocols · doi:10.2196/38223 · Cited by 4 · see citing works
Kline, A. C., Otis, N. P., Norman, S. B., Hunt, W. M., & Walter, K. H. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2325519 · Cited by 3 · see citing works
Chen, Y., Markowitz, J. C., Blanco, C., Hershman, D. L., Zhang, J. T., & Hellerstein, D. J. (2024) · Breast Cancer Research and Treatment · doi:10.1007/s10549-024-07250-9 · Cited by 2 · see citing works
Self-citationVeterans’ Trauma-Related Guilt and Self-Stigma Affect Treatment-Seeking Behavior
Finer, E. B., Schare, M. L., & Mazzone, G. (2025) · Journal of Veterans Studies · doi:10.21061/jvs.v11i2.728 · Cited by 1 · see citing works
Moral injury among military veterans
Thompson, S. (2025) · British Journal of Mental Health Nursing · doi:10.12968/bjmh.2025.0003
Sex differences in treatment outcomes among U.S. service members with comorbid PTSD and MDD
Glassman, L. H., Otis, N. P., Kline, A. C., Hunt, W. M., & Walter, K. H. (2026) · BMC Psychology · doi:10.1186/s40359-025-03878-4
Lewis, C., Thomas, B. J., Yun, J. W. S., Cloître, M., Karatzias, T., Roberts, N. P., Kitchiner, N., & Bisson, J. I. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2605806
Wortham, W. K., Sullivan, K. S., Huang, Y., Kim, S., Lancaster, S. L., Linkh, D. J., Renno, S., & Hassan, A. M. (2026) · Military Psychology · doi:10.1080/08995605.2026.2659398
- Authors
- Amsalem, D., Lopez-Yianilos, A., Lowell, A., Pickover, A. M., Arnon, S., Zhu, X., Suarez-Jimenez, B., Ryba, M., Bergman, M., Such, S., Zalman, H., Sanchez-Lacay, A., Lazarov, A., Markowitz, J. C., & Neria, Y.
- Affiliations
- Columbia University Irving Medical Center (US)
- ORCID
- Venue
- Psychological Trauma: Theory, Research, Practice, and Policy
- Published
- 2022-05
- Volume
- 14
- Issue
- 4
- Pages
- 578-586
- ISSN
- 1942-9681 (ISSN-L)
- 1942-969X
- PMC
- PMC8924016
- OpenAlex
- W3200882078
- Cited by
- 16
- References
- 39
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 1
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Trauma Theory Research Practice and Policy (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- New York-Presbyterian Hospital
- Stand for the Troops Foundation
- Bob Woodruff Foundation
- Acron Hill Foundation
- National Institute of Mental Health (K01 MH118428-01)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- treatment discontinuation, veterans, veterans' families, major depressive disorder, post-traumatic stress disorder, exposure therapy, military sexual trauma, depression severity, therapeutic relationship, clinician perspectives, patient dissatisfaction
- MeSH terms
- Major Depressive Disorder, Humans, Implosive Therapy, Military Personnel, Stress Disorders, Post-Traumatic, Veterans
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