Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

Lewis, Catrin; Roberts, Neil P.; Gibson, Samuel; Bisson, Jonathan I.

doi:10.1080/20008198.2019.1709709

Cited by 382Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsMigration, Health and Trauma

Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

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Lewis, Catrin, Roberts, Neil P., Gibson, Samuel, Bisson, Jonathan I.·2020·European Journal of Psychotraumatology

DOI 10.1080/20008198.2019.1709709PMC PMC7144189

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Abstract

Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates.Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity.Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression.Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14–18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated.Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.

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There remains a certain level of dropout rate in trauma-focused psychotherapy, with the pool dropout rate at 16%.
“First, there remains a certain level of dropout rate in trauma-focused psychotherapy, with the pool dropout rate at 16% [32].”
From Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial (2024) · cites this paper as [32]
The Discussion (Main findings; page unavailable) reports a pooled dropout rate of 16% for all psychological therapies for PTSD, not specifically trauma-focused psychotherapy. The Results (Meta-regression; page unavailable) report 18% dropout for trauma-focused therapies. The claim is right that dropout occurs, but assigns the 16% estimate to the wrong group. (LLM, conf=0.92)
Experimental — accuracy not yet measured
Studies have demonstrated notable dropout rates from trauma-focused therapies for PTSD.
“Despite the efficacy of these treatments, studies have demonstrated notable dropout rates (Lewis et al., 2020) and persistent residual symptoms (Larsen et al., 2019).”
From Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial (2024) · cites this paper as Lewis et al., 2020
A meta-analysis of PTSD treatment dropout rates (Lewis et al., 2020) found that the mean rate for nine trauma-focused cognitive behavioral group therapy studies was 24% (95% CI: 16-33%).
“A meta-analysis of PTSD treatment dropout rates (Lewis et al., 2020) found that the mean rate for nine trauma-focused cognitive behavioral group therapy studies was 24% (95% CI: 16–33%).”
From Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial (2024) · cites this paper as Lewis et al., 2020
Considering the study's definition of completion and the moderate rate of attrition, the ACT intervention was associated with a higher drop-out rate compared to the average rate for group-based trauma-focused therapies.
“Considering our study’s definition of completion and the moderate rate of attrition, our ACT intervention was associated with a higher drop-out rate compared to the average rate for group-based trauma-focused therapies.”
From Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial (2024) · cites this paper as Lewis et al., 2020

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“As noted by previous reviews, there is also a need for the standardized and consistent measurement of treatment acceptability across trials (Lewis, Roberts, Bethell, Robertson, & Bisson, 2018; Simon et al., 2019).”
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“Despite the efficacy of these treatments, studies have demonstrated notable dropout rates (Lewis et al., 2020) and persistent residual symptoms (Larsen et al., 2019).”
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Background

Authors: Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I.
Affiliations: Cardiff University (GB)
Cardiff and Vale University Health Board (GB)
Corresponding author: Lewis, Catrin
ORCID: Lewis, Catrin
Roberts, Neil P.
Bisson, Jonathan I.
Venue: European Journal of Psychotraumatology
Publisher: Informa UK Limited
Published: 2020-03-09
Volume: 11
Issue: 1
Pages: 1709709-1709709
ISSN: 2000-8066 (ISSN-L)
DOI: 10.1080/20008198.2019.1709709
PMC: PMC7144189
OpenAlex: W2994854287
Cited by: 382
References: 178
Citations by year: 2026: 58 · 2025: 77 · 2024: 85 · 2023: 66 · 2022: 47 · 2021: 37 · 2020: 12
FWCI: 3.17
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
Locations: European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: unfunded
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: post-traumatic stress disorder, psychotherapy, treatment discontinuation, treatment retention, trauma-focused psychotherapy, group therapy, military personnel, veterans, sexual trauma, predictors of dropout

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Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

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