The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index.
The problem of dropout from “gold standard” PTSD therapies
Open accessAbstract
Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the development and testing of various treatments for it. As implementation of PTSD therapies has increased, there is also increased attention to the key issues of retention and dropout. Retention refers to the percentage of patients who stay in a treatment for its intended dose, and dropout is the opposite (the percentage who leave prior to the intended dose); both of which have major implications for treatment outcomes. The two PTSD therapies most studied in relation to retention and dropout are Prolonged Exposure and Cognitive Processing Therapy, which have been the subject of massive, formal, multi-year dissemination roll-outs. Both of these evidence-based treatments are defined as gold-standard therapies for PTSD and showed positive outcomes and reasonable retention of patients in randomized controlled trials (RCTs). But an emerging picture based on real-world practice indicates substantial dropout. Such real-world studies are distinct from RCTs, which have consistently evidenced far lower dropout rates, but under much more restricted conditions (e.g. a more selective range of patients and clinicians). In this paper, the phenomena of retention and dropout are described based on real-world studies of Prolonged Exposure and Cognitive Processing Therapy, including rates, characteristics of patients, clinicians, and programs in relation to retention and dropout, and identification of clinical issues and future research on these topics. It is suggested that the term "gold-standard" evidence-based treatments should be reserved for treatments that evidence both positive results in RCTs but also feasibility and strong retention in real-world settings.
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“Overall, the commonly encountered difficulties with treatment adherence and completion in psychotherapy were not an obstacle with the workshop format [38].”
From One-Day Acceptance and Commitment Therapy Compared to Support for Depressed Migraine Patients: a Randomized Clinical Trial. (2020) · cites this paper as [38]
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A Multidimensional Meta-Analysis of Psychotherapy for PTSD
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.2.214 · Cited by 1,938
Cognitive processing therapy for sexual assault victims.
Resick, P. A., & Schnicke, M. K. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.60.5.748 · Cited by 1,490
Cognitive processing therapy for sexual assault victims.
Resick, P. A., & Schnicke, M. K. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.60.5.748 · Cited by 1,490
(2007) · Medical Entomology and Zoology · Cited by 1,118
Prolonged Exposure Therapy for PTSD: Therapist Guide: Emotional processing of traumatic experiences
Foa, E. B., Hembree, E., & Rothbaum, B. (2007) · doi:10.1093/med:psych/9780195308501.001.0001 · Cited by 1,050
A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD
Becker, C. B., Zayfert, C., & Anderson, E. (2004) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00138-4 · Cited by 759
Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations
Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008) · Psychiatry: Interpersonal and Biological Processes · doi:10.1521/psyc.2008.71.2.134 · Cited by 634
Meta-analysis of dropout in treatments for posttraumatic stress disorder
Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031474 · Cited by 633
Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., Resick, P. A., & Foa, E. B. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20588 · Cited by 486
Do patients drop out prematurely from exposure therapy for PTSD?
Hembree, E. A., Foa, E. B., Dorfan, N. M., Street, G. P., Kowalski, J., & Tu, X. (2003) · Journal of Traumatic Stress · doi:10.1023/b:jots.0000004078.93012.7d · Cited by 451
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Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment
Lancaster, C. L., Teeters, J. B., Gros, D., & Back, S. E. (2016) · Journal of Clinical Medicine · doi:10.3390/jcm5110105 · Cited by 225
Kozel, F. A., Motes, M. A., Didehbani, N., DeLaRosa, B., Bass, C., Schraufnagel, C. D., Jones, P., Morgan, C. R., Spence, J. S., Kraut, M. A., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.046 · Cited by 167
Towards an unconscious neural reinforcement intervention for common fears
Taschereau-Dumouchel, V., Cortese, A., Chiba, T., Knotts, J. D., Kawato, M., & Lau, H. (2018) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1721572115 · Cited by 153
Varker, T., Jones, K., Arjmand, H., Hinton, M., Hiles, S. A., Freijah, I., Forbes, D., Kartal, D., Phelps, A. J., Bryant, R. A., et al. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100093 · Cited by 144
A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder
Sciarrino, N. A., Warnecke, A. J., & Teng, E. J. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22556 · Cited by 109
Metadata
- Authors
- Najavits, L. M.
- Affiliations
- Boston University (US)
- Corresponding author
- Najavits, Lisa M.
- ORCID
- Najavits, Lisa M.
- Venue
- F1000Prime Reports
- Publisher
- Faculty Opinions Ltd
- Published
- 2015-04-02
- Volume
- 7
- Pages
- 43-43
- ISSN
- 2051-7599 (ISSN-L)
- PMC
- PMC4447050
- OpenAlex
- W2321666626
- Cited by
- 258
- References
- 49
- Citations by year
- 2026: 19 · 2025: 32 · 2024: 32 · 2023: 29 · 2022: 19 · 2021: 25 · 2020: 28 · 2019: 30 · 2018: 20 · 2017: 17 · 2016: 7
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- F1000Prime Reports (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- post-traumatic stress disorder, treatment discontinuation, treatment retention, prolonged exposure, cognitive processing therapy, evidence-based treatment, real-world implementation, treatment feasibility, psychotherapy adherence
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