The Phenomenon of Treatment Dropout, Reasons and Moderators in Acceptance and Commitment Therapy and Other Active Treatments: A Meta-Analytic Review
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Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes. This meta-analysis reviewed and systematically examined dropout effects of Acceptance and Commitment Therapy (ACT) as compared to other active treatments. The goals of this study were to compare treatment dropout rates and dropout reasons, examine the influence of demographic variables and identify possible therapy moderators associated with dropout. The current meta-analysis reviewed 76 studies of ACT reporting dropout rates for various psychological and health-related conditions. Across reviewed studies (N = 76), the overall weighted mean dropout rate was 17.95% (ACT = 17.35% vs. comparison conditions = 18.62%). Type of disorder, recruitment setting and therapists’ experience level were significant moderators of dropout. The most frequently reported reasons for dropout from ACT were lost contact, personal and transportation difficulties, whereas for comparative treatments they were lost contact, therapy factors and time demands. Given that most moderators of influence are not amenable to direct changes by clinicians, mediation variables should also be explored. Overall, results suggest that ACT appears to present some benefits in dropout rates for specific disorders, settings and therapists. There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting. Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option. There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting. Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
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Drop-out rates in other ACT studies were 18% (Karekla et al., 2019) and 16% (Ong et al., 2018).
“However, the drop-out rate for the ACT psychoeducation group was 53%, which is noticeably higher than reported for other ACT studies (18%, Karekla et al., 2019; 16%, Ong et al., 2018).”
From Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy (2024) · cites this paper as Karekla et al., 2019
The Dropout Rates section reports an average dropout rate of 17.35% for ACT trials, which is close to the cited 18%. The approximately 18% figure (17.95%) is the overall rate across ACT and comparison conditions, not the ACT-specific rate. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe dropout rate of this self-guided digital intervention (23%) is slightly higher than those of face-to-face, therapist-led ACT programs (15.8% and 17.35%).
“The dropout rate of this self-guided digital intervention (23%) is slightly higher than those of face-to-face, therapist-led ACT programs (15.8% [71] and 17.35% [72]).”
From Development and feasibility of a digital acceptance and commitment therapy⇓based intervention for generalized anxiety disorder: Pilot acceptability study (2021) · cites this paper as [72]
The Dropout Rates section reports an average ACT dropout rate of 17.35%, which is lower than the citing study’s stated 23%. But it is not a rate specifically for face-to-face, therapist-led ACT: the review also included self-help and web-based ACT studies. The 15.8% figure is attached to a different citation, not this source. (LLM, conf=0.89)
Experimental — accuracy not yet measuredTo account for the expected 17% dropout rate reported in a previous meta-analysis of ACT-based interventions, the research team intends to collect 4 additional participants per group.
“To account for the expected 17% dropout rate reported in a previous meta-analysis of ACT-based interventions [81], the research team intends to collect 4 additional participants per group.”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [81]
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GAUDIANO, B. A., BUSCH, A. M., WENZE, S. J., NOWLAN, K., EPSTEIN-LUBOW, G., & MILLER, I. W. (2015) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000092 · Cited by 37 · see citing works
(2017) · Europe PMC (PubMed Central) · Cited by 35 · see citing works
Moitra, E., LaPlante, A., Armstrong, M. L., Chan, P. A., & Stein, M. D. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1780-z · Cited by 28 · see citing works
McCracken, L. M., Sato, A., Wainwright, D., House, W., & Taylor, G. J. (2014) · Primary Health Care Research & Development · doi:10.1017/s1463423613000273 · Cited by 27 · see citing works
Duration of Treatment in Group Psychotherapy
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Clarke, S. P., Poulis, N., Moreton, B. J., Walsh, D. A., & Lincoln, N. B. (2017) · Disability and Rehabilitation · doi:10.3109/09638288.2016.1160295 · Cited by 23 · see citing works
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Vakili, Y., Gharraee, B., Habibi, M., Lavasani, F. F., & Rasoolian, M. (2014) · Zahedan Journal of Research in Medical Sciences · Cited by 12 · see citing works
Karekla, M., Konstantinou, P., Ioannou, M., Kareklas, I., & Gloster, A. T. (2019) · doi:10.23668/psycharchives.2594 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
1 of the 102 references couldn’t be matched to a known paper.
Research works printed but not linked: 5
- Clinical Psychology in Europe 2019, Vol.1(3), Article e33058 https://doi.org/10.32872/cpe.v1i3.33058 Clinical Psychology in Europe 2019, Vol.1(3), Article e33058 https://doi.org/10.32872/cpe.v1i3.33058 References · DOI
- Djordjevic, A., & Frögéli, E. (2012). Mind the gap: ACT for preventing stress-related ill-health among future nurses. A randomized controlled trial (Graduate thesis). Stockholm, Sweden: Institute for Clinical Neuroscience, Karolinska Institute.
- Karekla, M. (2004). A comparison between acceptance-enhanced panic control treatment and panic control treatment for panic disorder (Unpublished doctoral dissertation). University of New York, New York City, NY, USA.
- Kingston, J. (2008). A pilot randomized control trial of ACT vs. CBT-treatment as usual (CBT-TAU) for a heterogeneous group of treatment resistant patients (Unpublished doctoral thesis). University of Southampton, Southampton, United Kingdom.
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Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials
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“However, the drop-out rate for the ACT psychoeducation group was 53%, which is noticeably higher than reported for other ACT studies (18%, Karekla et al., 2019; 16%, Ong et al., 2018).”
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- Authors
- Karekla, M., Constantinou, P., Ioannou, M., Gloster, A. T., & Kareklas, I.
- Affiliations
- University of Cyprus (CY)
- University of Basel (CH)
- University at Albany, State University of New York (US)
- Venue
- Clinical Psychology in Europe
- Published
- 2019-09-20
- Volume
- 1
- Issue
- 3
- ISSN
- 2625-3410 (ISSN-L)
- OpenAlex
- W2973714138
- Cited by
- 29
- References
- 102
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 1
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Clinical Psychology in Europe (publishedVersion, cc-by)
- PsychOpen Gold (Leibniz Institute for Psychology) (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- ZooKeys (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Europe’s Journal of Psychology (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- treatment discontinuation, acceptance and commitment therapy, early termination, causes of dropout, therapist experience, psychotherapy outcome
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