Predicting treatment dropout among veterans receiving prolonged exposure therapy
Afsoon Eftekhari1, Jill J Crowley1, Margaret-Anne Mackintosh1
1National Center for PTSD, Dissemination and Training.
Summary
Younger veterans and those with combat trauma are more likely to drop out of prolonged exposure (PE) therapy. Early symptom changes do not predict dropout, despite clinician beliefs.
Area of Science:
- Psychiatry and Psychology
- Trauma and PTSD Treatment
Background:
- Prolonged Exposure (PE) therapy is a common treatment for posttraumatic stress disorder (PTSD).
- Understanding predictors of treatment dropout is crucial for improving patient outcomes in PE therapy.
Purpose of the Study:
- To identify demographic and early treatment factors that predict dropout from PE therapy.
- To investigate whether early symptom patterns in PTSD predict dropout from PE.
Main Methods:
- Analysis of data from 2,606 patients in the U.S. Veterans Health Administration PE Training Program.
- Logistic regression used to assess demographic, trauma history, and symptom data as predictors of dropout.
- Growth mixture modeling employed to examine the relationship between early PTSD symptom trajectories and dropout.
Main Results:
- 30.0% of patients dropped out before completing the minimum 8 sessions of PE.
- Younger age was significantly associated with higher dropout rates (OR = 0.97 per year).
- Focusing on childhood trauma predicted lower dropout risk compared to combat trauma (OR = 0.51).
Conclusions:
- Dropout from PE therapy is predictable by age and trauma type, but not by initial symptom severity or early symptom course.
- Clinicians frequently, though often inaccurately, attribute dropout to patient intolerance or distress.
- Findings suggest focusing on patient age and trauma type may help identify at-risk individuals for PE dropout.
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