Risk for psychotherapy drop-out in survival analysis: The influence of general change mechanisms and symptom severity

Dropping out of psychotherapeutic treatment (i.e., the patient ending treatment unilaterally) poses a problem for patients, therapists, and the health care sector. Previous research showed that changes in symptom severity and general change mechanisms (GCMs), such as interpersonal experiences, intrapersonal experiences, and problem actuation, might be related to drop-out. We investigated the relationship of these predictors and drop-out in a sample of 724 patients (21.1% drop-out) receiving cognitive-behavioral therapy in routine care from a German outpatient clinic. Survival analysis was used to account for the longitudinal nature of the data created by routine outcome monitoring and to deal with the time varying predictors, GCMs, and changes in symptom severity. As outcome, we predicted the risk of dropping out. Results showed that patient- and therapist-rated interpersonal experiences, which include alliance, significantly predicted the risk for drop-out. Contrary to previous research, intrapersonal experiences and symptom severity change did not predict drop-out. Overall, GCMs and symptom severity change accounted for 3.8% of explained variance in the outcome. These results entail that it is important to monitor interpersonal experiences over the course of treatment to identify patients at risk for drop-out. (PsycInfo Database Record (c) 2020 APA, all rights reserved).