Comparing dropout from cognitive processing therapy versus prolonged exposure: Results from a randomized clinical...

Area of Science:

• Psychiatry and Psychology
• Clinical Psychology
• Trauma Studies

Background:

• Dropout from evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such as cognitive processing therapy (CPT) and prolonged exposure (PE), is a significant issue in routine care, with rates ranging from 38% to 51%.
• Understanding the predictors and timing of dropout is crucial for developing targeted interventions to improve treatment retention.
• This study utilizes data from a large randomized controlled trial to investigate dropout patterns in CPT and PE for PTSD.

Purpose of the Study:

• To examine the timing and predictors of dropout from CPT and PE in a large sample of U.S. veterans with PTSD.
• To identify sociodemographic and psychosocial variables associated with dropout from these first-line trauma psychotherapies.
• To compare dropout rates and retention between CPT and PE.

Main Methods:

• A randomized controlled trial involving 916 U.S. veterans diagnosed with PTSD.
• Participants were randomized to either PE (n=455) or CPT (n=461).
• Data collected included demographic characteristics, PTSD and depression symptoms, quality of life, substance use, and treatment expectations. Dropout was defined as completing fewer than 12 sessions or fewer than protocol-required sessions for early responders.

Main Results:

• Dropout rates were significantly higher for PE (52.31%) compared to CPT (45.77%).
• Survival analyses revealed better retention in CPT, with significant differences emerging after Session 3.
• Slower reduction in PTSD symptom severity predicted dropout in CPT but not PE. Younger age, Black race, and service connection for PTSD were associated with higher dropout likelihood.

Conclusions:

• Few pretreatment predictors were identified, highlighting the need for further research into dropout mechanisms.
• Longitudinal studies incorporating time-varying predictors during treatment are recommended to better understand dropout from CPT and PE.
• Findings suggest potential differences in retention between CPT and PE that warrant further investigation.