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Meta-Analysis
. 2013 Jun;81(3):394-404.
doi: 10.1037/a0031474. Epub 2013 Jan 21.

Meta-analysis of dropout in treatments for posttraumatic stress disorder

Zac E Imel  1 , Kevin Laska, Matthew Jakupcak, Tracy L Simpson
Affiliations
Meta-Analysis

Meta-analysis of dropout in treatments for posttraumatic stress disorder

Zac E Imel et al. J Consult Clin Psychol. 2013 Jun.

Abstract

Objective: Many patients drop out of treatments for posttraumatic stress disorder (PTSD); some clinicians believe that trauma-focused treatments increase dropout.

Method: We conducted a meta-analysis of dropout among active treatments in clinical trials for PTSD (42 studies; 17 direct comparisons).

Results: The average dropout rate was 18%, but it varied significantly across studies. Group modality and greater number of sessions, but not trauma focus, predicted increased dropout. When the meta-analysis was restricted to direct comparisons of active treatments, there were no differences in dropout. Differences in trauma focus between treatments in the same study did not predict dropout. However, trauma-focused treatments resulted in higher dropout compared with present-centered therapy (PCT), a treatment originally designed as a control but now listed as a research-supported intervention for PTSD.

Conclusion: Dropout varies between active interventions for PTSD across studies, but variability is primarily driven by differences between studies. There do not appear to be systematic differences across active interventions when they are directly compared in the same study. The degree of clinical attention placed on the traumatic event does not appear to be a primary cause of dropout from active treatments. However, comparisons of PCT may be an exception to this general pattern, perhaps because of a restriction of variability in trauma focus among comparisons of active treatments. More research is needed comparing trauma-focused interventions to trauma-avoidant treatments such as PCT.

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Figures

Figure 1
Figure 1
Flow chart depicting the identification, retrieval, and selection of studies for the meta-analysis.
Figure 2
Figure 2
A forest plot depicting variability in the log odds of dropout among comparisons of active treatments. Note that the direction of the LOR is randomly assigned, thus the direction of any given effect size is arbitrary. Note: TD; Trauma Desentiziation, HYP; Hypnotherapy, PD; Brief Psychodynamic Therapy, PE; Prolonged Exposure, CR; Cognitive Restructuring, EMDR; Eye Movement Desensitization and Reprocessing, BIO; Biofeedback, TTP; Cognitive Behavior Trauma Treatment Protocol, SIT; Stress Inoculation Therapy, SS; Seeking Safety, RP; Relapse Prevention, PE+SIT; Prolonged Exposure plus Stress Inoculation Therapy, EXP; Exposure, CBT; Cognitive Behavioral Therapy, EXP+CR; Exposure+Cognitive Restructuring, CPT; Cognitive Processing Therapy, NET; Narrative Exposure Therapy, IPT; Interpersonal Therapy, CT; Cognitive Therapy
See this image and copyright information in PMC

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