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. 2019 Aug;87(8):745-755.
doi: 10.1037/ccp0000414. Epub 2019 Jun 17.

Predictors of treatment attendance in cognitive and dynamic therapies for major depressive disorder delivered in a community mental health setting

Mary Beth Connolly Gibbons  1 , Robert Gallop  1 , Donald Thompson  2 , Averi Gaines  1 , Agnes Rieger  1 , Paul Crits-Christoph  1
Affiliations

Predictors of treatment attendance in cognitive and dynamic therapies for major depressive disorder delivered in a community mental health setting

Mary Beth Connolly Gibbons et al. J Consult Clin Psychol. 2019 Aug.

Abstract

Objective: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion.

Method: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2.

Results: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, χ²(3) = 14.35, p = .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, χ²(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT.

Conclusions: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Figures

Figure 1:
Figure 1:
Attendance Patterns by Treatment.
Figure 2:
Figure 2:
Attendance Patterns by Treatment for Patients with High Levels of Trauma.
See this image and copyright information in PMC

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