Centro de Investigação em Psicologia (CIPsi), Escola de Psicologia, Universidade do Minho, Braga, Portugal.
Departamento de Psicologia, Universidade Católica de Petrópolis, Petrópolis, RJ, Brasil.
Braz J Psychiatry. 2018;40(2):123–127. doi: 10.1590/1516-4446-2017-2267. Epub 2017 Aug 30.
A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers.
The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up.
Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up).
These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.
很大一部分心理治疗患者未得到治疗，主要是因为他们中途退出。本研究比较了退出心理治疗的患者和完成治疗的患者的短期和长期结局。
该样本包括一项对照临床试验中的 63 名患者（23 名退出者和 40 名完成者），该试验比较了叙事治疗与认知行为治疗对重度抑郁症的效果。患者在第八次治疗、治疗后和 31 个月随访时接受评估。
与完成治疗的患者相比，退出者在最后一次就诊时改善较少，但在随访期间继续显著改善。一些退出者在接受小剂量治疗后（17%在放弃治疗前达到临床显著变化）有所改善，而另一些人则在更长时间后（62%在 31 个月随访时）才达到临床显著变化。
这些结果强调了有效处理有退出治疗风险的患者的重要性。退出治疗的患者也报告说没有治疗也能改善抑郁症状，但比完成治疗的患者需要更长的时间才能改善。这可能归因于抑郁的自然缓解。进一步的研究应该使用更大的患者数据库，最好通过荟萃分析收集。
