Massachusetts General Hospital/Harvard Medical School.
University of California Los Angeles.
Behav Ther. 2021 Nov;52(6):1364-1376. doi: 10.1016/j.beth.2021.03.007. Epub 2021 Mar 25.
Dropout from psychotherapy is common and can have negative effects for patients, providers, and researchers. A better understanding of when and why patients stop treatment early, as well as actionable factors contributing to dropout, has the potential to prevent it. Here, we examined dropout from a large randomized controlled trial of transdiagnostic versus single-diagnosis cognitive-behavioral treatment (CBT) for patients with anxiety disorders (n = 179; Barlow et al., 2017). We aimed to characterize the timing of and reasons for dropout and test whether participants who dropped out had different symptom trajectories than those who completed treatment. Results indicated that overall, the greatest risk of dropout was prior to the first treatment session. In single-diagnosis CBT, dropout risk was particularly elevated before the first session and after other early sessions, whereas in transdiagnostic CBT, dropout risk was low and stable before and during treatment. Participants most often dropped out due to failure to comply with study procedures or dissatisfaction with or desiring alternative treatment. Results from multilevel models showed that trajectories of anxiety symptoms did not significantly differ between dropouts and completers. These findings suggest that there may be specific time windows for targeted and timely interventions to prevent dropout from CBT.
从心理治疗中辍学是很常见的，可能会对患者、治疗师和研究人员产生负面影响。更好地了解患者何时以及为何会过早停止治疗，以及导致辍学的可操作因素，有可能预防辍学。在这里，我们研究了一项针对焦虑障碍患者（n=179；Barlow 等人，2017）的跨诊断与单一诊断认知行为治疗（CBT）的大型随机对照试验中辍学的情况。我们旨在描述辍学的时间和原因，并检验是否与完成治疗的患者相比，辍学的患者有不同的症状轨迹。结果表明，总体而言，辍学的最大风险发生在第一次治疗之前。在单一诊断 CBT 中，辍学风险在第一次治疗前和其他早期治疗阶段特别高，而在跨诊断 CBT 中，辍学风险在治疗前和治疗期间较低且稳定。参与者通常因未能遵守研究程序或对治疗不满意或希望选择替代治疗而辍学。多层次模型的结果表明，辍学者和完成者的焦虑症状轨迹没有显著差异。这些发现表明，可能存在特定的时间窗口，可以进行有针对性和及时的干预，以预防 CBT 中的辍学。
