Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

European Journal of Psychotraumatology

Catrin Lewis, Neil P. Roberts, Samuel Gibson & Jonathan I. Bisson


Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates.
Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity.
Method: A systematic review of dropout rates from randomised controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression.
Results: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14% – 18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatised by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated.
Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore reasons for dropout and to look at ways of increasing treatment retention.

Keywords: Post Traumatic Stress Disorder (PTSD); Psychological Therapy; Dropout; Systematic Review; Meta Analysis

Received 19 Oct 2019, Accepted 29 Oct 2019, Published online: 09 Mar 2020

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