Patient-Level Predictors of Premature Termination in Cognitive Processing Therapy for Posttraumatic Stress Disorder at a Diverse Community Health Center.
Robles-Gil, Claudia F.
- Although premature termination or dropout from psychotherapy has been shown to occur at high rates, there is considerable variability in the literature regarding which patient-level variables predict whether a patient is likely to drop out of treatment. Objective: The present study examined three patient-level domains–demographic variables, barriers to treatment, and initial impairment in posttrau... read morematic stress disorder (PTSD), depression, and anxiety symptomatology–with the objective of identifying patient-level predictors of dropout from Cognitive Processing Therapy (CPT) for PTSD in a diverse community health setting. Method: Data for this study were derived from a hybrid pilot implementation-effectiveness study of CPT for PTSD. Patients (N = 72) provided demographic information and completed the Posttraumatic Symptom Checklist-Specific Version, Patient-Health Questionnaire-9, Generalized Anxiety Disorder Checklist-7, and the Barriers to Treatment Questionnaire (BTQ) at baseline. Results: The overall rate of premature termination in this sample was 72.2%. Block-wise binary logistic regressions indicated that age significantly predicted premature termination, with every one-unit increase in age reducing the odds of dropping out of treatment by 6% (OR = 0.94, 95% CI: 0.89–0.99, p = .026). Financial and logistical barriers at baseline were also found to significantly predict premature termination (OR = 1.31, 95% CI: 1.03–1.66, p = .028): for every one-point increase in a patient’s BTQ Logistical/financial composite score, the likelihood of dropping out of treatment increased by 31%. No other demographic variables or BTQ domains were associated with dropout. Initial impairment measures were not found to predict dropout. Conclusion: The findings of this study have clinical implications for detecting patients at risk for premature termination from CPT in community settings and for implementing retention strategies that address patients’ financial and logistical concerns.read less