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Predictors of Treatment Discontinuation During Prolonged Exposure for PTSD

Published online by Cambridge University Press:  03 July 2017

Daniel F. Gros ,
Nicholas P. Allan ,
Cynthia L. Lancaster ,
Derek D. Szafranski  and
Ron Acierno
Daniel F. Gros*
Affiliation:
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401 and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
Nicholas P. Allan
Affiliation:
Department of Psychology, Ohio University, Porter Hall, Athens, OH
Cynthia L. Lancaster
Affiliation:
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401 and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
Derek D. Szafranski
Affiliation:
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401 and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
Ron Acierno
Affiliation:
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401 and College of Nursing, Medical University of South Carolina, Charleston, SC 29425
*
Correspondence to Daniel F. Gros, Mental Health Service 116, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29401, USA. E-mail: grosd@musc.edu
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Abstract

Background: Post-traumatic stress disorder (PTSD) is a highly prevalent and impairing condition for which there are several evidence-based psychotherapies. However, a significant proportion of patients fail to complete a ‘sufficient dose’ of psychotherapy, potentially limiting treatment gains. Aims: The present study investigated predictors of premature treatment discontinuation during a trial of prolonged exposure (PE) therapy for PTSD. Method: Combat veterans with PTSD were recruited to participate in a randomized clinical trial of PE delivered in person or via telehealth technologies. Of the 150 initial participants, 61 participants discontinued the trial before the completion of eight sessions (of an 8‒12 session protocol). Treatment condition (telehealth or in person) and factors identified by prior research (age, combat theatre, social support, PTSD symptoms) were tested as predictors of treatment discontinuation. Results: A Cox proportional hazards model (a subtype of survival analysis) was used to evaluate predictors of treatment discontinuation. Disability status and treatment condition were identified as significant predictors of discontinuation, with a noted disability and use of telehealth demonstrating higher risk. Conclusions: The present findings highlight the influence of telehealth and disability status on treatment discontinuation, while minimizing the role of the previously identified variables from studies with less sensitive analyses.

Keywords

PTSDdrop-outdiscontinuationveterantelehealthdisability
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 1 , January 2018 , pp. 35 - 49
Creative Commons
This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017

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