University of Twente Student Theses


Dropout in the treatment of PTSD : a systematic review and meta-analysis

Reinders, L.A. (2019) Dropout in the treatment of PTSD : a systematic review and meta-analysis.

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Abstract:Background. In clinical practice, a high rate of dropout in the treatment of posttraumatic stress disorder (PTSD) has been a concern for a long time because of its negative impact on patients, therapists and healthcare institutions. This systematic review and meta-analysis offers an overview of the scope of the problem of dropout in the treatment of patients with PTSD. This study has four major objectives: (a) to determine the dropout rate in the treatment of PTSD; (b) to assess whether a significant difference exists in dropout rate between Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE); (c) to determine the underlying reasons for dropout; and (d) to determine predictors of dropout. Understanding which reasons and predictors may have an impact on treatment adherence can provide insight into how dropout in the treatment of PTSD can be reduced. Method. A systematic review was conducted using the electronic databases SCOPUS and PsycINFO, including English peer-reviewed intervention studies published between 2000 and December 2018. A meta-analysis was conducted to estimate the pooled dropout rate and for the assessment of a significant difference in dropout rate between EMDR and PE. Results. Twenty studies were included (n = 1789) with a total of twenty-five reported dropout rates. The meta-analysis showed an average pooled dropout rate of 31,97%. An independent-samples t-test showed a significant difference in dropout rates between EMDR and PE. However, two studies contradicted that there is a significant difference in dropout rate between EMDR and PE (Van den Berg et al., 2015; Power et al., 2002). Both non-treatment-related reasons and treatment-related reasons for dropout were found. Predictive factors for dropout in patients with PTSD can be divided into demographic variables, trauma characteristics, symptom-related factors, personality characteristics, and other predictive factors. Contradictory evidence has been found for multiple predictive factors for treatment dropout. Discussion. This review demonstrated that approximately one-third of patients with PTSD quit treatment prematurely. It can be cautiously concluded that EMDR is favored when it comes to dropout. More research is needed to confirm this. It seems that catastrophic cognitions, anxiety and a tendency to avoid are important predictors for dropout. Apparently, for many patients it is difficult to be confronted with the trauma. Keywords. PTSD, dropout, EMDR, PE, review, meta-analysis
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
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