Symposium 82 - The dropout dilemma: Identifying and overcoming barriers to treatment completion in trauma-focused PTSD interventions

Chair(s)

• DS

  Danielle Shayani, B.S. (she/her/hers)

  Doctoral Student
  University of Delaware
  Newark, Delaware
• AH

  Adele Hayes, Ph.D. (she/her/hers)

  Professor
  University of Delaware
  Newark, Delaware

Discussant(s)

• PR

  Patricia Resick, ABPP, Ph.D. (she/her/hers)

  Professor
  Duke University School of Medicine
  Durham, North Carolina

Presenter(s)

• DS

  Danielle Shayani, B.S. (she/her/hers)

  Doctoral Student
  University of Delaware
  Newark, Delaware
• DS

  Daniel Szoke, Ph.D. (he/him/his)

  Rush University Medical Center
  Chicago, Illinois
• SL

  Stefanie LoSavio, ABPP (she/her/hers)

  University of Texas Health Science Center at San Antonio
  San Antonio, Texas

There are numerous evidence-based treatments (EBTs) for adults with posttraumatic stress disorder (PTSD), but dropout rates in trauma-focused treatments are high (Varker et al., 2021). Thus, identifying potential targets to minimize dropout is critical to maximize treatment completion and symptom outcomes. Current research on dropout in adult PTSD treatment has focused primarily on fixed and relatively immutable patient characteristics, such as demographics (e.g., age, sex) and also on pretreatment symptoms and functioning, but this approach has not yielded consistent predictors of dropout (Cooper et al., 2018). Another approach is to examine client factors that occur during treatment, which might reveal important information about the process of dropout. In addition, recent research on existing treatments for PTSD as well as the development of briefer, more efficient treatments have revealed modifications that can reduce dropout and optimize outcomes.

The innovative research in this symposium will highlight variables that unfold during treatment and predict dropout. We will also describe potential steps to minimize dropout with current modifications to cognitive processing therapy (CPT), a gold-standard treatment for PTSD and written exposure therapy (WET), a briefer treatment developed to ameliorate barriers to care. First, Danielle Shayani will present findings on predictors of dropout in CPT that is based on coding sessions from a randomized noninferiority clinical trial of CPT and WET. Second, Daniel Szoke will present on dropout rates across several intensive-CPT treatment programs that vary by program length, delivery format (e.g., in-person vs. virtual), adjunctive services (offered vs. not offered), and population (veteran vs. non-veteran). Intensive delivery of CPT is associated with lower rates of dropout regardless of treatment options and population. Third, Stefanie LoSavio will share dropout data from WET delivered at the Department of Veterans Affairs as part of a national rollout and will discuss predictors and reasons for dropout, as well as symptom trajectories of individuals who completed versus those who did not complete WET. Finally, our discussant, Patricia Resick, will facilitate a discussion about new developments in treatments for PTSD and how these implications could help further prevent dropout.

Attendees will learn about the prevalent problem of dropout in treatments for PTSD and how to recognize early signs of dropout among clients in specific types of trauma-informed treatments. Additionally, attendees will better understand how modifications to treatments for PTSD and the implementation of briefer EBTs might decrease dropout rates.