The efficacy of cognitive-behavioral therapy and the problem of drop-out.
ABSTRACT Treatment drop-out is a common problem in the everyday practice of psychotherapy. In the cognitive-behavioral psychology literature, there are scant data on drop-out from therapy and the data available vary widely according to the definition of drop-out and the intensity of treatment. This study presents results obtained in the Behavioural Therapy Unit of the University of Barcelona. Of the 203 patients seen in the unit, 89 (43.8%) dropped out, mostly in the early stages of the intervention. The most common reasons for this were low motivation and/or dissatisfaction with the treatment or the therapist (46.7%), external difficulties (40%), and patients' feeling of improvement (13.3%). Patients who dropped out differed from those who continued; they more often presented affective or eating disorders or problems with impulse control. The observed drop-out rate is in line with figures reported for psychotherapy in general and by those studies which have considered cognitive-behavioral therapy in particular.
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ABSTRACT: The authors report a meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder (GAD) that bear on the clinical utility and external validity of empirically supported therapies. The results suggest that a substantial proportion of patients with panic improve and remain improved; that treatments for depression and GAD produce impressive short-term effects: that most patients in treatment for depression and GAD do not improve and remain improved at clinically meaningful follow-up intervals: and that screening procedures used in many studies raise questions about generalizability, particularly in light of a systematic relation across studies between exclusion rates and outcome. The data suggest the importance of reporting, in both clinical trials and meta-analyses, a range of outcome indices that provide a more comprehensive, multidimensional portrait of treatment effects and their generalizability. These include exclusion rates, percent improved, percent recovered, percent who remained improved or recovered at follow-up, percent seeking additional treatment at follow-up, and data on both completer and intent-to-treat samples.Journal of Consulting and Clinical Psychology 01/2002; 69(6):875-99. · 4.85 Impact Factor
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ABSTRACT: This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.Journal of Consulting and Clinical Psychology 05/1998; 66(2):377-84. · 4.85 Impact Factor
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ABSTRACT: To characterize an outpatient public referral center for mental health and to assess factors associated with treatment dropout. A non-concurrent prospective study was undertaken to review 295 patient files. Patients, whose first consultation took place between January and December 1997, were followed-up for at least four months until April 1998. Patients were considered as having abandoned their treatment when, following a recommendation for at least a second visit, they did not return within four months after the first consultation. Social, demographic and clinical variables were compared to verify possible factors associated with dropout of treatment. Statistical analysis was performed using relative hazard (RR) with 95% confidence interval (CI) estimated by the Cox Regression Model. Cumulative incidence of treatment dropout was 39.2% while multivariate analysis indicated that the following characteristics were statistically associated with treatment interruption: to live outside the referral area (RR = 1.95), no history of previous psychiatric hospitalizations (RR = 1.88), alcohol or drug use at admission (RR = 1.72), spontaneous demand to the service (RR = 2.12), lack of bus-passes (RR = 3.68) and to have less than four clinical appointments (RR = 7.31). Our findings suggest that services should be aware of the high incidence of treatment interruption, especially among those with no history of previous psychiatric hospitalizations and with less institutional bonds. This may indicate that mental health services should develop and implement public policies targeted at this population.Revista Brasileira de Psiquiatria 07/2005; 27(2):113-8. · 1.86 Impact Factor