The efficacy of cognitive–behavioral therapy and the problem of drop-out

University of Barcelona, Spain.
Journal of Clinical Psychology (Impact Factor: 2.12). 06/2007; 63(6):585-92. DOI: 10.1002/jclp.20368
Source: PubMed


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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    • "In addition, concerns have been raised about the degree to which the prevailing behavioural approach, exposure with response prevention (ERP) is effective; " Of 118 subjects with OCD treated with 12 weeks of ERP, 48 appeared to be nonresponders " (van Balkom, Emmelkamp, Eikelenboom, Hoogendoorn, Smit & van Oppen, 2012, p. 366; although see Rosa- Alcázar, Sánchez-Meca, Gómez-Conesa & Marín-Martínez, 2008 for an interesting review in which the addition of imaginal exposure to ERP for OCD was better than exposure alone). The continued focus on behavioural methods is also of concern given the high number of drop-outs and refusals associated with traditional exposure-based interventions for OCD and other anxiety disorders (e.g., Foa et al., 2005; Bados, Balaguer & Saldaña, 2007). Our own recent work on this subject has revealed that certain cognitively-based approaches to the treatment of anxiety disorders (Milosevic & Radomsky, 2013) and of contamination-related OCD (Levy & Radomsky, in press) may indeed be more acceptable to potential clients/patients than traditional behaviour therapy (see also Parrish, Radomsky & Dugas, 2008; Rachman, Radomsky & Shafran, 2008; Rachman, Shafran, Radomsky & Zysk, 2011; van den Hout, Engelhard, Toffolo & van Uijen, 2011). "
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    ABSTRACT: There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory—Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n=57), participants diagnosed with an anxiety disorder other than OCD (n=24) and in undergraduate student controls (n=410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n=30) and those whose OCD excluded concerns related to contamination fear (n=27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.
    Journal of Obsessive-Compulsive and Related Disorders 07/2014; 3(2):181-187. DOI:10.1016/j.jocrd.2013.08.003 · 1.18 Impact Factor
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    • "The main reasons for not completing MBCT were grouped into three categories in line with previous studies.40 Of all the subjects who did not complete MBCT (n=17), 14 patients (82.4%) missed sessions due to low motivation and/or dissatisfaction with the treatment, two patients (11.8%) because of external difficulties, and one patient (5.9%) who believed he had improved. "
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    ABSTRACT: Purpose Although the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for panic disorder (PD) has been studied previously, data on the predictors of treatment outcomes in MBCT for PD are scarce. Materials and Methods Eighty patients with PD were screened to analyze treatment outcomes such as MBCT completion, treatment response, and remission after undergoing MBCT for PD. Sociodemographic characteristics, comorbid personality disorders, and baseline medication doses were examined. The study administered the Panic Disorder Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Anxiety Sensitivity Inventory-Revised to patients at baseline and at eight weeks. Results Sixty-five participants were enrolled in the present study. Comorbid personality disorder was significantly associated with MBCT non-completion. We found that anxiety sensitivity (AS) improvement after an eight week MBCT program was a statistically significant factor associated with treatment response. Using logistic regression analysis, AS improvement after MBCT showed significant association with PD remission after MBCT. Conclusion Comorbid personality disorders of participants could be a potential predictor of MBCT non-completion. Furthermore, AS improvement after MBCT may predict treatment response and remission after MBCT for PD. However, better designed studies with a larger number of patients are needed to confirm our findings.
    Yonsei medical journal 11/2013; 54(6):1454-62. DOI:10.3349/ymj.2013.54.6.1454 · 1.29 Impact Factor
    • "Also, first appointments are less often rescheduled (Sparr, Moffitt and Ward, 1993) and even for those who do rearrange, early nonattendance predicts later drop-out (Aubrey, Self and Halstead, 2003). Although there are few studies of initial nonattendance specifically within CBT services; one study reported a drop-out rate of 28% after the first session (Bados et al., 2007). Within IAPT settings, data from routine practice showed that one-third of referred individuals failed to opt-in, and a further quarter did not attend the first appointment, equating to an overall nonattendance rate of 50% of all referrals (K. "
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    ABSTRACT: Background: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. Aims: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. Method: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. Results: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, "Talking to a therapist will help me understand better how my mind works" had a significant association with subsequent attendance. Conclusions: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.
    Behavioural and Cognitive Psychotherapy 09/2012; 41(4):1-12. DOI:10.1017/S1352465812000811 · 1.69 Impact Factor
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