"It didn't fit for me:" A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans.

Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy. Veterans who dropped out from prolonged exposure or cognitive processing therapy (N = 28) completed qualitative interviews about their experiences. Interviews were coded by 2 coders using grounded theory. Therapy-related barriers were the largest category reported, and included lack of buy-in to the rationale or specific therapy tasks, believing that treatment was not working, alliance issues, or switching to a different treatment. Practical barriers and finding treatment "too stressful" were also common reasons for dropout. This research provides information that can shape how PTSD treatments are delivered in health care settings. Therapy-related barriers were the largest group, suggesting that providers may need to find more effective ways to communicate the rationale for these therapies or to tailor them to individual patients' needs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

• Publication year

  2020

• Venue

  Psychological services

• Publication date

  2020-11-01

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.1037/ser0000316PMID 30475041PMCID PMC6535373
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• The Influence of Patient Readiness on Implementation of Evidence-Based PTSD Treatments in Veterans Affairs Residential Programs

  2017cited by this paper
• Failure to Engage: A Qualitative Study of Veterans Who Decline Evidence-Based Psychotherapies for PTSD

  2017cited by this paper
• Increased Utilization of Prolonged Exposure and Cognitive Processing Therapy Over Time: A Case Example From a Large Veterans Affairs Posttraumatic Stress Disorder Clinic

  2017cited by this paper
• Childhood trauma and posttraumatic stress disorder in a real-world Veterans Affairs clinic: Examining treatment preferences and dropout.

  2016cited by this paper
• Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

  2015cited by this paper
• Psychological Trauma: Theory, Research, Practice, and Policy Treatment Initiation and Dropout From Prolonged Exposure and Cognitive Processing Therapy in a VA Outpatient Clinic

  2015cited by this paper
• The problem of dropout from “gold standard” PTSD therapies

  2015cited by this paper
• Increasing engagement in evidence-based PTSD treatment through shared decision-making: a pilot study.

  2014cited by this paper
• A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD.

  2014cited by this paper
• Characteristics of U.S. veterans who begin and complete prolonged exposure and cognitive processing therapy for PTSD.

  2014cited by this paper
• Predictors of Length of Stay Among OEF/OIF/OND Veteran Inpatient PTSD Treatment Noncompleters

  2014cited by this paper
• Implementation of evidence-based psychotherapies for posttraumatic stress disorder in VA specialty clinics.

  2014cited by this paper
• Early Treatment Withdrawal from Evidence-Based Psychotherapy for PTSD: Telemedicine and in-Person Parameters

  2014cited by this paper
• Intensive outpatient prolonged exposure for combat-related PTSD: A case study.

  2014cited by this paper
• Meta-analysis of dropout in treatments for posttraumatic stress disorder.

  2013cited by this paper
• Health service utilization before and after evidence-based treatment for PTSD.

  2013cited by this paper
• Psychotherapy for military-related posttraumatic stress disorder: review of the evidence.

  2013cited by this paper
• Manualized therapy for PTSD: flexing the structure of cognitive processing therapy.

  2012cited by this paper
• Premature discontinuation in adult psychotherapy: a meta-analysis.

  2012cited by this paper
• Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment.

  2011cited by this paper
• Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: a randomized control comparison with treatment as usual.

  2011cited by this paper
• No-shows, drop-outs and completers in psychotherapeutic treatment: Demographic and clinical predictors in a large sample of non-psychotic patients

  2011cited by this paper
• No One Leaves Unchanged: Insights for Civilian Mental Health Care Professionals Into the Military Experience and Culture

  2011cited by this paper
• A meta-analytic review of prolonged exposure for posttraumatic stress disorder.

  2010cited by this paper
• Dropout and therapeutic alliance: a meta-analysis of adult individual psychotherapy.

  2010cited by this paper
• Prolonged Exposure Therapy for PTSD : Emotional Processing of Traumatic Experiences Therapist Guide

  2007cited by this paper
• Physical and Mental Comorbidity, Disability, and Suicidal Behavior Associated With Posttraumatic Stress Disorder in a Large Community Sample

  2007cited by this paper
• Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial.

  2007cited by this paper
• Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics.

  2005cited by this paper
• Qualitative research in counseling psychology: A primer on research paradigms and philosophy of science

  2005cited by this paper
• Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice.

  2005cited by this paper
• Does imaginal exposure exacerbate PTSD symptoms?

  2002cited by this paper
• Posttraumatic stress disorder: the burden to the individual and to society.

  2000cited by this paper
• The Significance of Saturation

  1995cited by this paper
• Eye movement desensitization: a new treatment for post-traumatic stress disorder.

  1989cited by this paper
• The Discovery of Grounded Theory: Strategies for Qualitative Research

  1968cited by this paper

• Use of Broadband Assessments of Personality and Psychopathology in the Assessment of Psychological Trauma

  2026cites this paper
• Human-centered Perspectives on a Clinical Decision Support System for Intensive Outpatient Veteran PTSD Care

  2026cites this paper
• Misinformation during imagery rescripting exercises increases false memories

  2025cites this paper
• Factors Associated with Treatment Duration in a Trauma-Focused Community Mental Health Setting

  2025cites this paper
• Treatment of trauma - cognitive processing therapy or prolonged exposure? Analysis of leading approaches within the cognitive-behavioral paradigm

  2025cites this paper
• Written Exposure Therapy for Adolescents and Young Adults in Integrated Primary Care

  2025cites this paper
• Feasibility and acceptability of written exposure therapy group in a virtual outpatient setting

  2025cites this paper
• Who defines improvement? Patients' global reports of improvement compared to standardized measures of improvement in cognitive processing therapy for posttraumatic stress disorder.

  2025cites this paper
• Acceptance and Commitment Therapy for Posttraumatic Psychopathology: A Group-Based Telehealth Intervention.

  2025cites this paper
• Adapting MOVED as a web-based moral elevation intervention for veterans with PTSD: Using feedback from a pilot trial and subject matter experts

  2025cites this paper
• Clients' Reasons for Dropping Out of Therapy: A Qualitative Study

  2025cites this paper
• Veterans' experiences of somatic experiencing and prolonged exposure therapies for post‐traumatic stress disorder: A qualitative analysis

  2025cites this paper
• Trauma-focused evidence-based psychotherapy for post-traumatic stress disorder delivered via video telehealth in the Veterans Health Administration

  2025cites this paper
• Beyond symptom reduction: Veterans' goals for posttraumatic stress disorder treatment.

  2025cites this paper
• Clients' experiences of psychotherapeutic interventions addressing trauma

  2025cites this paper
• Process Improvement for Engaging With Trauma-Focused Evidence-Based Psychotherapy for PTSD

  2025cites this paper
• Effectiveness of prolonged exposure (PE) after implementation at a crime victim support centre

  2024cites this paper
• Towards an understanding of readiness for trauma-focussed therapy in post-traumatic stress disorder: A conceptual integration of empirical data and theoretical constructs.

  2024cites this paper
• Randomized controlled trial of computerized working memory training for Veterans with PTSD

  2024cites this paper
• The effectiveness of mindfulness-based stress reduction (MBSR) on depression, PTSD, and mindfulness among military veterans: A systematic review and meta-analysis

  2024cites this paper
• Veterans’ Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care

  2024cites this paper
• Unreal that feels real: artificial intelligence-enhanced augmented reality for treating social and occupational dysfunction in post-traumatic stress disorder and anxiety disorders

  2024cites this paper
• Evaluating the mobile Mantram Repetition Program for veterans with PTSD: A multimethod randomized feasibility trial of self-directed versus text support delivery.

  2024cites this paper
• Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions

  2024cites this paper
• Building resilience: A specialty clinic tailored to older adults at risk for violence and abuse

  2024cites this paper
• The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta-Analysis.

  2024cites this paper
• Current Research on Matching Trauma-Focused Therapies to Veterans: A Scoping Review.

  2024cites this paper
• Using machine learning to increase access to and engagement with trauma‐focused interventions for posttraumatic stress disorder

  2024cites this paper
• Massed written exposure therapy delivered to veterans with posttraumatic stress symptoms on an acute inpatient mental health unit.

  2024cites this paper
• Dropout in a clinical trial for comorbid PTSD and MDD among US service members: Are pretreatment characteristics predictive?

  2024cites this paper
• Treatment-related beliefs and reactions among trauma-focused therapy completers and discontinuers: A qualitative examination.

  2024cites this paper
• How is trauma-focused therapy experienced by adults with PTSD? A systematic review of qualitative studies

  2024cites this paper
• Clinician perspectives on technology-enhanced in vivo exposures during prolonged exposure therapy for PTSD.

  2023cites this paper
• Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders

  2023cites this paper
• Military Sexual Trauma Among Men: Gendered Experiences, Clinical Considerations, and Treatment Options

  2023cites this paper
• If it's offered, will they come? Practical considerations when offering intensive PTSD treatment in an outpatient Veterans Affairs PTSD clinic.

  2023cites this paper
• Use of Virtual Reality Techniques to Rehabilitate Military Veterans with Post-Traumatic Stress Disorder (Review)

  2023cites this paper
• Trauma survivors’ perceptions and experiences of prolonged exposure for PTSD at a psychology clinic

  2023cites this paper
• ‘Undoing a knot’: a qualitative study of massed 1-week Cognitive Processing Therapy

  2023cites this paper
• Emotional freedom technique versus written exposure therapy versus waiting list for post-traumatic stress disorder: protocol for a randomised clinical MRI study

  2023cites this paper
• MDMA-assisted psychotherapy with adolescents suffering from PTSD: Do or don’t? a qualitative study with youth, parents, and clinicians

  2023cites this paper
• Framework for Accurate Classification of Self-Reported Stress From Multisession Functional MRI Data of Veterans With Posttraumatic Stress

  2023cites this paper
• Using the multiphase optimization strategy to adapt cognitive processing therapy (CPT MOST): study protocol for a randomized controlled factorial experiment

  2023cites this paper
• Addressing Attrition from Psychotherapy for PTSD in the U.S. Department of Veterans Affairs

  2023cites this paper
• Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes.

  2023cites this paper
• Examining the Veterans Health Administration whole health model of care within the context of posttraumatic stress disorder.

  2023cites this paper
• Characterizing and Comparing Evidence-Based Psychotherapy Utilization Among Veterans with Co-occurring PTSD and Substance Use Disorder

  2023cites this paper
• Do early responders and treatment non-responders offer guidance to make CPT group a more effective treatment?

  2022cites this paper
• Clinician Concerns About Cognitive Processing Therapy: A Review of the Evidence

  2022cites this paper
• Veterans' reasons for dropping out of prolonged exposure therapy across three delivery modalities: A qualitative examination.

  2022cites this paper
• "I wish people could come together like we have," patient and provider perspectives on VA residential PTSD treatment.

  2022cites this paper
• Improvement in Veterans' Openness to Seeking Professional Psychological Help After Participating in Therapeutic Adventure Trips

  2022cites this paper
• Dropout from Prolonged Exposure among Individuals with Posttraumatic Stress Disorder and Comorbid Severe Mental Illness

  2022cites this paper
• Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

  2022cites this paper
• Evidence-Based Adjustments to Cognitive Processing Therapy to Reduce Dropout

  2022cites this paper
• Building strong therapeutic relationships quickly: The effect of the perceived working alliance on veterans' intensive PTSD treatment outcomes.

  2022cites this paper
• Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout

  2022influential citation
• Quetiapine as an adjunct to enhance engagement in prolonged exposure therapy for PTSD in veterans: A randomized, pilot trial

  2022cites this paper
• Veterans receiving a second course of cognitive processing therapy or prolonged exposure therapy: is it better to switch or stay the same?

  2022cites this paper
• Making sense of poor adherence in PTSD treatment from the perspectives of veterans and their therapists.

  2022cites this paper
• Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression

  2022cites this paper
• Anger and predictors of drop-out from PTSD treatment of veterans and first responders

  2021cites this paper
• Women Veterans' Attrition from the VA Healthcare System.

  2021cites this paper
• The Role(s) of Psychopharmacology in the Treatment of PTSD

  2021cites this paper
• The beginning of the end: a comparison of treatment completers and early dropouts in trainee-provided time-limited cognitive behavioral therapy

  2021cites this paper
• Quetiapine Augmentation of Cognitive Processing Therapy in Veterans with Posttraumatic Stress Disorder. Design and Methodology of a Pilot Study

  2021cites this paper
• Treatment dropout among veterans and their families: Quantitative and qualitative findings.

  2021cites this paper
• Within-treatment clinical markers of dropout risk in integrated treatments for comorbid PTSD and alcohol use disorder.

  2021cites this paper
• Equine-Assisted Therapy for Veterans with PTSD: Manual Development and Preliminary Findings

  2020cites this paper
• A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings

  2020cites this paper
• Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange.

  2020cites this paper
• Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

  2020cites this paper
• Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study

  2020cites this paper
• A Theory of Planned Behavior Scale for Adherence to Trauma-Focused Posttraumatic Stress Disorder Treatments.

  2020cites this paper
• Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review

  2020cites this paper
• Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

  2020cites this paper
• Evidence‐based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014

  2019cites this paper
• The Ethics of Neglecting Clinical Relationship and Alliance Building in Trauma-Focused Treatments

  2019cites this paper
• An Examination of Early Termination from Trauma-Focused Treatment for Posttraumatic Stress Disorder: A Literature Review and Mixed Methods Study Proposal

  year unknowncites this paper