Why was the treatment discontinued? - Reasons for attrition in evidence-based trauma-focused treatments

Sep 30, 2026

Post-traumatic stress disorder (PTSD) remains a debilitating condition despite the availability of evidence-based trauma-focused treatments, yet many studies report substantial dropout. This naturalistic study examined why such treatments are discontinued and which factors relate to problematic terminations, based on patient-reported PTSD symptoms during treatment and therapist-reported termination reasons. Logistic regression assessed associations with sex, age, baseline psychopathology, number of traumas, treatment type, and last-measurement therapeutic alliance.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 2025, VOL. 16, NO. 1, 2555044 [https://doi.org/10.1080/20008066.2025.2555044](https://doi.org/10.1080/20008066.2025.2555044) BASIC RESEARCH ARTICLE Why was the treatment discontinued? Reasons for attrition in evidence-based trauma-focused treatments Kristin Alve Glad a, Vidar Blokhus Ekrollb, Karina Egeland a and Harald Bækkelund a,c aNorwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; bDPS Stord, Helse Fonna, Stord, Norway; cResearch Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway ABSTRACT Background: Post-traumatic stress disorder (PTSD) is a debilitating mental disorder. Whereas effective treatments exist, many studies report high dropout rates. Objective: We aimed to get a better understanding of why evidence-based trauma-focused treatments are discontinued, and factors associated with problematic terminations, in a naturalistic setting. Method: Patients (N = 135) in outpatient mental health clinics, receiving evidence-based trauma-focused treatment, self-reported PTSD symptoms throughout their treatments. Additionally, their therapists were asked to fill out a form stating the reason(s) for treatment termination. Based on these two data sources, we classified each case according to whether the termination appeared to be problematic vs. unproblematic. Separate logistic regression analyses were then run to investigate the association between termination category and relevant variables ([i.e. sex](i.e. sex), age, baseline psychopathology, number of traumas, treatment type, and therapeutic alliance at last measurement time-point) . Results: Based on our categorization, most of the treatment terminations (n = 77, 57%) were deemed unproblematic (i.e. according to treatment plan and/or clinically relevant reduction in symptoms), whereas a significant minority (n = 26, 19%) could indicate problematic terminations (i.e. clinically relevant increase in symptoms, unexplained dropout, and/or above cut-off for PTSD at last measurement time-point) . Some of the cases that discontinued treatment earlier than planned could be described as early responders rather than as dropouts. Of the variables included in the logistic regression model, only therapeutic alliance was found to be significantly associated with termination category. Conclusions: This study highlights the need for a more nuanced approach to defining patient dropout. Our results also suggest that therapists may reduce the chance of a problematic trauma-focused treatment termination through securing a strong working relationship with the patient. ¿Por qué se interrumpió el tratamiento? Razones de abandono entratamientos basados en la evidencia centrados en el trauma Antecedentes: El trastorno de estrés postraumático (TEPT) es un trastorno mental debilitante. Aunque existen tratamientos eficaces, muchos estudios reportan altas tasas de abandono. Objetivo: Buscamos comprender mejor por qué se interrumpen los tratamientos centrados en el trauma basados en la evidencia, así como los factores asociados a terminaciones problemáticas, en un contexto naturalista. Método: Pacientes (N = 135) en clínicas ambulatorias de salud mental, que recibían tratamientocentrado en el trauma basado en la evidencia, informaron sus síntomas de TEPT a lo largo de sus terapias. Además, se pidió a sus terapeutas completar un formulario señalando la(s) razón(es) dela finalización del tratamiento. Con base en estas dos fuentes de datos, clasificamos cada caso según si la terminación parecía ser problemática o no problemática. Posteriormente, serealizaron análisis de regresión logística para investigar la asociación entre la categoría determinación y variables relevantes (sexo, edad, psicopatología basal, número de traumas, tipode tratamiento y alianza terapéutica en el último punto de medición). Resultados: Según nuestra categorización, la mayoría de las finalizaciones de tratamiento (n = 77; 57%) se

FAQs

How were treatment terminations classified in the study?

Terminations were classified as problematic or unproblematic based on therapist-reported reasons and changes in PTSD symptoms reported by patients during treatment.

Which variables were associated with problematic treatment termination?

Therapeutic alliance at the last measurement time-point was significantly associated with termination category, while patient characteristics and treatment type were not.

What did the results show about dropout rates?

Most terminations were deemed unproblematic (77, 57%), while a significant minority suggested problematic terminations (26, 19%). Some early discontinuations were characterized as early responders rather than dropouts.

Sep 30, 2026

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