A Treatment by Disorder Meta-Analysis of Dropout From Psychotherapy

Previous reviews of premature termination have yet to examine whether disparate psychotherapy treatments differ in their dropout rates for specific disorders. Using data from 587 studies, a series of meta-analyses were conducted comparing dropout rates between treatment approaches for 12 separate disorder categories. Although, significant differences between treatment approaches were found for depression [Q(9) = 22.69, p<.01], eating disorders [Q(7) = 14.63, p<.05], and posttraumatic stress disorder (PTSD) [Q(7) = 20.20, p<.01], treatments did not differ in their dropout rates for the remaining 9 diagnostic categories. Although integrative treatments resulted in the lowest dropout rates for depression and PTSD, dialectical-behavior therapy resulted in the lowest average dropout rate for eating disorders. The similarity in dropout rates for the majority of the disorder categories suggests that clients' decisions to drop out may depend more on other therapy variables (e.g., common factors, client characteristics, and therapist characteristics) rather than the specific type of treatment that is used. Additionally, our findings highlight the particular usefulness of an integrationist approach to therapy-it showed to be the most robust model for retaining clients in that its dropout rate was equal to or better than all of the other therapy approaches for 11 out of the 12 disorders examined.