In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete.
BACKGROUND
Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments.


METHODS
A multivariable model of dropout risk was constructed with randomized clinical trial data (n = 160) comparing prolonged exposure (PE) and cognitive processing therapy (CPT) for rape-induced PTSD. A two-step bootstrapped variable selection algorithm was applied to identify moderators of dropout as a function of treatment condition. Employing identified moderators in a model, fivefold cross-validation yielded estimates of dropout probability for each patient in each condition. Dropout rates between patients who did and did not receive their model-indicated treatment were compared.


RESULTS
Despite equivalent dropout rates across treatments, patients assigned to their model-indicated treatment were significantly less likely to drop out relative to patients who did not (relative risk = 0.49 [95% CI: 0.29-0.82]). Moderators included in the model were: childhood physical abuse, current relationship conflict, anger, and being a racial minority, all of which were associated with higher likelihood of dropout in PE than CPT.


CONCLUSIONS
Individual differences among patients affect the likelihood they will complete a particular treatment, and clinicians can consider these moderators in treatment planning. In the future, treatment selection models could be used to increase the percentage of patients who will receive a full course of treatment, but replication and extension of such models, and consideration of how best to integrate them into routine practice, are needed.
['Keefe|John R|JR|0000-0001-7250-8960', 'Wiltsey Stirman|Shannon|S|', 'Cohen|Zachary D|ZD|', 'DeRubeis|Robert J|RJ|', 'Smith|Brian N|BN|', 'Resick|Patricia A|PA|']
D000328:Adult D054523:Adult Survivors of Child Abuse D015928:Cognitive Behavioral Therapy D005260:Female D006801:Humans D007171:Implosive Therapy D007206:Individuality D008875:Middle Aged D010349:Patient Compliance D011902:Rape D013313:Stress Disorders, Post-Traumatic D055815:Young Adult
trauma treatment clinical trials CBT/cognitive behavior therapy PTSD/posttraumatic stress disorder behavior therapy empirical supported treatments