Category: PTSD

Symposium

Therapists' Attitudes Regarding Patients' Dropout From Prolonged Exposure and Cognitive Processing Therapy

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: PTSD Posttraumatic Stress Disorder | Psychotherapy Process | Evidence-Based Practice
Presentation Type: Symposium

About 35% of veterans who start prolonged exposure (PE) or cognitive processing therapy (CPT) do not complete the treatment (Kehle-Forbes et al., 2016). Dropout is often cited as a shortcoming and has been shown to limit provider adoption of these therapies (Cook et al., 2013; Steenkamp et al., 2015). As part of a larger qualitative study, we interviewed VA PE and CPT providers about the course of treatment of a prespecified patient of the provider being interviewed who dropped out of PE or CPT. Given the existing literature, we began conducting the interviews with the assumption that providers would view the patient’s dropout as problematic. The first four interviews cast doubt on that assumption, and as is common in qualitative research, we added the following question to the interview schedule to further explore that hunch: “What do you think about the fact that [Veteran] dropped out of PE/CPT? Do you consider it a bad outcome?” To date, 26 providers have been interviewed and asked the above question in reference to a veteran to whom they provided between one and six sessions of either PE (n = 14) or CPT (n = 12). Thematic analysis of the qualitative data was conducted using a mixed deductive and inductive approach. Preliminary analyses suggest that only a small minority (n = 5) of providers expressed a predominately negative attitude toward their veteran’s dropout. The most common theme associated with a positive attitude toward their patient’s dropout was the maintenance of rapport; providers expressed the belief that maintaining the therapeutic relationship was more important than keeping the veteran engaged in PE or CPT (implicit in this attitude was the assumption that these two goals were at odds with each other) and they hoped that continued rapport would encourage the veteran to reattempt PE or CPT in the future. Other themes associated with positive attitudes toward dropout included a perceived lack of patient readiness,  the importance of patient choice, and a belief that the veteran received what they needed from therapy prior to dropout. The implication of these findings on efforts to improve engagement in PE and CPT will be discussed.     

Shannon Kehle-Forbes

Women’s Health Sciences Division, National Center for PTSD, Minneapolis VA Healthcare System

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