Cognitive Behavioral Therapy: Why Do Patients Drop Out Early?

Researchers from the University of Houston have found some interesting clues as to why therapy patients drop out of their treatment programs.

Often, patients in therapy for cognitive behavioral issues, like anxiety and depression, will abandon their sessions and treatment program before it has run its course. This can have adverse results, as patients miss out on the potential of future benefits from finished plans.

"We believe the heartbeat of the finding is the speed of improvement, rather than the level of improvement," said Partha Krishnamurthy, lead author of the paper and director of the Institute for Health Care Marketing at the University of Houston's Bauer College of Business. "The faster they get better compared to where they started, the more likely they are to abandon treatment." 

The study, published in the Journal of Clinical Psychology, included 139 people in a 12-week course of cognitive behavioral therapy at the university. While each session was occurring, the patients' anxiety levels were assessed, to examine how they were feeling throughout treatment.

The belief of the team is that patients are often caught up in the stigma associated with mental health problems. Krishnamurthy believes that "the patient might be thinking of the stigma and reasoning, 'I've gotten better, so why should I continue being seen seeking treatment?'" according to the release.

Previous research has shown that up to half of patients end treatment prematurely. 

Behavioral therapy treatments are set up with the intention of a certain number of sessions taking place, be it 10, 12, or 15 sessions, with the total treatment plan being stretched out along that period. Patients often must decide if the benefits of the treatment are worth the costs, both financially and emotionally, to continue it.

This has led to many patients ending their treatments early, citing their improvements as their reasoning for leaving. Research suggests patients should actually continue treatment as long as they are improving. But, the research team found a correlation between reduced symptoms and stopping treatment, meaning traditional decision-making factors may not apply to mental health care, according to the release.

"As the patient starts experiencing improvement, the desire to get better becomes less pronounced compared to the social, emotional, financial and time costs of continuing therapy," the team wrote. "Clients who approached their symptom reduction goal were more likely to discontinue treatment activities. More importantly, we found ... that faster improvement leads to greater discontinuation." 

Krishnamurthy suggested that the issue may be resolved if the cost of therapy copays was reduced, and if therapists focus on future gains more so than progress made. If patients can be taught to focus on what can be achieved after treatment completion, they may be more inclined to see it through, according to MedicalXpress.

"How do you make people do those things that are not easy or fun?" he asked. "We need to reframe the issue. At the end of the day, good health outcomes are the result of patients' choice process, as much as they are based on drugs and devices. Understanding how patients make decisions is a critical component of improving health care." 

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