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Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters.

ABSTRACT: The present study examined predictors and moderators of dropout among 165 adults meeting DSM-IV criteria for posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Participants were randomized to 24 weeks of naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive AD counseling (the BRENDA manualized model).Logistic regression using the Fournier approach was conducted to investigate baseline predictors of dropout across the entire study sample. Rates of PTSD and AD symptom improvement were included to evaluate the impact of symptom change on dropout.Trauma type and rates of PTSD and AD improvement significantly predicted dropout, accounting for 76% of the variance in dropout. Accidents and "other" trauma were associated with the highest dropout, and physical assault was associated with the lowest dropout. For participants with low baseline PTSD severity, faster PTSD improvement predicted higher dropout. For those with high baseline severity, both very fast and very slow rates of PTSD improvement were associated with higher dropout. Faster rates of drinking improvement predicted higher dropout among participants who received PE.The current study highlights the influence of symptom trajectory on dropout risk. Clinicians may improve retention in PTSD-AD treatments by monitoring symptom change at regular intervals, and eliciting patient feedback on these changes.

SUBMITTER: Zandberg LJ

PROVIDER: S-EPMC4828304 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters.

Zandberg Laurie J LJ Rosenfield David D Alpert Elizabeth E McLean Carmen P CP Foa Edna B EB

Behaviour research and therapy 20160303

<h4>Objective</h4>The present study examined predictors and moderators of dropout among 165 adults meeting DSM-IV criteria for posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Participants were randomized to 24 weeks of naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive AD counseling (the BRENDA manualized model).<h4>Method</h4>Logistic regression using the Fournier approach was conducted to investigate b ...[more]

PMID: 26972745

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Project description:Background: Dropout from psychotherapy has negative impacts on clients, therapists, and health-care agencies. Research has identified a variety of variables as predictors of dropout, which can be grouped in three domains: socio-demographic, psychological, and treatment-related variables. Objective: In order to further clarify the question of predictors of dropout, an exploratory research design was applied to a large sample, testing 25 different variables from the three domains as possible predictors. Method: The sample included 386 adults who started an internet-based cognitive-behavioural treatment approach for posttraumatic stress disorder (PTSD) in Arabic. As the participants had different countries of origin and of current residence, multilevel analyses were performed. For the selection of predictor variables, the Least Absolute Shrinkage and Selection Operator was used. Results: Dropout rates did not vary significantly between participants from different countries of origin or from different countries of residence. Likewise, dropout did not vary significantly between clusters of individuals with the same country of origin and the same country of residence, i.e. the same migration path. Three of the 25 variables were identified as significant predictors for dropout: marital status (divorced participants' probability to drop out was higher compared to non-divorced, i.e. single, married, or widowed, clients), treatment credibility scores (higher dropout probability of participants with lower treatment credibility), and the participants' year of registration for the treatment (earlier years of registration predicted lower dropout probability). The overall ability of the three-factor-model to discriminate between dropout and completion was poor (AUC = 0.652, with low sensitivity and acceptable specificity). Conclusions: The predictors belong to the treatment-related domain (credibility, year of registration) or are specific to the target group (marital status). However, the results show that predicting treatment dropout continues to be a very challenging endeavour and indicate that it is important to look at each intervention individually.

Project description:BackgroundPosttraumatic stress disorder (PTSD) is associated with autonomic dysfunction as indicated by deficits in the sympathetic and parasympathetic nervous systems. These abnormalities are expressed as elevated heart rate and reduced heart rate variability (HRV), respectively. Intermittent theta-burst stimulation (iTBS), a form of transcranial magnetic stimulation, has demonstrated effectiveness in PTSD. Nevertheless, it remains unclear whether HRV may be an iTBS biomarker for PTSD and whether iTBS impacts autonomic activity.Materials and methodsFifty veterans with PTSD participated in a randomized controlled trial, receiving ten daily sessions of sham-controlled iTBS (right dorsolateral prefrontal cortex, 1800 pulses/day, 80% active motor threshold, 9.5 min). With a usable dataset (N = 47), HRV parameters were assessed as predictors of clinical response immediately after stimulation. iTBS effects on autonomic response (mean RR interval, root mean square of successive differences [RMSSD], total power [TP], and low-frequency/high-frequency [LF/HF] ratio) were evaluated using an ultra-short approach.ResultsTP and RMSSD were significant predictors of acute clinical response to iTBS. Individuals with higher TP had better response to iTBS with improved symptoms on the Clinician-Administered PTSD Scale (rs = -0.58, p = 0.004), and higher functionality on the Social and Occupational Function Scale (rs = 0.43, p = 0.04). Similarly, higher RMSSD was associated with superior outcomes (rs = -0.44, p = 0.04). No other significant changes in HRV metrics were observed (p ≥ 0.05).ConclusionsOur findings indicate that autonomic activity is a potential low-cost and technically simple predictive biomarker of iTBS response in PTSD. Less autonomic dysfunction was associated with superior clinical improvements with iTBS. Future studies might consider HRV acquisition during iTBS, as well as prospective testing of these findings in patients with elevated hyperarousal.

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Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters.

Publications

Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters.

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