Study: PTSD treatment dropout rates vary widely

About a quarter of U.S. service members and veterans who start psychotherapy for post-traumatic stress disorder quit before they finish treatment. But not all therapies are equal in their appeal, with some effective approaches reporting the highest dropout rates, according to research published by the American Psychological Association.

PTSD affects about 7% of veterans at some point in their lives, slightly higher than the rate seen in the general U.S. adult population, according to the U.S. Department of Veterans Affairs. Beyond PTSD's emotional impact, the American Heart Association notes that it can also raise the risk of heart disease and stroke, two conditions that disproportionately affect veterans.

Behind every statistic is a person who may be struggling to stay the course in treatment. By learning more about the patterns of who drops out and why, we can shape PTSD care so that it meets veterans where they are at."

Elizabeth A. Penix-Smith, PhD, lead author of Idaho State University and a National Research Council fellow, Walter Reed Army Institute of Research

In a meta-analysis of 181 studies covering 232 PTSD treatments and more than 124,000 military participants, researchers found an average of 25.6% of veterans and service members dropped out before finishing the recommended course of treatment for all PTSD therapies. However, rates differed significantly among the therapies.

Weekly trauma-focused approaches such as cognitive processing therapy and prolonged exposure had the highest dropout rates: 40.1% and 34.7%, respectively. Virtual reality exposure therapy also showed high dropout (37.2%). In contrast, present-centered therapy and mindfulness-based stress reduction showed lower dropout rates of 16.1% and 20%. Dropout rates from intensive outpatient versions of trauma-focused treatments ranged from 5.5% to 8.5%.

Researchers also discovered that group-based exposure therapy, which encourages teamwork and connection before diving into trauma work, kept participants engaged better than most therapies, with only 6.9% dropping out.

Dropout was especially high (46.4%) in programs treating PTSD alongside substance use disorders, compared with lower rates (23.2%) for programs targeting both PTSD and depression.

"This study provides better benchmarks for how often people disengage from different PTSD treatments," Penix-Smith said. "It highlights which therapies may be easier for some service members and veterans to stick with."

The findings, published in the journal Psychological Trauma: Theory, Research, Practice, and Policy, reveal that while some trauma-focused therapies remain highly effective, they may also see more clients leaving treatment early.

"Dropout rates remain a significant challenge in PTSD care for military populations," said Penix-Smith. "Identifying which protocols are more sustainable can help clinicians tailor care and policymakers prioritize treatments that keep patients engaged."

Penix-Smith suggests that when therapists use treatments with higher dropout rates, they should try proven ways to keep clients engaged-such as building trust, tracking progress and respecting what each client prefers.

"Our study findings underscore the importance of investing in interventions for preventing dropout or identifying methods for matching clients to their optimal treatment to reduce dropout," Penix-Smith said. "By focusing on approaches that are a good fit and by providing the right support along the way, we can make real progress in helping them recover from trauma."