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Dissertation: Outpatient Psychotherapy Dropouts – An Exploratory Meta-Analysis
Abstract according to the guidelines of the American Psychological Association (words ≤ 350)
The aim of this exploratory meta-analysis of 146 published studies (PsycINFO and PSYNDEX: 1.1.1984
to 31.12.2004) is the investigation of new correlations between outpatient dropout rates and many
variables (adult patients, therapists, treatments), and of psychological differences between dropouts
and completers. The meta-analysis is based on the random and mixed effects model (in brackets:
|Hedges d|, unless otherwise specified): Time-limited (1.13), structured (0.57) and cognitive
behavioral therapies (compared to certain therapies > 0.50) tend to have lower dropout rates.
Trained psychotherapists have somewhat lower dropout rates (0.28) compared with therapists in
training (therapist qualifications: 0.24). Psychologists and psychiatrists cause lower dropout rates
than therapists with other professional backgrounds (0.33).
Dropouts have somewhat worse therapy alliance (0.43) at baseline which deteriorates in the course
of therapy (0.68), worse patient satisfaction (0.57), and a moderately greater divergence of attitudes
and expectations concerning therapy and therapists (0.41).
Dropouts show more interpersonal problems at therapy start (0.29): more aggressive-hostile
interaction styles (0.33), stronger trait anger (0.45) and state anger (0.70), increased personality
disorder scores (0.45), more frequent diagnoses of personality disorders (0.31), increased impulsivity
(0.55), and lower social support (0.59).
Lower introspection and psychological insight scores (0.79), increased comorbid depression (0.57; all
depression measures: 0.37; lower therapy motivation: 0.51; less personal locus of control: 0.28;
lower expectations of treatment rationale and treatment outcome: 0.47) indicate stronger emotional
avoidance (Grosse Holtforth, et al., 2012) for dropouts.
Highest dropout rates were found for eating (37.4%) and personality disorders (38.9%) and the
lowest rates for anxiety disorders (24.2%). Concerning anorexia and bulimia nervosa, dropouts show
modestly more symptoms (0.39). Dropouts have somewhat less prior outpatient therapy experience
(0.29) and slightly more comorbid addiction disorders (0.31).
Exploratory results: Longer sessions in individual and group settings (1.17 and 3.86 respectively), free
choice of psychotherapists (0.49), and therapy preparation procedures reduce dropout rates (9.17).
Dropouts have greater hopelessness (0.94), lower active problem solving skills (0.46), and slightly
weakened self-efficacy (0.30). Methodological limitations such as missing data, diverse dropout
definitions etc., suggestions for research and for the reduction of dropout rates (mean: 34.8%, range:
10.3% to 81.0%) are discussed.
Abstract according to the guidelines of the Deutschen Gesellschaft für Psychologie (words ≤ 120):
The aim of this meta-analysis of 146 published studies (PsycINFO and PSYNDEX: 1.1.1984 to
31.12.2004) is the investigation of correlations between outpatient dropout rates and many variables
(adult patients, therapists, treatments), and of psychological differences between dropouts and
completers. Calculations are based on the random and mixed effects model (in brackets: |Hedges
d|): Dropouts show poorer alliance (0.56) and more interpersonal problems (0.29 to 0.55). Increased
comorbid depression (0.57) and less introspection (0.79) indicate more avoidance (Grosse Holtforth,
et al., 2012) for dropouts. Time-limited (1.13), structured (0.57) and cognitive behavioral therapies (>
0.50) have lower dropout rates. More results, methodological limitations, and suggestions for
research and for the reduction of dropout rates (mean: 34.8%, range: 10.3% to 81.0%) are discussed.
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