"It Didn't Fit for Me:" A Qualitative Examination of Dropout From Prolonged Exposure and Cognitive Processing Therapy in Veterans
"It Didn't Fit for Me:" A Qualitative Examination of Dropout From Prolonged Exposure and Cognitive Processing Therapy in Veterans
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DOI：
10.1037/ser0000316
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发表时间：
2020-11-01
影响因子：
2.3
通讯作者：
Cully, Jeffrey A.
中科院分区：
文献类型：
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作者：
Hundt, Natalie E.;Ecker, Anthony H.;Cully, Jeffrey A.
以创伤为中心的心理疗法，如长期暴露和认知加工疗法，是治疗创伤后应激障碍最有效的形式。这些治疗通常在退伍军人健康管理局提供;然而，辍学意味着一些退伍军人未能受益。过早结束治疗是心理治疗中的一个常见问题，平均有20%至25%的患者退出。本研究的目的是检查退伍军人的自我报告的原因退出长期暴露或认知加工治疗。退伍军人谁退出了长期暴露或认知加工治疗（N = 28）完成了定性采访他们的经验。访谈由2名编码员使用扎根理论进行编码。与治疗相关的障碍是报告的最大类别，包括缺乏对基本原理或特定治疗任务的认同，认为治疗不起作用，联盟问题或改用不同的治疗。实际障碍和发现治疗“压力太大”也是辍学的常见原因。这项研究提供的信息可以塑造如何在医疗保健环境中提供创伤后应激障碍治疗。与治疗有关的障碍是最大的一组，这表明提供者可能需要找到更有效的方法来传达这些治疗的理由或根据个别患者的需要进行调整。
Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy. Veterans who dropped out from prolonged exposure or cognitive processing therapy (N = 28) completed qualitative interviews about their experiences. Interviews were coded by 2 coders using grounded theory. Therapy-related barriers were the largest category reported, and included lack of buy-in to the rationale or specific therapy tasks, believing that treatment was not working, alliance issues, or switching to a different treatment. Practical barriers and finding treatment "too stressful" were also common reasons for dropout. This research provides information that can shape how PTSD treatments are delivered in health care settings. Therapy-related barriers were the largest group, suggesting that providers may need to find more effective ways to communicate the rationale for these therapies or to tailor them to individual patients' needs.