Requiring veterans to confront the traumatic experiences that caused their post-traumatic stress disorder (PTSD) may lead many to abandon therapy prematurely, according to new evidence review findings.
A review published Nov. 17 in the journal Psychological Trauma: Theory, Research, Practice, and Policy found that approximately a quarter of U.S. service members and veterans who begin psychotherapy for PTSD discontinue treatment before completion.
However, researchers discovered that certain therapies, despite proving effective, experience higher dropout rates compared to others.
Results demonstrate that trauma-focused approaches such as exposure therapy and cognitive processing therapy show higher dropout rates than approaches centered on mindfulness, meditation, and stress reduction.
Lead researcher Elizabeth Penix-Smith, a National Research Council fellow at the Walter Reed Army Institute of Research in Silver Spring, Maryland, explained in a news release: “Dropout rates remain a significant challenge in PTSD care for military populations.”
Penix-Smith added: “Identifying which protocols are more sustainable can help clinicians tailor care and policymakers prioritize treatments that keep patients engaged.”
Background notes from researchers indicate that roughly 7% of veterans experience PTSD at some stage in their lives, a rate slightly exceeding that observed among the general public. The disorder elevates the risk of heart disease and stroke.
For this research, investigators examined data from 181 prior studies encompassing 232 PTSD treatments and more than 124,000 military participants.
Researchers report that, on average, just under 26% of service members and veterans discontinued treatment before completing their recommended PTSD therapy.
However, the likelihood of dropping out varied widely depending on the type of therapy:
Cognitive processing therapy had the highest dropout rate at 40%. This method involves asking patients to revisit their traumatic experiences in detail and reflect on the thoughts and emotions connected to those events.
Exposure therapy showed a 35% dropout rate, while virtual reality exposure therapy had a rate of 37%. Both approaches center on gradually exposing individuals to memories or sensations that trigger PTSD symptoms, with the goal of reducing their emotional intensity over time.
Other approaches had notably lower dropout rates: present-centered therapy at 16% and mindfulness-based stress reduction at 20%.
Programs treating PTSD alongside substance use disorders saw the steepest dropout rates overall, with 46% of participants leaving before completion.
Conversely, group-based exposure therapy designed around teamwork and shared support had a dropout rate of just 7%.
“Behind every statistic is a person who may be struggling to stay the course in treatment,” Penix-Smith said.
“This study provides better benchmarks for how often people disengage from different PTSD treatments,” she added. “It highlights which therapies may be easier for some service members and veterans to stick with.”
She explained that this information may help clinicians offer additional support during more demanding therapies — such as building trust, monitoring progress, and honoring patient preferences — to decrease the likelihood of dropout.
“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.”