A recent study conducted at University of Houston has offered clues about why many people end cognitive behavioral therapy before the recommended course of treatment has ended.
The researchers found patients who improve quickly are more likely to drop out before completing treatment, losing the potential for future benefit. Lead author Partha Krishnamurthy said that they believe the heartbeat of the finding is the speed of improvement, rather than the level of improvement, adding that the faster they get better compared to where they started, the more likely they are to abandon treatment.
The stigma associated with mental health problems may be one reason. Although there is no direct evidence, he said the patient might be thinking of the stigma and reasoning, "I've gotten better, so why should I continue being seen seeking treatment?" As the patient starts experiencing improvement, the desire to get better becomes less pronounced compared to the social, emotional, financial and time costs of continuing therapy, they wrote, adding that clients who approached their symptom reduction goal were more likely to discontinue treatment activities.
People who began with the highest anxiety levels also were more likely to drop out. That could be because the illness affected their ability to decide they need treatment, Krishnamurthy said, as well as their ability to get to appointments and other issues. The researchers suggested patients with the highest anxiety levels could benefit "from immediate symptom relief strategies, such as relaxation exercises or medication."
And Krishnamurthy said that, while the work isn't intended to offer specific solutions, strategies such as focusing on future gains, rather than simply recognizing progress already made, could be helpful. Financial incentives - reducing co-pays for patients after they reach a certain point in the treatment, for example - also might help, he said.
The study is published in the Journal of Clinical Psychology