Trauma, Re-traumatisation and Dropout from Psychological Treatment for Post-Traumatic Stress Disorder (PTSD)

Simmons, Caroline (2020) Trauma, Re-traumatisation and Dropout from Psychological Treatment for Post-Traumatic Stress Disorder (PTSD). Doctoral thesis, University of East Anglia.

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Background: Trauma-exposure in children and young people has been linked to a wide range of adverse consequences (Dorsey et al., 2017). However, dropout from treatment following trauma has been found to be high (Ormhaug & Jensen, 2018). Evidence suggests some clinicians do not implement trauma-focused treatments (Becker et al., 2004). This has been linked to concern that treatment can exacerbate symptoms, ‘re-traumatise’ patients and increase risk of dropout (Finch et al., 2020a). Methods: A systematic review of the literature identified studies which have quantitatively examined variables that have a potential relationship with dropout from psychotherapeutic treatment for trauma-exposed children and young people. Findings from these 20 studies form the basis of a narrative synthesis. Data regarding participant dropout was extracted from 40 trials of treatments for PTSD in children and young people. Proportion meta-analyses estimated the prevalence of dropout. Odds Ratios compared the relative likelihood of dropout between different treatments and controls. Subgroup analysis assessed the impact of potential moderating variables. Results: A host of variables have been investigated regarding treatment dropout for trauma-exposed children and young people. Findings are mixed and inconsistent, but there is evidence to suggest some groups are at greater risk of dropout. However, treatment approach does not appear to be significantly linked to dropout: dropout from RCTs of trauma-focused treatments is low and is not more likely than from non-trauma focused arms. Conclusions: Trauma-focused treatments are well-tolerated by young people in trials however dropout from ‘real-world’ settings appears to be far higher. Potential reasons for this are explored, but a lack of consistency as to how dropout is defined makes this problematic. Adopting standardised reporting of dropout-relevant data in both research and clinical contexts would help address this. These findings contribute to an emergent evidence base in this area and directions for future research are identified. Particularly warranted is research that explores how retention in RCTs can be replicated in other settings, and the broadening of methodological approach and foci.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 07 Apr 2021 10:23
Last Modified: 07 Apr 2021 10:23


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