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A systematic review and meta-analysis of dropout rates from dialectical behavior therapy in randomized controlled trials

Many randomized controlled trials (RCTs) have shown that dialectical behavioral therapy (DBT) is effective for many different mental health problems. However, one important factor to consider when interpreting findings from RCTs of DBT is patient dropout, as dropout can compromise the validity of trial findings. A greater understanding of patient dropout in RCTs of DBT is needed before developing effective retention strategies.

This meta-analysis examined dropout rates from DBT in RCTs. A total of 40 trials met inclusion criteria. The weighted meta-analytic mean dropout rate was estimated to be 28% (95% CI = 24-33%), with estimates ranging from 33% (95% CI = 28%, 39%) for patients with borderline personality disorder and 17% (95% CI = 8%, 34%) for patients with eating disorders. Dropout rates were significantly unrelated to dropout definition, delivery format, therapist experience, and therapist adherence. Contrary to the hypotheses, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team.

Our findings suggest that just over one in four patients drop out from RCTs of DBT. Given the variability of reporting of patient dropout rates, we highlight the need for a standardized definition of dropout in RCTs. Greater information reported in RCTs of DBT will be important for the development of effective strategies designed to prevent future drop outs in RCTs. This is important for ensuring that the external and internal validity of trial findings are not compromised.

Read the full paper: Dixon, J.L. & Linardon, J.(in press). A systematic review and meta-analysis of dropout rates from dialectical behavior therapy in randomized controlled trials. Cognitive Behaviour TherapyDOI: 10.1080/16506073.2019.1620324

Photo by: gato-gato-gato

Pictured: Lucas J Dixon (left), Jake Linardon (right)



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