DROPOUT FROM ANXIETY REDUCTION PROGRAM: IMPACT OF SPEED OF IMPROVEMENT AND LEVEL OF ANXIETY

One of the features of the consumption of mental health services is that they are often consumed as a series of individual therapy sessions that are spread over time but are collectively required to achieve the therapeutic goal. As a result, patient drop-out is a significant risk in psychotherapy treatment regimes, with some studies reporting it to be as high as 48.86% Wierzbicki and Pekarik (1993). Dropout has been thought to be influenced by a range of different variables including patients’ demographic, historic, and attitudinal information (Corning and Malofeeva 2004; Kokotovic and Tracey 1987), clinical variables such as assessed and perceived severity of patients’ symptoms (Pekarik 1983; Turner et al. 1996), or patients’ thoughts or feelings regarding treatment (Reitzel et al. 2006).

This research focuses on two aspects of treatment effectiveness, the level of improvement in symptoms, and the speed of improvement in symptoms as potential antecedents of drop-out. The data came from 79 participants at an Anxiety Disorder Specialty Treatment Clinic situated in a major metropolitan area in the United States (43.04% were women) drawn from the general population (17 years to 71 years). We subjected the week-to-week anxiety scores (State-Trait Anxiety Inventory-State version; Spielberger 1983, STAIS-S) to survival analysis with the rate of improvement in anxiety and the level of anxiety at any given time as two-time varying predictors of dropout and duration of survival in the treatment program. Our principal finding is that dropout at any given week is influenced by the interaction between speed of improvement up until that week and the level of anxiety that week. Specifically, in any given week, those who improved more rapidly were also at higher risk for dropping out, but that this tendency was lower for those who had a higher level of anxiety in any given week.