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An evaluation of predictors of dropout from an Emotional Coping Skills programme in a community mental health service

Published online by Cambridge University Press:  04 July 2019

Shalini Raman  and
Thomas Richardson
Shalini Raman*
Affiliation:
University of Southampton Doctoral Programme of Clinical Psychology, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
Thomas Richardson
Affiliation:
Solent NHS Foundation Trust, Adult Mental Health, St Mary’s Community Health Campus, Milton Road, Portsmouth PO3 6AD, UK
*
*Corresponding author. Email: [email protected]
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Abstract

Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base.

Key learning aims

  1. (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature.

  2. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services.

  3. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention.

  4. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.

Keywords

cognitive behavioural interventiongroup psychotherapypersonality disorderservice evaluationtherapy outcometreatment adherence
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e35
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019. 

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References

Further reading

Chasson, GS, Vincent, JP, & Harris, GE (2008). The use of symptom severity measured just before termination to predict child treatment dropout. Journal of Clinical Psychology, 64, 891–904.CrossRefGoogle ScholarPubMed
Gunderson, JG, Frank, AF, Ronningstam, EF, Wachter, S, Lynch, VJ, & Wolf, PJ (1989). Early discontinuance of borderline patients from psychotherapy. Journal of Nervous & Mental Disease, 177, 38–42.CrossRefGoogle ScholarPubMed
Kröger, C, Harbeck, S, Armbrust, M, & Kliem, S (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51, 411–416.CrossRefGoogle Scholar
McMain, SF, Guimond, T, Barnhart, R, Habinski, L, & Streiner, DL (2017). A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatrica Scandinavica, 135, 138–148.CrossRefGoogle ScholarPubMed

References

Axelrod, SR, Perepletchikova, F, Holtzman, K, & Sinha, R (2011). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. American Journal of Drug and Alcohol Abuse, 37, 37–42.CrossRefGoogle ScholarPubMed
Baer, RA, Smith, GT, & Allen, KB (2004). Assessment of mindfulness by self-report. The Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191–206.CrossRefGoogle ScholarPubMed
Basu, S, Andrews, J, Kishore, S, Panjabi, R, & Stuckler, D (2012). Comparative performance of private and public healthcare systems in low-and middle-income countries: a systematic review. PLoS Medicine, 9, e1001244.CrossRefGoogle ScholarPubMed
Bornalova, MA, & Daughters, SB (2007). How does dialectical behaviour therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders? Clinical Psychology Review, 27, 923–943.CrossRefGoogle Scholar
Cairns, M (2014). Patients who come back: clinical characteristics and service outcome for patients re-referred to an IAPT service. Counselling and Psychotherapy Research, 14, 48–55.CrossRefGoogle Scholar
Chasson, GS, Vincent, JP, & Harris, GE (2008). The use of symptom severity measured just before termination to predict child treatment dropout. Journal of Clinical Psychology, 64, 891–904.CrossRefGoogle ScholarPubMed
Crossland, T, Hewitt, O, & Walden, S (2017). Outcomes and experiences of an adapted dialectic behaviour therapy skills training group for people with intellectual disabilities. British Journal of Learning Disabilities, 45, 208–216.CrossRefGoogle Scholar
Faul, F, Erdfelder, E, Lang, AG, & Buchner, A (2007). G* Power 3.0 manual. Available at: http://www.gpower.hhu.de/fileadmin/redaktion/Fakultaeten/Mathematisch-Naturwissenschaftliche_Fakultaet/Psychologie/AAP/gpower/GPower3-BRM-Paper.pdf Google Scholar
Feigenbaum, JD, Fonagy, P, Pilling, S, Jones, A, Wildgoose, A, & Bebbington, PE (2012). A real-world study of the effectiveness of DBT in the UK National Health Service. British Journal of Clinical Psychology, 51, 121–141.CrossRefGoogle ScholarPubMed
Field, AP (2013). Discovering Statistics using SPSS (4th edn). London, UK: Sage Publications.Google Scholar
Frank, AF, & Gunderson, JG (1990). The role of the therapeutic alliance in the treatment of schizophrenia: relationship to course and outcome. Archives of General Psychiatry, 47, 228–236.CrossRefGoogle ScholarPubMed
Gratz, KL, & Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
Hill, CE (2005). Therapist techniques, client involvement, and the therapeutic relationship: Inextricably intertwined in the therapy process. Psychotherapy: Theory, Research, Practice, Training, 42, 431.CrossRefGoogle Scholar
James, AC, Taylor, A, Winmill, L, & Alfoadari, K (2008). A preliminary community study of dialectical behaviour therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child and Adolescent Mental Health, 13, 148–152.CrossRefGoogle Scholar
Koerner, K, & Linehan, MM (2000). Research on dialectical behaviour therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 23, 151–167.CrossRefGoogle ScholarPubMed
Kröger, C, Harbeck, S, Armbrust, M, & Kliem, S (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51, 411–416.CrossRefGoogle Scholar
Leyro, TM, Bernstein, A, Vujanovic, AA, McLeish, AC, & Zvolensky, MJ (2011). Distress Tolerance Scale: a confirmatory factor analysis among daily cigarette smokers. Journal of Psychopathology and Behavioral Assessment, 33, 47–57.CrossRefGoogle ScholarPubMed
Lincoln, TM, Rief, W, Westermann, S, Ziegler, M, Kesting, ML, Heibach, E, & Mehl, S (2014). Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis. Psychiatry Research, 216, 198–205.CrossRefGoogle ScholarPubMed
Linehan, MM (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York, USA: Guilford Press.Google Scholar
Linehan, MM, Armstrong, A, Suarez, HE, Allmon, D, & Heard, HL (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.CrossRefGoogle ScholarPubMed
Linehan, MM, Comtois, KA, Murray, AM, Brown, MZ, Gallop, RJ, Heard, HL, … & Lindenboim, N (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.CrossRefGoogle ScholarPubMed
Linehan, MM, Korslund, KE, Harned, MS, Gallop, RJ, Lungu, A, Neacsiu, AD, … & Murray-Gregory, AM (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry, 72, 475–482.CrossRefGoogle ScholarPubMed
Maraz, A, Andó, B, Rigó, P, Harmatta, J, Takách, G, Zalka, Z, … Demetrovics, Z (2016). The two-faceted nature of impulsivity in patients with borderline personality disorder and substance use disorder. Drug and Alcohol Dependence, 163, 48–54.CrossRefGoogle ScholarPubMed
McMain, SF, Guimond, T, Barnhart, R, Habinski, L, & Streiner, DL (2017). A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatrica Scandinavica, 135, 138–148.CrossRefGoogle ScholarPubMed
Miller, SD, Duncan, BL, Brown, J, Sorrell, R, & Chalk, MB (2006). Using formal client feedback to improve retention and outcome: making ongoing, real-time assessment feasible. Journal of Brief Therapy, 5, 5–22.Google Scholar
Mundt, JC, Marks, IM, Shear, MK, & Greist, JM (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefGoogle ScholarPubMed
Neumann, A, van Lier, PA, Gratz, KL, & Koot, HM (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17, 138–149.CrossRefGoogle ScholarPubMed
Palmer, RS, Murphy, MK, Piselli, A, & Ball, SA (2009). Substance user treatment dropout from client and clinician perspectives: a pilot study. Substance Use & Misuse, 44, 1021–1038.CrossRefGoogle ScholarPubMed
Priebe, S, & Mccabe, R (2008). Therapeutic relationships in psychiatry: the basis of therapy or therapy in itself? International Review of Psychiatry, 20, 521–526.CrossRefGoogle ScholarPubMed
Rusch, N, Schiel, S, Corrigan, PW, Leihener, F, Jacob, GA, Olschewski, M, & Bohus, M (2008). Predictors of dropout from impatient dialectical behavior therapy among women with borderline personality disorder. Journal of Behaviour Therapy and Experimental Psychiatry, 39, 497–503.CrossRefGoogle Scholar
Sambrook, S, Abba, N, and Chadwick, P (2006). Evaluation of DBT emotional coping skills groups for people with parasuicidal behaviours. Behavioural and Cognitive Psychotherapy, 35, 241–244.CrossRefGoogle Scholar
Shelton, D, Sampl, S, Kesten, KL, Zhang, W, & Trestman, RL (2009). Treatment of impulsive aggression in correctional settings. Behavioral Sciences & the Law, 27, 787–800.CrossRefGoogle ScholarPubMed
Simons, JS, & Gaher, RM (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83–102.CrossRefGoogle Scholar
Skodol, AE, Buckley, P, & Charles, E (1983). Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality? Journal of Nervous & Mental Disease, 171, 405–410.CrossRefGoogle Scholar
Spitzer, RL, Kroenke, K, Williams, J. B. W, & Lowe, B (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Stiles, WB, Barkham, M, & Wheeler, S (2015). Duration of psychological therapy: relation to recovery and improvement rates in UK routine practice. British Journal of Psychiatry, 207, 115–122.CrossRefGoogle ScholarPubMed
Thomas, MC (2017). Working alliance factors and their relation to emotion, engagement and dropout in dialectical behavior therapy. Doctoral dissertation, Rutgers University, Graduate School of Applied and Professional Psychology.Google Scholar
Tompkins, KA, & Swift, JK (2015). Psychotherapy process and outcome research. The Encyclopedia of Clinical Psychology. John Wiley & Sons, Inc.Google Scholar
Trull, TJ, Sher, KJ, Minks-Brown, C, Durbin, J, & Burr, R (2000). Borderline personality disorder and substance use disorders: a review and integration. Clinical Psychology Review, 20, 235–253.CrossRefGoogle Scholar
Valentine, SE, Bankoff, SM, Poulin, RM, Reidler, EB, & Pantalone, DW (2014). The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71, 1–20.CrossRefGoogle ScholarPubMed
van den Bosch, LM, Verheul, R, Schippers, GM, & van den Brink, W (2002). Dialectical behavior therapy of borderline patients with and without substance use problems: implementation and long-term effects. Addictive Behaviors, 27, 911–923.CrossRefGoogle ScholarPubMed
Waldinger, RJ, & Gunderson, JG (1984). Completed psychotherapies with borderline patients. American Journal of Psychotherapy, 38, 190–202.CrossRefGoogle ScholarPubMed
Wells, JE, Browne, MO, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Angermeyer, MC, ... & Kessler, RC (2013). Dropout from out-patient mental health care in the World Health Organization’s World Mental Health Survey initiative. British Journal of Psychiatry, 202, 42–49.CrossRefGoogle Scholar
Whipple, JL, Lambert, MJ, Vermeersch, DA, Smart, DW, Nielsen, SL, & Hawkins, EJ (2003). Improving the effects of psychotherapy: the use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50, 59.CrossRefGoogle Scholar
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