title: Early treatment withdrawal from evidence-based psychotherapy for PTSD: telemedicine and in-person parameters.
abstract: OBJECTIVE
  To determine differences in reported barriers to treatment completion associated with telemedicine vs. in-person delivery of evidence-based treatment for PTSD in combat veterans.
  
  
  METHODS
  The present study was derived from two ongoing randomized controlled trials (RCTs) comparing in-person vs. telemedicine delivery of exposure therapy for PTSD. A one-time telephone assessment of participants who dropped out from the treatment phase of these two studies was conducted, with measures focusing on reported reasons for dropout, and perceived comfort and efficacy of the treatment modality. Dichotomous data were analyzed via chi-square and logistic regression; continuous data via ANOVA.
  
  
  RESULTS
  Forty-seven of 69 total dropouts participated. There was no difference in rate of dropout between modalities. A greater proportion of participants receiving in-person exposure therapy reported difficulties with logistical aspects of care (e.g., parking), whereas a greater proportion of participants receiving telemedicine therapy reported difficulty tolerating certain stressful aspects of treatment; however, those receiving telemedicine delivered treatment completed more sessions before dropping out. Participants in both conditions reported that they liked and were confident in their therapist Conclusions: Dropout reasons varied according to type of treatment delivery. Recommendations for future research are given in terms of modification of treatment protocol according to delivery modality.
authors.affiliation: Medical University of South Carolina.
authors.forename: Melba A
authors.initials: MA
authors.lastname: Hernandez-Tejada
authors.affiliation: Medical University of South Carolina.
authors.forename: James S
authors.initials: JS
authors.lastname: Zoller
authors.affiliation: Medical University of South Carolina Ralph H. Johnson Veterans Affairs Medical Center.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ruggiero
authors.affiliation: Medical University of South Carolina.
authors.forename: Abby Swanson
authors.initials: AS
authors.lastname: Kazley
authors.affiliation: Medical University of South Carolina Ralph H. Johnson Veterans Affairs Medical Center.
authors.forename: Ron
authors.initials: R
authors.lastname: Acierno
mesh_terms: D000328:Adult; D000368:Aged; D055317:Evidence-Based Practice / Q000592:standards; D006801:Humans; D007171:Implosive Therapy / Q000592:standards; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010352:Patient Dropouts / Q000523:psychology*; D011613:Psychotherapy / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000592:standards*; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: PTSD; attrition; psychotherapy; telemedicine