Veterans’ Reasons for Dropping Out of Prolonged Exposure Therapy Across Three Delivery Modalities: A Qualitative Examination

Stephanie Y. Wells, Leslie A. Morland, Samantha Hurst, George L. Jackson, Shannon M. Kehle-Forbes, Karisa Jaime, Gregory A. Aarons

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Premature dropout from posttraumatic stress disorder treatment (PTSD) hinders treatment response. Studies have primarily used quantitative methodology to identify factors that contribute to Veterans' premature dropout, which has yielded mixed results. Qualitative methods provide rich data and generate additional hypotheses about why Veterans discontinue PTSD treatment. This study aimed to understand Veterans' reasons for dropping out of prolonged exposure therapy (PE) and to examine if there are differences in reasons for dropout between three delivery modalities: in-home, in-person (IHIP), office-based telehealth (OBT), or home-based telehealth (HBT). Twenty-two Veterans who dropped out of PE from a parent randomized clinical trial participated in individual qualitative interviews about potential contextual and individual factors related to discontinuation. Team-based coding was used to conduct open and focused coding. Themes were generated that described factors that influenced Veterans' dropout from PE and constant comparison was used to explore differences in reasons between the three modalities. Most Veterans had multiple reasons for dropping out and reasons were similar across delivery modalities with few differences. Practical barriers (e.g., scheduling difficulties), attitudes toward mental health providers and therapy (e.g., stigma), psychological and physical health factors (e.g., perceived worsening of symptoms, pain), and the therapeutic context (e.g., disliking aspects of PE) contributed to Veterans' decisions to drop out from PE. Veterans in OBT reported more types of practical barriers than Veterans in HBT and IHIP. These findings can help generate hypotheses about interventions that may promote engagement and future studies should continue to study how to reduce dropout. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Original languageEnglish (US)
Pages (from-to)483-495
Number of pages13
JournalPsychological Services
Issue number3
StatePublished - Nov 3 2022

Bibliographical note

Funding Information:
This work was supported by the International Society for Traumatic Stress Studies Frank W. Putnam Trauma Scholars Research Award awarded to Stephanie Y. Wells and U.S. Department of Defense, Grant/Award Number W81XWH-12-1-0614 awarded to Leslie A Morland. Gregory A. Aarons was supported by National Institute on Drug Abuse Grant R01DA038466 and National Institute of Mental Health Grant R03MH117493. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the United States government or any of the institutions with which the authors are affiliated.

Publisher Copyright:
© 2022, Psychological Services. All Rights Reserved.


  • PTSD
  • Veterans
  • dropout
  • engagement
  • retention


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