About one in three people drop out before completing behavioral treatments designed to help them manage their weight, chronic pain, or stress, according to new research.
"Many clients with chronic health conditions are leaving programs prior to acquiring self-management strategies," said Michael E. Addis, PhD, one of the co-authors of the research. "Considering the benefits demonstrated by a range of behavioral medicine interventions, it is crucial to understand what may underlie such a substantial attrition rate and to develop appropriate interventions."
Addis and Mary J. Davis, both of Clark University, Worcester, MA, reviewed the results of 20 studies of attrition from behavioral medicine programs. The results of their analysis appear in the current issue of Annals of Behavioral Medicine.
Thirteen of the studies examined attrition from weight-loss programs, three focused on headache, three on chronic pain, and one on stress management. Attrition averaged 32 percent among those enrolled in weight loss programs, 35 percent among chronic pain and headache patients, and 24 percent among those enrolled in stress management programs.
Overall, the severity of the patient's condition and psychological variables, such as a history of previous emotional problems, were better predictors of dropout than were demographic factors, such as age and income, the researchers report.
People who drop out early from a program are also different from those who drop out much later. "Those who drop out early appear to experience a higher level of emotional distress," said Addis. "Late dropouts, in contrast, experience less anxiety about self-managing a chronic condition."
In their own research, Addis and Davis hypothesize that a trait called self-efficacy -- the degree to which people are confident they can manage their own condition -- is a powerful predictor of those who complete behavioral treatment programs.
"Clients with low levels of self-efficacy should be more likely to terminate treatment prematurely since continuation in programs requires clients to 'buy into' the idea that they can learn actively and utilize helpful coping strategies," said Addis.
Addis and Davis recommend future research be done to investigate variables that may predict retention of participants in behavioral treatments, including support from family and friends as well as the "therapeutic alliance" or bond that often develops between clients and program leaders.
Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine. For information about the journal, contact Arthur Stone, PhD, 516-632-8833.
Posted by the Center for the Advancement of Health www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
Journal
Annals of Behavioral Medicine