Abstract
Internet-based cognitive behavioral therapy (iCBT), provided with guidance, has been shown to outperform wait-list control conditions and appears to perform on par with face-to-face psychotherapy. However, dropout remains an important problem. Dropout rates for iCBT programs for depression have ranged from 0 to 75%, with a mean of 32%. Drawing from a recent study in which 117 people participated in iCBT with support, we examined participant characteristics, participants’ use of iCBT skills, and their experience of technical difficulties with iCBT as predictors of dropout risk. Educational level, extraversion, and participant skill use predicted lower risk of dropout; technical difficulties and openness predicted higher dropout risk. We encourage future research on predictors of dropout in the hope that greater understanding of dropout risk will inform efforts to promote program engagement and retention.
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Data Availability
Pending IRB approval for sharing, the dataset described in this paper is available from the corresponding author on reasonable request.
Notes
Dropout rates across study segments were: 39% (23 of 59) among those randomized to BtB, 65% (13 of 20) among those randomized to wait-list and subsequently offered BtB, and 45% (17 of 38) among non-randomized participants offered BtB. The 20 participants who had initially been assigned to wait-list were a subset of a larger group of 30, as 10 opted to not continue participation. An initial test suggested that study segment was associated with differential dropout risk (RR = 1.67; 95% CI 1.06–2.62, p = 0.03). However, study segment failed to predict dropout in our multivariate model (see Table 4).
We included the number of contacts as a covariate out of concern for the possibility that our measure of CBT skills could have been confounded with clients who had more contact with their coach and thus more opportunities to convey their use of CBT skills. There was an average of 2.6 (SD = 1.54; range = 0–9) calls completed between participants and their coaches and an average of 5.05 (SD = 2.72; range 0–12) emails exchanged between participants and their coaches.
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This study was funded in part by the National Center for Advancing Translational Sciences Award Number Grant KL2TR001068, awarded to NRF. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
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Iony D. Schmidt, Nicholas R. Forand, and Daniel R. Strunk declare that they have no conflict of interest.
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Schmidt, I.D., Forand, N.R. & Strunk, D.R. Predictors of Dropout in Internet-Based Cognitive Behavioral Therapy for Depression. Cogn Ther Res 43, 620–630 (2019). https://doi.org/10.1007/s10608-018-9979-5
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DOI: https://doi.org/10.1007/s10608-018-9979-5