Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

Anorexia nervosa: divergent validity of a prototype narrative

The objetive of this paper was to test the divergent validity (degree of discrimination) of an anoretic prototype narrative (i.e., communality of themes in the individual, core autobiographical memories), as well different characteristics of the participants which may be associated with the degree of prototype discrimination. Seventy participants diagnosed with anorexia nervosa participated in the study and were asked to indicate their degree of identification with four different narrative prototypes (depressive, agoraphobia, anorexic, alcoholic and drug addiction prototypes). Results did not confirm the divergent validity of the anorexic prototype narrative. Participants tended to identify primarily with the depressive prototype narrative. No significant differences were found between levels of identification with the anorexic prototype and depression, or agoraphobia and alcoholism prototype. The only significant difference found was between the anorexic and drug addiction prototype. However, severity and duration of the clinical condition were found to be associated with the degree of identification of prototype narrative. Results are discussed in terms of a transdiagnostic versus a prototype approach to the eating disorders psychopathology.

Suicide attempts and clinical severity of eating disorders: an exploratory study

The present study examines whether eating disorders patients with suicide attempts present differences in disordered eating and clinical traits compared to those without suicide attempts. A total of 144 patients with eating disorders (65 anorexia nervosa and 79 bulimia nervosa) completed the Eating Disorders Inventory (EDI; Garner, Omstead & Polivy, 1983), the Symptom Checklist-90-Revised (SCL-90; Derrogatis, 1977), and a questionnaire to assess eating behaviors and attitudes, information regarding suicide behaviors and other related traits (PQB and TIB (Machado & Soares, 2000); Cost B6 (Machado & Soares, 2000). Eating disorder patients with suicide attempts differed from there peers regarding to the weight history, mean of binge-purge attacks, use of vomiting to weight control, use of alcohol and psycho tropics, menstrual pattern, sexual attitude, and in some EDI and SCL-90 subscales. The findings of the current study show that suicide attempts are related to some indices of symptom history and severity for both diagnostic groups of eating disorders.