Beyond early termination: Predicting quality-related vs. quality-neutral dropout during the active phase of outpatient cognitive behavioral therapy

AbstractObjective: This study examined predictors of dropout during the active phase of outpatient CBT, distinguishing between quality-related and quality-neutral dropouts. The focus was on patient, process, and therapist variables, including the therapeutic alliance and early treatment courses.Method: Routine data from 590 outpatient psychotherapy patients were analyzed. Dropouts were classified as quality-related (dissatisfaction or lack of progress) or quality-neutral (external reasons). Logistic regression models identified predictors of quality-related dropout. Symptom improvement differences between dropout and regular completion were calculated using t-tests.Results: 24.2% of patients discontinued therapy for quality-related reasons, while 10.8% dropped out for quality-neutral reasons. Significant predictors were lower treatment satisfaction (OR = 1.07) and a weaker therapeutic alliance (OR = 0.86). Quality-related dropouts occurred between the 10th and 15th sessions, while quality-neutral dropouts were between the 20th and 25th sessions. Early deterioration was a marginal predictor of quality-related dropout, while 58.6% of early responders in the quality-related dropout group showed significant improvement before discontinuing therapy.Conclusion: Lower treatment satisfaction and a weaker therapeutic alliance predicted quality-related dropout. Some early dropouts still showed improvement, suggesting that discontinuation does not always reflect treatment failure. Differentiating between quality-related and quality-neutral dropouts clarifies dropout patterns and improves interpretation of treatment outcomes.