Defining the Profile of People With Emotional Disorders That Drop Out or Do Not Respond to Treatment After Receiving the Unified Protocol in Group Format

Abstract

Dropout, defined as the unilateral discontinuation of treatment before achieving goals or completing a set number of sessions, affects a large number of individuals. Additionally, many individuals do not experience an improvement of symptoms after treatment. This study has explored the profile of individuals who drop out or do not respond favourably to the Unified Protocol (UP) applied in group format. This is a secondary analysis of a RCT that involved 277 participants (78.3% women) diagnosed with emotional disorders who received 12-weekly group sessions at specialized mental health units. Socio-demographic variables, personality, anxiety and depression symptoms and emotional regulation were analysed at baseline, post-treatment and 12-month follow-up. Fewer emotional regulation difficulties at baseline predict higher dropout rates at post-treatment, with 28.9% of participants (n = 80) receiving fewer than six sessions. Additionally, 46.0% of participants showed no change in the severity of depressive symptoms, and 56.8% showed no change in anxiety symptoms post-treatment. At the 12-month follow-up, 31.1% of participants maintained the same severity level for depressive symptoms and 49.5% for anxiety symptoms. Higher baseline anxiety and emotional dysregulation and lower extraversion predicted higher depressive symptoms at post-treatment, and higher baseline anxiety predicted higher depressive symptomatology at the 12-month follow-up. Higher baseline depression and emotional dysregulation predicted higher post-treatment anxiety, and depression also predicted higher anxiety at the 12-month follow-up. Additionally, high baseline depression predicted higher neuroticism and emotional dysregulation and lower extraversion after treatment and at the 12-month follow-up (for neuroticism and extraversion). Finally, high baseline emotional dysregulation predicted higher neuroticism post-treatment, whereas high baseline maladjustment predicted lower emotional dysregulation at post-treatment. Emotional dysregulation, neuroticism, extraversion and especially baseline depression and anxiety symptoms are key factors associated with dropouts and treatment response when applying the UP in group format. Considering these variables may improve attendance and treatment outcomes.