Treatment retention profiles for combat veterans in individual and group therapy following the October 7th War.

Abstract

The present study aimed to examine dropout rates from individual versus group trauma-focused therapy among Israeli combat reservists seeking help following the October 7th War. This retrospective observational cohort study included 390 combat reservists treated in either individual (75.1%, n = 293) or group-based (24.9%, n = 97) trauma-focused therapy formats. Dropout was the dependent variable. Measures included the PCL-5, BSI-18, and POAMS. Time to dropout was analyzed using Cox proportional hazards regression, adjusting for demographic, military, and clinical covariates. Dropout rates varied substantially across modalities. Among individual therapies, rates ranged from 12.5% (PE) to 50.0% (CPT), while group interventions showed consistently lower rates, with group WET the lowest (7.84%). Individual therapy was associated with significantly higher dropout risk (HR = 2.58, 95% CI [1.40, 4.78], p = .003), remaining significant after adjustment (adjusted HR = 2.34, 95% CI [1.23, 4.46], p = .010). Baseline PTSD severity did not moderate this association when PCL-5 was modeled continuously (treatment modality × PCL-5: HR = 1.004, 95% CI [0.965, 1.043], p = .854), and the interaction remained non-significant after covariate adjustment (HR = 1.001, 95% CI [0.963, 1.040], p = .974). However, group-based trauma-focused therapy, and particularly group WET, was associated with significantly lower dropout rates compared to individual therapy among combat-exposed veterans. Importantly, this advantage persisted across varying levels of PTSD symptom severity at baseline. These findings have meaningful clinical implications for treatment planning in military populations.