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• Posted November 19, 2025

Some PTSD Therapy Approaches Prompt More Veterans To Flee Treatment

Forcing veterans to revisit the horrors that led to their post-traumatic stress disorder (PTSD) might prompt many to drop out of therapy, a new evidence review found.

About a quarter of U.S. service members and veterans who start psychotherapy for PTSD quit before they finish treatment, according to a review published Nov. 17 in the journal Psychological Trauma: Theory, Research, Practice, and Policy.

But some therapies, while proven to be effective, report higher dropout rates than others, researchers found.

Trauma-focused approaches like exposure therapy and cognitive processing therapy tended to have higher dropout rates than approaches focusing on mindfulness, meditation and stress reduction, results show.

“Dropout rates remain a significant challenge in PTSD care for military populations,” lead researcher Elizabeth Penix-Smith, a National Research Council fellow at the Walter Reed Army Institute of Research in Silver Spring, Maryland, said in a news release.

“Identifying which protocols are more sustainable can help clinicians tailor care and policymakers prioritize treatments that keep patients engaged,” Penix-Smith said.

About 7% of veterans suffer from PTSD at some point in their lives, slightly higher than the rate seen among the general public, researchers said in background notes. The disorder can increase risk of heart disease and stroke.

For the study, researchers analyzed data from 181 prior studies covering 232 PTSD treatments and more than 124,000 military participants.

On average, just under 26% of service members and veterans dropped out before finishing their recommended course of therapy for PTSD, researchers found.

But rates differed significantly between the therapies:

• Cognitive processing therapy had a dropout rate of 40%. This approach requires patients to detail their traumatic experiences and consider the thoughts and emotions linked to these memories.

• Exposure therapy had a dropout rate of 35%, and virtual reality exposure therapy a dropout rate of 37%. This type of therapy exposes people to memories or sensations that trigger PTSD, in hopes of desensitizing them.

• Present-centered therapy and mindfulness-based stress reduction had lower dropout rates of 16% and 20%.

Dropout was particularly high in programs treating PTSD alongside substance use disorders, with 46% of participants quitting prematurely, researchers found.

On the other hand, group-based exposure therapy that focused on teamwork and connection had a dropout rate of only 7%.

“Behind every statistic is a person who may be struggling to stay the course in treatment,” Penix-Smith said.

“This study provides better benchmarks for how often people disengage from different PTSD treatments,” she added. “It highlights which therapies may be easier for some service members and veterans to stick with.”

She noted that with this information, therapists can take additional steps when employing a challenging PTSD treatment to keep clients engaged such as building trust, tracking progress and respecting client preferences, to reduce the risk a patient will drop out.

“Our study findings underscore the importance of investing in interventions for preventing dropout or identifying methods for matching clients to their optimal treatment to reduce dropout,” Penix-Smith said. “By focusing on approaches that are a good fit and by providing the right support along the way, we can make real progress in helping them recover from trauma.”

More information

The American Psychological Association has more on cognitive processing therapy and exposure therapy.

SOURCE: American Psychological Association, news release, Nov. 17, 2025