The MHTP Evaluation and Quality Improvement (EQI) Lab is pleased to highlight a new project examining treatment dropout in Prolonged Exposure (PE) therapy for Posttraumatic Stress Disorder (PTSD)—a critical issue in the real-world delivery of evidence-based care. This study is led by Sarah Munguia, psychology doctoral intern, with Amanda Devane, PhD, serving as the primary consultant.
Advancing Clinical Insight Through Real-World Data
Prolonged Exposure therapy is a first-line, evidence-based treatment for PTSD; however, dropout rates in community settings remain substantial. Using data from 121 adults receiving PE within the Napa Solano Service Area outpatient psychiatry trauma program, this evaluation sought to better understand:
- Rates of treatment completion versus discontinuation
- Factors associated with dropout
- Timing of dropout during the course of treatment
- Patient-reported reasons for discontinuation
Initial findings are both encouraging and informative. Nearly two-thirds of patients (65.3%) completed PE, while others either transitioned to an alternative trauma-focused treatment (15.7%) or discontinued treatment (19.0%). Notably, commonly cited predictors of dropout—including age, gender, race/ethnicity, treatment modality (virtual vs. in-person), and baseline PTSD severity—explained only a small proportion of variance and were not statistically significant in this sample. These findings highlight the complexity of treatment engagement and the need for more nuanced, implementation-informed approaches.
Ongoing analyses will further examine when dropout is most likely to occur and assess treatment effectiveness, with the goal of informing program-level improvements and patient-centered retention strategies.
Trainee Development and Implementation Science in Action
In addition to its clinical and operational relevance, this project reflects Sarah Munguia’s broader professional development in clinical research and implementation science. Through her participation in the Implementation Science Specialty, Sarah is gaining hands-on experience in program evaluation, data analysis, and knowledge dissemination—skills that are essential for bridging research and clinical practice.
As part of the project’s dissemination efforts, Sarah is presenting this work as a poster at the Annual Congress of the World Confederation of Cognitive Behavioral Therapy in San Francisco, contributing to international discussions on trauma treatment delivery and engagement. The findings will also be shared internally through Kaiser Permanente trauma consultation forums and conference presentations, with plans for submission to a peer-reviewed journal.
Collaborative Mentorship
This project reflects strong collaboration and mentorship. Dr. Amanda Devane provided expert consultation throughout, supporting both methodological rigor and trainee development. The Implementation Science Specialty further contributed by fostering a collaborative learning environment and offering opportunities for dissemination.
Together, this work exemplifies the EQI Lab’s mission: leveraging data to improve care while training the next generation of clinician-scientists.
