{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:50:10Z","timestamp":1793717410000,"version":"4.6.1"},"reference-count":46,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006190","name":"US Department of Veterans Affairs Office of Research & Development","doi-asserted-by":"publisher","award":["IIR14 -030"],"award-info":[{"award-number":["IIR14 -030"]}],"id":[{"id":"10.13039\/100006190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007165","name":"University of Missouri","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007165","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Behaviour Research and Therapy"],"published-print":{"date-parts":[[2022,7]]},"DOI":"10.1016\/j.brat.2022.104123","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T23:42:51Z","timestamp":1653090171000},"page":"104123","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":46,"special_numbering":"C","title":["Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout"],"prefix":"10.1016","volume":"154","author":[{"given":"Shannon M.","family":"Kehle-Forbes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5482-1328","authenticated-orcid":false,"given":"Princess E.","family":"Ackland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele R.","family":"Spoont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Meis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Orazem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8555-0834","authenticated-orcid":false,"given":"Alexandra","family":"Lyon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5726-2026","authenticated-orcid":false,"given":"Helen R.","family":"Valenstein-Mah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula P.","family":"Schnurr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Zickmund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1416-1249","authenticated-orcid":false,"given":"Edna B.","family":"Foa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Chard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9870-799X","authenticated-orcid":false,"given":"Elizabeth","family":"Alpert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4932-305X","authenticated-orcid":false,"given":"Melissa A.","family":"Polusny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"2","key":"10.1016\/j.brat.2022.104123_bib1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1037\/0033-3204.38.2.171","article-title":"A review of therapist characteristics and techniques negatively impacting the therapeutic alliance","volume":"38","author":"Ackerman","year":"2001","journal-title":"Psychotherapy: Theory, Research, Practice, Training"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0272-7358(02)00146-0","article-title":"A review of therapist characteristics and techniques positively impacting the therapeutic alliance","volume":"23","author":"Ackerman","year":"2003","journal-title":"Clinical Psychology Review"},{"key":"10.1016\/j.brat.2022.104123_bib3","series-title":"Action-control: From cognition to behavior","first-page":"11","article-title":"From intentions to actions: A theory of planned behavior","author":"Ajzen","year":"1985"},{"issue":"2","key":"10.1016\/j.brat.2022.104123_bib4","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/1090198104263660","article-title":"Health promotion by social cognitive means","volume":"31","author":"Bandura","year":"2004","journal-title":"Health Education & Behavior"},{"key":"10.1016\/j.brat.2022.104123_bib5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.brat.2019.03.003","article-title":"Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members","volume":"118","author":"Berke","year":"2019","journal-title":"Behaviour Research and Therapy"},{"issue":"12","key":"10.1016\/j.brat.2022.104123_bib6","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1002\/jclp.22651","article-title":"Examining the effectiveness of an intensive, 2-week treatment program for military personnel and veterans with PTSD: Results of a pilot, open-label, prospective cohort trial","volume":"74","author":"Bryan","year":"2018","journal-title":"Journal of Clinical Psychology"},{"issue":"7","key":"10.1016\/j.brat.2022.104123_bib7","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1002\/jclp.20582","article-title":"Therapist responsiveness to child engagement: Flexibility within manual-based CBT for anxious youth","volume":"65","author":"Chu","year":"2009","journal-title":"Journal of Clinical Psychology"},{"issue":"Suppl 1","key":"10.1016\/j.brat.2022.104123_bib8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1037\/tra0000162","article-title":"The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs","volume":"9","author":"Cook","year":"2017","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"key":"10.1016\/j.brat.2022.104123_bib9","author":"Cooper"},{"issue":"4","key":"10.1016\/j.brat.2022.104123_bib10","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1037\/tra0000484","article-title":"Predicting treatment dropout among veterans receiving prolonged exposure therapy","volume":"12","author":"Eftekhari","year":"2020","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"issue":"6","key":"10.1016\/j.brat.2022.104123_bib11","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1037\/ccp0000044","article-title":"Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators","volume":"83","author":"Fernandez","year":"2015","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"4","key":"10.1016\/j.brat.2022.104123_bib12","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1001\/jama.2017.21242","article-title":"Effect of prolonged exposure therapy delivered over 2 Weeks vs 8 Weeks vs present-centered therapy on PTSD symptom severity in military personnel: A randomized clinical trial","volume":"319","author":"Foa","year":"2018","journal-title":"JAMA"},{"issue":"6","key":"10.1016\/j.brat.2022.104123_bib13","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1037\/a0030600","article-title":"Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy","volume":"80","author":"Galovski","year":"2012","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1037\/a0022705","article-title":"Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans","volume":"8","author":"Garcia","year":"2011","journal-title":"Psychological Services"},{"issue":"5","key":"10.1016\/j.brat.2022.104123_bib15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/jts.22038","article-title":"A systematic review of dropout from psychotherapy for posttraumatic stress disorder among Iraq and Afghanistan combat veterans: Dropout from PTSD treatment in OEF\/OIF veterans","volume":"28","author":"Goetter","year":"2015","journal-title":"Journal of Traumatic Stress"},{"issue":"2","key":"10.1016\/j.brat.2022.104123_bib16","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.beth.2010.07.005","article-title":"Exposure therapy for PTSD delivered to veterans via telehealth","volume":"42","author":"Gros","year":"2011","journal-title":"Behavior Therapy"},{"issue":"6","key":"10.1016\/j.brat.2022.104123_bib17","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/jts.22049","article-title":"Predictors of initiation and engagement of cognitive processing therapy among veterans with PTSD enrolled in collaborative care: Predictors of CPT use in TOP","volume":"28","author":"Grubbs","year":"2015","journal-title":"Journal of Traumatic Stress"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib19","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1037\/tra0000062","article-title":"Time course of treatment dropout in cognitive\u2013behavioral therapies for posttraumatic stress disorder","volume":"8","author":"Gutner","year":"2016","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"issue":"5","key":"10.1016\/j.brat.2022.104123_bib20","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1176\/appi.ps.201800361","article-title":"Predictors of treatment adequacy during evidence-based psychotherapy for PTSD","volume":"70","author":"Hale","year":"2019","journal-title":"Psychiatric Services"},{"issue":"2","key":"10.1016\/j.brat.2022.104123_bib21","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1037\/a0038535","article-title":"VA PTSD clinic director perspectives: How perceptions of readiness influence delivery of evidence-based PTSD treatment","volume":"46","author":"Hamblen","year":"2015","journal-title":"Professional Psychology: Research and Practice"},{"issue":"4","key":"10.1016\/j.brat.2022.104123_bib22","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1037\/tra0000485","article-title":"Feasibility of a 3-week intensive treatment program for service members and veterans with PTSD","volume":"12","author":"Held","year":"2020","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"issue":"5","key":"10.1016\/j.brat.2022.104123_bib23","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.cpr.2014.06.004","article-title":"Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors","volume":"34","author":"Holdsworth","year":"2014","journal-title":"Clinical Psychology Review"},{"key":"10.1016\/j.brat.2022.104123_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.janxdis.2019.102120","article-title":"Examining patterns of dose response for clients who do and do not complete cognitive processing therapy","volume":"68","author":"Holmes","year":"2019","journal-title":"Journal of Anxiety Disorders"},{"key":"10.1016\/j.brat.2022.104123_bib25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.brat.2013.09.011","article-title":"Child involvement, alliance, and therapist flexibility: Process variables in cognitive-behavioural therapy for anxiety disorders in childhood","volume":"52","author":"Hudson","year":"2014","journal-title":"Behaviour Research and Therapy"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib26","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.cbpra.2016.02.003","article-title":"It's worth it in the end\u201d: Veterans' experiences in prolonged exposure and cognitive processing therapy","volume":"24","author":"Hundt","year":"2017","journal-title":"Cognitive and Behavioral Practice"},{"key":"10.1016\/j.brat.2022.104123_bib27","series-title":"It didn't fit for me:\u201d A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans","author":"Hundt","year":"2018"},{"issue":"3","key":"10.1016\/j.brat.2022.104123_bib28","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1037\/a0031474","article-title":"Meta-analysis of dropout in treatments for posttraumatic stress disorder","volume":"81","author":"Imel","year":"2013","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1037\/a0033888","article-title":"From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System","volume":"69","author":"Karlin","year":"2014","journal-title":"American Psychologist"},{"issue":"3","key":"10.1016\/j.brat.2022.104123_bib30","article-title":"Patient engagement in PTSD treatment","volume":"28","author":"Kehle-Forbes","year":"2017","journal-title":"PTSD Research Quarterly"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1037\/tra0000065","article-title":"Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic","volume":"8","author":"Kehle-Forbes","year":"2016","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib32","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1037\/a0035286","article-title":"Depression sudden gains and transient depression spikes during treatment for PTSD","volume":"82","author":"Keller","year":"2014","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"4","key":"10.1016\/j.brat.2022.104123_bib33","article-title":"Implementing evidence\u2010based treatment protocols: Flexibility within fidelity","volume":"25","author":"Kendall","year":"2018","journal-title":"Clinical Psychology: Science and Practice"},{"key":"10.1016\/j.brat.2022.104123_bib34","article-title":"Temporary PTSD symptom increases among individuals receiving CPT in a hybrid effectiveness-implementation trial: Potential predictors and association with overall symptom change trajectory","author":"Larsen","year":"2020","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy."},{"issue":"1","key":"10.1016\/j.brat.2022.104123_bib35","article-title":"Dropout from psychological therapies for PTSD in adults: Systematic review and meta-analysis","volume":"11","author":"Lewis","year":"2020","journal-title":"European Journal of Psychotraumatology"},{"key":"10.1016\/j.brat.2022.104123_bib36","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.psychres.2019.02.027","article-title":"Factors associated with completing evidence-based psychotherapy for PTSD among veterans in a national healthcare system","volume":"274","author":"Maguen","year":"2019","journal-title":"Psychiatry Research"},{"issue":"4","key":"10.1016\/j.brat.2022.104123_bib37","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1037\/ccp0000384","article-title":"Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic","volume":"87","author":"Marques","year":"2019","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"3","key":"10.1016\/j.brat.2022.104123_bib38","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1037\/ccp0000386","article-title":"Sticking it out in trauma-focused treatment for PTSD: It takes a village","volume":"87","author":"Meis","year":"2019","journal-title":"Journal of Consulting and Clinical Psychology"},{"key":"10.1016\/j.brat.2022.104123_bib39","series-title":"Qualitative research & evaluation methods","author":"Patton","year":"2002"},{"issue":"6","key":"10.1016\/j.brat.2022.104123_bib40","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s10488-016-0755-0","article-title":"A review of studies on the system-wide implementation of evidence-based psychotherapies for posttraumatic stress disorder in the veterans health administration","volume":"43","author":"Rosen","year":"2016","journal-title":"Administration and Policy in Mental Health and Mental Health Services Research"},{"issue":"3","key":"10.1016\/j.brat.2022.104123_bib41","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1521\/psyc.2009.72.3.238","article-title":"A qualitative study of determinants of PTSD treatment initiation in veterans","volume":"72","author":"Sayer","year":"2009","journal-title":"Psychiatry: Interpersonal and Biological Processes"},{"issue":"5","key":"10.1016\/j.brat.2022.104123_bib42","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1002\/jts.22427","article-title":"Effectiveness of the intent to complete and intent to attend intervention to predict and prevent posttraumatic stress disorder treatment drop out among soldiers","volume":"32","author":"Shulman","year":"2019","journal-title":"Journal of Traumatic Stress"},{"issue":"5 Pt 2","key":"10.1016\/j.brat.2022.104123_bib43","first-page":"1101","article-title":"Qualitative methods: What are they and why use them?","volume":"34","author":"Sofaer","year":"1999","journal-title":"Health Services Research"},{"issue":"7","key":"10.1016\/j.brat.2022.104123_bib44","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1001\/jama.2019.20825","article-title":"First-line psychotherapies for military-related PTSD","volume":"323","author":"Steenkamp","year":"2020","journal-title":"JAMA"},{"key":"10.1016\/j.brat.2022.104123_bib45","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.janxdis.2017.01.002","article-title":"High rates of PTSD treatment dropout: A possible red herring?","volume":"47","author":"Szafranski","year":"2017","journal-title":"Journal of Anxiety Disorders"},{"issue":"6","key":"10.1016\/j.brat.2022.104123_bib46","doi-asserted-by":"crossref","DOI":"10.1136\/gpsych-2019-100153","article-title":"Client-level predictors of treatment engagement, outcome and dropout: Moving beyond demographics","volume":"32","author":"Youn","year":"2019","journal-title":"General Psychiatry"}],"container-title":["Behaviour Research and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0005796722000948?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0005796722000948?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:44:46Z","timestamp":1777387486000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0005796722000948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":46,"alternative-id":["S0005796722000948"],"URL":"https:\/\/doi.org\/10.1016\/j.brat.2022.104123","relation":{},"ISSN":["0005-7967"],"issn-type":[{"value":"0005-7967","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout","name":"articletitle","label":"Article Title"},{"value":"Behaviour Research and Therapy","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.brat.2022.104123","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"104123"}}