Jayasree Lakshmi
Jain University, India
Title: Attrition of adults with social anxiety disorder in a randomized controlled trial on metacognitive therapy versus applied relaxation
Biography
Biography: Jayasree Lakshmi
Abstract
Introduction: Attrition is a common phenomenon encountered in outpatient services and clinical trials. Identification of factors associated with attrition may help participants reach optimal improvement and prevent the worsening of symptoms.
Aim: The aim of the study was to identify factors associated with attrition in a randomized controlled trial (RCT) on metacognitive therapy (MCT) versus applied relaxation (AR) for social anxiety disorder (SAD).
Method: The sample comprised of individuals with SAD classified as completers (n=37) and non-completers (n=13). They were compared on sociodemographic and clinical variables, psychiatric comorbidity and pre-treatment scores on measures such as Liebowitz Social Anxiety Scale-Clinician Assessment (LSAS-CA) and Brief Fear of Negative Evaluation (BFNE).
Results: Results revealed that there was no statistically significant difference between completers and non-completers on sociodemographic and clinical variables except the status of medication (presence or absence). Majority of non-completers (54%) were not on medication. Seventy-eight percent (78%) of completers were on medication whereas as only 46% of non-completers were on medication. They were comparable on axis I and axis II psychiatric comorbidity at baseline and on all pre-treatment scores on outcome measures except on LSAS-CA and BFNE. In comparison with non-completers, completers had higher level of social anxiety and fear of negative evaluation.
Discussion: Higher severity of social anxiety symptoms among completers might have motivated them to attend sessions regularly. In the setting where study was conducted, pharmacological management for SAD versus cognitive behavioural interventions is determined based on clinical judgment regarding severity of illness and functional impairment. The reason for discontinuation by those who were not on medication may be due to the relatively less impact of social anxiety symptoms on functioning.
Conclusion: The severity of social anxiety and its impact on functioning may play important role in attrition in RCTs.