Understanding Dropout from Group Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Mixed Methods Investigation

Rationale: Group Cognitive Behavioral Therapy (CBT) is a resource-efficient treatment that increases access to psychotherapy. Yet approximately 25% of patients drop out prematurely, reducing its effectiveness and public health impact. Despite this, few studies have contacted patients post-dropout to survey their reasons for dropout. Understanding the patient perspective is critical to identify barriers and inform strategies to improve treatment retention. Objective: This study investigated reasons for dropout from group CBT for anxiety and related disorders, quantitatively contrasting individual- versus treatment-related factors and qualitatively identifying themes in patients’ own words. Methods: Adult outpatients (N = 84) who discontinued a 12-session group CBT program at a tertiary-care clinic completed the Reasons for Leaving Treatment Questionnaire (RLTQ) and provided optional qualitative feedback. A mixed-methods approach was employed: a paired-samples t test examined quantitative differences between individual-level and treatment-related factors, and qualitative responses (N = 36) underwent inductive thematic analysis. Results: On average, participants discontinued group CBT at session 5. Individual-level factors were more significantly endorsed than treatment-related factors as reasons for dropout. Qualitative analyses identified eight themes, with four major themes: (1) lack of relevance to specific issues/needs, (2) discomfort with group format and/or dynamics, (3) issues with facilitators and/or treatment organization, and (4) issues with CBT content, pace, structure, and/or length. Conclusion: Findings indicate that dropout is influenced not only by individual-level factors but also by modifiable treatment-related factors, pointing to actionable dropout-prevention strategies—including personalization, cohesion-building, shorter waitlists, and re-engagement after missed sessions.