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  • Oral presentation
  • Open Access

Finding modifiable predictors of treatment dropout: the role of the therapeutic alliance, readiness to change and acceptance of treatment approach

Journal of Eating Disorders20153 (Suppl 1) :O37

  • Published:


  • Cognitive Behavioural Therapy
  • Eating Disorder
  • Binary Logistic Regression
  • Therapeutic Alliance
  • Process Factor

Although abundant, research has been unable to identify consistent predictors of dropout from eating disorder treatment. One potential reason for this is the bias towards research into fixed, individual, patient factors (e.g. personality traits and duration of illness). This quantitative study aimed to confirm results of a qualitative study, which suggested that three process factors (therapeutic alliance, readiness to change and acceptance of treatment approach) were important contributors to patients' decision to drop out of treatment. The study involved data from 332 consecutive referrals (98% female) to a public outpatient eating disorder service, who received individual Cognitive Behavioural Therapy between 2005 and 2014. Almost 40% of the sample dropped out of treatment (defined as non-mutual termination). Binary logistic regressions showed that patient ratings on items related to the therapeutic alliance and acceptance of treatment approach (as measured by the Helping Alliance Questionnaire, Credibility / Expectancy Questionnaire, and a measure of the patient's perception of therapist) were significantly associated with treatment dropout. However, readiness to change items, and total questionnaire scores, were not significant predictors. Issues in the measurement and self-report of all of these factors may mask the true relationship between process factors and treatment dropout.

Authors’ Affiliations

University of Western Australia, Australia
Centre for Clinical Interventions, Austrlia


© Pannekoek et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.