Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change

The data that support the findings of this study are available from the corresponding author, JTO, upon request.
Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R-adj(2) = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time x dropout; beta(11) = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (beta(01) = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.
This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through national funds (PIDDAC). Dr. Oliveira was also supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education, through national funds, within the scope of the Transitory Disposition of Decree No. 57/2016, of 29 August, amended by Law No. 57/2017 of 19 July. We are grateful to Dr Paulo P. Machado, Dr Eugénia Gonçalves and Dr Sonia Gonçalves for serving as clinical supervisors.