Factors associated with dropout in a self-guided transdiagnostic intervention for a Mexican population
Abstract
Background: Technology has revolutionized mental health, enabling access to diverse and more accessible therapies. Telepsychology interventions, such as self-guided ones, offer personalized treatments through digital platforms. Although long-term studies are limited, these approaches have shown effectiveness in various disorders. Modality and the specific disorder influence the effectiveness of these therapies. Understanding and identifying factors that influence the abandonment of self-guided treatments is crucial to improving their design and increasing the likelihood of their completion.
Objective: This study seeks to identify factors that influence the abandonment of self-guided treatments for emotional problems related to stress and trauma. With this, it is possible to include tools that improve the effectiveness of these treatments.
Methods: The sample included 89 adults evaluated through diagnostic interviews, who met criteria for emotional or stress-related disorders and were assigned to a self-guided transdiagnostic treatment with eight modules that could be accessed at any time.
Results: A dropout rate of 81% of participants was identified, mainly during the first sessions. Through logistic regression analysis, some significant factors for abandonment were identified, such as place of residence and anxiety levels.
Conclusion: Strategies such as personalized reminders, continuous clarification of treatment objectives, and tools that drive patient motivation towards treatment could prevent abandonment. The results offer valuable information for optimizing telepsychology and ensuring success in self-guided psychological treatments in diverse technological and cultural contexts.
Downloads
References
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. https://doi.org/10.1037/0022-006X.56.6.893
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100. https://doi.org/10.1016/0272-7358(88)90050-5
Benjet, C., Zainal, N. H., Albor, Y., Alvis-Barranco, L., Carrasco-Tapias, N., Contreras-Ibáñez, C. C., ... & Kessler, R. C. (2023). A precision treatment model for internet-delivered cognitive behavioral therapy for anxiety and depression among university students: a secondary analysis of a randomized clinical trial. JAMA psychiatry, 80(8), 768-777. https://doi.org/10.1001/jamapsychiatry.2023.1675
Cárdenas López, G., Botella Arbona, C., Quero Castellano, S., De La Rosa Gómez, A., & Baños Rivera, R. M. (2014). Programa de telepsicología para el tratamiento de la fobia a hablar en público en población mexicana. Psicología Iberoamericana, 22(1), 45-54. https://doi.org/10.48102/pi.v22i1.145
Celleri, M., Cremades, C. F., Etchevers, M. J., & Garay, C. J. (2023). Effectiveness of the Unified Protocol for the transdiagnostic treatment of emotional disorders in online and group format in Argentina: Study protocol for a randomized controlled trial. Trials, 24(1), 678. https://doi.org/10.1186/s13063-023-07428-4
Cuijpers, P., & Schuurmans, J. (2007). Self-help interventions for anxiety disorders: An overview. Current Psychiatry Reports, 9(4), 284-290. https://doi.org/10.1007/s11920-007-0034-6
De La Rosa-Gómez, A., Flores-Plata, L. A., Esquivel-Santoveña, E. E., Santillán Torres Torija, C., García-Flores, R., Dominguez-Rodriguez, A., Arenas-Landgrave, P., Castellanos-Vargas, R. O., Berra-Ruiz, E., Silvestre-Ramírez, R., Miranda-Díaz, G. A., Díaz-Sosa, D. M., Hernández-Posadas, A., Flores-Elvira, A. I., Valencia, P. D., & Vázquez-Sánchez, M. F. (2022). Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: Study protocol for a randomized controlled trial. BMC Psychiatry, 22(1), 537. https://doi.org/10.1186/s12888-022-04132-6
De La Rosa-Gómez, A., Hernández-Posadas, A., Valencia, P. D., & Guajardo-Garcini, D. A. (2021). Análisis dimensional de la Escala de Dificultades en la Regulación Emocional (DERS-15) en universitarios mexicanos. Revista Evaluar, 21(2), 80-97. https://doi.org/10.35670/1667-4545.v21.n2.34401
Dennison, L., Morrison, L., Conway, G., & Yardley, L. (2013). Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior change: Qualitative Study. Journal of Medical Internet Research, 15(4), e86. https://doi.org/10.2196/jmir.2583
Dominguez-Rodriguez, A., Sanz-Gomez, S., González Ramírez, L. P., Herdoiza-Arroyo, P. E., Trevino Garcia, L. E., de la Rosa-Gómez, A., González-Cantero J. O., Macias-Aguinaga, V. & Miaja, M. (2023). The efficacy and usability of an unguided web-based grief intervention for adults who lost a loved one during the COVID-19 pandemic: randomized controlled trial. Journal of medical internet research, 25, e43839. https://doi.org/10.2196/43839
Donkin, L., & Glozier, N. (2012). Motivators and Motivations to Persist With Online Psychological Interventions: A Qualitative Study of Treatment Completers. Journal of Medical Internet Research, 14(3), 34-34. https://doi.org/10.2196/jmir.2100
Dworschak, C., Heim, E., & Maercker, A. (2022). Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis. Internet Interventions, 27, 100498. https://doi.org/10.1016/j.invent.2022.100498
Gadelha, M. J. N., Silva, L. R. M. D., Oliveira, A. P. D., Cavalcante, N. A., Araújo, V. S. D., Lopes, R. T., & Silva, N. G. D. (2021). Internet Cognitive Behavioral Therapy for social anxiety disorder: a systematic review. Revista Brasileira de Terapias Cognitivas, 17(2), 96-104. https://doi.org/10.5935/1808-5687.20210022.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26, 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15(1), 1-39. https://doi.org/10.1348/135910709X466063
Hirai, M., & Clum, G. A. (2006). A Meta-Analytic Study of Self-Help Interventions for Anxiety Problems. Behavior Therapy, 37(2), 99-111. https://doi.org/10.1016/j.beth.2005.05.002
Horsch, C., Lancee, J., Beun, R. J., Neerincx, M. A., & Brinkman, W.-P. (2015). Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups. Journal of Medical Internet Research, 17(9), e214. https://doi.org/10.2196/jmir.4115
Horsch, C., Spruit, S., Lancee, J., Van Eijk, R., Beun, R. J., Neerincx, M., & Brinkman, W.-P. (2017). Reminders make people adhere better to a self-help sleep intervention. Health and Technology, 7(2-3), 173-188. https://doi.org/10.1007/s12553-016-0167-x
Jiménez-Molina, Á., Franco, P., Martínez, V., Martínez, P., Rojas, G., & Araya, R. (2019). Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review. Frontiers in Psychiatry, 10, 664. https://doi.org/10.3389/fpsyt.2019.00664
Jurado, S., Villegas, M. E., Méndez, L., Rodríguez, F., Loperena, V., & Varela, R. (1998). La estandarización del Inventario de Depresión de Beck para los residentes de la Ciudad de México. Salud mental, 26-31.
Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., Berger, T., Botella, C., Breton, J. M., Carlbring, P., Christensen, H., De Graaf, E., Griffiths, K., Donker, T., Farrer, L., Huibers, M. J. H., Lenndin, J., Mackinnon, A., Meyer, B., … Cuijpers, P. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: An ‘individual patient data’ meta-analysis. Psychological Medicine, 45(13), 2717-2726. https://doi.org/10.1017/S0033291715000665
Krebs, M., González, L. M., Rivera, A., Herrera, P., & Melis, F. (2012). Adherencia a psicoterapia en pacientes con trastornos de ansiedad. Psykhe (Santiago), 21(2), 133-147.
Lin, T., Heckman, T. G., & Anderson, T. (2022). The efficacy of synchronous teletherapy versus in-person therapy: A meta-analysis of randomized clinical trials. Clinical Psychology: Science and Practice, 29(2), 167-178. https://doi.org/10.1037/cps0000056
Lopes, R. T., Gonçalves, M. M., Sinai, D., & Machado, P. P. (2015). Predictors of dropout in a controlled clinical trial of psychotherapy for moderate depression. International journal of clinical and health psychology, 15(1), 76-80. https://doi.org/10.1016/j.ijchp.2014.11.001
McCord, C., Bernhard, P., Walsh, M., Rosner, C., & Console, K. (2020). A consolidated model for telepsychology practice. Journal of Clinical Psychology, 76(6), 1060-1082. https://doi.org/10.1002/jclp.22954
McClellan, M. J., Osbaldiston, R., Wu, R., Yeager, R., Monroe, A. D., McQueen, T., & Dunlap, M. H. (2022). The effectiveness of telepsychology with veterans: A meta-analysis of services delivered by videoconference and phone. Psychological Services, 19(2), 294. http://dx.doi.org/10.1037/ser0000522
Nordby, E. S., Gjestad, R., Kenter, R. M. F., Guribye, F., Mukhiya, S. K., Lundervold, A. J., & Nordgreen, T. (2022). The Effect of SMS Reminders on Adherence in a Self-Guided Internet-Delivered Intervention for Adults With ADHD. Frontiers in Digital Health, 4, 821031. https://doi.org/10.3389/fdgth.2022.821031
Oliveira, C. T. D., & Dias, A. C. G. (2023). How can psychoeducation help in the treatment of mental disorders? Estudos de Psicologia (Campinas), 40, e190183. https://doi.org/10.1590/1982-0275202340e190183
Perski, O., Blandford, A., West, R., & Michie, S. (2017). Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Translational behavioral medicine, 7(2), 254-267. https://doi.org/10.1007/s13142-016-0453-1
Prashant Srivastava & Rishi Panday. (2016). Psychoeducation an Effective Tool as Treatment Modality in Mental Health. International Journal of Indian Psychology, 4(1). https://doi.org/10.25215/0401.153
Robles, R., Varela, R., Jurado, S., & Páez, F. (2001). Versión mexicana del Inventario de Ansiedad de Beck: Propiedades psicométricas. Revista mexicana de psicología, 18(2), 211-218.
Rodante, D. E., Kaplan, M. I., Olivera Fedi, R., Gagliesi, P., Pascali, A., José Quintero, P. S., Compte, E. J., Perez, A. I., Weinstein, M., Chiapella, L. C., & Daray, F. M. (2022). CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial. Archives of Suicide Research, 26(2), 801-818. https://doi.org/10.1080/13811118.2020.1834476
Sablone, S., Bellino, M., Lagona, V., Franco, T. P., Groicher, M., Risola, R., Violante, M. & Grattagliano, I. (2024). Telepsychology revolution in the mental health care delivery: a global overview of emerging clinical and legal issues. Forensic Sciences Research, 9(3), owae008. https://doi.org/10.1093/fsr/owae008
Saenz, J. J., Sahu, A., Tarlow, K., & Chang, J. (2020). Telepsychology: Training perspectives. Journal of Clinical Psychology, 76(6), 1101-1107. https://doi.org/10.1002/jclp.22875
Strauss, J. L., Guerra, V. S., Marx, C. E., Eggleston, A. M., & Calhoun, P. S. (2010). Adherence and psychotherapy. Improving Patient Treatment Adherence: A Clinician’s Guide, 215-240.
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: a meta-analysis. Journal of consulting and clinical psychology, 80(4), 547. https://doi.org/10.1037/a0028226
Taylor, C. B., Graham, A. K., Flatt, R. E., Waldherr, K., & Fitzsimmons-Craft, E. E. (2021). Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: An overview of systematic reviews and meta-analyses. European Journal of Public Health, 31(Supplement_1), i3-i10. https://doi.org/10.1093/eurpub/ckz208
Tiburcio, M., Lara, Ma. A., Martínez, N., Fernández, M., & Aguilar, A. (2018). Web-Based Intervention to Reduce Substance Abuse and Depression: A Three Arm Randomized Trial in Mexico. Substance Use & Misuse, 53(13), 2220-2231. https://doi.org/10.1080/10826084.2018.1467452
Titov, N., Dear, B. F., Johnston, L., Lorian, C., Zou, J., Wootton, B., Spence, J., McEvoy, P. M., & Rapee, R. M. (2013). Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: Randomised controlled trial. PloS One, 8(7), e62873. https://doi.org/10.1371/journal.pone.0062873
Tobak, B. A. (2021). Investigating the Effectiveness of Telepsychology Administered Cognitive Behavioral Therapy to Treat Anxiety and Depression Among College Age Individuals. William James College. Disponible en: ProQuest One Academic. (2716536833).
Turgoose, D., Ashwick, R., & Murphy, D. (2018). Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare, 24(9), 575-585. https://doi.org/10.1177/1357633X17730443
Walton, C., Gonzalez, S., Cooney, E. B., Leigh, L., & Szwec, S. (2023). Engagement over telehealth: Comparing attendance and drop-out between Dialectical Behaviour Therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic. https://doi.org/10.21203/rs.3.rs-2516011/v1
Copyright (c) 2025 Interacciones

This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the copyright and give the journal the right of the first publication and that they can edit it, reproduce it, distribute it, exhibit it and communicate it in the country and abroad through printed and digital media.
The digital version of the journal is registered under a Creative Commons license (Under Creative Commons License): Attribution 4.0 International (CC BY 4.0). Therefore, this work can be reproduced, distributed and publicly communicated in digital format, provided that the names of the authors and Interacciones.
Therefore, it is established that authors can make other independent and additional behavioural agreements for the non-exclusive distribution of the version of the article published in this journal (eg, include it in institutional repositories or publish it in a book) as long as it is clearly indicated that the work was published for the first time in this journal.