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SUMMARY  Although cognitive therapy is a promising treatment for depression, high drop-out rates and, conversely, the specific elements that make the intervention effective continue to puzzle practising clinicians. This article discusses both therapist-related factors (including competence and competencies) and patient-related factors (such as engagement in therapy and external logistical problems with attendance) that are related to drop-out and suggests practical ways to address them and improve outcomes. It examines cognitive and behavioural elements of manualised cognitive therapy and discusses findings relating to cognitive–behavioural therapy (CBT) in particular.   LEARNING OBJECTIVES•  Understand factors associated with high drop-out rates in the cognitive therapy of depression and ways to reduce them    •  Learn about treatment integrity in cognitive therapy of depression and its relationship to the clinical outcome    •  Identify specific cognitive therapy techniques associated with patients' improvement in depressionDECLARATION OF INTEREST  None.

Treatment outcomes in depression: reducing drop-out rates in cognitive therapy