Assessing the unwanted: A systematic review of instruments used to assess negative effects of psychotherapy

Abstract

ObjectiveWhile the efficacy of psychotherapy in the treatment of mental disorders is well examined, systematic research into negative effects of psychotherapy seems comparatively rare. Therefore, this review evaluates instruments for assessing negative effects of psychotherapy in order to create a consensus framework and make recommendations for their assessment.MethodsThe study selection procedure follows current best‐practice guidelines for conducting systematic reviews, with 10 included studies in three databases (PsycINFO, PubMed, and Web of Science). The nine instruments identified were each critically reviewed concerning the theoretical orientation, including the assessed domains of negative effects, psychometric properties, and diagnostic characteristics.ResultsSeventeen domains of negative effects of psychotherapy were identified but inconsistently assessed by the nine instruments. Most instruments provide some initial data on their psychometric properties. Regarding diagnostic characteristics, different item‐response formats are used but often with reference to “attribution to therapy.”ConclusionThis review indicates that the existing instruments for assessing negative effects of psychotherapy cover a wide range of relevant domains without any consensus on the most important ones and their psychometric properties are usually unsatisfactory. A framework for consensus, building on the definition and conceptualization of negative effects, is synthesized, and recommendations for improving the assessment are derived.

Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies

“…If participants skipped certain items of the INEP (e.g., about partnership), missing values were replaced with “0,” i.e., as if no NEP was present. Items in the INEP proved reliable; Cronbach’s α = 0.86 ( Ladwig et al, 2014 ; Herzog et al, 2019 ). In this investigation, Cronbach’s α values were 0.61 in study 1 and 0.87 in study 2.…”

“…However, many psychotherapists pay little attention to NEP in their own clinical practice and report to be unfamiliar with methods and criteria for identifying and preventing NEP ( Bystedt et al, 2014 ; Schermuly-Haupt et al, 2018 ). To enhance treatment outcome and patients’ wellbeing, the early identification of NEP and its conscious handling both in research and clinical practice is called for ( Meister et al, 2016 ; Herzog et al, 2019 ). As shown by the review of Jonsson et al (2014) , only 21% of randomized controlled trials of psychological treatments reported harm on the patient level.…”

Patient experiences of psychological therapy for depression: a qualitative metasynthesis

“…The findings of the present metasynthesis also highlight the importance of considering adverse effects of psychological therapies. These have historically been under-researched in the field and although there has been increasing recognition of the potential for and incidence of adverse effects, they remain under-assessed in clinical trials [64]. While it might be inevitable that some individuals experience therapy as challenging or even unhelpful, there are also findings that reveal the potential for harm, such as reports of finding other group members' emotions overwhelming; finding practicing certain techniques overwhelming; or finding that the Bodyscan can generate flashbacks.…”

“…In spite of this review published two decades ago, there remains limited development in methodologies to monitor such negative effects. A recent review of instruments to monitor negative effects found nine available instruments including one specifically for group psychotherapy published in German [64]. The authors found these measures to be inadequately validated and recommended that work was needed to develop a comprehensive consensus framework which could be used in routine outcome monitoring and research.…”

Innovative Psychotherapieforschung: auf dem Weg zu einer evidenz- und prozessbasierten individualisierten und modularen Psychotherapie

“…Statt der Messung der Therapieeffekte auf Skalenebene sollten (auch) die Item-und Personenebenen einschließlich der neuen Methoden zu symptomspezifischen Analysen einbezogen werden [5]. Schließlich gilt es, die jahrzehntelang in der Psychotherapie vernachlässigte Nebenwirkungsorientierung aufzugreifen, indem die negativen Effekte (Nebenwirkungen sowie unethisches Verhalten und Kunstfehler) im Prozess erfasst werden, um Psychotherapien nebenwirkungsärmer durchzuführen [33,42].…”