Definition, assessment and rate of psychotherapy side effects

Lindén, Michael; Schermuly-Haupt, Marie-Luise

doi:10.1002/wps.20153

Cited by 155 publications

(127 citation statements)

References 23 publications

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“…However, other negative outcomes and adverse events, including discrete behaviors (e.g., suicide), psychosocial outcomes (e.g., divorce; domestic violence), dropping out of treatment, and medication side effects (e.g., sexual dysfunction) arguably are distinct from depressive symptom levels [11] and may require different preventive efforts. Similarly, positive outcomes distinct from depressive symptoms are also important therapeutic targets (e.g., social-interpersonal functioning) [39].…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed two specific negative outcomes: Deterioration (symptom severity increases from pre- to post-treatment) [9] and extreme non-response (severe depressive symptoms post-treatment) [10], although many others are possible [11]. In complement, we defined two unusually-positive outcomes: Superior improvement (≥95% symptom reduction from pre- to post-treatment) and superior response (no depressive symptoms post-treatment).…”

Section: Introductionmentioning

confidence: 99%

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Divergent Outcomes in Cognitive-Behavioral Therapy and Pharmacotherapy for Adult Depression

Vittengl

Jarrett²,

Weitz

et al. 2016

AJP

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Objective Although the average depressed patient benefits moderately from cognitive-behavioral therapy (CBT) or pharmacotherapy, some experience divergent outcomes. We tested frequencies, predictors, and moderators of negative (deterioration, extreme non-response) and unusually-positive (superior improvement, superior response) symptomatic outcomes. Method Sixteen randomized clinical trials comparing CBT versus pharmacotherapy for unipolar depression provided individual patients’ (N=1700) Hamilton Rating Scale of Depression (HAM-D) and/or Beck Depression Inventory (BDI) scores pre- and post-treatment. We tested demographic and clinical predictors and treatment moderators of any deterioration (increases ≥1 HAM-D or BDI points), reliable deterioration (increases ≥8 HAM-D or ≥9 BDI points), extreme non-response (post-treatment HAM-D ≥21 or BDI ≥31), superior improvement (HAM-D or BDI decreases ≥95%), and superior response (post-treatment HAM-D or BDI =0) using multilevel models. Results About 5–7% of patients showed any deterioration, 1% reliable deterioration, 4–5% extreme non-response, 6–10% superior improvement, and 4–5% superior response on the HAM-D or BDI. Superior improvement on the HAM-D (OR=1.67) only and attrition (OR=1.67) were more frequent in pharmacotherapy versus CBT. Patients with deterioration and superior response had lower, whereas patients with extreme non-response and superior improvement had higher, symptoms pre-treatment. Conclusions Deterioration and extreme non-response (a) occur infrequently in randomized clinical trials comparing CBT versus pharmacotherapy for depression, and (b) mirror superior improvement and superior response in distributions of symptom changes and end-states, respectively. Pre-treatment symptom levels help forecast negative and unusually-positive outcomes but do not guide selection of CBT versus pharmacotherapy. Pharmacotherapy may produce clinician-rated superior improvement and attrition more frequently than does CBT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Divergent Outcomes in Cognitive-Behavioral Therapy and Pharmacotherapy for Adult Depression

Vittengl

Jarrett²,

Weitz

et al. 2016

AJP

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“…An adverse treatment reaction is categorised as a side effect when the treatment is correctly applied and a malpractice reaction when the treatment is not correctly applied. Side effects occurring routinely constitute the 'side effect profile' of that treatment, which the patients have the right to be informed about (Linden & Schermuly-Haupt, 2014).…”

Section: Introductionmentioning

confidence: 99%

Adverse effects of psychological therapy: An exploratory study of practitioners’ experiences from child and adolescent psychiatry

Jönsson

Johanson

Nilsson

et al. 2015

Clin Child Psychol Psychiatry

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The scientific knowledge about adverse effects of psychological therapies and how such effects should be detected is limited. It is possible that children and adolescents are particularly vulnerable and need specific support in order to express adverse effects. In this exploratory study, we used a qualitative approach to explore practitioners' experiences of this phenomenon. Fourteen practitioners providing psychological therapy within the Child and Adolescent Psychiatric Service were interviewed. Qualitative content analysis was applied to the data. Four overarching categories brought up by the practitioners were identified: vagueness of the concept (reflecting that the concept was novel and hard to define), psychotherapist-client interaction (encompassing aspects of the interaction possibly related to adverse effects), consequences for the young person (including a range of emotional, behavioural and social consequences) and family effects (e.g. professional complications and decreased autonomy for the parent). Professional discussions on these issues could improve psychological therapy for children and adolescents. Based on our findings and previous research, we propose three basic aspects to consider when adverse effects are detected and managed in this context: typology (form, severity and duration), aetiology (hypothesis about the causes) and perspective (adverse effects seen from the points of view of different interested parties).

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“…An historically influential meta‐analysis (Smith & Glass, ) of 375 psychotherapy outcome studies found that the typical therapy client is better off than 75% of untreated individuals, and that few important differences in effectiveness could be established among many quite different types of psychotherapy. However, in recent overviews of psychotherapy research studies, Linden and Schermuly‐Haupt () found an emerging consensus that unwanted events should be expected in between 5% and 20% of psychotherapy patients, and Jarrett () suggested that studies (e.g. Lambert & Bergin, ; Mohr, ) have fairly consistently found that about 10% of patients/clients get worse after starting therapy.…”

Section: Outcome Studies On Potential Harmful Effects Of Psychotherapymentioning

confidence: 99%

The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails

Knox¹

2019

Brit J Psychotherapy

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A good therapeutic alliance has been found to be the best predictor of outcome in psychotherapy, but psychotherapists also need to develop an understanding of the mechanisms by which that alliance is created and the factors that may damage that alliance and contribute to harmful effects of psychotherapy. I explore these factors in three contexts: the nature of the therapy itself, the characteristics of the therapist, and the dynamics of the patient-therapist relationship. I discuss the research that suggests that potentially harmful processes can be avoided by a dynamic-agentive systems model, which views psychotherapy as a conversation, in which turn-taking, rupture and repair, and perspectivetaking are the intersubjective tools that help to build the therapeutic alliance and that can be the focus for further study into the mechanisms by which psychotherapy is helpful or harmful. The neuroscience research that supports this model is summarized.

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Definition, assessment and rate of psychotherapy side effects

Cited by 155 publications

References 23 publications

Divergent Outcomes in Cognitive-Behavioral Therapy and Pharmacotherapy for Adult Depression

Divergent Outcomes in Cognitive-Behavioral Therapy and Pharmacotherapy for Adult Depression

Adverse effects of psychological therapy: An exploratory study of practitioners’ experiences from child and adolescent psychiatry

The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails

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