Psychotherapies should be assessed for both benefit and harm

Abstract

The past four decades have witnessed a transformation in research on the benefits of psychological therapies. However, even though therapists highlight that negative and adverse effects are seen in day-to-day practice, research on the negative effects of psychotherapy is insufficient. Given the unrelenting popularity of therapies, the argument for examining the adverse effects of psychotherapy would seem to be compelling. Such a strategy would extend beyond supervision of individual therapists to the introduction of monitoring systems that allow for a more systematic examination of failed psychotherapy interventions (such as exist for medication prescribing). The starting point could be the development of a consensus on how to define, classify and assess psychotherapy side-effects, unwanted events, adverse reactions, etc. This would provide a conceptual framework for communication, monitoring and research. This approach should not be viewed as an attack on therapies: every branch of medicine learns from mistakes, the same must surely be true for psychological treatments.

Research Review: Harnessing the power of individual participant data in a meta‐analysis of the benefits and harms of the Incredible Years parenting program

“…The outcomes included in the primary trials were most likely included based on the hypothesis that they might reveal benefits, rather than harms. Revealing harmful effects sometimes requires different outcome measures (Bonell et al, 2015;Scott & Young, 2016). Thus, our study was equipped to pick up on some aspects of harm (i.e., adverse effects on outcomes related to the program aims), but not other aspects (i.e., adverse effects on outcomes other than those related to the program aims).…”

The science and practice of psychotherapy: the critical need for quality assurance and vigilance to monitor the ratio of benefits to risks of therapies

“…Whilst clinicians recognize the benefits of medications and/or psychotherapy for a spectrum of mental conditions, patient organizations and the media tend to advocate enthusiastically for the use of psychotherapy (1)(2)(3)(4). The main reasons for these prevailing attitudes are the negative views of medications (e.g.…”

“…Importantly, the research exposes the lack of consensus on how to define and examine the adverse effects of therapy (11,12), and the need for empirical research on whether change in mental state (including increase in distress after a session) can be an early marker of longer-term improvement with therapy (13) or is more likely to be an indicator of an adverse reaction to it (14). Until we are better able to answer that question and in the absence of empirical predictors of likely adverse effects of therapy, clinical monitoring can provide rudimentary insights into the negative effects of therapy and begin the process of differentiating them from lack of therapeutic efficacy or from short-lived (but distressing) therapy side-effects (4,11,14).…”

“…Overall, these new studies (6, 7) offer an important reminder of the need to develop a more coherent strategy for examining failed psychotherapy interventions (4,12,14). Research could enhance our understanding of the mechanisms of action of therapies and of 'what works for whom' and leads to improvements in techniques and practice (4).…”

“…Research could enhance our understanding of the mechanisms of action of therapies and of 'what works for whom' and leads to improvements in techniques and practice (4). Clinically, models exist that help professionals actively participate in postmarketing surveillance and recording drug harms.…”