Side Effects Of Psychotherapy Research Articles

Side Effects in Psychodynamic and Cognitive Behavior Therapy

Therapists and the public are becoming increasingly aware that psychotherapy can have side effects. The prevalence varies depending on the patients, treatments, settings, assessment methods and the researched type of side effect. Objective of this study is to assess side effects of routine outpatient psychodynamic and cognitive behaviour therapy. In a cross-sectional study cognitive behaviour therapist (n = 73) and psychodynamic psychotherapists (n = 57) were asked in a semi-structured interview about unwanted events and side effects in reference to their most recent patients (N = 276) using a domain inspection method. Their reports were cross-checked by an expert assessor. Multiple random-intercept models were conducted to investigate the influence of various variables. Therapists reported in 170 patients (61.4%) a total of 468 unwanted events. There was at least one side effect in 33.2% of the cases. Most frequent side effects were “strains in family relations” and “deterioration of symptoms”. Illness severity has a significant influence on the amount of side effects reported. The data confirm that side effects of psychotherapy are frequent. The difference between side effects and unwanted events shows the importance of such a distinction. The reporting of side effects for one in three patients may indicate an under recognition of side effects or reporting of only relevant or disturbing side effects.

The preliminary development and psychometric properties of the Psychotherapy Side Effects Scale

Side effects in psychotherapy are common and have a negative impact on patients or clients. However, effective evaluation tools are still lacking and have not been fully studied. The present study aims to develop a scale with good reliability and validity to measure the side effects of psychotherapy. The 25 items in the Psychotherapy Side Effects Scale (PSES) were condensed and distributed to 420 subjects online to test its psychometric properties. The internal consistency of the PSES was satisfactory to excellent (Cronbach's ɑ coefficient was .95, and the Guttman split-half coefficient was 0.88). A statistically significant negative correlation between the satisfaction score and the total score of the PSES was shown (r=-0.51, p<.001). The PSES could effectively discriminate between two groups with and without side effects (F=250.95, p<.001) and was able to predict the occurrence of side effects in psychotherapy with an area under curve of 0.932 and a 95% confidence interval of 0.900-0.964 (p<.001). A cutoff was set at 36 points in total PSES score, from which the maximum Youden's index (=0.72) could be obtained. The positive rate of the PSES was 24% (101/420). The PSES showed good internal consistency, content validity, concurrent validity, discriminant validity and predictive validity in evaluating and identifying side effects in psychotherapy. More advanced reliability testing methods and structural validity testing for PESE need to be practiced in the future to better serve clinical practice.

Therapists and psychotherapy side effects in China: A machine learning-based study

ObjectiveSide effects in the psychotherapy are sometimes unavoidable. Therapists play a significant role in the side effects of psychotherapy, but there have been few quantitative studies on the mechanisms by which therapists contribute to them. MethodsWe designed the Psychotherapy Side Effects Questionnaire-Therapist Version (PSEQ-T) and released it online through an official WeChat account, where 530 therapists participated in the cross-sectional analysis. The therapists were classified into groups with and without perceptions of clients’ side effects. A number of features were selected to distinguish the therapists by category. Six machine learning-based algorithms were selected and trained by our dataset to build classification models. We leveraged the Shapley Additive exPlanations (SHAP) method to quantify the importance of each feature to the therapist categories. ResultsOur study demonstrated the following: (1) Of the therapists, 316 perceived clients’ side effects in psychotherapy, with a incidence of 59.6%; the most common type was “make the clients or patients feel bad” (49.8%). (2) A Random Forest-based machine-learning classifier offered the best predictive performance to distinguish the therapists with and without perceptions of clients' side effects, with an F1 score of 0.722 and an AUC value of 0.717. (3) “Therapists’ psychological activity” was the most relevant feature for distinguishing the therapist category. ConclusionsOur study revealed that the therapist's mastery of the limitations of psychotherapy technology and theory, especially the awareness and construction of their psychological states, was the most critical factor in predicting the therapist's perception of the side effects of psychotherapy.

Influencing Factors and Machine Learning-Based Prediction of Side Effects in Psychotherapy.

Background: Side effects in psychotherapy are a common phenomenon, but due to insufficient understanding of the relevant predictors of side effects in psychotherapy, many psychotherapists or clinicians fail to identify and manage these side effects. The purpose of this study was to predict whether clients or patients would experience side effects in psychotherapy by machine learning and to analyze the related influencing factors.Methods: A self-compiled “Psychotherapy Side Effects Questionnaire (PSEQ)” was delivered online by a WeChat official account. Three hundred and seventy participants were included in the cross-sectional analysis. Psychotherapy outcomes were classified as participants with side effects and without side effects. A number of features were selected to distinguish participants with different psychotherapy outcomes. Six machine learning-based algorithms were then chosen and trained by our dataset to build outcome prediction classifiers.Results: Our study showed that: (1) the most common side effects were negative emotions in psychotherapy, such as anxiety, tension, sadness, and anger, etc. (24.6%, 91/370); (2) the mental state of the psychotherapist, as perceived by the participant during psychotherapy, was the most relevant feature to predict whether clients would experience side effects in psychotherapy; (3) a Random Forest-based machine learning classifier offered the best prediction performance of the psychotherapy outcomes, with an F1-score of 0.797 and an AUC value of 0.804. These numbers indicate a high prediction performance, which allowed our approach to be used in practice.Conclusions: Our Random Forest-based machine learning classifier could accurately predict the possible outcome of a client in psychotherapy. Our study sheds light on the influencing factors of the side effects of psychotherapy and could help psychotherapists better predict the outcomes of psychotherapy.

Predictors and impact of psychotherapy side effects in young adults

AbstractWhat should we tell our younger clients—who may or may not have chosen to come to therapy—about possible risks of engaging in psychotherapy? To explore this question, we examined psychotherapy side effects in 366 young adults with a history of psychotherapy or counselling. Psychotherapy side effects were common, with 41% of participants reporting at least one. Perceived lack of control over the decision of when and how to engage in therapy was the strongest predictor of experiencing therapy side effects. Of the different kinds of side effects, feeling that therapy had gone on too long and experiencing worsening of existing symptoms were the most strongly predictive of poor therapy outcomes such as dissatisfaction with care and lower perceived improvements. Finally, there was a significant association between reporting side effects of psychiatric medications and side effects of psychotherapy, suggesting common factors that contribute to side effect experience across treatment modalities. These findings highlight the need to monitor possible side effects during psychotherapy and counselling, and to have an open dialogue with our youngest clients and their families about the likelihood for negative outcomes when they are compelled to engage in therapy.

Adverse Effects of Psychotherapy in Depressed Patients - First Application of the Positive and Negative Effects of Psychotherapy Scale (PANEPS)

The Positive and Negative Effects of Psychotherapy Scale (PANEPS), a self report questionnaire to measure positive effects (PE) and unwanted events (UE) during the last psychotherapy (PT), was applied for the first time within a sample of patients with depression. The questionnaires applicability was tested and delivered first empirical results about PE and UE of a PT within this population. The 43 items of the PANEPS were completed during an online survey by 135 persons with a current or previous depressive disorder. UE were further divided into side effects (SE), malpractice (MP) and unethical misconduct (UM). In addition, sociodemographic information (age, sex, state of relationship), details about previous psychotherapeutic treatment and the last therapy were collected. The PANEPS was tested and revised using a principal components analysis with varimax rotation. A four-factor solution was determined, reflecting the previously defined scales (PE, SE, MP, UM) and allowed for further reduction of the PANEPS. The final version of the PANEPS showed satisfactory to excellent internal consistency with Cronbach's α between 0.72 and 0.92 A total of 95.6% of the participants reported at least one PE (range=0-5, M=3.3, SD=1.4) and 52.6% at least one UE (range=0-14, M=1.8, SD=2.9). From the sample, 38.5% reported at least one SE (range=0-6, M=0.8, SD=1.3), 26.7% at least one experience of MP (range=0-10, M=0.9, SD=1.9) und 8.1% at least one case of UM (range=0-4, M=0.1, SD=0.5). PE were negatively correlated with MP, but not with SE and UM. We found associations between characteristics of the sample and occurrence of WE and UE. Over half of the participants in our study confirmed presence of at least one UE as measured with the PANEPS, with unexpected high approval of at least one MP or UM. Especially the current symptomatology (PHQ-9) seems to be relevant for the approval of PE and UE of a PT. The negative association between PE and MP underlines the importance of guideline-oriented treatment for successful psychotherapy. Side effects of psychotherapy are common in patients with depression and should be measured regularly.

Definition, assessment and rate of psychotherapy side effects.

Psychotherapy is often seen as a first line treatment, because patients and therapists consider this mode of treatment harmless in comparison, for instance, to drug treatment. This assumption is supported by the fact that there are only limited scientific reports on psychotherapy side effects (1,2). There is, however, some evidence which suggests that psychotherapy can have frequent or serious negative consequences, like all effective treatments (3–5). There are several reasons why awareness of psychotherapy side effects is limited and research on this issue is insufficient. First, the psychotherapist is the “producer” of treatment and therefore responsible, if not liable, for all negative effects, which results in a perceptional bias towards positive rather than negative effects (6). Second, psychotherapy does not only focus on symptoms but also on social behavior, so that the spectrum of possible negative effects is much broader than in pharmacotherapy (7). Third, there is even no consensus on what to call negative: for instance, when evaluating a manuscript on psychotherapy side effects, a reviewer wrote: “a divorce can be both positive and negative, and crying in therapy can reflect a painful experience but can also be a positive and therapeutic event”. Fourth, there is a lack of differentiation between side effects and therapy failure or deterioration of illness (8). Fifth, there are no generally accepted instruments for the assessment of psychotherapy side effects and no rules on how to plan scientific studies or monitor side effects in randomized controlled clinical trials (2).

2843 – The problem of side effects in psychotherapy: adverse treatment reactions or unwanted events

The side effects of drugs are deemed so important that their pubblication are strictly regulated by national health agency. But no one agency requires such warnings connected to other mental health including Psychotherapy. In contrast to all pharmacotherapy studies in groups of patients, there is precious little information about the safety of psychotherapeutic interventions, which are also, in some patients and in some instances, associated with events that need to be noted. Actually empirical research on the negative effects of psychotherapy is largely insufficient, partly there is a lack of theoretical concept on how to define, classify and assess psychotherapy effects. This is a badly understudied issue, but of high clinical relevance, given that these treatments are so frequently recommended for the management of patients with psychopathological problems. And while there are many different forms of psychotherapy, virtually all of them share the matter discussed in this paper. Unfortunately, many psychotherapists won't discuss or acknowledge about side effects, despite they occour all the time. Some plausible definitions are considered as unwanted events, adverse reactions, deterioration of illness, malpractice reactions, treatment emergent reactions, treatment non response, therapeutic risks, controindications. Now that psychotherapy has become an accepted and effective option within the health care community, researchers and therapists need to do a better job of describing and examining the negative side effects of psychotherapy. Recognition of effects have to be a characteristic of good therapists and treatments, to improve the quality of care.

How to Define, Find and Classify Side Effects in Psychotherapy: From Unwanted Events to Adverse Treatment Reactions

Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of theoretical concept on how to define, classify and assess psychotherapy side effects. This paper proposes a model for the definition, classification and assessment of psychotherapy side effects. Definitions are provided for 'unwanted events', 'treatment-emergent reactions', 'adverse treatment reactions', 'malpractice reactions', 'treatment non-response', 'deterioration of illness', 'therapeutic risks' and 'contraindications'. We describe processes analysing the causality of negative events and the correctness of treatment. A procedural model on how to find, classify and evaluate negative events is described, the unwanted event to adverse treatment reaction (UE-ATR) checklist. Recognition of adverse treatment effects is a characteristic of good therapists and treatments. Psychotherapists should be sensitive for negative effects. This can help improve the quality of treatment. The UE-ATR checklist can be used in psychotherapy trials, quality assurance, clinical practice and training of psychotherapists.

The Therapist as a Vital Factor in Side-Effects of Psychotherapy

Berk and Parkers’ article ‘The elephant on the couch: side-effects of psychotherapy’ is a timely and much needed acknowledgement of the need to remember the hallowed medical rule primum non nocere ...

Seeing the Complexity of the Side-Effects of Psychotherapy: Many Different Sides to the Elephant?

I read with interest the article by Berk and Parker and agree that it is important to be aware of both the beneficial and potentially harmful effects of psychotherapy [1].In this response, I would ...

A Review of Side Effects and Adverse Events of Non-Drug Medicine (Nonpharmaceutical Complementary and Alternative Medicine): Psychotherapy, Mind-Body Medicine and Clinical Holistic Medicine

Background: Review of side effects of psychotherapy, bodywork (without high-energy manipulations), mind-body medicine, body-psychotherapy, sexology, clinical holistic medicine and complementary and alternative medicine (CAM).Method: We reviewed 857 records from a combined Medline/PubMed and PsycINFO search on “psychotherapy AND side effects" We also searched for “mind-body medicine," “bodywork," “body-psychotherapy," “clinical holistic medicine," “CAM," “sexology," “sexological examination," “physiotherapy," and specific side effects like “psychosis," “re-traumatization," “suicide," "hypomania," “depersonalisation," “derealization" and the drugs Lysergic acid diethylamide (LSD-25), “psilosybin," “mescaline," “Peyote" and MDMA (3,4-methylenedioxy-N-methamphetamine (MDMA) for searches. We looked for all case reports 1950-2009 and studies that included data on side effects and negative events.Results: Non-drug medicine did not have significant side effects (NNH (number needed to harm)&gt; 18,000) and the only severe side effect was rare, brief reactive psychosis, a temporary illness with full recovery (NNH &gt;65,000). Non-drug therapy did not significantly cause re-traumatization, implanted memories, or induction of suicide (NNH&gt;100,000). The most intensive psychotherapy enhanced with psychotropic (hallucinogenic) drugs had serious, but rare side effects and only for the mentally ill, psychiatric patients: brief reactive psychosis (NNH=556), suicide attempts (NNH=833), and suicide (NNH=2,500).Conclusions: Non-drug (non-pharmaceutical) medicine seems to be safe even for seriously physically and mentally ill patients and, whenever efficient, therefore recommended as treatment of choice.

Unerwünschte Effekte, Nebenwirkungen und Behandlungsfehler in der Psychotherapie

There is ample proof for the efficacy of psychotherapy but no systematic research on unwanted effects. Cases of malpractice represent a special problem as they always result from a therapist's inadequate behaviour. Furthermore, it is especially difficult in psychotherapy to distinguish between negative life events, unavoidable and undesirable developments of the disease, side effects of psychotherapy and positive treatment effects. In psychotherapy unwanted effects (UEs) can occur in the context of diagnostic problems, selection of the wrong treatment focus, technically inadequate interventions, sensitization processes, or inadequate development of a therapeutic alliance. Examples and case vignettes will be presented for these types of UEs and conclusions will be drawn as to how UE management can be improved.