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Huth D, Bräscher AK, Tholl S, Fiess J, Birke G, Herrmann C, Jöbges M, Mier D, Witthöft M. Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial. Psychol Med 2024; 54:1122-1132. [PMID: 37842765 DOI: 10.1017/s0033291723002921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting. METHODS The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention. RESULTS The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33-0.49). CONCLUSIONS Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.
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Affiliation(s)
- Daniel Huth
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah Tholl
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Johanna Fiess
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Germany
| | | | | | - Daniela Mier
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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2
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Richter C, Rutschmann R, Romanczuk-Seiferth N. Few negative effects of psychotherapy in a psychiatric day hospital: a follow-up survey to a multiprofessional treatment with acceptance and commitment therapy. Front Psychiatry 2024; 15:1235067. [PMID: 38389983 PMCID: PMC10881704 DOI: 10.3389/fpsyt.2024.1235067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
While there are many studies on psychotherapy and its efficacy - in terms of desired outcomes - there is comparatively little evidence on the possible negative effects of psychotherapy. The aim of this study was to investigate the possible negative effects of a multi-professional psychiatric day hospital treatment for patients with mental health disorders based on Acceptance and Commitment Therapy (ACT), including possible confounding factors. Fifty-one patients with a range of psychiatric diagnoses were assessed three months after an ACT-based psychiatric day hospital treatment. Questionnaires were used to measure negative effects of psychotherapy (INEP), subjective quality of life (WHOQOL-BREF), and symptomatology (BDI-II and SCL-90-R). Correlational analyses and group comparisons were performed to determine the relationship between the sum of reported negative effects on the one hand and symptomology, quality of life, and sociodemographic variables (gender, age, diagnosis, education) on the other hand. At least one negative effect out of a list of 18 possible effects was reported by 45% of participants, and 10% reported more than two. The number of negative effects reported correlates positively with symptomology and negatively with quality of life. The sum of reported negative effects does not correlate with age or gender and does not vary by education level and primary diagnosis. In the light of previous findings, patients included in this study showed lower rates of negative effects, both overall and at item level. Practical implications of these findings are discussed.
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Affiliation(s)
- Christoph Richter
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Ronja Rutschmann
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- MSB Medical School Berlin, Department of Psychology, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- MSB Medical School Berlin, Department of Psychology, Berlin, Germany
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3
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Strauss B. "You Can't Make an Omelet Without Breaking Eggs": Studies on Side Effects and Adverse Events in Group Psychotherapy. Int J Group Psychother 2021; 71:472-480. [PMID: 38449230 DOI: 10.1080/00207284.2021.1890089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paveltchuk F, Mourão SEDQ, Keffer S, Costa RT, Nardi AE, Carvalho MR. Negative effects of psychotherapies: A systematic review. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Stella Keffer
- Federal University of Rio de Janeiro Rio de Janeiro Brazil
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5
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Dietrichkeit M, Hagemann-Goebel M, Nestoriuc Y, Moritz S, Jelinek L. Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression. Sci Rep 2021; 11:7861. [PMID: 33846503 PMCID: PMC8041905 DOI: 10.1038/s41598-021-87198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
Although awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of "symptoms" and "quality". Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.
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Affiliation(s)
- Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany.
| | | | - Yvonne Nestoriuc
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Glanert S, Sürig S, Grave U, Fassbinder E, Schwab S, Borgwardt S, Klein JP. Investigating Care Dependency and Its Relation to Outcome (ICARE): Results From a Naturalistic Study of an Intensive Day Treatment Program for Depression. Front Psychiatry 2021; 12:644972. [PMID: 34737714 PMCID: PMC8562106 DOI: 10.3389/fpsyt.2021.644972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background: This study explores the association of experienced dependency in psychotherapy as measured with the CDQ (Care Dependency Questionnaire) and treatment outcome in depression. Furthermore, the course of care dependency and differences in the CDQ scores depending on the received type of treatment, MCT (metacognitive therapy), or CBASP (cognitive behavioral analysis system of psychotherapy), were investigated. Methods: The study follows a prospective, parallel group observational design. Patients suffering from depression received an 8-week intensive day clinic program, which was either CBASP or MCT. The treatment decision was made by clinicians based on the presented symptomatology and with regard to the patients' preferences. The patients reported depressive symptoms with the QIDS-SR16 (Quick Inventory of Depressive Symptomatology) and levels of experienced care dependency with the German version of the CDQ on a weekly basis. Mixed-model analyses were run to account for the repeated-measures design. Results: One hundred patients were included in the analyses. Results indicate that higher levels of care dependency might predict a less favorable outcome of depressive symptomatology. Levels of care dependency as well as depressive symptoms decreased significantly over the course of treatment. There was no significant between-group difference in care dependency between the two treatment groups. Conclusion: The results suggest that care dependency might be associated with a worse treatment outcome in depressed patients. In general, care dependency seems to be a dynamic construct, as it is changing over time, while the levels of care dependency seem to be independent from the received type of treatment. Future research should continue investigating the mechanisms of care dependency in a randomized controlled design. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier: DRKS00023779.
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Affiliation(s)
- Sarah Glanert
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Svenja Sürig
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Ulrike Grave
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.,Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Sebastian Schwab
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
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7
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Richter C. Subjektive Nebenwirkungsklagen von Borderline-Patienten – zwei Jahre nach einer tagesklinischen Behandlung. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Einleitung:</i></b> Die Erfassung von negativen Effekten (nE) von Psychotherapie (PT) ist wichtig, um Schwachstellen von PT zu identifizieren und die Behandlungsqualität zu verbessern. Studienziel ist, zu untersuchen, welche nE Patienten nach einer tagesklinischen Behandlung für Borderline-Persönlichkeitsstörungen (BPS) mit einem Dialektisch-Behavioralen Therapieschwerpunkt (DBT) beschreiben, welche Einflussfaktoren vorliegen und wie die Klagen inhaltlich zu verstehen sind. <b><i>Material und Methoden:</i></b> Katamnestisch wurden BPS-Patienten 22,6 Monate nach Therapieende befragt, an welche nE sie sich mit Bezug zu einer zwölfwöchigen tagesklinischen Behandlung erinnern. Messinstrumente waren BDI, BSL-95 und INEP. <b><i>Ergebnisse:</i></b> 35 Frauen und 6 Männer antworteten (50% von 82). Im Mittel wurden 11,2 nE benannt, die subjektiv auf die DBT-Behandlung zurückgeführt wurden. 97,6% berichten von Verschlechterung ihres Befindens, 87,8% erinnern sich an Probleme in der therapeutischen Beziehung, 43,9% klagten über Verschlechterungen in der Beziehung, 70,7% über finanzielle Probleme in Folge der tagesklinischen Behandlung und 29,3% über Stigmatisierungserleben. Die Zahl der nE korrelierte mit höherem Alter zum Therapiestart (<i>p</i> < 0,01) sowie höherer Symptomlast anhand der BSL-95 (<i>p</i> < 0,01) bzw. BDI (<i>p</i> < 0,01) zum Befragungszeitpunkt. <b><i>Diskussion:</i></b> Es konnte gezeigt werden, dass Patienten bei Vorlage des INEP über eine erhebliche Rate an Negativerfahrungen im Rahmen der tagesklinischen Behandlung klagen. Der lange Rückerinnerungszeitraum von 3 bis 51 Monaten und die Korrelation mit der aktuellen Symptomatik stellen die Validität der Antwort in Frage. Ergebnisse von Selbstratinginstrumenten zur Nebenwirkungserfassung bedürfen einer sehr sorgfältigen Interpretation.
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8
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Gerke L, Meyrose AK, Ladwig I, Rief W, Nestoriuc Y. Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies. Front Psychol 2020; 11:2144. [PMID: 32982878 PMCID: PMC7478145 DOI: 10.3389/fpsyg.2020.02144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Negative effects of psychotherapy (NEP) include side effects, malpractice, and unethical behavior. Its setting-specific frequencies and predictors are mostly unknown. The two presented studies aim to investigate NEP and its predictors systematically across different treatment settings. In study 1, N = 197 patients of a German outpatient center were recruited, on average, 3.76 years after the termination of psychotherapy. In study 2, data from N = 118 patients of two German inpatient clinics were collected at admission (t0), discharge (t1), and 9-month follow-up (t2). All participants evaluated the negative effects of their previous out- or inpatient psychotherapy with the Inventory for the Balanced Assessment of Negative Effects in Psychotherapy and a priori hypothesized predictors. At least one side effect was reported by 37.3% of inpatients (t2) and 15.2% of outpatients. At least one case of malpractice and unethical behavior was reported by 28.8% of inpatients (t2) and 7.1% of outpatients. Inpatients reported significantly more side effects (U = 14347, z = 4.70, p < 0.001, r = 0.26) and malpractice and unethical behavior (U = 14168, z = 5.21, p < 0.001, r = 0.29) than outpatients. Rates of severe malpractice in the form of breaking confidentiality and physical and sexual abuse were less than 1% in both settings. Predictors of side effects were prior experience with psychotherapy and current interpersonal difficulties in the outpatient setting and higher motivation for psychotherapy (t0) in the inpatient setting. Predictors of malpractice and unethical behavior were younger age in the outpatient setting and poor therapeutic alliance, prior negative experience with malpractice and unethical behavior, and higher outcome expectations in the inpatient setting. NEP are common in both, in- and outpatient settings. Inpatients are at higher risk for the NEP than outpatients. To safeguard patients’ wellbeing, the systematic assessment and distinction of side effects and malpractice and unethical behavior should gain more attention in research and clinical practice.
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Affiliation(s)
- Leonie Gerke
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany
| | - Ann-Katrin Meyrose
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Ladwig
- Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Yvonne Nestoriuc
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany.,Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Schermuly-Haupt ML, Linden M. Erwartungen und Kenntnisse von Ausbildungskandidaten in Verhaltenstherapie zu Psychotherapienebenwirkungen. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000505594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Die Aufklärung, Erkennung, Vorbeugung und Bearbeitung von Psychotherapienebenwirkungen stellt hohe Anforderungen an Therapeuten. Grundsätzlich gilt zudem, dass es psychologische Barrieren gibt, negative therapeutische Entwicklungen wahrzunehmen und dem eigenen therapeutischen Handeln zuzuordnen. Dazu trägt bei, dass dieses Thema bislang in der Ausbildung eher wenig Beachtung findet und kaum systematisch abgehandelt wird. Um den eventuellen Handlungsbedarf abschätzen zu können, sind Daten von Interesse zu den einschlägigen Einstellungen und Kenntnissen von Therapeuten in Ausbildung. <b><i>Methode:</i></b> In einem halbstrukturierten Interview wurden 100 Psychotherapeuten in Ausbildung mit dem Schwerpunkt Verhaltenstherapie zu Nebenwirkungen ihrer Arbeit befragt. Die Therapeuten machten Angaben zur Qualität, Häufigkeit und den möglichen Ursachen von Psychotherapienebenwirkungen. <b><i>Ergebnisse:</i></b> Therapeuten in Ausbildung rechnen in etwa jedem 2. Fall mit dem Auftreten von Nebenwirkungen. Sie erwarten vor allem Symptomverschlechterung und negative Entwicklungen im sozialen Netz. Es zeigt sich eine Tendenz, das eigene Verfahren und die eigenen Behandlungen für weniger riskant zu halten als die der Kollegen. Ursachen von Nebenwirkungen sehen die Therapeuten vor allem in der therapeutischen Beziehung sowie Therapeutenvariablen und weniger in Patientencharakteristika. <b><i>Schlussfolgerung:</i></b> Psychotherapeuten in Ausbildung sind sich dem Problem der Nebenwirkungen durchaus bewusst, was ein guter Ansatzpunkt für die Vermittlung entsprechender Ausbildungsinhalte ist. An den Aus- und Weiterbildungsinstituten sollten Seminare zum Problem der Psychotherapienebenwirkungen zum Standard gehören.
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10
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Herzog P, Lauff S, Rief W, Brakemeier EL. Assessing the unwanted: A systematic review of instruments used to assess negative effects of psychotherapy. Brain Behav 2019; 9:e01447. [PMID: 31647202 PMCID: PMC6908878 DOI: 10.1002/brb3.1447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE While 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. METHODS The 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. RESULTS Seventeen 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." CONCLUSION This 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.
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Affiliation(s)
- Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Sören Lauff
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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11
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Schneibel R, Wilbertz G, Scholz C, Becker M, Brakemeier EL, Bschor T, Zobel I, Schmoll D. Adverse events of group psychotherapy in the in-patient setting - results of a naturalistic trial. Acta Psychiatr Scand 2017; 136:247-258. [PMID: 28561929 DOI: 10.1111/acps.12747] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Adverse events of psychotherapy have often been neglected in research. In this study, potential adverse events of group psychotherapies in a psychiatric hospital were systematically assessed, explored for predictors and linked to treatment outcome. METHOD A naturalistic trial was conducted in 180 in-patients attending different group psychotherapies. Adverse events were assessed using three different measures: (i) weekly reporting of unwanted treatment reactions, (ii) mood changes in response to every single group session and (iii) premature group termination. RESULTS Different measures of adverse events were weakly associated. Deterioration of mood state and/or unwanted treatment reactions were experienced by 60-65% of all patients. Reports of unwanted treatment reactions decreased over time and were negatively associated with symptom improvement. However, mood state deterioration was constant and unrelated to treatment outcome. The rate of premature group termination was 34%. Significant predictors of adverse events included patient characteristics as well as disadvantageous group conditions. CONCLUSIONS For the majority of patients, group psychotherapy in the in-patient setting is associated with adverse events. Changes over time and a strong correlation with general symptom severity must be considered in the assessment and interpretation of adverse events. Predictors should be considered as potential risk factors in future research.
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Affiliation(s)
- R Schneibel
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany
| | - G Wilbertz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Scholz
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - M Becker
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - E-L Brakemeier
- Psychologische Hochschule Berlin, Berlin, Germany.,Philipps-University of Marburg, Marburg, Germany
| | - T Bschor
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - I Zobel
- Fresenius University of Applied Sciences, Berlin, Germany
| | - D Schmoll
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany
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12
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Holsting AF, Pedersen HF, Rask MT, Frostholm L, Schröder A. Is psychotherapy for functional somatic syndromes harmful? A mixed methods study on negative effects. J Psychosom Res 2017; 98:113-121. [PMID: 28554366 DOI: 10.1016/j.jpsychores.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/07/2017] [Accepted: 05/11/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Concern for negative effects of psychotherapy for functional somatic syndromes (FSS) has been expressed by clinicians and some patient associations, which may prevent patients from seeking treatment. Therefore, we sought to explore the occurrence and characteristics of negative effects from group-based psychotherapy as experienced by patients with severe or multiple FSS. METHODS An adapted version of the explanatory sequential mixed methods design was applied. We used data from an on-going pilot study on Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction. Negative effects were measured by Inventory for the assessment of Negative Effects of Psychotherapy (INEP). In addition, telephone interviews were conducted with randomly chosen patients and patients who reported negative effects. The latter were asked to elaborate on their INEP response. Quantitative data were analysed descriptively while interview transcripts were explored by thematic analysis. RESULTS Eighty patients responded to the questionnaire (89%). Negative effects to different extent (from 'slightly agree' to 'fully agree') were reported by 25 (31%). The most frequent negative effects were dependence on the therapist (12%), feeling down after therapy (6%) and insurance problems (7%). By exploring 27 participants' experiences of negative effects 3 main themes were identified: relations in therapy, outcome and transition from therapy to everyday life. CONCLUSION Patients with FSS reported a few specific negative effects, all with low frequency. Generally, therapy was well-received. Some patients did however express negative effects both within and outside the therapeutic context. It is important to inform patients about potential negative effects prior to psychotherapy.
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Affiliation(s)
- A F Holsting
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - H F Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - M T Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - L Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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13
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Frank F, Wilk J, Kriston L, Meister R, Shimodera S, Hesse K, Bitzer EM, Berger M, Hölzel LP. Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual--study protocol of a multisite randomised controlled trial. BMC Psychiatry 2015; 15:259. [PMID: 26497218 PMCID: PMC4619254 DOI: 10.1186/s12888-015-0633-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapses and rehospitalisations are common after acute inpatient treatment in depressive disorders. Interventions for stabilising treatment outcomes are urgently needed. Psychoeducational group interventions for relatives were shown to be suitable for improving the course of disease in schizophrenia and bipolar disorders. A small Japanese monocentre randomised controlled trial also showed promising results for depressive disorders. However, the evidence regarding psychoeducation for relatives of patients with depressive disorders is unclear. METHODS/DESIGN The study is conducted as a two-arm multisite randomised controlled trial to evaluate the incremental effect of a brief psychoeducational group intervention for relatives as a maintenance treatment on the course of disease compared to treatment as usual. Primary outcome is the estimated number of depression-free-days in patients within one year after discharge from inpatient treatment. 180 patients diagnosed with unipolar depressive disorders as well as one key relative per patient will be included during inpatient treatment and randomly allocated to the conditions at discharge. In the intervention group, relatives will participate in a brief psychoeducational group intervention following the patient's discharge. The intervention consists of four group sessions lasting 90 to 120 min each. Every group session contains informational parts as well as structured training in problem-solving. In both study conditions, patients will receive treatment as usual. Patients as well as relatives will be surveyed by means of questionnaires at discharge and three, six, nine and twelve months after discharge. In addition to the primary outcome, several patient-related and relative-related secondary outcomes will be considered and health economics will be investigated. DISCUSSION Our study will provide evidence on the incremental effect of a brief psychoeducational intervention for relatives as a maintenance treatment after inpatient depression treatment. Positive results may have a major impact on health care for depression. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00006819; Trial registration date: 2014 Oktober 31; Universal Trial Number (UTN): U1111-1163-5391.
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Affiliation(s)
- Fabian Frank
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, D-79117, Freiburg, Germany.
| | - Juliette Wilk
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kohasu, Okoh-cho, Nankokushi, Kochi, 783-8505, Japan.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University Medical Center Tübingen, Calwerstraße 14, D-72072, Tübingen, Germany.
| | - Eva-Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, D-79117, Freiburg, Germany.
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
| | - Lars P Hölzel
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
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