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

Negative effects in randomized controlled trials of psychotherapies and psychological interventions: A systematic review

Background: Psychotherapy is a key evidence-based method for the treatment of mental disorders. However, little research has been published on the negative effects of psychotherapies. Aims: We examined this issue through a systematic literature review of previous systematic reviews on randomized controlled trials (RCTs). Methods: We focused on previous reviews and meta-analyses on 1) RCTs examining the effectiveness of psychotherapies and 2) previous reviews and meta-analyses specifically focusing on the negative effects of psychotherapy. We included publications published in PubMed and the Cochrane Databases from the year 2000 or later. Results: Of the 1,430 relevant publications, only a small proportion (30%) mentioned negative outcomes, mostly withdrawal. Only 57 of the extracted original studies monitored potential negative effects, and only three small-scale studies indicated negative effects. Conclusions: The systematic monitoring of negative effects in psychotherapy has not been given the same attention as has been given to the benefits of therapy.

Evaluation of the Effect of Comprehensive Nursing in Psychotherapy of Patients with Depression

The purpose of this study is to understand the emotional experience and psychological intervention of patients with depression and to explore the intervention effect of nursing intervention in the psychological treatment of patients with depression, so as to provide clinical nursing work recommendations and provide reference for the implementation of intervention methods for patients with depression. In addition, through case analysis, this paper combines controlled trials to study the effect of comprehensive nursing in the psychotherapy of patients with depression and combines mathematical statistics to process data. Through the analysis of controlled trials, it can be known that on the basis of conventional medication, interventional guidance for patients with depression through comprehensive nursing programs can play an ideal effect in improving the depression of patients. Moreover, it can effectively improve the patient's quality of life after intervention and enhance the patient's nursing satisfaction.

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.

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

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.

Negative Therapiefolgen körperorientierter Gruppenpsychotherapie am Beispiel der Konzentrativen Bewegungstherapie

Hintergrund

Es liegen bislang keine empirischen Untersuchungen zu negativen Therapiefolgen körperorientierter Psychotherapie vor. Am Beispiel der Konzentrativen Bewegungstherapie (KBT), die in der stationären Psychotherapie als adjuvantes körperorientiertes Gruppenpsychotherapieverfahren etabliert ist, wird untersucht, welche negativen Therapiefolgen Patienten in der (teil-)stationären KBT-Gruppenbehandlung angeben, und wie sich diese im Vergleich zu den Ergebnissen anderer Studien darstellen. Verschiedene Patienten- und Behandlungsmerkmale werden als Einflussgrößen berücksichtigt sowie der Zusammenhang zur Behandlungsbeurteilung durch die Patienten überprüft.

Material und Methoden

Es füllten 251 Patienten die Kurzform des Negative Effects Questionnaire (NEQ), den Fragebogen zu Nebenwirkungen in der Gruppentherapie und unerwünschten Gruppenerfahrungen (NUGE-24) sowie den Therapiebeurteilungsfragebogen für die Konzentrative Bewegungstherapie im Gruppentherapie-Setting (TBF-KBT-G) am Ende ihrer KBT-Gruppenbehandlung aus. Alter und Geschlecht sowie Zahl der Gruppentermine und Art der Behandlungseinrichtung wurden als Kovariablen erfasst. Zum Vergleich wurden die statistischen Kennwerte der Publikationen zum NEQ und NUGE-24 herangezogen.

Ergebnisse

Von mindestens einer negativen Therapiefolge berichteten 59,4 % der Patienten. Die Hälfte von ihnen gab mindestens 2 negative Effekte an, die sich v. a. auf bestimmte Beschwerden als Folgen der Behandlung bezogen. Negative Effekte dadurch, dass die Behandlung in der Gruppe erfolgt, lagen nur in geringem Maß vor und betrafen v. a. das Erleben persönlicher Überforderung. Für die Kovariablen ließen sich nur wenige Effekte ermitteln. Zur Behandlungsbeurteilung ergaben sich mehrere fast ausschließlich negative signifikante Korrelationen.

Schlussfolgerungen

Negative Therapiefolgen sind bei der (teil-)stationären KBT-Gruppenbehandlung wie auch bei anderen Therapieverfahren häufig zu verzeichnen. Es gibt kaum Hinweise auf ein typisches Risikoprofil oder dass diese Form der Behandlung im Vergleich zu anderen Behandlungen eine besondere Belastung darstellt. Die Untersuchungsergebnisse unterstreichen die Notwendigkeit, Patienten klare Informationen über das therapeutische Vorgehen sowie über mögliche negative Effekte selbst bei positivem Behandlungsverlauf zu vermitteln.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

Background

Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.

Methods

In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.

Discussion

The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.

Trial registration

ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

Response Rates in Online Surveys With Affective Disorder Participants

Abstract. A meta-analysis was performed to determine whether response rates to online psychology surveys have decreased over time and the effect of specific design characteristics (contact mode, burden of participation, and incentives) on response rates. The meta-analysis is restricted to samples of adults with depression or general anxiety disorder. Time and study design effects are tested using mixed-effects meta-regressions as implemented in the metafor package in R. The mean response rate of the 20 studies fulfilling our meta-analytic inclusion criteria is approximately 43%. Response rates are lower in more recently conducted surveys and in surveys employing longer questionnaires. Furthermore, we found that personal invitations, for example, via telephone or face-to-face contacts, yielded higher response rates compared to e-mail invitations. As predicted by sensitivity reinforcement theory, no effect of incentives on survey participation in this specific group (scoring high on neuroticism) could be observed.

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

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.