Harmful treatments in psychotherapy.

McKay, Dean; Jensen‐Doss, Amanda

doi:10.1037/cps0000023

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…across mental disorders). [12][13][14][15] However, various studies have underscored the relevance of investigating potential harms in clinical trials on psychological treatments. For instance, one study found that about 93% of individuals treated with psychotherapy for obsessive-compulsive disorder reported experiencing at least one adverse event during treatment.…”

mentioning

confidence: 99%

Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events

Hoppen

Lindemann²,

Morina³

2022

Br J Psychiatry

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Background Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking. Aims To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD. Method We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms. Results We included 56 RCTs (4230 patients). Incidences of harms were generally low (0–5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15–0.28) and active control conditions (RR = 0.36, 95% CI 0.14–0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive–behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31–0.95) and with no differential risk of deterioration and AEs. Conclusions The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.

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confidence: 99%

Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events

Hoppen

Lindemann²,

Morina³

2022

Br J Psychiatry

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“…Another grave feature is the bizarre treatment interventions that a few participants reported. While the psychotherapy field is moving in an evidence-based direction, there still seem to be some psychotherapists who use nonscientific methods that could be potentially harmful (McKay & Jensen-Doss, 2021).…”

Section: Discussionmentioning

confidence: 99%

Psychotherapist factors that patients perceive are associated with treatment failure.

Alfonsson,

Fagernäs,

Beckman

et al. 2024

Psychotherapy

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Psychotherapy is a well-established and effective treatment for various psychiatric problems, but a substantial proportion of patients do not benefit from it, and many terminate treatment prematurely. Previous studies suggest that therapist dissatisfaction may play a pivotal role in premature treatment termination. This study, therefore, aimed to investigate therapist factors that may contribute to less-than-optimal results and dropout. Data were collected through a survey of patients (n = 736) with the experience of previous unsuccessful psychotherapy treatments. Based on prior research, the survey covered 13 therapist behaviors and traits, such as being unstructured or unengaged. The most common therapist factor that patients associated with treatment failure was poor assessment/understanding (86.7%), followed by inflexibility (71.7%) and poor knowledge (70.1%). Furthermore, this study identified four novel therapist-related factors: breaking the treatment contract, inappropriate sexual behaviors or comments, using nonconventional methods, and dominating behaviors. Overall, this study highlights the significance of therapist-related factors in premature treatment termination and treatment failure, shedding light on the crucial role therapists play in the therapeutic process. Understanding these factors is essential for improving psychotherapy outcomes and reducing dropout rates. Further investigations are needed to explore the impact of these therapist behaviors on treatment outcomes and to develop strategies for enhancing therapist competencies and skills to foster a more effective therapeutic alliance.

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“…This allows therapists not only to track progress (and potential side effects) on an individual level but also to measure the variability of change as a function of patient characteristics, treatment interventions, therapists, and clinics/services (Barkham & Lambert 2021). For example, on an aggregated level, the data can serve to investigate side effects, treatment dosage, therapist effects, and clinic effects (e.g., McKay & Jensen-Doss 2021). The session-by-session assessment structure is accompanied by statistical and methodological developments to analyze the nested structure of longitudinal data (e.g., Raudenbush & Bryk 2002).…”

Section: Session-by-session Assessmentsmentioning

confidence: 99%

Measurement-Based and Data-Informed Psychological Therapy

Lutz

Schwartz

Delgadillo

2022

Annu. Rev. Clin. Psychol.

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Outcome measurement in the field of psychotherapy has developed considerably in the last decade. This review discusses key issues related to outcome measurement, modeling, and implementation of data-informed and measurement-based psychological therapy. First, an overview is provided, covering the rationale of outcome measurement by acknowledging some of the limitations of clinical judgment. Second, different models of outcome measurement are discussed, including pre–post, session-by-session, and higher-resolution intensive outcome assessments. Third, important concepts related to modeling patterns of change are addressed, including early response, dose–response, and nonlinear change. Furthermore, rational and empirical decision tools are discussed as the foundation for measurement-based therapy. Fourth, examples of clinical applications are presented, which show great promise to support the personalization of therapy and to prevent treatment failure. Finally, we build on continuous outcome measurement as the basis for a broader understanding of clinical concepts and data-driven clinical practice in the future. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Harmful treatments in psychotherapy.

Cited by 8 publications

References 17 publications

Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events

Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events

Psychotherapist factors that patients perceive are associated with treatment failure.

Measurement-Based and Data-Informed Psychological Therapy

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