Iatrogenic Effects of Psychosocial Interventions: Treatment, Life Context, and Personal Risk Factors

Abstract

Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.

Mental Health Services and Personal Recovery in California: A Population-Based Analysis

“…These findings are consistent with the notion that internalized stigma may be a motivating factor in leaving treatment (52,53) and that stigma tends to persist over time (54). Previous research indicates that iatrogenic effects of therapeutic interventions are predicted by heightened internalized stigma and lack of social support (55). Additionally, individuals who did not find treatment useful may have opted to discontinue, a rational choice, but one that underscores the need for improved treatment.…”

Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation

“…A side effect is any unexpected effect that is secondary to the intended effect of the treatment (Linden, 2013). An event can also be categorized a “side effect” if it is not described in the “product labeling”, “package insert”, “marketing or advertising” (NIA, 2011; OHRP, 2007) – descriptions that are often lacking for meditation practices (and behavioral interventions more generally, despite a comparable incidence of AEs to pharmacological treatments; Crawford et al, 2016; Linden, 2013; Mohr, 1995; Moos, 2005, 2012). Whether the result of correct or incorrect treatment, a treatment-emergent reaction may include the appearance of novel symptoms that did not exist before treatment, or the exacerbation or re-emergence of a pre-existing condition.…”

What are the primary ethical considerations of evidence-based practice and practice-based evidence?

“…For example, Cuijpers et al (2018) found a 4% deterioration rate among patients who received a bona fide treatment. Moos (2012) found that between 7% and 13% of patients in substance misuse treatment got worse during treatment; Castonguay, Boswell, and Constantino et al (2010) found that between 5% and 10% of outpatients got worse during psychotherapy; and Crawford et al (2016) found that 5% of the respondents in the British National Health Insurance Program reported that they experienced long-lasting harmful effects from psychotherapy. Consequently, psychotherapists need to be sensitive to the possibility that some patients may become worse during psychotherapy and should take steps to redirect treatment when such deterioration occurs.…”