Negative Effects of a Multimodal Inpatient CBASP Program: Rate of Occurrence and Their Impact on Treatment Outcome in Chronic and Treatment-Resistant Depression

Abstract

Background: A growing number of studies indicate that the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is effective in treating chronic depression. However, there is no systematic research into possible negative effects. Therefore, the objectives of the study were to investigate the rate of occurrence of negative effects of an inpatient CBASP program and their impact on treatment response.Methods: Patients with chronic depression and treatment resistance who completed the 12-week multimodal inpatient CBASP treatment program in an open trial (N = 52) retrospectively completed the Inventory for the Assessment of Negative Effects of Psychotherapy (INEP) during follow-up data collection. Severity of depressive symptoms was assessed self- and observer-rated at admission, discharge, and 6 months follow-up. Rates of occurrence of negative effects were calculated and binary logistic regression analyses were conducted to determine the relationship to treatment outcome.Results: The results indicate that 92.3% of patients reported having experienced at least one negative effect and 45.2% indicated dependence on their therapist. Stigmatization and financial concerns as well as intrapersonal changes were reported by about one-third. Only dependence on the therapist negatively impacted treatment outcome in both outcome measures.Conclusions: While almost all patients reported at least one negative effect of a multimodal inpatient CBASP treatment program, most of the reported negative effects appear to be benign. However, dependence on the therapist seems to have a negative impact on treatment outcome. If these results can be replicated in future large-scale, randomized controlled prospective studies, CBASP therapists should be aware of possible dependence and consciously address it during treatment.

Few negative effects of psychotherapy in a psychiatric day hospital: a follow-up survey to a multiprofessional treatment with acceptance and commitment therapy

“…The most common negative effect was periods of feeling bad (31.2% and 30.2%, respectively). In an inpatient CBASP treatment for chronic depression, 92.3% of patients reported at least one negative effect, with the most common negative effect being feelings of dependence on the therapist (45.2%) ( 10 ). In a DBT-oriented psychiatric day hospital for patients with borderline syndrome, 97.6% of the patients reported at least one negative effect with the most prevalent effect of longer periods of feeling bad (97.6%) ( 11 ).…”

“…The Inventory for the Assessment of Negative Effects of Psychotherapy (INEP; 7) is a questionnaire that assesses negative effects of psychotherapy, as defined above, as well as therapeutic malpractice from the patient's perspective. It is practical and has been used in several studies with patients with mental health disorders (7)(8)(9)(10)(11). In these studies, between 58.7% and 97.6% of the patients reported at least one negative effect, such as having difficulty making important decisions without their therapist, having more downs around the end of therapy, or feeling hurt by the therapist's statements.…”

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

“…Side effects as measured with the INEP have been linked to poorer therapeutic alliance (measured with the Helping Alliance Questionnaire), more interpersonal difficulties (measured with the Inventory of Interpersonal Problems, Gerke, Meyrose, Ladwig, Rief, & Nestoriuc, 2020), higher treatment expectations (Abeling, Müller, Stephan, Pollmann, & De Zwaan, 2018;Rheker, Beisel, Kräling, & Rief, 2017) and lower treatment satisfaction (Ladwig et al, 2014). Treatment response, on the other hand, is not generally reduced if side effects are present (Herzog, Häusler, Normann, & Brakemeier, 2021). Two studies using the INEP found side effects in 15-20% of mixed outpatient CBT samples in university clinics (Gerke et al, 2020;Nestoriuc & Rief, 2013).…”

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

“…There is also increasing interest in determining specific negative effects of a given psychotherapy. For instance, patients with chronic depression and treatment resistance who received Cognitive Behavioral Analysis System of Psychotherapy (CBASP) reported negative effects of up to 92.3% and dependence on their therapist of 45.2% (Herzog et al., 2021 ). The lack of standardized definitions and effective evaluation tools may be the main reasons that the side effects of psychotherapy have not been fully studied (Herzog et al., 2019 ).…”