Unwanted Events and Side Effects in Cognitive Behavior Therapy, 2018, Schermuly-Haupt et al

Dolphin

Dolphin

Senior Member (Voting Rights)
Probably a minority interest. I think the biggest concern with CBT for ME/CFS is the graded activity component. However, potentially other aspects may cause problems.

Adverse effects from nonpharmacological therapies have not been studied as closely as adverse effects from pharmacological approaches in general.

Free full text:
https://link.springer.com/article/10.1007/s10608-018-9904-y

Cognitive Therapy and Research

June 2018, Volume 42, Issue 3, pp 219–229 | Cite as

Unwanted Events and Side Effects in Cognitive Behavior Therapy
  1. 1.Research Group Psychosomatic Rehabilitation at the Charité University Medicine BerlinBerlinGermany
  2. 2.Institute for Behavior Therapy BerlinBerlinGermany
  3. 3.Duke-National University of SingaporeSingaporeSingapore
Original Article
First Online: 09 March 2018

  • Abstract
Side effects (SEs) are negative reactions to an appropriately delivered treatment, which must be discriminated from unwanted events (UEs) or consequences of inadequate treatment. One hundred CBT therapists were interviewed for UEs and SEs in one of their current outpatients. Therapists reported 372 UEs in 98 patients and SEs in 43 patients. Most frequent were "negative wellbeing/distress" (27% of patients), "worsening of symptoms" (9%), "strains in family relations" (6%); 21% of patients suffered from severe or very severe and 5% from persistent SEs. SEs are unavoidable and frequent also in well-delivered CBT. They include both symptoms and the impairment of social life. Knowledge about the side effect profile can improve early recognition of SEs, safeguard patients, and enhance therapy outcome.

Keywords
Psychotherapy Unwanted events Side effects Adverse treatment reactions Quality assurance Cognitive behavior therapy Deterioration
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I admit I haven't read the whole thing but,

Therapists reported ....
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And how do we know that therapists haven't under reported, I wonder?

It would be interesting to see if, when questioned, their patients would report the same number of SEs and UEs. After all,isn't it what the patient feels that counts? Otherwise, why would they be in therapy?

It may very well be that sometimes patients don't tell the therapist if they have suffered UEs or SEs because they want to end the relationship as quickly as possible but feel they have to play along, for some reason.
 
Blog post:

Interviews with 100 CBT-therapists reveal 43 per cent of clients experience unwanted side-effects from therapy
https://digest.bps.org.uk/2018/08/1...xperience-unwanted-side-effects-from-therapy/

Examples of severe side-effects included: “suicidality, breakups, negative feedback from family members, withdrawal from relatives, feelings of shame or guilt, or intensive crying and emotional disturbance during sessions.”
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Interestingly, before the structured interviews, the therapists were asked off the top of their heads whether they felt their client had had any unwanted effects – in this case 74 per cent said they had not. Often it was only when prompted to think through the different examples of potential side-effects that they became aware of their prevalence. This chimes with earlier research that’s documented the biases that can lead therapists to believe therapy has been successful when it hasn’t.
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I agree with @Invisible Woman's comment. Why not ask the patients?

My one experience of 'supportive' CBT was definitely negative, but I very much doubt the therapist thought so. His complete lack of perception when doing the therapy that made him such a crap therapist would, I'm sure extend to complete lack of perception in evaluating its effects.
 
Isn't there a massive source of potential bias in that what the patient and the therapist view as a side effect is different and whether and how much harm it caused?

I'm sure it's easier for the therapist to rationalize side effects as being good for the patient even if the patient did not think so. In the case of something like a relationship breakup, the therapist might easily see it as a good thing based on surface knowledge, predjudice or bias.

Even in a clear cut situation, who decides a breakup should happen can have a big difference to psychological well-being.
 
omg I was googling to see if I could find this adverse events checklist mentioned in the paper and see what it involves maybe why couldnt the patients fill it in rather than therapists

and I found this 2008 editorial from Nutt and Sharpe Uncritical positive regard? Issues in the efficacy and safety of psychotherapy which actually proposes there should be a way of reporting harms - they suggested a Pink Card scheme http://journals.sagepub.com/doi/pdf/10.1177/0269881107086283

absolutely no excuse for MS not doing a decent job on harms in PACE - he could have set up a pink card scheme for the trial as an example of good practice

ETA back on thread has anyone been able to find a copy of the checklist I couldnt and then got distracted by MS
 
Trish said:
My one experience of 'supportive' CBT was definitely negative, but I very much doubt the therapist thought so. His complete lack of perception when doing the therapy that made him such a crap therapist would, I'm sure extend to complete lack of perception in evaluating its effects.
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I've had one experience of "supportive" CBT and my experience was just like yours. My therapist was a youngish man, probably in his early 30s, and I'm a (female) old fogey. He was utterly deaf to the things I was telling him, blind to the effects it was having on me to talk about the things that were affecting me, and just looked excruciatingly embarrassed most of the time. Having depressed me even further than I already was, after 4 sessions he told me the next session would have to be my last (it was NHS-supplied Talking Therapy). I did manage to get a 6th session as far as I recall but, at the end of it, all I remember was that I had two things I was expected to do to "get better" and I was physically, mentally, and emotionally incapable of doing either.

Edit : grammar
 
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I had IAPT CBT which wasnt supportive Ive mentioned before it was like a sausage machine lowest common denominator. The youngish woman was pleasant enough but had to stick to the framework which made her come across as an automaton, unengaged. In fact one of those chat things you get online that dont have a real person behind them would have done the same job - maybe that is the long term agenda of these organisations as it would slash their costs and maximise profits. Im sure a lot of the people delivering this cheap CBT know it is crap, but they need a job.
 
@Michiel Tack

I'm writing from a UK perspective, and I'm writing with my crystal ball in front of me...

Your first and third links are dated 2015, the middle one 2018. I haven't seen any evidence in real life in the last three years that CBT is becoming less popular or less believed in or less used by the medical profession or the government. What the patients feel is really irrelevant because it is usually all that is available in the UK unless people pay to go private. The government would love people to pay for everything. That is why there are lists being published every few months of operations that will no longer be funded and drugs that won't be prescribed. Those lists will keep coming and the number of treatments available from the NHS will keep on shrinking while a greater and greater proportion of the population will be told they are mentally ill and that is why they won't be treated - their problems are not real they are all in the patient's head. But Newspeak will be used to try and pull the wool over patients' eyes so they think they are being properly treated for a while. How many patients know what a functional disorder is, or what somatization means? I can imagine that many patients go home and tell their families what their diagnosis is and would not look it up to find out they've been tarred with the mental health brush. But it will count against some people if they try and claim benefits, that's for sure.

And while all this is going on the government will tell people that the NHS will stay free at the point of delivery and, of course, they believe in and are proud of the NHS.

:mad:
 
Sharpe retweeted a link to this study:

Adverse effects of psychotherapy for depression: new meta-analysis looks at deterioration rates
"This is a simple idea; that we should measure the potential harms of psychotherapy, as well as potential benefits."

"This meta-analysis aimed to pull together all information about deterioration rates in randomised controlled trials of psychotherapy for depression."

"Only three of the 18 studies met all four quality criteria, seven met three criteria, two met two and 6 studies only met one of the quality criteria, indicating that most studies had a high risk of bias."

"
Conclusions
In summary, this meta-analysis identified that undertaking psychotherapy may reduce the risk of deterioration for depression symptoms, however this is in the context of an evidence base that mostly excludes deterioration as an outcome."


upload_2018-8-26_16-14-5.jpeg
This research highlights the importance of including data on deterioration in randomised controlled trials of psychotherapy, even if it appears to be non-significant. We cannot assume there are no negative effects in the absence of data."

https://www.nationalelfservice.net/treatment/psychotherapy/adverse-effects-psychotherapy-depression/
 
Trying to find a relevant thread to ask some questions about CBT.
Are there any guidelines or rules about the content of any CBT?

I ask this because, more and more, 'they' seem to be targeting quite specific issues within the context of a particular illness.
as an example I came across this :
"The aim of the study was to see if the group sessions reduced the problem of hot flushes and night sweats after breast cancer treatment."
https://www.cancerresearchuk.org/ab...s-after-treatment-for-breast-cancer#undefined

and the results:
"The flush monitor showed that there was not much difference between the 2 groups in how often they had hot flushes or night sweats. But women who had group sessions rated their quality of life as better than women in the treatment as usual group."

the guardian then ran an article:
Cognitive behavioural therapy helps menopause symptoms, study finds
https://www.theguardian.com/society/2012/feb/15/cognitive-behaviour-therapy-menopause-symptoms

Obviously, again, the results are presented in a way to suggest a positive outcome and it would seem the women found the group sessions helpful, but the actual problem (ie hot flushes) was unaffected.

But, my question really is about what the therapists say/recommend to patients who are dealing with very specific illnesses and suffering from symptoms that arise because of their illness (or in this case the drug treatment they are receiving to treat it).
What medical qualifications do these therapists have in relation to the kind of patients they are 'treating'?
Are there any safety measures in place to ensure that whatever 'advice' patients are given will not directly or indirectly cause them harm?
 
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It is a self reinforcing cycle. If you can change a response to a questionnaire after a few weeks , then you can treat anything.

It would be interesting to know how many responded to please the therapist, or to never have to do it again.
Was there any control for bias?
 
Merged threads

The toxic side effects of therapy: 40% of people experience more distress from cognitive behavioral therapy, 2018

Article in the Daily Mail about a scientific study which criticises use of CBT as a therapy. This is not in relation to ME and I havent read the actual scientific paper, but from the article it looks like there are arguments that could be translated to it's use in other ilnesses.

"The toxic side effects of THERAPY: 40% of people experience more distress from cognitive behavioral therapy, study finds"

https://www.dailymail.co.uk/health/...-patients-experience-effects-study-finds.html

Cognitive behavioral therapy (CBT) is widely considered the safest treatment for many mental illnesses - but that doesn't mean it is without side effects, new research reveals.

About 40 percent of Americans have seen or are currently seeing a therapist, and CBT is both the most popular and best clinically proven form of talk therapy.

By nature, however, it involves the stress of revisiting past traumas and painful issues and confronting one's own shortcomings.

And that means that that nearly half of therapy patients come away with 'side effects,' such as disruption of relationships, feelings of guilt and shame and even suicidal thoughts, according to a new German study.....​
 
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from that article-

"The therapists themselves were surprised by the negative effects they realized therapy might have on their patients. Before being asked specific questions, three quarters of the counselors said they didn't think that CBT had negative effects."
 
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