Woman during a psychotherapy session

    Almost half of CBT patients experience negative side effects

    16 October 2018

    Over 40 per cent of patients who undergo CBT (cognitive behavioural therapy) experience negative side effects, according to a new study by German researchers.

    They asked 100 CBT-therapists to recall their most recent client who had taken part in at least 10 sessions of CBT, then asked if their client had experienced any of 17 possible unwanted events during therapy, such as deterioration, new symptoms, distress, strains in family relations, or stigma.

    The therapists reported an average of 3.7 unwanted events per client. Based on the descriptions, the interviewer then rated the likelihood of each unwanted event being directly attributable to the therapeutic process.

    The researchers estimated that 43 per cent of clients had experienced at least one unwanted side-effect from CBT, most often distress, deterioration and strains in family relations. Over 40 per cent of side-effects were rated as severe or very severe, and over 25 per cent lasted weeks or months, though the majority were mild or moderate and transient.

    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.’

    The study’s lead author, Marie-Luise Schermuly-Haupt, said: ‘We argue that they are side-effects although they may be unavoidable, justified, or even needed and intended. If there were an equally effective treatment that did not promote anxiety in the patient, the present form of exposure treatment would become unethical as it is a burden to the patient.’

    ‘An awareness and recognition of unwanted events and side effects in all therapies will benefit patients, improve therapy or reduce attrition, analogous to the benefit of measurement-based monitoring of treatment progress.’