Cited by 230Psychometric Methodologies and TestingAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Testing and Assessment

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The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments

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Rozental, Alexander, Kottorp, Anders, Forsström, David, Månsson, Kristoffer, Boettcher, Johanna, Andersson, Gerhard, Furmark, Tomas, Carlbring, Per·2019·Behavioural and Cognitive Psychotherapy

DOI 10.1017/s1352465819000018

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Abstract

Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically. Aims: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision. Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data were analysed using Rasch analysis, i.e. a modern test theory application. Results: (1) the NEQ exhibits fairness in testing across sociodemographics, (2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, (3) uses a rating scale that advances monotonically in steps of 0 to 4, and (4) is suitable for monitoring negative effects on an item-level. Conclusions: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

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A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · cited 1×
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“A similar study was conducted using Rasch analysis for the Depression, Anxiety and Stress Scales (Lovibond and Lovibond, 1995), suggesting that a number of items could be removed and that it was not supported as a general instrument for mental distress (Shea et al.”
Method
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“Research on the efficacy of evidencebased approaches, such as cognitive behaviour therapy (CBT), suggest that a large number of patients improve thanks to the interventions they receive (Hofmann et al., 2012).”
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A Rating Formulation for Ordered Response Categories
Andrich, D. (1978) · Psychometrika · doi:10.1007/bf02293814 · Cited by 2,984 · cited 1×
“This can be helpful for identifying abnormal responses that might warrant further development of the instrument (Andrich, 1978).”
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Mantel, N. (1963) · Journal of the American Statistical Association · doi:10.1080/01621459.1963.10500879 · Cited by 2,899 · cited 1×
“The magnitude of DIF was evaluated using the Mantel-Haenszel statistic for polytomous scales using log-odds estimators (Mantel, 1963).”
Method
Summated Rating Scale Construction
Spector, P. E. (1992) · Sage eBooks · doi:10.4135/9781412986038 · Cited by 2,173 · cited 1×
“This converted item measure is then applied to determine whether they are scored on a similar unidimensional construct, which is often viewed as crucial in terms of validity in both classical and modern test theory (Spector, 1992).”
Method
SURVEY RESEARCH
Krosnick, J. A. (1999) · Annual Review of Psychology · doi:10.1146/annurev.psych.50.1.537 · Cited by 1,852 · cited 1×
“It is possible that the negative effects that were reported were affected by recall bias, primacy-recency effects, and social desirability (Krosnick, 1999), resulting in less valid responses.”
Background
Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9)
Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00198-8 · Cited by 1,558 · cited 2×
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Method
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Greenberg, L. S., & Pinsof, W. M. (1986) · Cited by 1,386

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Background
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Persson, A., Finn, D. W., Broberg, A., Westerberg, A., Magnusson, Å., & Molander, O. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4192944
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“Such items can negatively impact the overall quality of the instrument (Azzarkasyi et al., 2019; Rozental et al., 2019).”
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“The NEQ shows acceptable psychometric properties (Rozental et al., 2019).”
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Additional file 6 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.26707769
Additional file 1 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.25621913
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Additional file 1 of Developing a process for assessing the safety of a digital mental health intervention and gaining regulatory approval: a case study and academic’s guide
Taher, R., Hall, C. L., Bergin, A. D. G., Gupta, N., Heaysman, C. L., Jacobsen, P., Kabir, T., Kalnad, N., Keppens, J., Hsu, C.-W., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26974360
Additional file 4 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.26707763
Additional file 5 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.26707766
Additional file 2 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.25622121
Additional file 2 of Deep phenotyping towards precision psychiatry of first-episode depression — the Brain Drugs-Depression cohort
Jensen, K. H. R., Dam, V. H., Ganz, M., Fisher, P. M., Ip, C.-T., Sankar, A., Marstrand-Joergensen, M. R., Ozenne, B., Osler, M., Penninx, B. W. J. H., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22623805
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Additional file 1 of Deep phenotyping towards precision psychiatry of first-episode depression — the Brain Drugs-Depression cohort
Jensen, K. H. R., Dam, V. H., Ganz, M., Fisher, P. M., Ip, C.-T., Sankar, A., Marstrand-Joergensen, M. R., Ozenne, B., Osler, M., Penninx, B. W. J. H., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22623802
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Additional file 2 of Developing a process for assessing the safety of a digital mental health intervention and gaining regulatory approval: a case study and academic’s guide
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Additional file 3 of Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)
Arendt, I.-M. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Figshare · doi:10.6084/m9.figshare.26707760
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“Firstly, an existing validated measure of negative effects in psychological therapy 25 was reviewed to explore an acceptable format to seek these views and obtain examples of question content, which were then considered alongside expressed negative effects of NPA from the literature described in…”
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“…Revised (range 12-84; higher scores denote stronger alliance [51]), (3) treatment satisfaction with the Client Satisfaction Questionnaire (range 0-32; higher scores reflect greater satisfaction [52]), and (4) negative effects with the Negative Effects Questionnaire-20 (NEQ-20; [53]).”
Self-citation

Authors: Rozental, A., Kottorp, A., Forsström, D., Månsson, K., Boettcher, J., Andersson, G., Furmark, T., & Carlbring, P.
Affiliations: Karolinska Institutet (SE)
Malmö University (SE)
Stockholm University (SE)
Uppsala University (SE)
Freie Universität Berlin (DE)
Linköping University (SE)
Corresponding author: Rozental, Alexander
ORCID: Rozental, Alexander
Kottorp, Anders
Forsström, David
Månsson, Kristoffer
Boettcher, Johanna
Andersson, Gerhard
Furmark, Tomas
Carlbring, Per
Venue: Behavioural and Cognitive Psychotherapy
Publisher: Cambridge University Press (CUP)
Published: 2019-03-15
Volume: 47
Issue: 5
Pages: 559-572
ISSN: 1352-4658 (ISSN-L)
1469-1833
DOI: 10.1017/s1352465819000018
OpenAlex: W2922529521
Cited by: 230
References: 46
Citations by year: 2026: 47 · 2025: 47 · 2024: 47 · 2023: 32 · 2022: 30 · 2021: 15 · 2020: 7 · 2019: 4
FWCI: 10.19
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: Behavioural and Cognitive Psychotherapy (publishedVersion, cc-by)
PubMed (publishedVersion)
Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
Malmö University Publications (Malmö University) (submittedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
Funders: University of Illinois at Urbana-Champaign
University of Illinois at Chicago
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Keywords: adverse effects, psychometric properties, Rasch analysis, differential item functioning, item response theory, short-form scale, treatment outcome monitoring, mental illness
MeSH terms: Negative Results, Adult, Mental Disorders, Female, Humans, Male, Psychology, Psychometrics, Surveys and Questionnaires, Reproducibility of Results, Treatment Failure

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The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments

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