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Negative Effects of Internet Interventions: A Qualitative Content Analysis of Patients' Experiences with Treatments Delivered Online
Open accessAbstract
Internet interventions are defined as the delivery of health care-related treatments via an online or a smartphone interface, and have been shown to be a viable alternative to face-to-face treatments. However, not all patients benefit from such treatments, and it is possible that some may experience negative effects. Investigations of face-to-face treatments indicate that deterioration occurs in 5-10% of all patients. The nature and scope of other negative effects of Internet interventions is, however, largely unknown. Hence, the current study explored patients' reported negative experiences while undergoing treatments delivered via the Internet. Data from four large clinical trials (total N = 558) revealed that 9.3% of patients reported some type of negative effects. Qualitative content analysis was used to explore the patients' responses to open-ended questions regarding their negative experiences. Results yielded two broad categories and four subcategories of negative effects: patient-related negative effects (insight and symptom) and treatment-related negative effects (implementation and format). Results emphasize the importance of always considering negative effects in Internet-based interventions, and point to several ways of preventing such experiences, including regular assessment of negative events, increasing the flexibility of treatment schedules and therapist contact, as well as prolonging the treatment duration.
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“Rozental et al. (2015) in a review from four clinical trials with a total sample of 558 participants identified that 9.3% of the participants indicated a negative effect.”
From A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial (2021) · cites this paper as Rozental et al. (2015)
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“Besides positive effects (eg, decrease of symptom severity), IMIs can also have negative side effects (eg, time pressure).118”
In the citing paper
“Rozental and colleagues shows that ICBT has the same rates of deterioration as other treatments, normally 5-10% of patients (Rozental et al., 2015)”
From Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial (2017) · cites this paper as Rozental et al., 2015
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Cited by
Sorted by citations
Internet-Delivered Psychological Treatments
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Self-citationErbe, D., Eichert, H.-C., Riper, H., & Ebert, D. D. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6588 · Cited by 532
“Also, negative effects such as frustration due to failure or time pressure might be associated with the Internet treatment format [10-13].”
Ebert, D. D., Van Daele, T., Nordgreen, T., Karekla, M., Compare, A., Zarbo, C., Brugnera, A., Øverland, S., Trebbi, G., Jensen, K. L., et al. (2018) · European Psychologist · doi:10.1027/1016-9040/a000318 · Cited by 437
Internet interventions: Past, present and future
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Self-citationRozental, A., Kottorp, A., Forsström, D., Månsson, K., Boettcher, J., Andersson, G., Furmark, T., & Carlbring, P. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000018 · Cited by 230
“…statement among researchers (Rozental et al., 2014), a qualitative analysis of the responses to open-ended questions among patients in treatment (Rozental et al., 2015), and a literature review, items for the Negative Effects Questionnaire (NEQ) were generated and investigated using an…”
MethodSelf-citationOvercoming procrastination? A meta-analysis of intervention studies
van Eerde, W., & Klingsieck, K. B. (2018) · Educational Research Review · doi:10.1016/j.edurev.2018.09.002 · Cited by 257
Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2016) · PLOS ONE · doi:10.1371/journal.pone.0157503 · Cited by 223
“Items were generated by consulting a number or researchers [32], distributing open-ended questions [42], analyzing patient responses using qualitative method [44], and a comprehensive literature review.”
MethodSelf-citationForsell, E., Bendix, M., Holländare, F., Szymanska von Schultz, B., Nasiell, J., Blomdahl-Wetterholm, M., Eriksson, C., Kvarned, S., Lindau van der Linden, J., Söderberg, E., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.06.013 · Cited by 175
“Rozental and colleagues shows that ICBT has the same rates of deterioration as other treatments, normally 5–10% of patients (Rozental et al., 2015), meaning that this treatment is at least as, if not more, safe as other non-pharmacological options.”
BackgroundRamsey, W. A., Heidelberg, R. E., Gilbert, A. M., Heneghan, M. B., Badawy, S. M., & Alberts, N. M. (2019) · Psycho-Oncology · doi:10.1002/pon.5280 · Cited by 173
Hermes, E. D., Lyon, A. R., Schueller, S. M., & Glass, J. E. (2019) · Journal of Medical Internet Research · doi:10.2196/11752 · Cited by 149
“For instance, there may be sunk or opportunity costs of time for consumers who initially engage in a BIT and have difficulty, subsequently dropping out [68].”
Ebert, D. D., Donkin, L., Andersson, G., Andrews, G., Berger, T., Carlbring, P., Rozenthal, A., Choi, I., Laferton, J. A. C., Johansson, R., et al. (2016) · Psychological Medicine · doi:10.1017/s0033291716001562 · Cited by 154
“Despite the fact that the topic of potential negative effects of both Internet-based treatments (Kiluk et al. 2011; Boettcher et al. 2014; Rozental et al. 2014, 2015; Bengtsson et al. 2015) and face-to-face psychotherapy (Lilienfeld, 2007; Barlow, 2010; Dimidjian & Hollon, 2010; Linden, 2013;…”
BackgroundSelf-citationWallin, E. E. K., Mattsson, S., & Olsson, E. M. G. (2016) · JMIR Mental Health · doi:10.2196/mental.5324 · Cited by 136
“Concerns about negative side effects and safety have also been reported among individuals that have completed Internet-based interventions [31].”
BackgroundBarriers to older adults’ uptake of mobile-based mental health interventions
Pywell, J., Vijaykumar, S., Dodd, A., & Coventry, L. (2020) · Digital Health · doi:10.1177/2055207620905422 · Cited by 156
“Notably, Rozental et al.(45) found that difficulty interacting with the intervention’s interface and other technical problems can elicit negative psychological effects.”
BackgroundRozental, A., Magnusson, K., Boettcher, J., Andersson, G., & Carlbring, P. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000158 · Cited by 137
“Rozental et al. (2015), in a qualitative content analysis of patients’ responses to open-ended questions distributed at posttreatment regarding negative effects in ICBT, found that certain patients experienced deterioration and novel symptoms in the beginning of the treatment period, related to…”
BackgroundSelf-citationRozental, A., Castonguay, L., Dimidjian, S., Lambert, M., Shafran, R., Andersson, G., & Carlbring, P. (2018) · BJPsych Open · doi:10.1192/bjo.2018.42 · Cited by 124
“18 Furthermore, several instruments for assessing potentially harmful events during treatment have recently been proposed, such as, the Negative Effects Questionnaire, 10 which could be useful for determining the relationship between adverse and unwanted events and treatment outcome.”
Self-citationVan Daele, T., Karekla, M., Kassianos, A. P., Compare, A., Haddouk, L., Salgado, J., Ebert, D. D., Trebbi, G., Bernaerts, S., Van Assche, E., et al. (2020) · Journal of Psychotherapy Integration · doi:10.1037/int0000218 · Cited by 122
Koh, W. Q., Felding, S. A., Budak, K. B., Toomey, E. C., & Casey, D. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02277-9 · Cited by 128
“[96], which found that such technical problems evoked negative psychological effect among users.”
BackgroundSchuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A.-R. (2018) · Journal of Medical Internet Research · doi:10.2196/11007 · Cited by 121
“Finally, the increased salience of potential risks of Web-based interventions is currently not supported by evidence [45-47].”
BackgroundAlfonsson, S., Olsson, E., & Hursti, T. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5352 · Cited by 118
“…of negative effects in online psychotherapy, some participants reported feeling pressured by their online therapist or the demands of the treatment schedule [51], but in this study, external motivation was measured at baseline and corresponded to the reasons why participants took part in the study.”
Domhardt, M., Steubl, L., Boettcher, J., Buntrock, C., Karyotaki, E., Ebert, D. D., Cuijpers, P., & Baumeister, H. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101953 · Cited by 106
“While crucial evidence on the potential negative effects (Rozental, Boettcher, Andersson, Schmidt, & Carlbring, 2015) and deterioration rates in IMIs for depression are available else-where (Ebert et al., 2016; Karyotaki et al., 2018) – indicating no substantial differences between IMIs and…”
BackgroundSelf-citationAn Internet-Based Intervention for Chronic Pain
Lin, J., Paganini, S., Sander, L., Lüking, M., Ebert, D. D., Buhrman, M., Andersson, G., & Baumeister, H. (2017) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2017.0681 · Cited by 110
Self-citationInternet interventions for depression: new developments
Schröder, J., Berger, T., Westermann, S., Klein, J. P., & Moritz, S. (2016) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2016.18.2/jschroeder · Cited by 105
Taylor, H., Strauss, C., & Cavanagh, K. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102078 · Cited by 102
Experiences of non-adherence to Internet-delivered cognitive behavior therapy: a qualitative study
Johansson, O., Michel, T., Andersson, G., & Paxling, B. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.02.006 · Cited by 99
Self-citationDeterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis
Fernández-Álvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P. L., Baños, R. M., Benbow, A. A., Bouchard, S., Bretón-López, J. M., et al. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.06.005 · Cited by 79
Self-citationKladnitski, N., Smith, J., Uppal, S., James, M. A., Allen, A. R., Andrews, G., & Newby, J. M. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100310 · Cited by 77
Ebert, D. D., Harrer, M., Apolinário-Hagen, J., & Baumeister, H. (2019) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9721-0_29 · Cited by 76
Rozental, A., Andersson, G., & Carlbring, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00589 · Cited by 74
Murray, G., Leitan, N., Berk, M., Thomas, N., Michalak, E. E., Berk, L., Johnson, S. L., Jones, S. H., Perich, T., Allen, N. B., et al. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.02.024 · Cited by 71
Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms
Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., Hadjistavropoulos, H., & Tillfors, M. (2016) · Internet Interventions · doi:10.1016/j.invent.2015.11.002 · Cited by 65
“Some of the therapists' spontaneous responses may be useful in therapy (Rozental et al., 2015), however, so not seeing the therapist can also at times be a disadvantage.”
BackgroundSelf-citationHolst, A., Nejati, S., Björkelund, C., Eriksson, M. C. M., Hange, D., Kivi, M., Wikberg, C., & Petersson, E. (2017) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2017.1288813 · Cited by 74
“ARTICLE HISTORY Received 4 August 2015 Accepted 11 November 2016 KEYWORDS Depression; primary care; Internet based treatment; iCBT; qualitative research; focus groups; general practice; Sweden”
BackgroundLindegaard, T., Seaton, F., Halaj, A., Berg, M., Kashoush, F., Barchini, R., Ludvigsson, M., Sarkohi, A., & Andersson, G. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2020.1771414 · Cited by 62
Self-citationFernández-Álvarez, J., Díaz-García, A., González-Robles, A., Baños, R., García-Palacios, A., & Botella, C. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.09.001 · Cited by 60
“Nevertheless, little research has been carried out on the negative effects of Internet interventions (Rozental et al., 2015).”
BackgroundImpact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy
Baumeister, H., Terhorst, Y., Grässle, C., Freudenstein, M., Nübling, R., & Ebert, D. D. (2020) · PLoS ONE · doi:10.1371/journal.pone.0236995 · Cited by 53
“On the other hand, IMIs require more self-regulation, self-reflection and selfmanagement competencies, which might lead to time pressure or frustration [19] and might come along with communication problems given the lack of visual cues in the therapeutic process [20].”
BackgroundWeisel, K. K., Zarski, A.-C., Berger, T., Krieger, T., Schaub, M. P., Moser, C. T., Berking, M., Dey, M., Botella, C., Baños, R., et al. (2019) · Internet Interventions · doi:10.1016/j.invent.2018.04.002 · Cited by 57
Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression
Lutz, W., Arndt, A., Rubel, J. A., Berger, T., Schröder, J., Späth, C., Meyer, B., Greiner, W., Gräfe, V., Hautzinger, M., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7367 · Cited by 58
“This could increase adherence by addressing a possibly important concern of some participants who may otherwise feel like the intervention is not adequately targeting their problems [52].”
BackgroundTherapists' Experiences of Conducting Cognitive Behavioural Therapy Online vis-à-vis Face-to-Face
Bengtsson, J., Nordin, S., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1053408 · Cited by 48
“Sucala et al. (2012) and Cook and Doyle (2002) found evidence that the more the modalities of communication used (for example, mail, chat or video chat), the stronger the working alliance being perceived by the client.”
BackgroundSelf-citationUrech, A., Krieger, T., Möseneder, L., Biaggi, A., Vincent, A., Poppe, C., Meyer, B., Riper, H., & Berger, T. (2019) · Psychotherapy Research · doi:10.1080/10503307.2018.1430910 · Cited by 43
Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus
Beukes, E. W., Allen, P. M., Baguley, D., Manchaiah, V. K. C., & Andersson, G. (2018) · American Journal of Audiology · doi:10.1044/2018_aja-imia3-18-0004 · Cited by 46
Self-citationSander, L., Paganini, S., Lin, J., Schlicker, S., Ebert, D. D., Buntrock, C., & Baumeister, H. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1193-6 · Cited by 47
“For this reason, we followed the key recommendations of Rozental and colleagues [98].”
MethodWallin, E., Norlund, F., Olsson, E. M. G., Burell, G., Held, C., & Carlsson, T. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9690 · Cited by 36
“The observed low treatment activity and described negative experiences related to design and usability call attention to what has been described as a risk of distress and frustration when faced with technological difficulties [40].”
BackgroundSchaub, M. P., Blankers, M., Lehr, D., Boß, L., Riper, H. M., Dekker, J., Goudriaan, A. E., Maier, L. J., Haug, S., Amann, M., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011457 · Cited by 46
Lindegaard, T., Kashoush, F., Holm, S., Halaj, A., Berg, M., & Andersson, G. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03297-w · Cited by 47
“[37] related to implementation of tasks assigned during treatment where some patients reported feeling like failures after unsuccessful implementation attempts and questioned whether they would ever recover from their condition or benefit from the treatment.”
BackgroundSelf-citationBlended CBT versus face-to-face CBT: a randomised non-inferiority trial
Mathiasen, K., Andersen, T. E., Riper, H. M., Kleiboer, A. M., & Roessler, K. K. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1140-y · Cited by 40
Kraepelien, M., Schibbye, R., Månsson, K., Sundström, C., Riggare, S., Andersson, G., Lindefors, N., Svenningsson, P., & Kaldo, V. (2020) · Journal of Parkinson's Disease · doi:10.3233/jpd-191894 · Cited by 41
“However, feeling frustrated or stressed when trying to follow through with an ICBT program is common also in other patient groups [39].”
BackgroundSelf-citationRozental, A., Forsström, D., Tangen, J. A., & Carlbring, P. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.05.001 · Cited by 39
Self-citationHadjistavropoulos, H. D., Faller, Y. N., Klatt, A., Nugent, M. N., Dear, B. F., & Titov, N. (2018) · Community Mental Health Journal · doi:10.1007/s10597-018-0286-0 · Cited by 37
“There were also some suggestions for patients to be able to adjust their treatment timelines to meet their learning needs, which is in line with past research (Richards et al. 2016; Rozental et al. 2015).”
BackgroundResultKüchler, A.-M., Albus, P., Ebert, D., & Baumeister, H. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100245 · Cited by 34
History and current status of ICBT
Andersson, G., Carlbring, P., & Lindefors, N. (2016) · Guided Internet-Based Treatments in Psychiatry · doi:10.1007/978-3-319-06083-5_1 · Cited by 36
Self-citationThew, G. R. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000033 · Cited by 36
“…online programmes may have potential negative effects, such as distress due to realizing the extent of a problem or being unable to complete a therapy task, or an overall worsening of symptoms that should be carefully monitored and reported (Rozental et al ., 2014; Rozental et al ., 2015).”
Mathiasen, K., Andersen, T. E., Lichtenstein, M. B., Ehlers, L. H., Riper, H., Kleiboer, A., & Roessler, K. K. (2022) · Journal of Medical Internet Research · doi:10.2196/36577 · Cited by 34
Jonsson, U., Johanson, J., Nilsson, E., & Lindblad, F. (2015) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104515614072 · Cited by 35
Nilsson, A., Magnusson, K., Carlbring, P., Andersson, G., & Hellner, C. (2020) · Addiction · doi:10.1111/add.14900 · Cited by 34
“One cited reason for deterioration in psychotherapy is that participants may be exposed to negative aspects of their lives, causing more negative emotions and thoughts which, in turn, could exacerbate their problems.[80] Involving CSOs in PG treatment could possibly intensify this process.”
Self-citationKladnitski, N., Smith, J., Allen, A., Andrews, G., & Newby, J. M. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.06.003 · Cited by 37
“Further research is needed to understand whether online mindfulness-based interventions are associated with side-effects or adverse events (Rozental et al., 2015), or whether there are any contraindications for self-guided mindfulness practice over the internet (Dobkin et al.”
BackgroundBerg, M., Malmquist, A., Rozental, A., Topooco, N., & Andersson, G. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02833-4 · Cited by 34
Self-citationAlyami, A., Alswat, M. M., Omer, I., Ahmed, M., Alshammari, S. H., Alsaggaf, K., Amoudi, J. H., & Aljafari, D. (2020) · Saudi Medical Journal · doi:10.15537/smj.2020.5.25061 · Cited by 31
Dirkse, D., Hadjistavropoulos, H. D., Alberts, N. A., Karin, E., Schneider, L. H., Titov, N., & Dear, B. F. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00810-9 · Cited by 29
Negative effects in internet-based interventions for depression: a qualitative content analysis
Fenski, F., Rozental, A., Heinrich, M., Knaevelsrud, C., Zagorscak, P., & Boettcher, J. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100469 · Cited by 28
Self-citationSimonsson, O., Engberg, H., Bjureberg, J., Ljótsson, B., Stensils, J., Sahlin, H., & Hellner, C. (2021) · JMIR Formative Research · doi:10.2196/17910 · Cited by 32
“Furthermore, difficulties in fulfilling assignments and adhering to treatment [57] and feeling worse on occasions [38] have been stated as possible negative effects of online treatment before.”
Backgroundvan de Leur, J. C., Buhrman, M., Åhs, F., Rozental, A., & Jansen, G. B. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02907-3 · Cited by 30
“Despite a marked increase in research of psychological interventions during the past two decades, the adverse effects from these treatments have been widely neglected, and the need for more rigorous exploration is frequently advocated [39, 40].”
BackgroundSelf-citationDülsen, P., & Baumeister, H. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02404-y · Cited by 32
“Lately these efforts of establishing common ways have also been put forward for IMIs [ 22 , 23].”
Schaub, M. P., Tiburcio, M., Martínez-Vélez, N., Ambekar, A., Bhad, R., Wenger, A., Baumgartner, C., Padruchny, D., Osipchik, S., Poznyak, V., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/21686 · Cited by 27
“At the 6-month follow-up, participants were asked to grade any negative effects they had experienced, as per the report by Rozental et al [19], and if they had received any external help.”
Contextualizing the negative effects of psychotherapy
Rosendahl, J., Klatte, R., Frenzl, D., Castonguay, L. G., Vybíral, Z., & Strauss, B. M. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00472-8 · Cited by 33
“In addition to the findings on the negative effects of face-to-face psychotherapy, there is robust evidence of the negative effects of Internet-based psychotherapy stemming from individual patient data meta-analyses 116–118 and qualitative content analyses 119,120 .”
Schaub, M. P., Tiburcio, M., Martinez, N., Ambekar, A., Balhara, Y. P. S., Wenger, A., Monezi Andrade, A. L., Padruchny, D., Osipchik, S., Gehring, E., et al. (2018) · Addiction · doi:10.1111/add.14034 · Cited by 25
Amanvermez, Y., Karyotaki, E., Cuijpers, P. J., Salemink, E., Spinhoven, P., Struijs, S. Y., & de Wit, L. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100369 · Cited by 29
“However, based on the findings of similar studies (Boettcher et al., 2014; Rozental et al., 2015), we anticipate minimal risk for the participants in this study.”
BackgroundGullickson, K. M., Hadjistavropoulos, H. D., Dear, B. F., & Titov, N. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100278 · Cited by 26
Baumgartner, C., Schaub, M. P., Wenger, A., Malischnig, D., Augsburger, M., Walter, M., Berger, T., Stark, L., Ebert, D. D., Keough, M. T., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/27463 · Cited by 27
“3 months follow-up Negative effects [44]”
MethodWeisel, K. K., Zarski, A., Berger, T., Krieger, T., Moser, C. T., Schaub, M. P., Görlich, D., Berking, M., & Ebert, D. D. (2020) · Journal of Medical Internet Research · doi:10.2196/16450 · Cited by 26
“The negative effects were similar to what has been found in previous work, such as the occurrence of symptom deterioration or the emergence of novel symptoms [56].”
ResultZhou, C., Ai, Y., Wang, S., Yuan, Y., Zhang, A., Hu, H. Z., & Wang, Y. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05645-3 · Cited by 25
Staccini, P., Fernández-Luque, L., & Informatics, S. E. F. T. I. Y. S. O. C. H. (2016) · Yearbook of Medical Informatics · doi:10.15265/iy-2016-045 · Cited by 23
Beahm, J. D., McCall, H. C., Carleton, R. N., Titov, N., Dear, B., & Hadjistavropoulos, H. D. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100481 · Cited by 23
“ICBT is convenient for users and shows treatment outcomes similar to face-to-face cognitive behavioural therapy, especially when combined with provider support (Andersson, 2016; Andersson et al., 2019; Karyotaki et al., 2021; Sijbrandij et al., 2016).”
BackgroundRozental, A., Kothari, R., Wade, T., Egan, S., Andersson, G., Carlbring, P., & Shafran, R. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000090 · Cited by 22
“Rozental et al. (2015a), for instance, found that among clients undergoing ICBT for procrastination, it was not uncommon to express a desire for a face-to-face contact.”
BackgroundSelf-citationCounseling Psychological Understanding and Considerations of the Metaverse: A Theoretical Review
Lee, K. (2023) · Healthcare · doi:10.3390/healthcare11182490 · Cited by 27
“Although the context of therapeutic interventions in the metaverse is different, in cyber-counseling over the Internet, 9.3% of the participants reported experiencing at least one adverse effect [64], especially because some of the symptoms worsened during treatment.”
BackgroundInfluentialSextl-Plötz, T., Steinhoff, M., Baumeister, H., Cuijpers, P. J., Ebert, D. D., & Zarski, A. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100760 · Cited by 26
“In particular, more research on predictors/moderators of symptom deterioration (Ebert et al., 2016; Kar-yotaki et al., 2018b) and other negative effects in IMIs (Rozental et al., 2015) is essential to provide precise intervention recommendations and enhance the safety of their application.”
Bodschwinna, D., Lorenz, I., Bauereiß, N., Gündel, H., Baumeister, H., & Hönig, K. (2022) · Psycho-Oncology · doi:10.1002/pon.5917 · Cited by 20
“This follows the CONSORT‐Guidelines17 as well as recommendations from Rozental and Colleagues.18 The present study aims to explore the feasibility and acceptance of the newly developed online intervention PartnerCARE.”
BackgroundMethodInfluentialApolinário-Hagen, J. (2018) · Psychiatry Investigation · doi:10.30773/pi.2018.06.26 · Cited by 21
Asplund, R. P., Jäderlind, A., Björk, I. H., Ljótsson, B., Carlbring, P., & Andersson, G. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100282 · Cited by 20
“However, participants have suggested more individualized interventions and express the importance of customizing both feedback and therapist support (Gerhards et al., 2011; Ly et al., 2015; O'Mahen et al., 2015; Rozental et al., 2015b; Svartvatten et al., 2015).”
BackgroundSelf-citationBlampied, M., Bell, C., Gilbert, C., & Rucklidge, J. J. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2020.1740595 · Cited by 23
Bőthe, B., Baumgartner, C., Schaub, M. P., Demetrovics, Z., & Orosz, G. (2020) · Journal of Behavioral Addictions · doi:10.1556/2006.2020.00037 · Cited by 24
Schlicker, S., Weisel, K. K., Buntrock, C., Berking, M., Nobis, S., Lehr, D., Baumeister, H., Snoek, F. J., Riper, H. M., & Ebert, D. D. (2019) · Journal of Diabetes Research · doi:10.1155/2019/2634094 · Cited by 20
“Such negative effects might include negative changes in relationships with friends and family and negative changes in effect due to the IMI itself [54, 55].”
BackgroundDominguez-Rodriguez, A., Martínez-Luna, S. C., Hernández Jiménez, M. J., De La Rosa-Gómez, A., Arenas-Landgrave, P., Esquivel Santoveña, E. E., Arzola-Sánchez, C., Alvarez Silva, J., Solis Nicolas, A. M., Colmenero Guadián, A. M., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.644782 · Cited by 18
Online ethics: where will the interface of mental health and the internet lead us?
Cosgrove, V. E., Gliddon, E., Berk, L., Grimm, D., Lauder, S., Dodd, S., Berk, M., & Suppes, T. M. (2017) · International Journal of Bipolar Disorders · doi:10.1186/s40345-017-0095-3 · Cited by 19
“3% of participants reported at least one potentially treatment-related adverse event (Rozental et al. 2015).”
BackgroundEkström, V., & Johansson, M. (2019) · Addiction Science & Clinical Practice · doi:10.1186/s13722-019-0173-1 · Cited by 20
Negative effects of psychotherapies: A systematic review
Paveltchuk, F. D. O., Mourão, S. E. D. Q. C., Keffer, S., da Costa, R. T., Nardi, A. E., & de Carvalho, M. R. (2021) · Counselling and Psychotherapy Research · doi:10.1002/capr.12423 · Cited by 20
Women’s experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth
Baylis, R., Ekdahl, J., Haines, H. M., & Rubertsson, C. (2019) · Women and Birth · doi:10.1016/j.wombi.2019.05.006 · Cited by 17
Amann, M., Haug, S., Wenger, A., Baumgartner, C., Ebert, D. D., Berger, T., Stark, L., Walter, M., & Schaub, M. P. (2018) · JMIR Research Protocols · doi:10.2196/resprot.9484 · Cited by 17
“Furthermore, the occurrence of any negative effects will be identified, as in Rozental et al, at the 3-month follow-up assessment [45].”
BackgroundPromises and risks of web-based interventions in the treatment of depression
Hegerl, U., & Oehler, C. (2020) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2020.22.2/uhegerl · Cited by 17
Behr, S., Garcia, L. M., Lucas, J., Kohlhase, E., Puetz, M., Boettcher, J., Schaeuffele, C., & Knaevelsrud, C. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100821 · Cited by 16
“They also require appropriate handling of stress and frustration that may arise from a tight treatment schedule or technical difficulties (Fenski et al., 2021; Rozental et al., 2015).”
Self-citationAmarnath, A., Ozmen, S., Struijs, S. Y., de Wit, L. M., & Cuijpers, P. J. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100612 · Cited by 18
Dandachi‐FitzGerald, B., Houben, S. T. L., Broers, N. J., & Merckelbach, H. L. G. J. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3014 · Cited by 17
Högdahl, L., Levallius, J., Björck, C., Norring, C. E. A., & Birgegård, A. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.07.002 · Cited by 15
Hayes, D., Fleming, I., & Wolpert, M. (2015) · Current Treatment Options in Pediatrics · doi:10.1007/s40746-015-0037-1 · Cited by 14
Baumgartner, C., Bilevicius, E., Khazaal, Y., Achab, S., Schaaf, S., Wenger, A., Haug, S., Keough, M. T., Hodgins, D. C., & Schaub, M. P. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-032110 · Cited by 16
Bielinski, L. L., & Berger, T. (2020) · Counseling Psychology and Psychotherapy · doi:10.17759/cpp.2020280305 · Cited by 17
Küchler, A.-M., Schultchen, D., Pollatos, O., Moshagen, M., Ebert, D. D., & Baumeister, H. (2020) · Trials · doi:10.1186/s13063-020-04868-0 · Cited by 12
Watson, P., Leroux, E. J., Chowdhury, M., Mehra, K., Henderson, J. L., Szatmári, P., & Hawke, L. D. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-022-02431-w · Cited by 12
“These include worsening or lack of improvement of symptoms, development of new symptoms, social difficulties such as increased family distress, stigma, and dependency on the therapist (Berk & Parker, 2009; Linden, 2013; Rozental et al., 2015; Schermuly-Haupt et al., 2018).”
BackgroundInfluentialIs psychotherapy for functional somatic syndromes harmful? A mixed methods study on negative effects
Holsting, A. F., Pedersen, H. F., Rask, M. T., Frostholm, L., & Schröder, A. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.05.010 · Cited by 13
A Low‐Intensity, High‐Frequency Intervention to Reduce Procrastination
Wessel, J., Bradley, G., & Hood, M. (2020) · Applied Psychology · doi:10.1111/apps.12293 · Cited by 12
“All rights reserved participant access, and time investment required of participants (Rozental et al., 2015; van Eerde & Klingsieck, 2018).”
BackgroundSayar, H., Vøllestad, J., & Nordgreen, T. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.990833 · Cited by 12
Internet-based self-help intervention for procrastination: randomized control group trial protocol
Ying, Z., & Wang, J. (2023) · Trials · doi:10.1186/s13063-023-07112-7 · Cited by 20
“Rozental A, Forsell E, Svensson A, Forsström D, Andersson G, Carlbring P. Differentiating procrastinators from each other: a cluster analysis.”
Influential
Metadata
- Authors
- Rozental, A., Boettcher, J., Andersson, G., Schmidt, B., & Carlbring, P.
- Affiliations
- Stockholm University (SE)
- Freie Universität Berlin (DE)
- Linköping University (SE)
- Florida State University (US)
- Corresponding author
- Rozental, Alexander
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2015-02-23
- Volume
- 44
- Issue
- 3
- Pages
- 223-236
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W2061701598
- Cited by
- 189
- References
- 64
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 15 · 2023: 19 · 2022: 13 · 2021: 23 · 2020: 23 · 2019: 16 · 2018: 20 · 2017: 11 · 2016: 12 · 2015: 8
- FWCI
- 27.55
- Type
- journal article
- Language
- en
- Open access
- green
- urn.kb.se
- Licence
- other-oa
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- PubMed (publishedVersion)
- DiVA (Stockholm University) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- online intervention, online therapy, adverse outcomes, patient experience, treatment deterioration, treatment implementation, treatment format, therapist contact, treatment duration, treatment scheduling
- MeSH terms
- Mental Disorders, Clinical Trials as Topic, Humans, Therapy, Computer-Assisted, Patient Satisfaction, Internet, Qualitative Research
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