Welche Risiken und Nebenwirkungen hat Psychotherapie? - Entwicklung des Inventars zur Erfassung Negativer Effekte von Psychotherapie (INEP)
Abstract
Hintergrund: Negative Effekte von Psychotherapie sind bis heute wenig systematisch untersucht. Diese Studie stellt die Konstruktion eines Selbstbeurteilungsverfahrens zur Erfassung negativer Effekte von Psychotherapie vor. Patienten und Methoden: Ein Itempool zur breiten Erfassung möglicher erlebter negativer Veränderungen durch Psychotherapie in den Bereichen intrapersonelle Veränderungen, Partnerschaft, Freunde und Familie, Arbeitsplatz, therapeutisches Fehlverhalten und Stigmatisierung wurde über Literaturrecherchen und Expertenbefragungen generiert. Items wurden bipolar formuliert, um ein negatives Priming zu verhindern. Zusätzlich wurde die jeweilige Attribution der Veränderung auf die Psychotherapie oder andere externe Ursachen erfragt. Im Zeitraum von November 2010 bis Februar 2011 nahmen 195 ehemalige Psychotherapiepatienten (74,9% weiblich; Alter M = 38,4 Jahre; SD = 11,8) an einer Onlineuntersuchung teil, bei der auch die Rahmenbedingungen der Psychotherapie erfragt wurden. Ergebnisse: Von 195 Befragten gaben 93,8% (n = 183) an, negative Effekte durch ihre Psychotherapie erlebt zu haben. Die höchsten Raten erlebter negativer Effekte ergaben sich in den Bereichen intrapersonelle Veränderungen (15,8%), Stigmatisierung (14,9%) und Partnerschaft (12,0%). Schwerwiegendes therapeutisches Fehlverhalten wie sexuelle Belästigung (2,6%) oder körperliche Gewalt (1%) durch den Therapeuten hatten eine geringe Prävalenz. Anhand von Itemanalysen sowie inhaltlichen Kriterien wurde das Inventar zur Erfassung negativer Effekte von Psychotherapie (INEP) mit 21 Items erstellt (α = 0,86). Diskussion: Ein Großteil der negativen Veränderungen trat innerhalb des therapeutischen Settings auf (z.B. verletzende Aussagen des Therapeuten, Phasen der Niedergeschlagenheit). Zudem wurden mehr negative Effekte genannt, wenn die therapeutische Beziehung als negativ beschrieben wurde. Schlussfolgerung: Negative Effekte von Psychotherapien sind feststellbar und können mittels Patientenbefragungen und einer systematischen Analyse, via INEP erfasst werden. Die Analyse des Instruments in weiteren klinischen Subpopulationen ist notwendig.
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This result fits literature that shows that psychological interventions, online and offline, can initially evoke negative effects and symptom deteriorations.
“On the one hand, this result fits literature that shows, that psychological interventions, online and offline, can initially evoke negative effects and symptom deteriorations (Ladwig et al., 2014; Rozental et al., 2016).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Ladwig et al., 2014
The Abstract reports negative effects during or after psychotherapy, and the 'Negative Effekte von Psychotherapie' section reports symptom deterioration in prior psychotherapy studies. The paper describes an online survey of former patients, not online-delivered interventions, and does not establish that deterioration occurs specifically at the start of treatment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe INEP showed good internal consistency (α=.86) and a seven-factor structure explaining 56% of variance in a prior sample.
“The INEP showed good internal consistency (α=.86) and a sevenfactor structure which explained 56% of variance.”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Ladwig et al., 2014
The INEP-development section reports a seven-factor solution explaining 55.8% of variance, but that analysis used the initial 52 items. The same section reports Cronbach’s α = .86 for the 21 items selected for the final INEP. The figures match the claim, but they describe different item sets rather than both being results for the final instrument. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe INEP has good psychometric properties.
“The INEP, which was developed and validated in German and has good psychometric properties [174],”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [174]
Negative effects of the EMPATIA program will be assessed by the INEP every 2 weeks during program participation.
“Nevertheless, negative effects of the EMPATIA program will be assessed by the INEP [174] every 2 weeks during program participation.”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [174]
The 21-item INEP has good internal consistency (α = 0.86).
“The 21-item inventory has a good internal consistency of α = 0.86 (Ladwig et al., 2014).”
The INEP records whether negative changes experienced during or after treatment in the social and/or work environment are attributed to the psychotherapeutic intervention.
“The INEP records whether any negative changes, which are experienced during or after the treatment in the social and/or work environment, are attributed on the psychotherapeutic intervention.99”
The original INEP scale has high internal consistency (α = 0.86).
“The original scale has demonstrated high internal consistency with a Cronbach’s α of 0.86 [78].”
The original INEP-On scale shows high internal consistency of α = .85.
“The original scale shows a high internal consistency of α = .85 [87].”
From Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial (2020) · cites this paper as [87]
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References 12 · Cited by 227
Research works printed but not linked: 2
- [4]4. Haupt M, Linden M: Nebenwirkungen und Neben- wirkungserfassung in der Psychotherapie -Das ECRS-ATR-Schema. Psychoth Soz 2011;13:9-27.
- [6]6. Lambert MJ, Ogles BM: The efficacy and effective- ness of psychotherapy; in Lambert MJ (ed): Bergin and Garfield's Handbook of Psychotherapy and Behavior Change, ed 5. New York, Wiley and Sons, 2004, pp 139-193.
- Authors
- Ladwig, I., Rief, W., & Nestoriuc, Y.
- Affiliations
- Philipps University of Marburg (DE)
- Universität Hamburg (DE)
- Venue
- Verhaltenstherapie
- Publisher
- S. Karger AG
- Published
- 2014
- Volume
- 24
- Issue
- 4
- Pages
- 252-263
- ISSN
- 1016-6262 (ISSN-L)
- 1423-0402
- OpenAlex
- W1720041517
- Cited by
- 227
- References
- 12
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 24 · 2023: 23 · 2022: 22 · 2021: 26 · 2020: 24 · 2019: 19 · 2018: 23 · 2017: 14 · 2016: 8 · 2015: 7 · 2014: 2 · 2013: 1
- FWCI
- 12.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Verhaltenstherapie (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- self-report instrument development, stigmatization, treatment failure, psychotherapy supervision
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