Patient experience of negative effects of psychological treatment: results of a national survey
Open accessAbstract
Background: To make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions. Aims: To determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders. Method: Cross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received. Results: Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22–1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54–0.79). Conclusions: One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts.
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Psychological and behavioural therapies may on occasion confer deterioration and harm.
“While assumed to be exclusively beneficial, psychological, and behavioural therapies may on occasion confer deterioration and harm [104,105,106].”
Crawford et al. (2016) found that in a survey of over 14,000 UK NHS psychological therapy patients, just over 5% reported lasting bad effects of treatment.
“whilst Crawford et al. (2016) found that in a survey of over 14,000 UK NHS psychological therapy patients, just over 5% reported lasting bad effects of treatment.”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Crawford et al. (2016)
In psychotherapy, between 3 and 10% of clients get worse.
“studies consistently show that between 3 and 10% of psychotherapy clients get worse (Crawford et al. 2016; Hansen et al. 2002; Lambert 2013; Mohr 1995; Strupp et al. 1977).”
From Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples (2021) · cites this paper as Crawford et al. 2016
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- Authors
- Crawford, M. J., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., Clarke, J., & Parry, G. D.
- Affiliations
- Imperial College London (GB)
- Centre for Mental Health (GB)
- Royal Holloway University of London (GB)
- Corresponding author
- Crawford, Mike J.
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-03
- Volume
- 208
- Issue
- 3
- Pages
- 260-265
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2291190402
- Semantic Scholar
- 6f3337294312bf51796eb05860b5746209d6a4b9
- Cited by
- 225
- References
- 15
- Citations by year
- 2026: 5 · 2025: 23 · 2024: 19 · 2023: 27 · 2022: 26 · 2021: 29 · 2020: 27 · 2019: 22 · 2018: 18 · 2017: 18 · 2016: 11
- FWCI
- 30.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- adverse effects, patient experience, common mental disorders, psychotherapy, prevalence, risk factors, older adults, informed consent, patient information
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Cross-Sectional Studies, England, Female, Humans, Male, Middle Aged, Minority Groups, Psychotherapy, Risk Factors, Wales, Multivariate Analysis, Logistic Models, Outcome Assessment, Health Care, Young Adult, Self Report
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