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"Studying the Shadows of Psychology"-on reporting of adverse effects associated w/ psychological tx

Tom Kindlon

Senior Member
Messages
1,734
Studying the Shadows of Psychology
Psychological treatment is often perceived as harmless. But despite examples of unexpected negative effects, research on psychological methods seldom mentions adverse effects. An American article presents reason for concern, writes psychologist Ulf Jonsson, Research Associate at SBU.

continues at:

http://www.sbu.se/upload/VoP/engelsk/Eng_VoP_2013.pdf


This is two pages long (excluding a page of images). It is not that heavy e.g. no numbers. It touches on some of the issues I brought up in my paper:


Bulletin of the IACFS/ME. Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. 2011;19(2):59-111
http://iacfsme.org/BULLETINFALL2011/Fall2011KindlonHarmsPaperABSTRACT/tabid/501/Default.aspx

Unfortunately the article then finishes by looking at one trial in particular, the PACE Trial, and making it out it clearly found CBT and GET were not more risky.

I discussed the PACE Trial in particular in Section 6 of my paper, "PACE Trial – A model of excellence in harms reporting?"
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
How irritating. If writing an essay specifically on potential deterioration after psychological treatments, then at least present the facts correctly when presenting an example of 'good' practise!

"But the results of the randomised trial indicated that none of the three complementary treatments increased the risk for deterioration or serious negative reactions."

Perhaps I can agree that results for 'serious negative reactions' were published (although I seem to remember there being questions raised about the quality of these results), but the deterioration rates (as an equivalent measure to the improvement rates) have not been published. So the evidence is not available to say that the treatments did not increase the risk for 'deterioration'.
 
Messages
15,786
Perhaps I can agree that results for 'serious negative reactions' were published (although I seem to remember there being questions raised about the quality of these results), but the deterioration rates (as an equivalent measure to the improvement rates) have not been published. So the evidence is not available to say that the treatments did not increase the risk for 'deterioration'.
They divided the adverse events into serious and non-serious. Serious meant being hospitalized, dying, etc, and essentially everything else was "non-serious". Hence someone could have a major PEM episode and be completely disabled for weeks, yet it would be categorized right alongside with feeling a bit achy after exercise.
 

Tom Kindlon

Senior Member
Messages
1,734
Much of the SBU publication looks interesting. I am reading more than just the shadows section.
Thanks. I thought the first three sections were interesting enough and could be useful for people who want to learn about evidence-based therapies and how this reviews can be undertaken. The other articles were condition specific and I found them less interesting.
 

Tom Kindlon

Senior Member
Messages
1,734
Here's a somewhat related piece from the Swedish media this week:

Original in Swedish: http://www.svt.se/nyheter/sverige/okanda-risker-med-terapi

http://www.microsofttranslator.com/...t.se/nyheter/sverige/okanda-risker-med-terapi


Beyond the risks of therapy
28 January


Despite the fact that every fourth Swede ever received therapy is very little known about the risks associated with this type of treatment. It shows a new compilation.



Although psychotherapy is generally an effective treatment, so there are also several examples of that certain forms of therapy can do more harm than good for patients.

One of the scientifically most contested treatments, the therapy that tries to bring out repressed memories in a patient and who should have gotten Sture Bergwall, or Thomas Quick as he was then called, to admit nearly 40 murders before he took back everything. According to Christian Rück, Associate Professor of Psychiatry at the Karolinska Institutet, the whole case Thomas Quick is seen as a side effect of psychotherapy, although this is an extreme example.

— Psychotherapy usually has mild and quite expected side effects, which the patient can get an increase in anxiety during the time the treatment is going on. But there is also the odd forms of therapy, as if to bring out repressed memories of the patient where things can come up that are false memories; abuse, murder and so on, as in the case of Thomas Quick. And it could have devastating consequences for the patient himself and for other people who are involved, "he said.

Case Qiuck discussed

Christian Rück is also the initiator of a scientific conference on the case of Thomas Quick, which begins tomorrow. There are risks of psychotherapy and the knowledge gaps are discussed.

According to a Sifo survey from 2011, more than every fourth Swede ever received help from a psychologist or therapist. Although therapy is such a common form of treatment is very little known about the risks of research treatment can mean for some patients.

The scientific studies over the years have shown that psychotherapy is a very effective tool in the fight against mental illness has been too focused on identifying the positive effects of the treatment, not the negative. A procedure which according to Ulf Jonsson, psychologist and project manager at the State's preparation for medical evaluation, SBU, would have been unthinkable in studies of such drugs or other medical treatments.

Large gaps in knowledge

In a summary that SVT received have SBU reviewed more than 100 studies on the effect of psychological therapies for patients suffering from various forms of mental illness. Only a few, four studies, was judged to have adequate information about the potential risks of the treatment.

– There are large gaps to fill, says Ulf Jonsson at SBU, who hope that the compilation should be able to help researchers in psychology is beginning to study the effects of the back pages.

According to one of the few critical scientific compilations made, (http://pps.sagepub.com/content/2/1/53.abstract) by the American psychology professor Scott Lilienfeld, there are a lot of therapies that, overall, does more harm than good for the patients.

Examples include so-called debriefing calls in a group with people who have been exposed to traumatic and stressful experiences shortly after the incident occurred, or grief therapy for people who have lost a loved one.

Even so-called "scared straight" program that became popular in the United States in the late 1970s, where rowdy young people may visit prisons and meet criminal is considered counterproductive, as well as attempts to "tease" alter egos in people who suffer from multiple personality disorder in order to reach a positive treatment outcomes.

Återgestaltningsterapi critiqued

The Sture Bergwall method according to multiple sources should have been treated with, so called återgestaltningsterapi that aims to recover repressed memories, is also criticized hard by Lilienfeld. There is a great risk that false memories can be planted among the patients. In addition to this type of therapy caused thousands, maybe tens of thousands of unconfirmed allegations of abuse against their relatives in the United States, also figures to suggest that both the number of suicides and psychiatric compulsory care increased dramatically among the patients who underwent this type of treatment.

Christian Rück, Associate Professor of Psychiatry at the Karolinska Institutet, think that psychotherapy research, not least in Sweden, has become increasingly better over recent years to also examine whether the treatment can cause adverse effects, but that much more could be done. He also believes that the control of the therapies offered in Sweden and who must get better.

Today, anyone can call themselves a therapist. It's like going to a massage therapist or whatever. There is no control. And it means that people can get hurt, "says Christian Rück.

•Therese Bergstedt therese.bergstedt@svt.se

Published:28 January 2014-19: 24

Updated:28 January 2014-19: 46