It can’t hurt, right? Adverse effects of psychotherapy in patients with depression

  • Steffen MoritzEmail author
  • Yvonne Nestoriuc
  • Winfried Rief
  • Jan Philipp Klein
  • Lena Jelinek
  • Judith Peth
Original Paper


Despite growing awareness of occasional adverse effects of psychological treatments, only a few instruments cover side effects and other unwanted effects of psychotherapy. For the present study, the Positive and Negative Effects of Psychotherapy Scale (PANEPS) was evaluated in a population of individuals with depression who had completed at least one course of face-to-face psychotherapy. A total of 135 individuals with a current or previous depressive episode as verified by a diagnostic interview filled out the online version of the PANEPS, which is designed to capture both positive and adverse events. Factor analysis yielded four dimensions: positive effects, side effects, malpractice, and unethical conduct. Internal consistency of the individual subscales was satisfactory to excellent (Cronbach’s α: 0.72 and 0.92). Positive effects were reported by virtually all patients (95.6%). At the same time, approximately half of the sample noted at least one adverse event (52.6%). Among these, side effects (38.5%) and malpractice (26.7%) were significantly more prevalent than unethical conduct (8.1%). As expected, positive effects were negatively correlated with adverse events. Our results challenge the common clinical assumption that some degree of destabilization is necessary for symptom improvement. The survey was conducted anonymously, and the sample underwent diagnostic verification. The results indicate a need for improved treatment guidelines and mechanisms to monitor treatment.


Side effects Adverse events Psychotherapy Depression Malpractice unethical conduct 


Compliance with ethical standards

Conflict of Interest



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of Clinical Psychology and PsychotherapyPhilipps-University of MarburgMarburgGermany
  4. 4.Department of Psychiatry and PsychotherapyLübeck UniversityLübeckGermany

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