Cognitive Therapy and Research

, Volume 42, Issue 3, pp 219–229 | Cite as

Unwanted Events and Side Effects in Cognitive Behavior Therapy

  • Marie-Luise Schermuly-Haupt
  • Michael LindenEmail author
  • A. John Rush
Original Article


Side effects (SEs) are negative reactions to an appropriately delivered treatment, which must be discriminated from unwanted events (UEs) or consequences of inadequate treatment. One hundred CBT therapists were interviewed for UEs and SEs in one of their current outpatients. Therapists reported 372 UEs in 98 patients and SEs in 43 patients. Most frequent were "negative wellbeing/distress" (27% of patients), "worsening of symptoms" (9%), "strains in family relations" (6%); 21% of patients suffered from severe or very severe and 5% from persistent SEs. SEs are unavoidable and frequent also in well-delivered CBT. They include both symptoms and the impairment of social life. Knowledge about the side effect profile can improve early recognition of SEs, safeguard patients, and enhance therapy outcome.


Psychotherapy Unwanted events Side effects Adverse treatment reactions Quality assurance Cognitive behavior therapy Deterioration 



The authors thank the Institute for Behavior Therapy Berlin, the Centre for Psychotherapy at the Humboldt-University Berlin and the Institute for Behavior Therapy Brandenburg for participating in the study. We would also like to acknowledge the editorial assistance of Jon Kilner, MS, MA (Pittsburgh, PA).

Compliance with Ethical Standards

Conflict of Interest

Marie-Luise Schermuly-Haupt, Michael Linden and A. John Rush declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Research Group Psychosomatic Rehabilitation at the Charité University Medicine BerlinBerlinGermany
  2. 2.Institute for Behavior Therapy BerlinBerlinGermany
  3. 3.Duke-National University of SingaporeSingaporeSingapore

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