Cognitive behavioral therapy (CBT) is widely considered the safest treatment for many mental illnesses – but that doesn’t mean it is without side effects, new research reveals.
About 40 percent of Americans have seen or are currently seeing a therapist, and CBT is both the most popular and best clinically proven form of talk therapy.
By nature, however, it involves the stress of revisiting past traumas and painful issues and confronting one’s own shortcomings.
And that means that that nearly half of therapy patients come away with ‘side effects,’ such as disruption of relationships, feelings of guilt and shame and even suicidal thoughts, according to a new German study.
Cognitive behavioral therapy is a safe and effective treatment for mental health disorders like anxiety and depression, but 43 percent of patients have side effects that may be ‘necessary’
Many Americans opt to do regular therapy sessions rather than take drugs, or even quit taking antidepressants and anti-anxiety medications simply because the side effects can be intense and unpleasant.
For example, Prozac is one of the most commonly prescribed antidepressants. But its side effects often include insomnia and feelings of anxiety – both of which can worse mental depression and mental health conditions.
CBT does not have side effects in exactly the same chemical sense that drugs do, and is now considered as effective if not more so than medication.
But, as is often the case, ‘safer’ or ‘lower risk’ is not the same as being with out risk.
Because it is not a pharmaceutical, talk therapy doesn’t get tested and approved by the FDA the way Prozac was (although, interestingly, the agency does give the go-ahead to apps for CBT).
So a team of researchers at the Charité University of Medicine in Berlin decided to investigate the possible negative outcomes.
Getting an objective measure of these side effects is tricky, so the team decided to ask therapists, rather than patients, to report changes for the worse.
They asked 100 therapists about both side effects and unwanted effects of therapy. Side effects are simply any unintentional effect, while unwanted ones are always negative, but of course there is a good deal of overlap between the two categories.
Each therapist was asked to to choose a patient who had been to at least 10 sessions of CBT with them, including a recent one, and answer a checklist of 17 questions based on that individual.
The sample patients experienced about 3.7 ‘unwanted’ events each, by their counselors’ own accounts.
The researchers extrapolated that to mean that about 43 percent of all clients must have at least one adverse event as a result of therapy.
But these ‘side effects’ don’t look quite like those that a voice-over runs through on drug commercials.
Instead, the most common effects included breakups, greater tension in family relationships or withdrawal from family members, feelings of guild and shame or intense emotions during therapy sessions.
Psychotherapy is not harmless
Some even thought that their patients might be more likely to feel suicidal after or as a result of therapy.
About 40 percent of the time, the therapists believed these side effects were severe, and in about 25 percent of cases these tumultuous effects persisted for weeks or even months.
The therapists themselves were surprised by the negative effects they realized therapy might have on their patients. Before being asked specific questions, three quarters of the counselors said they didn’t think that CBT had negative effects.
But the researcher’s resounding conclusion from the study was the opposite.
‘Psychotherapy is not harmless,’ they said.
Encouragingly, though, the researchers could not find any reason to believe that unethical practices had led to these negative side effects.
Instead, they suggested that the therapists may have even over-estimated adverse consequences and the difficult feelings brought up by therapy may be part of the process of dealing with negative thoughts and feelings.
The researchers did, however, caution that exposure therapy – which incrementally recreates situations that are anxiety- or depression-provoking in order to help retrain the patient on how to deal with them – should be approached delicately.
‘We argue that they are side effects although they may be unavoidable, justified, or even needed and intended,’ they said.
‘If there were an equally effective treatment that did not promote anxiety in the patient, the present form of exposure treatment would become unethical as it is a burden to the patient.’
Simply acknowledging the possibility of these side effects should give therapists a better sense of potential blind spots and pit falls.
‘An awareness and recognition of unwanted events and side effects in all therapies will benefit patients, improve therapy or reduce attrition, analogous to the benefit of measurement-based monitoring of treatment progress,’ the said.