Negative effects on family functioning from psychosocial treatments: a recommendation for expanded safety monitoring 2007 Szapocznik et al

ME/CFS Science Blog

Senior Member (Voting Rights)

Abstract​

Whereas biomedical products are required to be tested for safety with respect to vulnerable organ systems, psychosocial treatments are not required to be tested for safety with respect to vulnerable social systems such as the family. This article provides some evidence for the need to document the potential negative effects of psychosocial treatments on family-level outcomes. Three randomized controlled trials are reviewed in which independent ratings or self-reports of family functioning were measured. Each of the 3 studies compared the efficacy of a family and a nonfamily treatment. Totally unexpectedly, the nonfamily treatment in each of the 3 trials demonstrated significant declines in family functioning. The authors suggest that psychosocial treatments with vulnerable populations have the potential to produce negative side effects on families. Therefore, it is important to conduct further research to determine whether safety studies should be required for psychosocial treatments.

Link:
Negative effects on family functioning from psychosocial treatments: a recommendation for expanded safety monitoring - PubMed
 
Older study from 2007, some quotes that might be relevant to ME/CFS research:
Whereas biomedical products are required to be tested for safety with respect to vulnerable organ systems, psychosocial treatments are not required to be tested for safety with respect to vulnerable social systems such as the family
We suggest that like biomedical products, the safety of psychosocial treatments should be examined before tests of efficacy are conducted
 
We suggest that like biomedical products, the safety of psychosocial treatments should be examined before tests of efficacy are conducted
In case others have interest in exploring this further - some time ago I started compiling a list of papers that either assessed harms reporting in psychobehavioural trials, recommended enhanced safety monitoring or reporting for such interventions, or made that comparison to how safety is assessed in interventions such as medications or devices. These are what I found:

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice
"A total of 132 eligible trials were identified. Only 28 trials (21%) included information that indicated any monitoring of harms on patient level. Four (3%) of these trials provided a description of adverse events as well as the methods used for collecting these data. Five of the trials (4%) reported adverse events but did not give complete information about the method. An additional four reports (3%) briefly stated that no adverse events occurred, whereas 15 trials (11%) only provided information on deterioration or indicated monitoring of deterioration."

Mostly harmless? Clinical practice guidelines need further consideration of psychotherapy adverse effects
"Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making."

2843 – The problem of side effects in psychotherapy: adverse treatment reactions or unwanted events
"The side effects of drugs are deemed so important that their pubblication are strictly regulated by national health agency. But no one agency requires such warnings connected to other mental health treatment including Psychotherapy. In contrast to all pharmacotherapy studies in groups of patients, there is precious little information about the safety of psychotherapeutic interventions, which are also, in some patients and in some instances, associated with adverse events that need to be noted."

Adverse events in psychotherapy randomized controlled trials: A systematic review
"Because the AE recording approaches of the individual studies differed substantially, results could only be compared to a limited extent. Consistent with other findings, this review demonstrates that AEs can be expected to affect more than one in ten participants. Serious AEs occurred more than in one in 21 participants in psychotherapy RCTs.[/url]

Adverse Events of Psychological Interventions: Definitions, Assessment, Current State of the Research and Implications for Research and Clinical Practice
"But while in other fields of health care the safety of interventions is studied alongside effectiveness, adverse events (AEs) have only recently been assessed in clinical studies of psychological interventions."
"Measures of AEs and SAEs as well as more nuanced descriptions of dropout should be included in all clinical studies of psychological interventions. If this happens, we might learn that psychological interventions differ with respect to AEs, SAEs and acceptability. As many psychological interventions are about equally effective, they might one day be chosen based on differences in their safety profile rather than their differential effectiveness."

Defining and assessing adverse events and harmful effects in psychotherapy study protocols: A systematic review.
"Our results imply that clinical researchers do not apply standardized approaches with regard to harm concepts, assessment, and management."

Negative Effects of Psychological Treatments: An Exploratory Factor Analysis of the Negative Effects Questionnaire for Monitoring and Reporting Adverse and Unwanted Events
"In comparison to pharmacological research, studies involving psychological treatments seldom report the possibility of negative effects [14]. A recent review showed that only one-fifth of a large number of randomized controlled trials mentioned the occurrence of harm [15]."
 
Back
Top Bottom