title: Negative Effects of Psychological Treatments: An Exploratory Factor Analysis of the Negative Effects Questionnaire for Monitoring and Reporting Adverse and Unwanted Events.
abstract: Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest self-reported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used from www.neqscale.com.
authors.affiliation: Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
authors.forename: Alexander
authors.identifier: http://orcid.org/0000-0002-1019-0245
authors.initials: A
authors.lastname: Rozental
authors.affiliation: Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|Department of Occupational Therapy, University of Illinois at Chicago, Chicago, United States of America.
authors.forename: Anders
authors.initials: A
authors.lastname: Kottorp
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Boettcher
authors.affiliation: Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.|Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
mesh_terms: D000328:Adult; D003710:Demography; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires