New research focuses on side effects of internet-based therapy

While many people who suffer from depression and anxiety are helped by seeing a psychologist, others don't get better or actually get worse. Psychological treatment can have negative side effects, like any medicine. This unexplored territory is the focus of a new dissertation out of Stockholm University.

'We know now that therapy is an effective treatment for different forms of mental illness. What we don't know so much about is whether certain patients can actually get worse or have other types of side effects from their treatment,' says Alexander Rozental, licensed psychologist and PhD in psychology.

He has, among other topics, researched the effectiveness of online cognitive behavioural therapy. Online CBT is more or less like following a self-help book with the support of a psychologist through email. The method is recommended by the Swedish National Board of Health and Welfare guidelines which Sweden's local governments rely upon heavily.

'This dissertation is the first to examine the side effects of internet-based therapy. There's no international research, either. That's why this research is so important. If we're going to use this method widely, we have to be aware of the risks,' says Alexander.

The part of the dissertation that focused on internet-based therapy showed that around 6% of the 3000 patients studied got worse during treatment. In another study, people who had received psychotherapy, for example, in an outpatient psychiatric setting, in the past few years were asked if they had experienced other types of negative effects.

'We saw that a third of people had a difficult memory resurface, had more anxiety, or felt stressed. It was also not uncommon to have a poor relationship with the therapist or low-quality treatment.'

It's not so surprising that people can feel worse when dealing with unpleasant experiences in therapy. It's also true that a treatment than can have a positive effect on some people can affect others negatively, just like medicine. What is needed is a better understanding of side effects, both for catching patients who become worse earlier and protecting patients from rogue therapists.

'I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any. I also think that society should regulate who is allowed to provide treatment. There are currently no laws preventing an unlicensed person from working in mental health,' he says.