No pain, no gain? Adverse effects of psychotherapy in obsessive-compulsive disorder and its relationship to treatment gains

Objective: It is almost a matter of fact for both clinicians and patients that pharmacological agents exert wanted as well as unwanted effects. In contrast, unwanted events of psychotherapy have long been neglected. Method: The present study investigated the frequency and correlates of wanted and unwanted effects of psychotherapy in 85 participants with obsessive-compulsive disorder (OCD). The study was performed anonymously over the Internet in order to reduce response biases. Results: Most patients showed ambivalent appraisals: 95% named at least one wanted effect, whereas 93% named at least one adverse treatment reaction (i.e., side-effect) and 89% indicated at least one instance of (subjective) malpractice. Complaints about unethical behavior were named by 14% of the participants. Wanted and unwanted effects were negatively correlated. Prevalent side-effects included development of new symptoms in 29% of the participants, for example, in the course of exposure treatment. Conclusions: Our findings corroborate prior reports that adverse effects in psychotherapy are common, even if treatment is successful. Results refute a "no pain no gain" view: adverse events negatively impact outcome. Findings await confirmation in well-characterized in- and outpatient samples.