Does It Harm?

Abstract: Objective: This study is the first to examine the frequency of negative effects associated with outpatient cognitive behavioral therapy (CBT) for children and adolescents. Methods: Youths treated at a university outpatient clinic and their caregivers completed an adapted version of the Kinder-INEP during psychotherapeutic treatment. We assessed (a) negative effects and (b) side effects, defined as any negative effects causally attributed to the treatment. Results: We collected data from 174 patients (11 – 21 years; n = 148 self-reports, n = 124 proxy-reports). 87.2 % of patients (caregivers: 82.3 %) reported at least one negative effect, and 66.9 % of patients (caregivers: 61.3 %) reported at least one side effect. The most frequent side effects were feeling different from others due to therapy, fear of stigmatization, and missing the therapist with dependency-related concerns. The mean number of reported side effects did not differ between patients and caregivers, but cross-informant agreement was low. Patient-reported side effects were positively associated with patients’ age and negatively associated with caregiver-reported baseline hyperactivity. Conclusions: Youth report side effects from outpatient CBT at rates comparable to adults. We need further research on how to handle negative effects to improve psychotherapeutic services.