The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments

Rozental, Alexander; Kottorp, Anders; Forsström, David; Månsson, Kristoffer; Boettcher, Johanna; Andersson, Gerhard; Furmark, Tomas; Carlbring, Per

doi:10.1017/s1352465819000018

Cited by 104 publications

(94 citation statements)

References 38 publications

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“…Negative Effects Questionnaire (NEQ): The self-report measure consists of three parts for a total of 32 items ( 47 ). First, respondents endorse specific items in case they have occurred or not during treatment, yes/no (dummy coded as a variable: 1/0).…”

Section: Methods and Analysismentioning

confidence: 99%

COVID Feel Good—An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus

Riva

Bernardelli²,

Browning

et al. 2020

Front. Psychiatry

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Background Living in the time of the COVID-19 means experiencing not only a global health emergency but also extreme psychological stress with potential emotional side effects such as sadness, grief, irritability, and mood swings. Crucially, lockdown and confinement measures isolate people who become the first and the only ones in charge of their own mental health: people are left alone facing a novel and potentially lethal situation, and, at the same time, they need to develop adaptive strategies to face it, at home. In this view, easy-to-use, inexpensive, and scientifically validated self-help solutions aiming to reduce the psychological burden of coronavirus are extremely necessary. Aims This pragmatic trial aims to provide the evidence that a weekly self-help virtual reality (VR) protocol can help overcome the psychological burden of the Coronavirus by relieving anxiety, improving well-being, and reinforcing social connectedness. The protocol will be based on the “Secret Garden” 360 VR video online ( ) which simulates a natural environment aiming to promote relaxation and self-reflection. Three hundred sixty–degree or spherical videos allow the user to control the viewing direction. In this way, the user can explore the content from any angle like a panorama and experience presence and immersion. The “Secret Garden” video is combined with daily exercises that are designed to be experienced with another person (not necessarily physically together), to facilitate a process of critical examination and eventual revision of core assumptions and beliefs related to personal identity, relationships, and goals. Methods This is a multicentric, pragmatic pilot randomized controlled trial involving individuals who experienced the COVID-19 pandemic and underwent a lockdown and quarantine procedures. The trial is approved by the Ethics Committee of the Istituto Auxologico Italiano. Each research group in all the countries joining the pragmatic trial, aims at enrolling at least 30 individuals in the experimental group experiencing the self-help protocol, and 30 in the control group, over a period of 3 months to verify the feasibility of the intervention. Conclusion The goal of this protocol is for VR to become the “surgical mask” of mental health treatment. Although surgical masks do not provide the wearer with a reliable level of protection against the coronavirus compared with FFP2 or FFP3 masks, surgical masks are very effective in protecting others from the wearer’s respiratory emissions. The goal of the VR protocol is the same: not necessarily to solve complex mental health problems but rather to improve well-being and preserve social connectedness through the beneficial social effects generated by positive emotions.

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Section: Methods and Analysismentioning

confidence: 99%

COVID Feel Good—An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus

Riva

Bernardelli²,

Browning

et al. 2020

Front. Psychiatry

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“…In conjunction with each item, the patient also decides whether or not he/she has experienced the adverse event at all, and whether it could be attributed to the treatment or other external circumstances. The scale has been shown to have good reliability and to effectively measure the adverse effects of psychological interventions [ 51 ]. While the NEQ is developed to measure adverse events in psychological treatments, the current treatment was multimodal.…”

Section: Methodsmentioning

confidence: 99%

Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

et al. 2020

Self Cite

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Background Long-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting. Method This open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured. Results There were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91–1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry. Conclusion SED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population. Trial registration This study was registered on Clinicaltrials.gov 2017.12.02 (Identifier: NCT03360136).

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“…ICBT clinical trials sometimes report rates of deterioration (i.e., percentage of the sample that experienced a significant increase in symptoms) or non-response (i.e., percentage of the sample that reported a non-significant improvement in symptoms) by comparing clients' symptom scores at pre- and post-treatment (Barak et al, 2008; Boettcher et al, 2014; Ebert et al, 2016; Rozental et al, 2019a; Rozental et al, 2017). Researchers have also used self-report measures, such as the Negative Effects Questionnaire, at post-treatment as a means of exploring negative effects associated with ICBT, although such measures have not yet been widely adopted (Rozental et al, 2016; Rozental et al, 2019b).…”

Section: Introductionmentioning

confidence: 99%

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

Gullickson

Hadjistavropoulos

Dear

et al. 2019

Internet Interventions

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Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious form of treatment for anxiety and depression, yet it is still possible for clients to experience negative effects associated with treatment. In the ICBT literature, the term negative effects is broadly used to refer to all potentially adverse or unwanted events or experiences that are perceived as undesirable by the client and may or may not be associated with long-term symptoms or distress. Previous ICBT studies have asked clients to retrospectively describe negative effects at post-treatment; however, no research has examined the content of clients' emails to their therapist to see whether clients are reporting negative effects as they arise. In the current study, 96 clients (80 completers; 16 non-completers) were randomly selected from a published ICBT trial and directed content analysis was used to examine client emails for mention of negative effects. In addition, correlational analyses were used to examine the relationship between negative effects and: 1) demographic characteristics; 2) treatment engagement; 3) treatment satisfaction; 4) working alliance; and 5) symptom outcomes among completers. The results indicated that 61.5% of clients experienced at least one negative effect during treatment, although total number of negative effects was not significantly correlated with client demographic characteristics, lessons completed, working alliance, treatment satisfaction, or symptom outcomes. Among completers, technical difficulties, implementation problems, and negative emotional states were the most commonly reported negative effects, whereas dropout was the most commonly reported negative effect by non-completers. Negative effects that have been identified in previous research, such as symptom deterioration, novel symptoms, and severe adverse events, were not identified in client emails. The high incidence of negative effects in the current study suggests there may be value in systematically monitoring client emails for negative effects throughout treatment as a supplement to retrospective post-treatment reports. This will give therapists the opportunity to intervene as negative effects occur and potentially mitigate any impact they have on treatment outcomes. Future research, both qualitative and quantitative, is needed to gain a more nuanced understanding of negative effects associated with ICBT.

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The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments

Cited by 104 publications

References 38 publications

COVID Feel Good—An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus

COVID Feel Good—An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus

Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

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