Background: The effectiveness of psychological interventions is undisputed. But while in other fields of health care, safety of interventions is studied alongside effectiveness, adverse events (AEs) have only recently been assessed in clinical studies of psychological interventions. This critical review summarizes the definition, assessment and current research status of AEs of psychological interventions. Summary: AEs are defined as any untoward event or unfavorable change that occurs in the course of a psychological intervention. AEs that are caused by the intervention can be classified into side effects of correctly applied treatment, malpractice (i.e. incorrectly applied treatment) and unethical conduct (e.g. sexual abuse). Ideally, they are assessed by independent raters or alternatively by self-report questionnaires that should also cover serious adverse events (SAEs, e.g. suicide attempts or self-injurious behaviors). About one to two in three patients report at least one AE and results of meta-analyses suggest that treatments might differ in frequency and/or severity of AE and in treatment acceptability (measured as dropout rates). Key Messages: Measures of AEs and SAEs as well as more nuanced descriptions of dropout should be included in all clinical studies of psychological interventions. If this happens, we might learn that psychological interventions differ with respect to AEs, SAEs and acceptability. As many psychological interventions are about equally effective, they might one day be chosen based on differences in their safety profile rather than their differential effectiveness. Ideally, reducing AEs might also lead to more effective interventions.

While most methods of psychotherapy are about equally effective, it is unclear whether different methods of psychotherapy differ in the severity of negative effects. It is also unclear whether negative effects impact the long-term outcome of treatment and whether this impact is moderated by psychotherapy method. To address these questions, we have analyzed data from an observational study of 144 patients from an intensive day treatment program for depression. During a shared-decision making process, patients were assigned to either the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Metacognitive Therapy (MCT). Negative effects were assessed with the Negative Effects Questionnaire (NEQ), severity of depressive symptoms was assessed with the self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR). Due to the observational nature of the study, the two treatment groups were propensity score matched to account for baseline differences. Results show that severity of negative effects (NEQ) did not differ between patients treated with CBASP and MCT. We also found that only patients treated with CBASP improved further after treatment and this improvement differed depending on the severity of negative effects. Those with the lowest severity of negative effects had the greatest improvement in symptoms during the follow-up period. This suggests that both treatments were equally tolerated but they might differ in long-term outcome and they might differ in the impact of negative effects on long-term outcome. These results need to be considered with caution however due to the considerable drop-out rate during the follow-up period and the observational nature of our study.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was specifically developed by James McCullough to treat patients with persistent depressive disorder (PDD). CBASP assumes that patients with PDD have interpersonal difficulties and that these difficulties are rooted in adverse childhood experiences that result in a specific deficit in social cognition (perceptual disconnection). The goal of CBASP is to overcome these interpersonal difficulties by systematic behavioral analyses. This talk will give an overview of the evidence base for perceptual disconnection in PDD and the effectiveness of CBASP. For details, see https://bit.ly/3Vq8RMV.

Fragestellung: Beeinflussen interpersonelle Eigenschaften den Therapieerfolg des Cognitive Behavioral Analysis System of Psychotherapy (CBASP) oder der Metakognitiven Therapie (MCT)? Methodik: In dieser naturalistischen Studie wurden präinterventionelle interpersonelle Fertigkeiten durch den IMI-R und den LQPT-SF erhoben. Der Veränderungswert im QIDS-SR16 diente als Indikator des Therapieerfolgs. 85 Patienten (34 CBASP; 51 MCT) wurden in der Hauptanalyse untersucht. Ergebnisse: CBASP und MCT führten zu einer signifikanten Reduktion der depressiven Symptomatik. Bei initial stark ausgeprägtem feindselig-submissiven Verhalten fiel der Therapieerfolg von CBASP geringer aus als bei initial schwacher Ausprägung dieses Merkmals. Bei einer Behandlung mit MCT hatte diese Merkmalsausprägung keinen signifikanten Einfluss auf den Therapieerfolg. Fazit: Sollten diese Ergebnisse repliziert werden können, würde das bedeuten, dass Patienten mit ausgeprägten feindselig-submissiven Eigenschaften eher MCT als CBASP angeboten werden sollte.

Background: Music performance anxiety (MPA) is an issue concerning musicians from all levels but is still a rather neglected topic in the education and employment of musicians. This study investigated the link between self-esteem, MPA, and depression within a German-speaking sample of musicians of different professions. The underlying question of this study was generated during psychotherapy treatment of musicians with depression and MPA. Thus, we investigated whether musicians with low self-esteem had MPA or depression. Methods: An online questionnaire on self-esteem, performance anxiety, and depression was sent to a sample (n=295) of German musicians of different professions and levels of education. The assessment tools in the online questionnaire included the Rosenberg-Self-Esteem-Scale, the Kenny Music-Performance-Anxiety-Inventory, and the Beck-Depression-Inventory. Results: Music students had a significantly lower self-esteem scores compared to employed professionals and amateurs and a higher MPA compared to employed musicians. Regression analyses showed a significant prediction of depression by self-esteem and MPA. Specifically, low self-esteem and the cognitive and behavioral aspects of MPA were significant predictors of depression. Partial mediation by MPA between self-esteem and depression was found. Conclusion: Low self-esteem and MPA could predict depression. The scores of the entire sample of musicians regarding their MPA and depression were higher than in the general German population. These results highlight the importance of education and removal of negativity regarding performance anxiety in order to improve psychotherapy methods and ensure musicians' health in general.