Negative side effects of psychological treatments are rare
Psychological interventions are effective in treating post-traumatic stress disorders (PTSD) in children and adolescents. But can they also have unwanted side effects? To answer this question, an international research team led by Dr Thole H. Hoppen and Professor Nexhmedin Morina from the Institute of Psychology at the University of Münster has conducted the first meta-analysis of its kind, which has now been published in the Journal of Child Psychology and Psychiatry. The researchers came to a clear conclusion: unwanted side effects of psychotherapy, specifically in the treatment of PTSD in children and adolescents, are rare. “By analyzing numerous studies, we were able to show that most children and adolescents did not discontinue therapy prematurely, and they were not exposed to an increased risk of side effects,” explains Thole H. Hoppen, the lead author of the study. Less than 0.01% of children and adolescents with PTSD reported symptom deterioration after the end of treatment. The occurrence of adverse events during psychological treatments was also very rare (0.29% of patients).
In collaboration with working groups from the University of Freiburg and the British universities King’s College London and the University of East Anglia in Norwich, the researchers evaluated 71 studies that dealt with possible risks of psychotherapeutic treatment in their analyses. This approach was new. While there is always information on possible risks and side effects of medication such as psychotropic medication, potential adverse effects of psychotherapy have long been neglected in research. “Although the effectiveness of psychological treatments for PTSD is well established, their safety profile remains understudied,” reports Nexhmedin Morina, senior author of the study. Despite growing research attention, no meta-analysis had so far systematically summarised the available studies. By conducting a broad search in health databases, the researchers were able to draw on published data from more than 5,600 children and adolescents.
They investigated potential negative side effects of psychotherapeutic treatment. These included discontinuing treatment, a significant deterioration of the disorder after the end of treatment, and further unwanted consequences such as increased suicidal tendencies during the treatment phase or the worsening of a comorbid (i.e. simultaneously experienced) condition such as depression. “The rates of unwanted side effects are negligible and not significantly more frequent than in control groups. The results are encouraging for clinical practice,” Thole Hoppen states. This was especially true for so-called trauma-focused cognitive behavioural therapy, in which the traumas (such as sexual violence, serious traffic accidents, war experiences, severe physical violence, injuries after catastrophic natural disasters) are openly discussed.
Trauma-focused methods in particular are often misunderstood as being potentially harmful because the persons affected fear that direct confrontation with traumatic memories could worsen symptoms. As a result, some affected children and adolescents, as well as their parents, avoided psychotherapeutic treatment. “This worry constitutes a significant barrier and may, among other things, contribute to the chronicity of the disorder,” Nexhmedin Morina points out.
On the one hand, many affected individuals avoided trauma treatment due to such reservations. On the other hand, many less experienced therapists also expressed concerns that confronting traumatic memories might be harmful. “Our findings should encourage those affected and their relatives to seek – and their therapists to offer – psychotherapeutic treatment, including trauma-focused treatments. Delaying or avoiding treatment for post-traumatic stress disorders can have negative consequences – especially in childhood and adolescence,” Thole Hoppen stresses.
The authors have made all data and analysis scripts publicly available, thereby meeting high standards with regard to open science and reproducibility of results.
Original publication
Hoppen, T.H., Schlüter, S., Placzek, M., Lindemann, A.S., Kip, A., Schlechter, P., Meiser-Stedman, R. and Morina, N. (2026), Incidence and relative risk of negative outcomes of psychological interventions for pediatric posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.70216