Some psychological interventions do more harm than good. Unlike medicines, these therapies skip formal approval. They also lack a strong system for reporting side effects. Programs such as DARE failed to cut illegal drug use. And critical incident stress debriefing does not seem to lower the risk of PTSD.
Summary: Many psychological interventions may not work, or may even cause harm. Unlike drugs, these therapies are not well regulated. They do not go through an approval process like drugs do. The system for reporting harm is also poor. Experts believe much of the research behind these therapies is biased or flawed. Most psychology studies lack hard data. Their results rest on how people say they feel. The studies are often small. Or they give weight to outcomes that matter less. Common programs like DARE have failed to cut illegal drug abuse. Critical incident stress debriefing (CISD) does not seem to lower the risk of PTSD. Most professional groups, like the APA, admit that whether these therapies work is in dispute. Yet they stay popular.
Some of these therapies are flawed or rest on biased results. To see how, you need a few basic ideas from medical research.
Harm does not have to mean physical harm or side effects. A therapy that gives no benefit can also count as harm. It wastes time and money on something that does not work.
It is harder to judge whether these therapies work. That is because most measures are “subjective” and not “objective.”
Subjective measures are feelings and other symptoms people report. They are hard to measure. Feeling better, tiredness, memory, focus, sadness and emotional stress are all hard to measure. There is no way to measure these things with precision.
Objective data are things like blood pressure, body weight, heart rate and blood sugar. As you can see, these things are easy to measure.
In psychology, most research measures or counts subjective data. So bias can creep in easily.
Also, many of these studies are small, with fewer people taking part. In general, if a therapy has a small effect, you need more people to confirm or measure it.
Another trick is to use a false endpoint, or to make a big deal of minor findings. Take a program that tells students about the risks of drug abuse. At the end of the class, you ask them if they learned anything. Most might agree the class helped. But in reality, it may do nothing to prevent drug abuse.
Why do therapy studies report fewer negative results?
Researchers worry that many studies are biased these days. Take one study that looked at 4600 papers on many medical subjects. It found that in just seventeen years, between 1990 and 2007, reports of positive results grew by 22%. That means reporting is getting less objective1.
In psychology, most data are subjective, so things are even worse. One study found that close to 90% of research papers used the wrong statistics2. Studies already show there are many potentially harmful therapies (PHTs). They come from wrong reporting, too much weight on minor facts, and overstating what a therapy does. Sometimes authors use murky statistics to confuse readers3.
Does the FDA regulate psychological therapies?
Getting a drug approved is a long and hard process. In many cases it takes a decade. The US FDA also has a system for reporting harm from drugs. That is why some drugs that first looked good but later caused harm are pulled from the market4.
These therapies are a very different story. The US FDA does not approve them. Some get the nod on grounds that are hard to grasp. Some rest on one poorly designed study. And there is no sound way to report harm, or to report that a therapy does nothing.
Which psychological therapies do not work?
Many common psychological therapies do not work and may even do more harm. Take the DARE program (Drug Abuse Resistance Education Program). There is little proof that it works. Yet millions go to this program each year.
After the DARE program, many studies report that it helped. An equal number of students say it did not affect them. But look at the data on drug abuse among students since the program began. It is more than clear that it failed to reach any of its goals. In fact, the numbers show that illegal drug abuse and alcohol abuse have both risen5. So many experts believe the money for this program could be put to better use, like improving the education system.
Another example is critical incident stress debriefing (CISD). A person who went through stress or trauma retells the event to a group. Psychologists believe that venting this way may bring relief. Films often show this therapy as a way to manage PTSD. But there is no proof that it works. The American Psychological Association (APA) confirms some reports even show the reverse. People who went through CISD had a higher risk of PTSD6.
Many global groups share this view. The British Psychological Society also thinks most of these therapies do not work and may even cause harm. It classifies them as PHTs7.
Frequently asked questions
Why did DARE fail?
There is little evidence that DARE, the Drug Abuse Resistance Education program, ever worked. Students give mixed reports. But drug-use data since the program began show it failed to reach any of its goals. Illegal drug use and alcohol abuse among students have both risen. Millions of dollars still go to it every year. Many experts say that money would do more good improving the education system.
What are examples of psychological interventions?
Psychological interventions are programs and therapies that work on thoughts, feelings and behavior. They do not act as a drug. Two common examples stand out. One is DARE, the classroom program that teaches students about the risks of drug abuse. The other is critical incident stress debriefing (CISD). In it, a person who went through trauma retells the event to a group. Both stay popular, and neither has shown that it works.
Can therapy do more harm than good?
Yes. Harm is not only a physical injury or a side effect. A therapy that gives no benefit still costs time and money that could have gone to something that works. Some go further. The American Psychological Association notes reports of a higher risk of PTSD in people who went through stress debriefing. The British Psychological Society classifies such treatments as potentially harmful therapies.
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References
1. Fanelli D. Negative results are disappearing from most disciplines and countries. Scientometrics. 2011;90(3):891-904. doi:10.1007/s11192-011-0494-7
2. Nuijten MB, Hartgerink CHJ, van Assen MALM, Epskamp S, Wicherts JM. The prevalence of statistical reporting errors in psychology (1985–2013). Behav Res. 2016;48(4):1205-1226. doi:10.3758/s13428-015-0664-2
3. Williams AJ, Botanov Y, Kilshaw RE, Wong RE, Sakaluk JK. Potentially harmful therapies: A meta-scientific review of evidential value. Clinical Psychology: Science and Practice. 2021;28(1):5-18. doi:10.1111/cpsp.12331
4. Center for Drug Evaluation and Research. Questions and Answers on FDA’s Adverse Event Reporting System (FAERS). FDA. Published May 22, 2019. Accessed October 8, 2021. https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers
5. Lesser B. Does the DARE Program Work? | Dual Diagnosis. Accessed October 8, 2021. https://dualdiagnosis.org/drug-addiction/dare-program-work/
6. critical-incident stress debriefing – APA Dictionary of Psychology. Accessed October 8, 2021. https://dictionary.apa.org/critical-incident-stress-debriefing
7. When therapy causes harm | The Psychologist. Accessed October 8, 2021. https://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm