Psychological treatments can be beneficial in relation to a number of psychiatric disorders, both in terms of alleviating mental distress and improving well-being (c.f., Cuijpers et al., 2013). However, far less attention has been given to the possibility of inadvertently causing negative effects, with few studies reporting their incidence (Jonsson, Alaie, Parling, & Arnberg, 2014). Several prominent researchers and clinicians have therefore urged that more investigations should be performed in order to better understand their occurrence and characteristics (Lilienfeld, 2007; Barlow, 2010; Dimidjian & Hollon, 2010). Lately, findings from various naturalistic investigations show that 5-10% of all patients undergoing psychological treatments deteriorate (c.f., Hatfield, McCullough, Frantz, & Krieger, 2010), and similar estimates have been found in randomized controlled trials of Internet-based psychological treatments (Rozental et al., 2017), suggesting that negative effects occur and need to be monitored.

Meanwhile, other types of negative effects have also been proposed, such as adverse and unwanted events occurring during the course of treatment (c.f., Linden & Schermuly-Haup, 2014). This might involve new symptoms, social stigma, and interpersonal difficulties that affect the patient negatively, some being related to the treatment interventions being delivered, others having an association with circumstances in the patient’s life (Strupp & Hadley, 1977). These negative effects have, however, been yet even less explored, with a few notable and important exceptions (Parker, Fletcher, Berk, & Paterson, 2013; Linden, 2013; Ludwig, Rief, & Nestoriuc, 2014). Thus, not much is currently known about what these negative effects are and how the may influence the patient or the ongoing treatment, warranting further research.

With the intention of examining these potentially adverse and unwanted events in psychological treatments, a novel self-report measure was therefore created, the Negative Effects Questionnaire (NEQ). Using the results from a consensus statement (Rozental et al., 2014), a pilot study investigating negative effects (Boettcher et al., 2014), a qualitative analysis of the patients’ own experiences of adverse and unwanted events (Rozental et al., 2015), as well as a literature review, it was developed and evaluated on a sample of 653 patients. The self-report measure is presently available in eleven different languages and can be downloaded and used for free. It contains 32 items that are scored on a five point Likert-scale (0-4) and differentiates between negative effects that are attributed to treatment and those possibly caused by other circumstances, as well as one open-ended question.



New and improved scoring help with this Excel-file: NEQ_scoring_matrix_(2022-02-10).xlsm


[ New paper ] Rozental, A., Kottorp, A., Forsström, D., Månsson, K., Boettcher, J., Andersson, G., Furmark, T., & Carlbring, P. (2019). The Negative Effects Questionnaire: Psychometric properties of an instrument for assessing adverse and unwanted events in psychological treatments. Behavioural and Cognitive Psychotherapy, 47(5), 559-572. doi:10.1017/S1352465819000018


The NEQ is now available in Czech, Greek, and Polish, see under download.


A shorter version of the NEQ is now available. For more information on its psychometric properties please see the reference below. The shorter version is also available under download.


Main Developers and Curators

  • Alexander Rozental is a Licensed Psychologist and Post Doctoral Researcher at the Department of Clinical Neuroscience at Karolinska Institutet, as well as an Honorary Senior Lecturer at the Institute of Child Health at University College London.
  • Per Carlbring is a Licensed Psychologist, Licensed Psychotherapist, Board Certified Specialist in Clinical Psychology, and Professor in clinical psychology the Department of Psychology at Stockholm University.

Associate Developers

  • Anders Kottorp is a Licensed Occupational Therapist, Professor in occupational therapy, and Dean of the Faculty of Health and Society at Malmö University.
  • Johanna Boettcher is a Licensed Psychologist and PhD at the Department of Clinical Psychology and Psychotherapy at Freie Universität Berlin
  • Gerhard Andersson is a Licensed Psychologist, Licensed Psychotherapist, Board Certified Specialist in Clinical Psychology, and Professor in clinical psychology at the Department of Behavioural Sciences and Learning at Linköping University, as well as the Department of Clinical Neuroscience at Karolinska Institutet.