"At least do no harm" cannot be satisfied when failing to measure for possible harm

Area of Science:

• Psychology
• Behavioral Science
• Clinical Psychology

Background:

• Behavioral health research and practice have historically neglected the systematic study and communication of adverse experiences resulting from psychological interventions.
• This oversight poses significant ethical and practical challenges for informed decision-making in clinical settings.

Purpose of the Study:

• To highlight the insufficient prioritization of understanding and communicating adverse experiences in psychological interventions.
• To identify the multifaceted reasons behind this deficit, including theoretical, methodological, and systemic issues.
• To propose future directions for improvement in research and practice.

Main Methods:

• The study critically reviews existing literature and theoretical frameworks concerning harm in psychological interventions.
• It analyzes common biases and methodological limitations that impede the study of adverse experiences.
• The authors discuss the absence of established harm models, measurement tools, and rigorous testing methodologies.

Main Results:

• A significant lack of foundational commitment to the principle of 'at least do no harm' was identified.
• Key barriers include confirmation bias, absence of harm-specific theoretical models, inadequate measurement systems for adverse events, insufficient rigorous testing, and a lack of adversarial collaborations and quality improvement systems.
• These factors collectively contribute to the underreporting and under-investigation of negative outcomes.

Conclusions:

• There is a critical need for behavioral health professionals to proactively address and communicate adverse experiences associated with psychological treatments.
• Implementing robust theoretical models, valid measurement tools, rigorous testing, and collaborative quality improvement systems is essential.
• Prioritizing patient safety through a stronger commitment to 'do no harm' principles is paramount for ethical and effective practice.