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  • 1.
    Ahlström, Katrin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Von Below, Camilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists' experiences of transition to remote psychotherapy2022In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 36, no 3, p. 256-274Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.

  • 2. Binde, Per
    et al.
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsström, David
    Criminogenic problem gambling: a study of verdicts by Swedish courts2022In: International Gambling Studies, ISSN 1445-9795, E-ISSN 1479-4276, Vol. 22, no 3, p. 344-364Article in journal (Refereed)
    Abstract [en]

    This study explored the characteristics and consequences of criminogenic problem gambling in Sweden. All verdicts (N = 283,884) delivered by Swedish general courts between 2014 and 2018 were subjected to a key word search for the term ‘problem gambling’ and its synonyms. Verdicts that met the search criterion (n = 1,232) were inspected manually and cases in which problem gambling clearly was the main cause for committing crime (n = 282) were analyzed quantitatively. The most common types of crimes were fraud and embezzlement (67%). Each year around 400 individuals, companies, and organizations became victims of gambling-driven crimes, with nonprofit organizations being the most severely affected. Those convicted for such crimes were older, and to a greater extent female and first-time offenders, compared to national statistics on crimes in general. This suggests that in Sweden, middle-aged women are a high-risk group for severe gambling problems that should be monitored particularly closely by gambling companies for indications of problematic gambling. We conclude that although crimes driven by problem gambling are relatively rare in the justice system, they bring considerable harm to victims and the perpetrators themselves.

  • 3. Binde, Per
    et al.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The Swedish translation of DSM-5 “Gambling Disorder”: Reflections on nosology and terminology2015In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, no 2, p. 219-226Article in journal (Other academic)
    Abstract [en]

    In this commentary we discuss the translation into Swedish of the term Gambling Disorder (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2015). An earlier commentary in this journal described and discussed the translation into Finnish (Castrén, Salonen, Alho, & Lahti, 2014).

  • 4. Buhrman, Monica
    et al.
    Gelberg, Olle
    Jovicic, Filip
    Molin, Katarina
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Rozental, Alexander
    Treating perfectionism using internet-based cognitive behavior therapy: A study protocol for a randomized controlled trial comparing two types of treatment2020In: Internet Interventions, ISSN 2214-7829, Vol. 21, article id 100338Article in journal (Refereed)
    Abstract [en]

    Perfectionism is characterized by setting high standards and striving for achievement, sometimes at the expense of social relationships and wellbeing. Despite sometimes being viewed as a positive feature by others, people with perfectionism tend to be overly concerned about their performance and how they are being perceived by people around them. This tends to create inflexible standards, cognitive biases, and performance-related behaviors that maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy has been shown to be a viable treatment for perfectionism, both in terms of reducing levels of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies indicate that it can be successfully delivered via the Internet, both with regular support and guidance on demand from a therapist. In the present study protocol, a clinical trial for perfectionism is described and outlined. In total, 128 participants will be recruited and randomized to either a treatment that has already been demonstrated to have many benefits, Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying depression and anxiety disorders. The results will be investigated with regard to self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are expected to have a positive impact, but the difference between the two conditions in terms of their specific effects and adherence are currently unknown and will be explored. The clinical trial is believed to lead to a better understanding of how perfectionism can be treated and the specificity of different treatments.

  • 5.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Kristoffer
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Boettcher, Johanna
    Furmark, Tomas
    Andersson, Gerhard
    The Negative Effects Questionnaire: Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments2019Conference paper (Other academic)
    Abstract [en]

    Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggest that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically. 

    Methods: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.

    Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data was analyzed using Rasch analysis, i.e., a modern test theory application. Results: 1) the NEQ exhibits fairness in testing across sociodemographics, 2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, 3) uses a rating scale that advances monotonically in steps of 0-4, and 4) is suitable for monitoring negative effects on an item-level. 

    Conclusion: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

  • 6. Engström, Ellinor
    et al.
    Olsson, Erik
    Oscarsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Outcome of iCBT for ADHD symptoms: A randomized controlled study2023In: Abstracts from the 12th Swedish Congress on internet interventions (SWEsrii), Uppsala University, Sweden, 2023, p. 2-2Conference paper (Other academic)
    Abstract [en]

    Attention deficit hyperactivity disorder is a disorder characterized by, hyperactivity, impulsivity, lack of attention.The condition results in several impairments that can impair everyday functioning and lead to underperformance. At present, there are not many large scale studies that have investigated the effect of Internet-based Cognitive Behavioral Therapy (iCBT) for ADHD symptoms. This study presents the outcome of a clinical trial of internet- based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. Approximately a hundred participants with symptoms of ADHD will be included in the first wave (recruitment for the second wave comprised of an additional 100 participants is ongoing) and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. The study utilizes an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects both on an individual and group level. Implications for iCBT for ADHD symptoms will be discussed.

  • 7. Erlandsson, Anette
    et al.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Accessibility at What Price? Therapists’ Experiences of Remote Psychotherapy with Children and Adolescents During the COVID-19 Pandemic2022In: Journal of Infant, Child, and Adolescent Psychotherapy, ISSN 1528-9168, Vol. 21, no 4, p. 293-308Article in journal (Refereed)
    Abstract [en]

    Psychotherapy has traditionally been delivered in person, but recent technological advances have made it possible to conduct remote treatments. There is currently strong evidence for the efficacy of guided self-help with online support from a therapist, but less is known about video-mediated psychotherapy. The COVID-19 pandemic has however forced many therapists to provide remote treatments. This transition might be especially trying for therapists of children and adolescents, but their experiences are underexplored. This study aimed to investigate their perceptions of video-mediated psychotherapy. Semi-structured interviews were conducted with 16 therapists and analyzed using thematic analysis. The therapists described how they struggled with technical and ethical issues and tried to overcome the loss of their usual therapeutic tools. They were concerned that the online format led to less effective treatments or could have negative effects, even if it might increase care availability. Generally, they felt frustrated, inadequate, and stressed, and experienced less job satisfaction. The therapists concluded that video-mediated sessions might be a good alternative for children and adolescents – provided the therapists themselves could determine for whom and when to offer video sessions. Implications of their experiences are discussed, including how psychotherapy training might have to incorporate issues related to remote psychotherapy.

  • 8.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The use and experience of responsible gambling tools: An explorative analysis of user behavior regarding a responsible gambling tool and the consequences of use2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Responsible gambling tools are an intervention that is designed to decrease gambling among individuals with an at-risk gambling behavior. Studies have indicated that responsible gambling tools can decrease gambling behavior, but little is known about how this intervention is used by gamblers. The aim of the present thesis was to explore different facets of the use, experience and functions of these tools. Study I used descriptive statistics and latent class analysis (LCA) combined with multinomial regression to explore the use of the responsible gambling tool Playscan among 9528 gamblers (regular and at-risk gamblers). The participants had volunteered to use the tool. The functions of the tool had a high rate of initial use but a low rate of repeated use. The LCA identified five user classes. Two of the classes (self-testers and multifunctional users) were defined as high users of the tool and had a higher risk of developing gambling problems according to multinomial regression. The multifunctional users were characterized by an extensive use of all the functions while the other high usage class had an extensive use of the self-test. The three other classes were as follows: those who did not use the tool, those who visited the tool but did not engage in any of the functions, and those who only used the tool’s advice on how to decrease their gambling. Participants’ reasons for use and non-use of the tool were attributed to their degree of need of the tool and its functions. The tool’s most widely used function was the self-test that investigated the level of negative consequences faced by a user due to his or her gambling. Study II was a qualitative study investigating participants’ views, experiences and their reasons for using the tool. The study was conducted by interviewing 20 volunteer users of the tool. These semi-structured interviews were analyzed by thematic analysis. The results showed that the users had a positive attitude towards the tool and understood its purpose. The self-test was the most widely used function in this sample as well. However, the participants’ positive attitude toward the tool did not effectively encourage them to use it; they displayed low use of the tool’s functions. This paradox was explained by lack of feedback and the fact that some participants did not understand that they had registered to use the tool. Providing more feedback and tailoring the feedback to individual users were seen as ways of bridging the paradox. Study II also found that participants used the gambling website (which Playscan was linked to) in an analogue way, preparing their bets before placing them online. This limited the time they spent on the site and inhibited their use of Playscan. Study III was motivated by the extensive use of the self-test among users in Study I and Study II. The aim of Study III was to investigate the psychometric properties of the self-test (known as GamTest) to better understand how it could be used with Playscan in the most efficient way. Two thousand two hundred and thirty four respondents answered the questionnaire, along with instruments measuring depression, anxiety and another instrument measuring problems due to gambling. Factor analysis, parallel analysis, Cronbach’s alpha, and correlations were used to establish the tool’s psychometric properties. The results yielded a three-factor model, excellent reliability, and high correlation with the Problem Gambling Severity Index (PGSI), endorsing the validity of the self-test. The results also indicated that the questionnaire could be effectively shortened. Overall, the studies show that the tool has an initial high use, low repeated use and that the self-test is the most used feature. In addition, the self-test had good psychometric properties. 

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  • 9.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Chahin, Gabriel
    Savander, Samuel
    Mentzoni, Rune A.
    Gainsbury, Sally
    Measuring loot box consumption and negative consequences: Psychometric investigation of a Swedish version of the Risky Loot Box Index2022In: Addictive Behaviors Reports, ISSN 2352-8532, Vol. 16, article id 100453Article in journal (Refereed)
    Abstract [en]

    Loot boxes are products in videogames that is earned by playing a video game or by buying them. Loot boxes has similar mechanisms as a lottery and there is an ongoing debate if loot boxes are gambling. However, to understand the potential harm of loot boxes valid instruments are needed. An English study psychometrically evaluated an instrument focused on risky loot box use called the Risky Loot Box Index. The study evaluated 12 item scale and based on a factor analysis it was reduced to a five-item scale. The aim of our study is to evaluate a Swedish version of the 12-item instrument from a psychometric perspective. Two samples recruited via an online survey were used. The first sample was recruited from the gambling site Unibet. A mail with an invitation to participate was sent to esports bettors and sport bettors at the gambling site. The second sample was recruited from a Facebook forum focused on e-sports. An invitation was posted on the forum to partake in the study. A total of 195 of respondents (96% men and 4% women) with a mean age of 33.76 (SD = 12.34) answered the Unibet survey and 169 respondents (96% men and 4% women and non-binary) with a mean age of 23.89 (SD = 5.52) answered the Facebook survey. An exploratory factor analysis yielded a two-factor seven item solution. The factors were overconsumption regarding time spent on loot boxes and the other factor was focused on overconsumption of loot boxes in terms of spending money. The confirmatory factor analysis conducted in the Facebook sample validated the result from the exploratory factor analysis. The conclusion of the study is that the Swedish version of the Risky Loot Index has good psychometric properties and can used to measure risky loot box consumption. 

  • 10.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hesser, Hugo
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Usage of a Responsible Gambling Tool: A Descriptive Analysis and Latent Class Analysis of User Behavior2016In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, no 3, p. 889-904Article in journal (Refereed)
    Abstract [en]

    Gambling is a common pastime around the world. Most gamblers can engage in gambling activities without negative consequences, but some run the risk of developing an excessive gambling pattern. Excessive gambling has severe negative economic and psychological consequences, which makes the development of responsible gambling strategies vital to protecting individuals from these risks. One such strategy is responsible gambling (RG) tools. These tools track an individual’s gambling history and supplies personalized feedback and might be one way to decrease excessive gambling behavior. However, research is lacking in this area and little is known about the usage of these tools. The aim of this article is to describe user behavior and to investigate if there are different subclasses of users by conducting a latent class analysis. The user behaviour of 9528 online gamblers who voluntarily used a RG tool was analysed. Number of visits to the site, self-tests made, and advice used were the observed variables included in the latent class analysis. Descriptive statistics show that overall the functions of the tool had a high initial usage and a low repeated usage. Latent class analysis yielded five distinct classes of users: self-testers, multi-function users, advice users, site visitors, and non-users. Multinomial regression revealed that classes were associated with different risk levels of excessive gambling. The self-testers and multi-function users used the tool to a higher extent and were found to have a greater risk of excessive gambling than the other classes.

  • 11.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Jansson-Fröjmark, Markus
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Centre for Psychiatry Research, Sweden.
    Hesser, Hugo
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Experiences of Playscan: Interviews with users of a responsible gambling tool2017In: Internet Interventions, ISSN 2214-7829, Vol. 8, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Online gambling, encompassing a wide variety of activities and around-the-clock access, can be a potential risk factor for gamblers who tend to gamble excessively. Yet, the advent of online gambling has enabled responsible gambling (RG) features that may help individuals to limit their gambling behaviour. One of these features is RG tools that track gamblers' behaviour, performs risk assessments and provides advice to gamblers. This study investigated users' views and experiences of the RG tool Playscan from a qualitative perspective using a semi-structured interview. The tool performs a risk assessment on a three-step scale (low, medium and high risk). Users from every risk category were included. Twenty interviews were carried out and analysed using thematic analysis. Two main themes with associated sub-themes were identified: “Usage of Playscan and the gambling site” and “Experiences of Playscan”. Important experiences in the sub-themes were lack of feedback from the tool and confusion when signing up to use Playscan. These experiences counteracted positive attitudes that should have promoted usage of the tool. Providing more feedback directly to users is a suggested solution to increase usage of the RG tool.

  • 12.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jenny, Cisneros Örnberg
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Responsible gambling in practice: A case study of views and practices of Swedish oriented gambling companies2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 2, p. 91-107Article in journal (Refereed)
    Abstract [en]

    The Swedish gambling market faces a major change in legislation that will allow foreign-based companies to apply for a gambling licence in Sweden. A key element in the new legislation are consumer protection measures. The Swedish gambling market is currently divided between licensed companies and non-Swedish-based companies providing online gambling services without a licence in Sweden. How these companies view their responsibility for preventing gambling-related harm and how prepared they are for the new regulations are important questions regarding the new Swedish gambling market. Aims: To compare and analyse the views and practices on problem gambling and responsible gambling (RG) measures among licensed and unlicensed gambling companies on the Swedish market. Design/Methods/Data: Eleven semi-structured interviews were carried out with responsible gambling managers who are members of either of the two Swedish industry associations. Content analysis was used to analyse the interviews. Results: Non-licensed companies have implemented behaviour tracking and monitoring of gamblers in a more extensive way than licensed companies. Both the licensed and the unlicensed companies conceptualise problem gambling in a similar manner and rely on informed choice in preventing gamblers from developing problems, seemingly arguing that offering responsible gambling measures on their website is enough. Conclusions: There are several similarities in how the two types of companies define problem gambling and responsible gambling. Both groups lack a critical perspective when discussing RG. There is a need for companies not only to provide RG measures, but to take an active role in preventing harm among gamblers. Future research should focus on exploring how companies work with RG after the legislative change.

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  • 13.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
    Kottorp, Anders
    Rozental, Alexander
    Lindner, Philip
    Jansson-Fröjmark, Markus
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Psychometric properties of the Jonsson-Abbott Scale: Rasch and confirmatory factor analyses2022In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 936685Article in journal (Refereed)
    Abstract [en]

    Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.

  • 14.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Jansson-Fröjmark, Markus
    Hesser, Hugo
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    GamTest: Psychometric Evaluation in a Low-Gambling General Population2020In: Journal of Gambling Issues, E-ISSN 1910-7595, Vol. 44, p. 77-102, article id 5Article in journal (Refereed)
    Abstract [en]

    Instruments that investigate different aspects of gambling activities are needed to distinguish negative consequences. Because gambling is a complex activity that occurs both offline and online, different questionnaires are necessary for screening and risk classification. GamTest, an instrument used by several gambling companies, was designed to cover different aspects of gambling: money and time spent, as well as social, financial, and emotional consequences. This study explores GamTest’s psychometric properties in a general population. A total of 2,234 Swedish respondents completed an online survey containing demographic questions, the questionnaire (GamTest), and the Problem Gambling Severity Index (PGSI). A confirmatory factor analysis was performed and GamTest’s reliability and validity tested. The confirmatory factor analysis yielded an inclusive fit. The internal consistency (omega) for the five factors was high (.79–.91), indicating good reliability, and a high positive correlation with the PGSI supported the validity of the GamTest. The inclusive fit of the confirmatory factor analysis can be explained by the low endorsement of negative consequences of gambling in the sample. However, GamTest seems to have good reliability and validity. The utility of GamTest is discussed in relation to its psychometric properties and its use in the responsible gambling tool Playscan.

  • 15.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindner, Philip
    Jansson-Fröjmark, Markus
    Hesser, Hugo
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    GamTest: Psychometric evaluation in the general populationIn: Article in journal (Refereed)
  • 16.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Stockholm Health Care Services, Sweden; Uppsala University, Sweden.
    Lindner, Philip
    Månsson, Kristoffer N. T.
    Ojala, Olivia
    Hedman-Lagerlöf, Maria
    El Alaoui, Samir
    Rozental, Alexander
    Lundin, Johan
    Jangard, Simon
    Shahnavaz, Shervin
    Sörman, Karolina
    Lundgren, Tobias
    Jayaram-Lindström, Nitya
    Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic: A mediation study2022In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 1045709Article in journal (Refereed)
    Abstract [en]

    When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.

  • 17.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Uppsala University, Uppsala, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Oscarsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Buhrman, Monica
    Rozental, Alexander
    A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder2023In: Internet Interventions, ISSN 2214-7829, Vol. 33, article id 100652Article in journal (Refereed)
    Abstract [en]

    Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.

  • 18.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rafi, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Dropouts’ usage of a responsible gambling tool and subsequent gambling patterns2020In: Cogent Psychology, E-ISSN 2331-1908, Vol. 7, no 1, article id 1715535Article in journal (Refereed)
    Abstract [en]

    Responsible gambling measures are mainly implemented by the gambling industry to reduce excessive gambling and gambling-related harm. These measures include responsible gambling tools that target online gamblers, typically through behavior tracking, feedback, and, in some cases, advice on how to reduce gambling. Playscan is a responsible gambling tool implemented at gambling sites in several countries with many users in Norway and Sweden. Previous studies have indicated that these tools have limited repeated use. Also, the tools have shown to have a low effect on decreasing gambling behavior. Our aim has been to investigate usage and effect of Playscan among Norwegian gamblers (N = 835) that began to use Playscan and then opted out. These gamblers had a high initial use, but extensive lack of repeated use of the functions included in the tool (secondary data was used). The majority of the gamblers used Playscan for a short period of time. The results indicate that the participants did not gamble less after using Playscan (gambling data analyzed using ANOVA). A hypothesis that can be suggested is that short-term use of Playscan do not decrease the level of gambling for this sample. Also, low-risk gamblers seems to have increased their gambling after using Playscan. The results implies that level of use and length of use needs to be taken into account when evaluating the effect of responsible gambling tools. The low level of use in this sample and in other studies implies that strategies to increase is needed.

  • 19.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Rozental, Alexander
    Kottorp, Anders
    Lindner, Philip
    Jansson-Fröjmark, Markus
    Hesser, Hugo
    Further Exploration of the Psychometric Properties of GamTest: A Rasch Analysis2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 9, article id 4824Article in journal (Refereed)
    Abstract [en]

    GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population. 

  • 20.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, S.
    Rizzo, A.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial2015In: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii), Linköping: Linköping University Press , 2015, p. 20-20Conference paper (Refereed)
    Abstract [en]

    Procrastination can be defined as a voluntarily delay of an intended course of action despite expecting to be worse-off for the delay, and is considered a persistent behavior pattern that can result in major psychological suffering, which in turn can constitute a major problem for many individuals. There a not many studies available on treating procrastination. A previous Internet based RCT with guided and unguided treatment aimed to decrease procrastination yielded positive results for individuals who volunteered to receive treatment. This current study has the aim to further increase the knowledge regarding treatment for procrastination. It is a RCT comparing unguided and group treatment aimed to decrease procrastination in a student population. Demographic data from the included participants and preliminary outcome data is presented. These results are discussed and compared to the previous RCT and other studies evaluating the effect of treatment aimed to decrease procrastination.

    Download full text (pdf)
    SWEsrii 2015 Program with abstracts
  • 21.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet.
    Rozental, Alexander
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Alcohol Use and Gambling Associated with Impulsivity among a Swedish University Sample2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 4, article id 2436Article in journal (Refereed)
    Abstract [en]

    Excessive alcohol use and gambling can have negative consequences. Across countries, the risk of excessive alcohol use is more common in university populations than in the general population. However, few studies have investigated the prevalence of both alcohol use and gambling in this group. This study explores these behaviours in a Swedish university setting. In addition, this study investigates how impulsivity affects alcohol use and gambling. In total, 794 Swedish students answered an online survey. Data were analysed using descriptive statistics to determine prevalence, and multinomial logistic regression was used to determine the contribution of impulsivity, age, and sex to alcohol use and gambling. Compared to the Swedish national prevalence, the prevalence was higher for excessive alcohol use, but the prevalence of gambling was at the same level or lower. High levels of impulsivity and male sex increased the risk of excessive alcohol use, while older age lowered the risk of excessive alcohol use and gambling. The results indicate that primarily young men could benefit from primary prevention in a university setting. Also, screening for impulsivity in men might be one way to identify risk groups in a university population.

  • 22.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; The Centre for Psychotherapy, Education and Research, Sweden.
    Rozental, Alexander
    Wiklund, Emma
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Gamblers' Perception of the Playscan Risk Assessment: A Mixed-Methods Study2022In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 38, no 2, p. 591-606Article in journal (Refereed)
    Abstract [en]

    Responsible gambling (RG) tools are globally widespread; they aim to prevent or decrease the harm caused by gambling. However, existing research suggests that several included features do not decrease gambling or significantly reduce the subsequent harm. Most of the previous studies have used gambling data to understand the changes in gambling behavior. However, the literature lacks research regarding gamblers' experience and perception of RG tools, which may provide insight into increasing the usage and effectiveness of RG tools. This mixed-methods study aimed to explore gamblers' perception of their risk assessment in the RG tool Playscan regarding developing harmful gambling problems. Overall, 757 participants rated the perceived accuracy of their risk assessment and their perception of the overall RG tool that conducted the assessment. Participants were also allowed to leave a comment providing feedback, which was analyzed using thematic analysis. Quantitative data was analyzed using logistic regression and structural equation modeling. Qualitative analyses revealed that most of the participants were pleased with the risk assessment and found it helpful. Moderated mediation analysis showed that participants' assessment agreement partially mediated the association between expressing a negative view and their general view of Playscan. These results highlight the need to decrease the level of disagreement for promoting a better general view of RG tools to potentially increase their usage and effectiveness.

  • 23.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Utbud av stöd och behandling för spelproblem: En studie om utmaningar inför förtydligat ansvar i lagstiftningen2018Report (Other academic)
    Abstract [en]

    On the 1st of January 2018, the Swedish legislation was subject to change due to a need to clarify the responsibility of care givers to prevent and provide support and treatment for gambling problems. The aim of this study has been to review the current situation of available support and treatment for gambling problems in Sweden, before the change in legislation took place. The Public Health Agency of Sweden and the Support Line (a telephone hotline service) has provided relevant information. Interviews have been conducted with sixteen key actors in the gambling treatment field representing municipalities, regional health care, authorities and non-governmental organisations. The interview material was analysed using thematic analysis. Preliminary results were presented for a group of treatment providers to validate the results and to collect further comments. The study showed that support and treatment for people with gambling problems are fragmentary and arbitrary on the national level. Support and treatment is available in some parts of the country but often relying on individual treatment providers’ own engagement, which creates a vulnerable situation in terms of availability and continuity of competence. The treatment offered is mainly cognitive behavioural therapy and there is a need to diversify and integrate various treatment options for different target groups. Non-governmental organisations play an important role by offering complimentary support as such, but also when treatment is not available. The main conclusion was that the municipal social services and the regional healthcare system in general are badly equipped to meet the needs of problem gamblers due to lack of resources and competence. Further efforts to provide education for personnel and implementation of screening routines to facilitate early detection in social services and health care settings are suggested. Despite ongoing development work, the legislative changes are challenging for municipalities and regional health care to accomplish satisfactory cooperation based on the needs of gamblers and their concerned significant others. A follow-up study will take place during 2019/2020 to review the development of support and treatment for gambling problems after the implementation of the new legislation.

  • 24.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sverige .
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Utbud av stöd och behandling för spelproblem. Uppföljning av förtydligat ansvar i lagstiftningen2020Report (Other academic)
    Abstract [en]

    New legislation of the responsibility of social services and health care services to offer support and treatment for gambling problems was introduced in Sweden on the 1st of January 2018. In this report, a follow-up study of the development of help-seeking, availability of support and treatment and collaboration between care givers is presented. The aim of the study was to identify progress and remaining challenges to offer people with gambling problems and their concerned significant others the help they need. Interviews were conducted with 16 key representatives from relevant authorities, organisations, self-help groups and treatment options before the new regulations (see Forsström & Samuelsson, 2018) took place and two years after. This report also describes a survey conducted by the Public Health Agency, results from the support line for gamblers on the development of treatment availability in municipalities and regions as well as data from self-help groups.

  • 25.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Spångberg, Jessika
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Public Health Agency of Sweden, Sweden.
    Pettersson, Agneta
    Brolund, Agneta
    Odeberg, Jenny
    A systematic review of educational programs and consumer protection measures for gambling: an extension of previous reviews2021In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 29, no 5, p. 398-412Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Besides supply reduction, preventive interventions to reduce harm from gambling include interventions for the reduction of demand and to limit negative consequences. Several interventions are available for gamblers, e.g. limit-setting. Reviews have been published examining the evidence for specific measures as well as evaluating the effect of different measures at an overall level. Only a few of these have used a systematic approach for their literature review. The aim of this systematic review and meta-analysis is twofold. First, to assess the certainty of evidence of different preventive measures in the field of educational programs and consumer protection measures, including both land-based and online gambling. The second is to present shortcomings in eligible studies to highlight what type of information is needed in future studies.

    Method: This systematic review included measures administered in both real-life settings and online. Twenty-eight studies fulfilled our inclusion criteria and had low or moderate risk of bias.

    Results: The results showed that only two measures (long term educational programs and personalized feed-back) had an impact on gambling behavior. Follow-up period was short, and measures did not include gambling as a problem. The certainty in most outcomes, according to GRADE, was very low. Several shortcomings were found in the studies.

    Discussion: We concluded that the support for preventive measures is low and that a consensus statement regarding execution and methods to collect and analyze data for preventive gambling research is needed. Our review can serve as a starting point for future responsible gambling reviews since it evaluated certainty of evidence.

    Download full text (pdf)
    fulltext
  • 26.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Sundström, Christopher
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Berman, Anne H.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Internet-Delivered Cognitive Behavioral Therapy for Problematic Alcohol Use in a Workplace Setting: Protocol for Quantitative and Qualitative Evaluation of Feasibility and Outcomes2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 7, article id e18693Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based cognitive behavioral therapy (ICBT) for mental health issues has been successfully implemented in routine health care settings, and research indicates that ICBT can also be applied to decrease problematic alcohol use in workplace settings. However, studies investigating the feasibility of implementing ICBT in a workplace setting have been lacking.

    Objective: The current study aims to investigate the feasibility of delivering ICBT for problematic alcohol use within an employee assistance program (EAP).

    Methods: The study has a quantitative naturalistic design, quantitively comparing ICBT and face-to-face treatment, and allowing for qualitative interviews with employees and employers. Recruitment of participants follows a five-session in-person psychological assessment at an EAP regarding an employee's presumed problematic alcohol consumption. All assessed employees referred to ICBT or face-to-face treatment will be offered participation in the study. Interviews will be held with employees and their employer representatives following ICBT to elucidate both stakeholders' experience and perception of ICBT and its context. Outcome comparisons between ICBT and face-to-face treatment will be assessed quantitatively using a Reliable Change Index and analysis of variance. Thematic analysis and Grounded Theory will be used to analyze the interview material.

    Results: The study is set to begin in April 2020 and to end in September 2021. The aim is to recruit up to 150 participants to the quantitative part of the study and 45 participants (15 employees and 30 employer representatives) to the qualitative part of the study.

    Conclusions: The current study will provide knowledge that is lacking and urgently needed on how to implement ICBT for problematic alcohol use in a workplace setting.

  • 27. Kjellberg, Alexa
    et al.
    Holmberg, Laura
    Oscarsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Treatment related helping and hindering factors for iCBT for ADHD symptoms: A qualitative study2023In: Abstracts from the 12th Swedish Congress on internet interventions (SWEsrii), Uppsala University, Sweden, 2023, p. 6-Conference paper (Other academic)
    Abstract [en]

    Attention deficit hyperactivity disorder (ADHD) is a condition with symptoms such as hyperactivity, impulsivity, lack of attention. ADHD can affect every day for an individual in a comprehensive way leading to poor performance and negative consequences. However, little is known about what influences treatment success and what patients experience as helping and hindering in this context. The aim of this current study is to evaluate helping and hindering factors for undergoing iCBT for ADHD. An additional focus on helping and hindering factors outside the treatment setting also included. Participants are recruited from a randomized controlled trial and those who completed the treatment is asked to participate in the study. The goal of the treatment is to increase everyday functioning and decrease ADHD symptoms. Participants are interviewed via telephone using a semi-structured interview guide and transcribed ad verbatim. The interviews are analyzed using thematic analysis. The results regarding helping and hindering factors are discussed in relation to treatment adherence and outcome of treatment. The study will inform how future treatments can be implemented in a better way.

  • 28.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Frykheden, Ola
    Andersson, Erik
    Ljótsson, Brjann
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The Brunnsviken Brief Quality of life scale (BBQ): a novel, free self-rating scale of subjective quality of life2015Conference paper (Other academic)
  • 29.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Jonsson, Jakob
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Berman, Anne H.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Transitioning Between Online Gambling Modalities and Decrease in Total Gambling Activity, but No Indication of Increase in Problematic Online Gambling Intensity During the First Phase of the COVID-19 Outbreak in Sweden: A Time Series Forecast Study2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 554542Article in journal (Refereed)
    Abstract [en]

    Introduction: The COVID-19 outbreak will likely have a public health impact beyond immediate disease transmission. Little is known about whether social distancing and other societal changes has provoked an increase in gambling, whether decreased betting opportunities due to paused sports events spurred gamblers to transition to online casino gambling, or whether any of these factors have had an impact on problem gambling.

    Methods: Data on lookup queries against the Swedish Gambling Paus registry, logging all initiated gambling sessions by all licensed gambling providers, from 2019-01-01 (start of registry) to 2020-04-08 (well into the first phase of the outbreak) were analyzed using TBATS time series forecasting to estimate trends after the first domestic COVID-19 death. Obfuscated data on daily total wagered and deposited amounts, split by modality (casino or betting, and low and high intensity, respectively) for the equivalent period were supplied by a licensed online gambling provider.

    Results: Total gambling activity decreased by 13.29% during the first phase of the outbreak compared to forecast. Analyses of online gambling data revealed that although betting decreased substantially in synchrony with a slight increase in online casino gambling, there was no increase in likely problematic, high-intensity gambling and neither did total online gambling increase.

    Conclusions: This first, preliminary study revealed no increase in Swedish gambling activity, total or specifically online, in the first phase of the COVID-19 outbreak. Future research should examine whether pandemic-induced transitioning between gambling modalities and/or increased participation in gambling, leads to long-term effects on prevalence of problem gambling.

  • 30.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Frykheden, Ola
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Erik
    Ljótsson, Brjánn
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 3, p. 182-195Article in journal (Refereed)
    Abstract [en]

    Measurements of subjective quality of life (QoL) are an important complement to symptom ratings in clinical research and practice. Despite there being several established QoL self-rating scales, we identified a need for a freely accessible, easy-to-use inventory, validated for use with both clinical and non-clinical samples, based on the overall life satisfaction conceptualization of QoL. The Brunnsviken Brief Quality of life scale (BBQ) was designed to meet these requirements. Items were selected by performing a factor analysis on a large data-set of QoL ratings collected previously. Six life areas (Leisure time, View on life, Creativity, Learning, Friends and Friendship, and View of self) were identified as important for overall QoL and were included in the BBQ. A psychometric evaluation was performed using two independent samples: healthy undergraduate students (n = 163), and a sample seeking treatment for social anxiety disorder (n = 568). Results suggested a unifactorial structure, with good concurrent and convergent validity, high internal and test-retest reliability, and accurate classification ability. We conclude that the BBQ is a valid and reliable measure of subjective QoL for use in clinical and research settings. The BBQ is presently available in 31 languages and can be freely downloaded from www.bbqscale.com.

  • 31.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 748-748Conference paper (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) is a common disorder associated with impaired quality of life (QoL), that indexes anxious distress and avoidance related to social situations. The DSM-5 features a specifier to delineate those with only performance-related social anxiety, yet little is known whether performance- and interaction-related anxieties have a differential impact on total QoL and on different QoL domains. To investigate this, we pooled screening data from eight intervention studies for SAD (n = 2017). Total sample mean age was 35.28 (SD = 12.26) and 69% were female. SAD symptoms were measured using the self-rated Liebowitz Social Anxiety Scale with items classified as measuring either performance or interaction anxiety. QoL, both total and across four domains, was measured using the Quality of Life Inventory. Data was analyzed using multiple regression models featuring the two anxiety scores as predictors, and by simulating the Performance-only specifier through 2˙2 median-split subgrouping and standard ANOVAs. Both interaction and performance anxieties were independently associated with lower QoL in general and across domains. Interaction anxiety had a larger negative impact on Personal Growth- and Achievement-related QoL than performance anxiety. The High-Performance/Low-Interaction-group rated higher Achievement-related QoL compared to the Low-Performance/High-Interaction-group (p = .012), yet groups were matched on total QoL and on other domains. Other group differences were in the expected direction.

    QoL impairments in SAD is primarily driven by number of feared social situations, and only secondarily by types of fear social situations, with interaction anxiety having a larger, negative impact on some QoL domains.

  • 32. Rozental, Alexander
    et al.
    Bennett, Sophie
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ebert, David D.
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis2018In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 9, article id 1588Article, review/survey (Refereed)
    Abstract [en]

    Background: Procrastination can be stressful and frustrating, but it seldom causes any major distress. However, for some people, it can become problematic, resulting in anxiety, lowered mood, physical complaints, and decreased well-being. Still, few studies have investigated the benefits of targeting procrastination. In addition, no attempt has previously been made to determine the overall efficacy of providing psychological treatments.

    Methods: A systematic review and meta-analysis was conducted by searching for eligible records in Scopus, Proquest, and Google Scholar. Only randomized controlled trials comparing psychological treatments for procrastination to an inactive comparator and assessing the outcomes by a self-report measure were included. A random effects model was used to determine the standardized mean difference Hedge's g at post-treatment. Furthermore, test for heterogeneity was performed, fail-safe N was calculated, and the risk of bias was explored. The study was pre-registered at Prospero: CRD42017069981.

    Results: A total of 1,639 records were identified, with 12 studies (21 comparisons, N = 718) being included in the quantitative synthesis. Overall effect size g when comparing treatment to control was 0.34, 95% Confidence Interval [0.11, 0.56], but revealing significant heterogeneity, Q(20) = 46.99, p < 0.00, and I2 = 61.14%, 95% CI [32.83, 84.24]. Conducting a subgroup analysis of three out of four studies using cognitive behavior therapy (CBT) found an effect size g of 0.55, 95% CI [0.32, 0.77], and no longer showing any heterogeneity, Q(4) = 3.92, p = 0.42, I2 = 0.00%, 95% CI [0.00, 91.02] (N = 236). Risk of publication bias, as assessed by the Egger's test was not significant, z = −1.05, p = 0.30, fail-safe N was 370 studies, and there was some risk of bias as rated by two independent researchers. In terms of secondary outcomes, the self-report measures were too varied to present an aggregated estimate.

    Conclusions: Psychological treatments seem to have small benefits on procrastination, but the studies isplayed significant between-study variation. Meanwhile, CBT was associated with a moderate benefit, but consisted of only three studies. Recommendations for future research are provided, including the use of more valid and reliable outcomes and a screening interview at intake.

  • 33. Rozental, Alexander
    et al.
    Bennett, Sophie
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ebert, David
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis2019In: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume II. Posters / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 2, p. 310-310Conference paper (Refereed)
    Abstract [en]

    Introduction: Procrastination can be stressful and frustrating, but it seldom causes any major distress. However, for some people, it can become problematic, resulting in anxiety, lowered mood, physical complaints, and decreased well-being. Still, few studies have investigated the benefits of targeting procrastination. In addition, no attempt has previously been made to determine the overall efficacy of providing psychological treatments.

    Method: A systematic review and meta-analysis was conducted by searching for eligible records in Scopus, Proquest, and Google Scholar. Only randomized controlled trials comparing psychological treatments for procrastination to an inactive comparator and assessing the outcomes by a self-report measure were included. A random effects model was used to determine the standardized mean difference Hedge’s g at post- treatment. Furthermore, test for heterogeneity was performed, fail-safe N was calculated, and the risk of bias was explored. The study was pre-registered at Prospero: CRD42017069981.

    Results: A total of 1639 records were identified, with twelve studies (21 comparisons, N = 718) being included in the quantitative synthesis. Overall effect size g when comparing treatment to control was 0.34, 95% Confidence Interval [0.11, 0.56], but revealing significant heterogeneity, Q(20) = 46.99, p < .00, and I2 = 61.14%, 95% CI [32.83, 84.24]. Conducting a subgroup analysis of three out of four studies using cognitive behavior therapy (CBT) found an effect size g of 0.55, 95% CI [0.32, 0.77], and no longer showing any heterogeneity, Q(4) = 3.92, p = 0.42, I2 = 0.00%, 95% CI [0.00, 91.02] (N = 236). Risk of publication bias, as assessed by the Egger’s test was not significant, z = -1.05, p = 0.30, fail-safe N was 370 studies, and there was some risk of bias as rated by two independent researchers. In terms of secondary outcomes, the self-report measures were too varied to present an aggregated estimate.

    Discussion: Psychological treatments seem to have small benefits on procrastination, but the studies displayed significant between-study variation. Meanwhile, CBT was associated with a moderate benefit, but consisted of only three studies. Recommendations for future research are provided, including the use of more valid and reliable outcomes and a screening interview at intake.

  • 34. Rozental, Alexander
    et al.
    Buhrman, Monica
    Jovicic, Filip
    Gelberg, Olle
    Molin, Katarina
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Treating perfectionism using internet-based cognitive behavior therapy: Comparing two types of treatment2022In: Abstracts from the 11th Swedish Congress on internet interventions (SWEsrii), Gothenburg, Sweden, 23-24 May 2022, Linköping: Linköping University Electronic Press, 2022, p. 11-11Conference paper (Refereed)
    Abstract [en]

    Introduction: Perfectionism is characterized by setting high standards and being concerned about performance, which can have a negative impact on interpersonal relationships and psychological wellbeing. Cognitive behavior therapy (CBT), administered in a face-to-face setting and via the Internet, has previously demonstrated promising effects with regard to symptoms of perfectionism and related problems, for example depression. However, no clinical trial has used an active comparator. In the current study, Internet-based CBT (iCBT) was compared to Internet-based Unified Protocol (iUP) for self-referred participants seeking treatment for perfectionism.

    Methods: In total, 138 participants were deemed eligible and randomized to receive two types of treatment via the Internet, iCBT and iUP. Eight modules over eight weeks were distributed, containing both psychoeducation and homework assignments. If needed, participants could also receive support on demand from three therapists. A number of self-report measures were administered prior to and after the treatment period. At the time of the conference, the results of both conditions will be analyzed using an intention-to-treat, mixed model-analysis, applying maximum likelihood estimation to account for missing data.

    Results: Results from the post-treatment assessment showed that half of the participants (52.9%) had opened all of the eight modules, with no difference between the conditions. For the main outcome measure, the Clinical Perfectionism Questionnaire, the within-group effect size Cohen’s d was 1.61 for iCBT and 1.83 for iUP. For the secondary outcome measures, effects ranged from d 0.33 to 0.67. At the time of the conference, additional results from two follow-up assessments, six- and 12-months, will also be presented.

    Conclusion: Perfectionism can lead to significant difficulties and sometimes warrant treatment. CBT has been shown to benefit those affected by helping them change inflexible standards, refute cognitive biases, experiment with more flexible behaviors, and basing one’s self-worth on more than performance. The current study replicates prior research findings that CBT for perfectionism can successfully be delivered via the Internet, which could help disseminate an effective treatment to those in need.

  • 35.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsell, E.
    Svensson, A.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Understanding and treating procrastination2015Conference paper (Other academic)
    Abstract [sv]

    Prokrastinering definieras som beteendet att medvetet förhala ett tilltänkt handlingsförlopp, trots medvetenhet om att det kan medföra negativa konsekvenser. Utöver att påverka prestationen på en given uppgift eller aktivitet har prokrastinering även visat sig vara associerat med sämre psykisk och fysisk hälsa. Trots detta är forskning på effektiva behandlingsinterventioner för prokrastinering ytterst begränsat. Aktuellt symposium syftar till att delge resultaten från två kliniska studier där kognitiv beteendeterapi har använts i behandling av personer med svåra problem av prokrastinering, dels i form av Internetbaserad självhjälpsbehandling, dels i form av gruppbehandling. Utöver en presentation av utfallet ges dessutom en genomgång av en klusteranalys av de deltagare som har sökt hjälp för prokrastinering, vilken visar på behovet av noggrann screening och god differentialdiagnostik inför en behandling.

  • 36.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsell, Erik
    Svensson, Andreas
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Differentiating procrastinators from each other: A cluster analysis2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 6, p. 480-490Article in journal (Refereed)
    Abstract [en]

    Procrastination refers to the tendency to postpone the initiation and completion of a given course of action. Approximately one-fifth of the adult population and half of the student population perceive themselves as being severe and chronic procrastinators. Albeit not a psychiatric diagnosis, procrastination has been shown to be associated with increased stress and anxiety, exacerbation of illness, and poorer performance in school and work. However, despite being severely debilitating, little is known about the population of procrastinators in terms of possible subgroups, and previous research has mainly investigated procrastination among university students. The current study examined data from a screening process recruiting participants to a randomized controlled trial of Internet-based cognitive behavior therapy for procrastination (Rozental et al., in press). In total, 710 treatment-seeking individuals completed self-report measures of procrastination, depression, anxiety, and quality of life. The results suggest that there might exist five separate subgroups, or clusters, of procrastinators: “Mild procrastinators” (24.93%), “Average procrastinators” (27.89%), “Well-adjusted procrastinators” (13.94%), “Severe procrastinators” (21.69%), and “Primarily depressed” (11.55%). Hence, there seems to be marked differences among procrastinators in terms of levels of severity, as well as a possible subgroup for which procrastinatory problems are primarily related to depression. Tailoring the treatment interventions to the specific procrastination profile of the individual could thus become important, as well as screening for comorbid psychiatric diagnoses in order to target difficulties associated with, for instance, depression.

  • 37.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsell, Erik
    Svensson, Andreas
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psychometric evaluation of the Swedish version of the pure procrastination scale, the irrational procrastination scale, and the susceptibility to temptation scale in a clinical population2014In: BMC Psychology, E-ISSN 2050-7283, Vol. 2, article id 54Article in journal (Refereed)
    Abstract [en]

    Background: Procrastination is a prevalent self-regulatory failure associated with stress and anxiety, decreased well-being, and poorer performance in school as well as work. One-fifth of the adult population and half of the student population describe themselves as chronic and severe procrastinators. However, despite the fact that it can become a debilitating condition, valid and reliable self-report measures for assessing the occurrence and severity of procrastination are lacking, particularly for use in a clinical context. The current study explored the usefulness of the Swedish version of three Internet-administered self-report measures for evaluating procrastination; the Pure Procrastination Scale, the Irrational Procrastination Scale, and the Susceptibility to Temptation Scale, all having good psychometric properties in English.

    Methods: In total, 710 participants were recruited for a clinical trial of Internet-based cognitive behavior therapy for procrastination. All of the participants completed the scales as well as self-report measures of depression, anxiety, and quality of life. Principal Component Analysis was performed to assess the factor validity of the scales, and internal consistency and correlations between the scales were also determined. Intraclass Correlation Coefficient, Minimal Detectable Change, and Standard Error of Measurement were calculated for the Irrational Procrastination Scale.

    Results: The Swedish version of the scales have a similar factor structure as the English version, generated good internal consistencies, with Cronbach’s α ranging between .76 to .87, and were moderately to highly intercorrelated. The Irrational Procrastination Scale had an Intraclass Correlation Coefficient of .83, indicating excellent reliability. Furthermore, Standard Error of Measurement was 1.61, and Minimal Detectable Change was 4.47, suggesting that a change of almost five points on the scale is necessary to determine a reliable change in self-reported procrastination severity.

    Conclusions: The current study revealed that the Pure Procrastination Scale, the Irrational Procrastination Scale, and the Susceptibility to Temptation Scale are both valid and reliable from a psychometric perspective, and that they might be used for assessing the occurrence and severity of procrastination via the Internet.

  • 38.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Almquist Tangen, Josefine
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Experiences of undergoing Internet-based cognitive behavior therapy for procrastination: A qualitative study2015In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 3, p. 314-322Article in journal (Refereed)
    Abstract [en]

    Internet interventions constitute a promising and cost-effective treatment alternative for a wide range of psychiatric disorders and somatic conditions. Several clinical trials have provided evidence for its efficacy and effectiveness, and recent research also indicate that it can be helpful in the treatment of conditions that are debilitating, but do not necessarily warrant more immediate care, for instance, procrastination, a self-regulatory failure that is associated with decreased well-being and mental health. However, providing treatment interventions for procrastination via the Internet is a novel approach, making it unclear how the participants themselves perceive their experiences. The current study thus investigated participants' own apprehension of undergoing Internet-based cognitive behavior therapy for procrastination by distributing open-ended questions at the post-treatment assessment, for instance, “What did you think about the readability of the texts”, “How valuable do you believe that this treatment has been for you?”, and “The thing that I am most displeased with (and how it could be improved) is …”. In total, 75 participants (50%) responded, and the material was examined using thematic analysis. The results indicate that there exist both positive and negative aspects of the treatment program. Many participants increased their self-efficacy and were able to gain momentum on many tasks and assignments that had been deferred in their everyday life. Meanwhile, several participants lacked motivation to complete the exercises, had too many conflicting commitments, and were unable to keep up with the tight treatment schedule. Hence, the results suggest that Internet interventions for procrastination could profit from individual tailoring, shorter and more manageable modules, and that the content need to be adapted to the reading comprehension and motivational level of the participant.

  • 39. Rozental, Alexander
    et al.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Hussoon, Ayah
    Klingsieck, Katrin B.
    Procrastination Among University Students: Differentiating Severe Cases in Need of Support From Less Severe Cases2022In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 783570Article in journal (Refereed)
    Abstract [en]

    Procrastination refers to voluntarily postponing an intended course of action despite expecting to be worse off for this delay, and students are considered to be especially negatively affected. According to estimates in the literature, at least half of the students believe procrastination impacts their academic achievements and well-being. As of yet, evidence-based ideas on how to differentiate severe from less severe cases of procrastination in this population do not exist, but are important in order to identify those students in need of support. The current study recruited participants from different universities in Sweden to participate in an anonymous online survey investigating self-rated levels of procrastination, impulsivity, perfectionism, anxiety, depression, stress, and quality of life. Furthermore, diagnostic criteria for pathological delay (PDC) as well as self-report items and open-ended questions were used to determine the severity of their procrastination and its associated physical and psychological issues. In total, 732 participants completed the survey. A median-split on the Pure Procrastination Scale (PPS) and the responses to the PDC were used to differentiate two groups; “less severe procrastination” (PPS ≤ 2.99; n = 344; 67.7% female; M age = 30.03; SD age = 9.35), and “severe procrastination” (PPS ≥ 3.00; n = 388; 66.2% female; M age = 27.76; SD age = 7.08). For participants in the severe group, 96–97% considered procrastination to a problem, compared to 42–48% in the less severe group. The two groups also differed with regard to considering seeking help for procrastination, 35–38% compared to 5–7%. Participants in the severe group also reported more problems of procrastination in different life domains, greater symptoms of psychological issues, and lower quality of life. A thematic analysis of the responses on what physical issues were related to procrastination revealed that these were characterized by stress and anxiety, e.g., tension, pain, and sleep and rest, while the psychological issues were related to stress and anxiety, but also depression, e.g., self-criticism, remorse, and self-esteem. The current study recommends the PPS to be used as an initial screening tool, while the PDC can more accurately determine the severity level of procrastination for a specific individual.

  • 40. Rozental, Alexander
    et al.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Uppsala University, Sweden; Karolinska Institutet, & Stockholm Health Care Services, Sweden.
    Johansson, Magnus
    A psychometric evaluation of the Swedish translation of the Perceived Stress Scale: a Rasch analysis2023In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 690Article in journal (Refereed)
    Abstract [en]

    Background Stress reflects physical and psychological reactions to imposing demands and is often measured using self-reports. A widely-used instrument is the Perceived Stress Scale (PSS), intended to capture more general aspects of stress. A Swedish translation of the PSS is available but has not previously been examined using modern test theory approaches. The aim of the current study is to apply Rasch analysis to further the understanding of the PSS’ measurement properties, and, in turn, improve its utility in different settings.

    Methods Data from 793 university students was used to investigate the dimensionality of different version of the PSS (14, 10, and 4 items) as well as potential response patterns among the participants.

    Results The current study demonstrates that the PSS-14 has two separate factors, divided between negatively worded items (perceived stress) and positively worded items (perceived [lack of] control), although with only the negative subscale exhibiting good reliability. Response patterns were analyzed using Differential Item Functioning, which did not find an influence of gender on any of the items, but for age regarding the positive subscale (items 6 and 9). The PSS-10 also demonstrated adequate reliability for the negative subscale, but the PSS-4 was not deemed suitable as a unidimensional scale.

    Conclusions Based on the results, none of the versions of the PSS should be used by sum-scoring all of the items. Only the negative items from the PSS-14 or PSS-10 can be used as unidimensional scales to measure general aspects of stress. As for different response patterns, gender may nevertheless be important to consider, as prior research has found differences on several items. Meanwhile, content validity is discussed, questioning the relevance of anger and being upset when measuring more general aspects of stress. Finally, a table to convert the PSS-7 (i.e., negative items) ordinal sum scores to interval level scores is provided.

  • 41.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Nilsson, S.
    Mårtensson, L.
    Rizzo, A.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing certain tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress, such as, stress and anxiety. Cognitive Behavior Therapy (CBT) is often considered treatment of choice, but few studies have investigated its effectiveness in regular clinical settings. The current study explored its treatment effects using a pragmatic randomized controlled trial comparing treatment delivered during eight weeks as unguided self-help via the Internet (ICBT) or as group CBT. Methods: In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures included self-reported procrastination, depression, anxiety, and physical and psychological well-being, which were distributed at pre- and post-treatment, as well as six-month follow-up. An outcome measure of procrastination was also administered weekly. Results: Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed that both unguided ICBT and group CBT yielded large within-group effect sizes on procrastination, Cohen’s d = 1.24-1.29, 95% Confidence Interval (CI) [0.76-1.74], and small to moderate benefits for depression, anxiety, and well-being, d = 0.37-0.68, 95% CI [-0.06-1.12]. In total, 32.6% were improved at post-treatment and 45.6% at follow-up. No differences between conditions were observed directly after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in unguided ICBT showed signs of deterioration. Discussion: The findings from the current study suggest that CBT might be an effective treatment for students with problems of procrastination, but that a group format may be better for some in order to sustain their benefits over time.

  • 42.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017In: BABCP Manchester 2017: Abstract Book, 2017, p. 60-60Conference paper (Refereed)
    Abstract [en]

    Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing certain tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress, such as, stress and anxiety. Cognitive Behavior Therapy (CBT) is often considered treatment of choice, but few studies have investigated its effectiveness in regular clinical settings.

    The current study explored its treatment effects using a pragmatic randomized controlled trial comparing treatment delivered during eight weeks as unguided self-help via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures included self-reported procrastination, depression, anxiety, and physical and psychological well-being, which were distributed at pre- and posttreatment, as well as six-month follow-up. An outcome measure of procrastination was also administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates.

    The results showed that both unguided ICBT and group CBT yielded large within-group effect sizes on procrastination, Cohen's d = 1.24- 1.29, 95% Confidence Interval (CI) [0.76- 1.74], and small to moderate benefits for depression, anxiety, and well-being, d = 0.37-0.68, 95% CI [-0.06-1.12]. In total, 32.6% were improved at post-treatment and 45.6% at follow- up. No differences between conditions were observed directly after the treatment period, however, participants in group CBT continued or maintained their improvement at follow- up, while participants in unguided ICBT showed signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for students with problems of procrastination, but that a group format may be better for some in order to sustain their benefits over time. Procrastination is a common problem among university students, but few clinical trials have investigated the efficacy of different treatment interventions for this condition. The current study compared the results of CBT delivered as an unguided Internet-based treatment and CBT distributed in groups. The findings suggest that a both formats is beneficial for many individuals with difficulties of procrastination, but that group CBT could be better for some, at least in the long-run. Together with a previous randomised controlled trial of CBT for procrastination evidence now looks promising with regard to providing effective treatments for this condition, but more research is warranted in terms of improving the results and to evaluate the benefits using also behavioural measures.

  • 43.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Conference paper (Refereed)
    Abstract [en]

    Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing certain tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress, such as, stress and anxiety. Cognitive Behavior Therapy (CBT) is often considered treatment of choice, but few studies have investigated its effectiveness in regular clinical settings. The current study explored its treatment effects using a pragmatic randomized controlled trial comparing treatment delivered during eight weeks as unguided self-help via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures included self-reported procrastination, depression, anxiety, and physical and psychological well-being, which were distributed at pre- and post-treatment, as well as six-month follow-up. An outcome measure of procrastination was also administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed that both unguided ICBT and group CBT yielded large within-group effect sizes on procrastination, Cohen’s d = 1.24-1.29, 95% Confidence Interval (CI) [0.76-1.74], and small to moderate benefits for depression, anxiety, and well-being, d = 0.37-0.68, 95% CI [-0.06-1.12]. In total, 32.6% were improved at post-treatment and 45.6% at follow-up. No differences between conditions were observed directly after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in unguided ICBT showed signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for students with problems of procrastination, but that a group format may be better for some in order to sustain their benefits over time.

  • 44.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2018In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, no 2, p. 180-197Article in journal (Refereed)
    Abstract [en]

    Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress. Cognitive behavior therapy (CBT) is believed to reduce procrastination, but few studies have investigated its effectiveness in a regular clinical setting. The current study explored its effects using a pragmatic randomized controlled trialcomparing treatment delivered during 8 weeks as self-guided CBT via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures on procrastination, depression, anxiety, and well-being were distributed at pre- and posttreatment as well as 6-month follow-up. An outcome measure of procrastination was administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed large within-group effect sizes on procrastination, Cohen’s d of 1.29 for ICBT, 95% Confidence Interval (CI) [0.81, 1.74], and d of 1.24 for group CBT, 95% CI [0.76, 1.70], and small to moderate benefits for depression, anxiety, and well-being. In total, 33.7% were regarded as improved at posttreatment and 46.7% at follow-up. No differences between conditions were observed after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in self-guided ICBT showed some signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for those struggling with severe procrastination, but that a group format may be better for some to sustain their benefits over time and that the clinical significance of the results need to be investigated further.

  • 45.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, Sam
    Rizzo, Angela
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial.2014In: Internet Interventions, ISSN 2214-7829, Vol. 1, no 2, p. 84-89Article in journal (Refereed)
    Abstract [en]

    Procrastination is defined as a voluntarily delay of an intended course of action despite expecting to be worse-off for the delay, and is considered a persistent behavior pattern that can result in major psychological suffering. About one-fifth of the adult population and half of the student population are presumed having substantial difficulties due to recurrent procrastination in their everyday lives. However, chronic and severe procrastinators seldom receive adequate care due to preconceptions and the lack of understanding regarding procrastination and the treatment interventions that are assumed beneficial. Cognitive-behavioral therapy is often deemed a treatment of choice, although the evidence supporting its use is scarce, and only one randomized controlled trial has been performed. The primary aim of the proposed study is therefore to test the efficacy of cognitive-behavioral therapy delivered as either a group intervention or via the Internet. Participants will consist of students recruited through the Student Health Centre at Karolinska Institutet. A randomized controlled trial with a sample size of 100 participants divided into blocks of thirty will be used, comparing an eight-week Internet-based cognitive-behavioral therapy intervention, and an eight-week group cognitive-behavioral therapy based intervention. It is believed that the proposed study will result in two important findings. First, different treatment interventions in cognitive-behavioral therapy are assumed to be helpful for people suffering from problems caused by procrastination. Second, both an Internet-based cognitive-behavioral therapy intervention and a group intervention are presumed suitable for administering treatment for procrastination, which is considered important as the availability of adequate care is limited, particularly among students. The proposed study will increase the knowledge regarding the efficacy of different treatments of procrastination, as well as enhance the overall comprehension of the difficulties related to dilatory behavior.

  • 46. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Månsson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The Negative Effects Questionnaire: Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments2019In: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume I. Research, Applied Issues / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 1, p. 227-227Conference paper (Other academic)
    Abstract [en]

    Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggest that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically. Aims: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision. Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data was analyzed using Rasch analysis, i.e., a modern test theory application. Results: 1) the NEQ exhibits fairness in testing across sociodemographics, 2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, 3) uses a rating scale that advances monotonically in steps of 0-4, and 4) is suitable for monitoring negative effects on an item-level. Conclusion: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations

  • 47. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Kristoffer
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments2019In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 47, no 5, p. 559-572Article in journal (Refereed)
    Abstract [en]

    Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically.

    Aims: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.

    Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data were analysed using Rasch analysis, i.e. a modern test theory application.

    Results: (1) the NEQ exhibits fairness in testing across sociodemographics, (2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, (3) uses a rating scale that advances monotonically in steps of 0 to 4, and (4) is suitable for monitoring negative effects on an item-level.

    Conclusions: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

  • 48. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Kristoffer N. T.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Measuring adverse and unwanted events in psychotherapy2018Conference paper (Refereed)
    Abstract [en]

    Background: Psychotherapy offers many benefits, but research also indicate that negative effects sometimes occur. The Negative Effects Questionnaire (NEQ) was therefore developed to help researchers and clinicians determine the occurrence and characteristics of such incidents. 

    Method: The NEQ was evaluated in two studies, using data from both clinical trials and a survey distributed among individuals in the general population (Ns 653 and 564). 

    Results: The results from an exploratory factor analysis suggest that six factors could be relevant to retain: symptoms, quality, dependency, stigma, hopelessness, and failure, with poor treatment quality and therapeutic relationship having the highest self-rated negative effects. Further, the results from a Rasch analysis, a modern test theory application, suggest that the self-report measure exhibits fairness in testing across sociodemographics and that it is suitable for monitoring items with regard to their frequencies or levels of impact. Overall, 18.8% of the patients experienced more stress, 12.6% reported the resurfacing of unpleasant memories, and 12.2% were more anxious during treatment, implying that adverse and unwanted events are not uncommon in psychotherapy and may have to be monitored. 

    Conclusion: The NEQ could be a useful self-report measure to investigate negative effects in both research and clinical practice.

  • 49. Rozental, Alexander
    et al.
    Sörman, Karolina
    Ojala, Olivia
    Jangard, Simon
    El Alaoui, Samir
    Månsson, Kristoffer N. T.
    Shahnavaz, Shervin
    Lundin, Johan
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Hedman-Lagerlöf, Maria
    Lundgren, Tobias
    Jayaram-Lindström, Nitya
    Mental health in individuals with self-reported psychiatric symptoms during the COVID-19 pandemic: Baseline data from a swedish longitudinal cohort study2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 933858Article in journal (Refereed)
    Abstract [en]

    Objective: Individuals with psychiatric disorders may be both vulnerable and sensitive to rapid societal changes that have occurred during the COVID-19 pandemic. To fully understand these impacts, repeated measurements of these individuals are warranted. The current longitudinal study set out to perform monthly assessment of individuals with common psychiatric disorders using established questionnaires with a possibility for them to self- rate their symptoms, over time.

    Methods: Recruitment of individuals who identified themselves as struggling with mental health problems, living in Sweden between July 2020 and June 2021 using an online survey. The individuals answered questions on demographics, psychiatric history, current psychiatric symptoms (e.g., Patient Health Questionnaire, PHQ-9; General Anxiety Disorder, GAD-7), somatic health, health-care contacts and any changes therein during the pandemic. Monthly, longitudinal assessments are still ongoing (consenting participants provide data for 1 year), and here we present descriptive statistics from the baseline measurement. All measurements from baseline (>400 items), and follow-ups are presented in detail.

    Results: A total of 6.095 participants (average age 35 years) submitted complete baseline data. Marital status (43% single) and number of years of education (48% highest degree being high school) were evenly distributed in this population. The most common lifetime psychiatric disorder in the sample was depressive disorder (80.5%) and generalized anxiety disorder (45.9%), with a substantial proportion having severe symptoms of depression. (30.5%) and anxiety (37.1%). Lifetime suicidal ideation (75.0%) and non-suicidal self-harm (57.7%) were prevalent in the group and 14.5% reported drug use during the pandemic. Allergies (36.8%) were the most common somatic condition, followed by irritable bowel syndrome (18.7%). For those having experienced a traumatic event, 39% showed symptoms during the pandemic indicating PTSD. Regarding contact with mental health services during the pandemic, 22% had established a new contact, and 20% reported to have increased their psychiatric medication compared to before the pandemic.

    Conclusion: Baseline data collected during the pandemic from individuals in Sweden with pre-existing psychiatric disorders demonstrate that this sample represents a population suitable for an investigation on the long-term impact of the pandemic, as intended by the longitudinal investigation that is ongoing. Follow-up questionnaires over a 12-month period are being collected and will indicate how the health and well-being of this population was impacted during the changes and uncertainties that have been characteristic of the past 2 years.

  • 50.
    Sundström, Christopher
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet and Stockholm Health Care Services, Sweden.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet and Stockholm Health Care Services, Sweden.
    Berman, Anne H.
    Khadjesari, Zarnie
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    What do we know about alcohol internet interventions aimed at employees?: A scoping review2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 929782Article, review/survey (Refereed)
    Abstract [en]

    Background: Internet interventions are a promising avenue for delivering alcohol prevention to employees. The objective of this scoping review was to map all research on alcohol internet interventions aimed at employees regardless of design, to gain an overview of current evidence and identify potential knowledge gaps.

    Methods: We conducted a literature search in three data bases (PsycInfo, PubMed, and Web of Science). Eligibility criteria were that (1) the study targeted employees age ≥18 years; (2) the intervention was delivered predominantly online; (3) the study focused specifically or in part on alcohol use; and (4) the study was published in English in a peer-reviewed academic journal. Two reviewers independently screened, reviewed, and extracted data.

    Results: Twenty studies were included, of which 10 were randomized controlled trials, five were secondary analyses, three were feasibility trials, one was a cohort study and one described the rationale and development of an intervention. No qualitative studies were found. Randomized trials tended to show effects when interventions were compared to waitlists but not when more intensive interventions were compared to less intensive ones. We identified two design-related aspects where studies differed; (1) whether all applicants were included regardless of alcohol use level and (2) whether the intervention was explicitly framed as alcohol-focused or not. Significant recruitment problems were noted in several studies.

    Conclusions: Alcohol internet interventions hold promise in delivering alcohol prevention to employees, but heterogeneity in study design and difficulties in recruitment complicate interpretation of findings.

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