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  • 1.
    Binde, Per
    et al.
    University of Gothenburg.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    The Swedish translation of DSM-5 “Gambling Disorder”: Reflections on nosology and terminology2015Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, nr 2, s. 219-226Artikel i tidskrift (Refereegranskat)
    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).

  • 2.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Kottorp, Anders
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Månsson, Kristoffer
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boettcher, Johanna
    Furmark, Tomas
    Andersson, Gerhard
    The Negative Effects Questionnaire: Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments2019Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 3.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    The use and experience of responsible gambling tools: An explorative analysis of user behavior regarding a responsible gambling tool and the consequences of use2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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. 

  • 4.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hesser, Hugo
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Usage of a Responsible Gambling Tool: A Descriptive Analysis and Latent Class Analysis of User Behavior2016Ingår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, nr 3, s. 889-904Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson-Fröjmark, Markus
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Centre for Psychiatry Research, Sweden.
    Hesser, Hugo
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Experiences of Playscan: Interviews with users of a responsible gambling tool2017Ingår i: Internet Interventions, ISSN 2214-7829, Vol. 8, s. 53-62Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Jenny, Cisneros Örnberg
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Responsible gambling in practice: A case study of views and practices of Swedish oriented gambling companies2019Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, nr 2, s. 91-107Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Lindner, Philip
    Jansson-Fröjmark, Markus
    Hesser, Hugo
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    GamTest: Psychometric evaluation in the general populationIngår i: Artikel i tidskrift (Refereegranskat)
  • 8.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Nilsson, S.
    Rizzo, A.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial2015Ingår i: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii), Linköping: Linköping University Press , 2015, s. 20-20Konferensbidrag (Refereegranskat)
    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.

  • 9.
    Forsström, David
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Samuelsson, Eva
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Utbud av stöd och behandling för spelproblem: En studie om utmaningar inför förtydligat ansvar i lagstiftningen2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Den 1 januari 2018 genomfördes lagändringar som innebar ett förtydligat ansvar för socialtjänsten samt hälso-och sjukvården att förebygga, motverka och bistå individer med insatser vid spelmissbruk. Syftet med föreliggande studie var att undersöka utbudet av stöd och behandling vid spelproblem innan lagändringen trädde i kraft. En sammanställning av befintliga uppgifter från Folkhälsomyndigheten och Stödlinjen gjordes. Intervjuer genomfördes med sexton nyckelpersoner inom spelbehandlingsfältet från kommuner, landsting, myndigheter och frivilligorganisationer. Intervjumaterialet analyserades med hjälp av tematisk analys. Preliminära resultat presenterades för en grupp behandlare för att validera och få kommentarer. Undersökningen visade att stödet för personer med spelproblem varierar i landet och är fragmentariskt. På vissa orter finns behandling att tillgå, men dagens behandlingsutbud bygger på enskilda behandlare som har ett specialintresse för målgruppen. Det är ofta bara en till två behandlare i en organisation som arbetar med målgruppen vilket skapar en sårbarhet. Få personer utbildas på övergripande nivå och om en behandlare slutar ersätts sällan personen. Den behandling som erbjuds är huvudsakligen kognitiv beteendeterapi. Det finns behov av att utveckla mer specifika och integrerade behandlingsalternativ till olika målgrupper. Frivilligorganisationer fyller en viktig funktion genom att erbjuda stöd som komplement till behandling eller som alternativ och när behandling inte finns tillgänglig. Det huvudsakliga resultatet är att kommuner och landsting är dåligt rustade för att möta att målgruppen. Resurser och kompetens saknas på många håll för att tillhandahålla stöd och behandling som kan hjälpa hjälpsökande att komma ur ett problemspelande. Mer satsning på utbildning och screening föreslås som sätt att åtgärda bristerna. Även om utvecklingsarbete påbörjats innebär lagändringarna en stor utmaning för kommuner och landsting för att få till fungerande samverkan för att tillmötesgå spelares och deras anhörigas behov. En uppföljning av föreliggande studie planeras under 2019/2020 för att kartlägga hur behandlingsutbudet har utvecklats efter att lagändringen trädde i kraft.

  • 10.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Frykheden, Ola
    Andersson, Erik
    Ljótsson, Brjann
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    The Brunnsviken Brief Quality of life scale (BBQ): a novel, free self-rating scale of subjective quality of life2015Konferensbidrag (Övrigt vetenskapligt)
  • 11.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Frykheden, Ola
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Erik
    Ljótsson, Brjánn
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation2016Ingår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 3, s. 182-195Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016Ingår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 748-748Konferensbidrag (Refereegranskat)
    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.

  • 13. Rozental, Alexander
    et al.
    Bennett, Sophie
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Ebert, David D.
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis2018Ingår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, artikel-id 1588Artikel i tidskrift (Refereegranskat)
    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.

  • 14. Rozental, Alexander
    et al.
    Bennett, Sophie
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ebert, David
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis2019Ingår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume II. Posters / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 2, s. 310-310Konferensbidrag (Refereegranskat)
    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.

  • 15.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsell, E.
    Svensson, A.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Understanding and treating procrastination2015Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 16.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsell, Erik
    Svensson, Andreas
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Differentiating procrastinators from each other: A cluster analysis2015Ingår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, nr 6, s. 480-490Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsell, Erik
    Svensson, Andreas
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Psychometric evaluation of the Swedish version of the pure procrastination scale, the irrational procrastination scale, and the susceptibility to temptation scale in a clinical population2014Ingår i: BMC Psychology, E-ISSN 2050-7283, Vol. 2, artikel-id 54Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Almquist Tangen, Josefine
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Experiences of undergoing Internet-based cognitive behavior therapy for procrastination: A qualitative study2015Ingår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 3, s. 314-322Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Nilsson, S.
    Mårtensson, L.
    Rizzo, A.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Konferensbidrag (Refereegranskat)
    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.

  • 20.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Nilsson, Simon
    Mårtensson, Lina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Ingår i: BABCP Manchester 2017: Abstract Book, 2017, s. 60-60Konferensbidrag (Refereegranskat)
    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.

  • 21.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Nilsson, Simon
    Mårtensson, Lina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Konferensbidrag (Refereegranskat)
    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.

  • 22.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Nilsson, Simon
    Mårtensson, Lina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2018Ingår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, nr 2, s. 180-197Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Nilsson, Sam
    Rizzo, Angela
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial.2014Ingår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 2, s. 84-89Artikel i tidskrift (Refereegranskat)
    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.

  • 24. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Månsson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Negative Effects Questionnaire: Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments2019Ingår i: 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, s. 227-227Konferensbidrag (Övrigt vetenskapligt)
    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

  • 25. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Månsson, Kristoffer
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments2019Ingår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 47, nr 5, s. 559-572Artikel i tidskrift (Refereegranskat)
    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.

  • 26. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Månsson, Kristoffer N. T.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Measuring adverse and unwanted events in psychotherapy2018Konferensbidrag (Refereegranskat)
    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.

  • 27.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Changes in anaclitic–introjective personality dimensions, outcomes, and psychoanalytic technique: a multi-case study2014Ingår i: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 28, nr 4, s. 397-410Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates changes in latent mental structures along the anaclitic and introjective dimensions in relation to outcomes in 14 cases of publicly financed psychoanalysis. The method of prototype matching was adapted for personality assessment, and multiple outcome measures were applied. For the anaclitic cases, symptom reduction was accompanied by more mature integration of anaclitic and introjective personality dimensions, while the introjective cases showed symptom reduction without such improvement. This could indicate that sustainable change in latent mental structures is more difficult to achieve in introjective than in anaclitic patients. Further research is needed to validate these preliminary results.

  • 28.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Levander, Sonja
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Fostering change in personality configurations: anaclitic and introjective patients in psychoanalysis2015Ingår i: Book of Abstracts: Society for Psychotherapy Research 46th Annual International Meeting June 24 - 27, 2015 Philadelphia, Pennsylvania, U.S.A., 2015, s. 56-56Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Aim: Treatment goals in psychoanalysis often include changes in underlying psychological structures. Different patterns of change have been demonstrated in anaclitic and introjective patients. This study takes a further step and examines changes in the anaclitic-introjective personality configurations following psychoanalysis, as well as patients’ experiences of these changes in a series of 14 cases. Method: Outcome measures included SCL-90, SASB and SOC pretreatment, at termination and at 2-year follow-up. Personality assessments were based on repeated interviews and applying prototype-matching methodology. Patients’ experiences were explored by applying inductive thematic analysis. Results: We found a moderate increase in the other polarity, with more mature and integrated expressions of relatedness and self-definition, while still maintaining the basic personality configuration. These changes were more pronounced in the anaclitic group. On the group level, the patients improved on all self-report measures, with outcomes comparable to meta-analytic data, and the improvements continued after termination. However, outcomes on the self-report measures were more favorable in the introjective group. Patients described their experienced changes in terms of complementary personality configuration, but the introjective group described more benefits from psychoanalysis. Several patients expressed their ambivalence to these changes and a feeling of loss of their former selves. The patients’ view of their analysts and the analytic method were congruent with the patients’ primary personality configuration. Discussion: In order to reactivate developmental processes, the psychoanalytic technique has to be adjusted to the anaclitic and introjective patients’ different needs and defenses.

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