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  • 301.
    Philips, Björn
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Stockholm County Council, Sweden; Karolinska Institutet, Sweden.
    Wennberg, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD). Karolinska Institutet, Sweden.
    Konradsson, Per
    Franck, Johan
    Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study2018Inngår i: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, nr 1, s. 1-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. Methods: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. Results: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group - a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. Conclusion: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

  • 302. Powers, M. B.
    et al.
    Levin-Coon, A.
    Miller, W.
    Caven, A.
    MacClements, J.
    Oh, J.
    Bernhardt, J.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Smits, J. A. J.
    A Randomized Controlled Trial of Animated Versus Live Action Virtual Reality Therapy for Anxiety & Pain in a Level I Trauma Center2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    While virtual reality exposure therapy (VRET) shows promise as a treatment for anxiety and pain (Powers & Emmelkamp, 2008), many users complain that computer-generated virtual reality (VR) stimuli appear unrealistic, eccentric, and too much like a video game (Kwon, Powell, & Chalmers, 2013). Historically, programmers using video game assets and computer-generated imagery (CGI) created VR content. While CGI can be used to make intricate virtual environments, unless there is a team of expert digital artists, the virtual stimulus may look unrealistic and exhibit a number of graphical glitches that could prove distracting in therapy. Furthermore, CGI often suffers from the uncanny valley effect, where CGI representations of people are perceived as unsettling as the representations become more lifelike. Thus, the only method to overcome the uncanny valley effect is to present the VR as less realistic (CGI) or photorealistic. In addition, current CGI VR packages are expensive and difficult to implement in widespread medical settings. Recently, however, an exciting alternative to traditional computer-generated VR has emerged: 360-Degree 3-D HD Video VR (Live Action). The benefit of Live Action VR as opposed to CGI VR is that it is photorealistic and doesn’t cause the uncanny valley effect of CGI. In addition, the projected cost of the end product is approximately $500 and delivered using a portable VR headset. In this RCT, participants in a Level I Trauma Center reporting pain (N = 78) were randomized to waitlist, 10-minutes of CGI VR, or 10-minutes of Live Action VR. Consistent with prediction, both VR conditions showed greater reduction in anxiety relative to waitlist (p < .05). However, there was no difference between the conditions. The two VR conditions also showed significantly greater reductions in pain (p < .001) and pain interference (p < .001) relative to the waitlist with no differences between conditions. As expected, participants rated Live Action VR significantly more realistic than CGI VR (p < .001) and reported a greater sense of being in the virtual world (p < .05). Finally, 92% of participants in the waitlist preferred to view the Live Action VR.

  • 303. Powers, M.
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Recent Advances in Virtual Reality Therapy2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    This session will present recent advances in virtual reality therapy for mental disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (Virtually Better, Oculus Rift) and mobile (Samsung Gear) systems along with new stimuli and capture techniques. Together, these advances improve the efficacy and availability of high tech solutions to previous obstacles in the delivery of cognitive behavioral therapy. The first presentation will present data on the relative efficacy of enhanced (360 3D HD film) virtual reality exposure therapy (VRET) to standard VRET (animated stimuli). The second presentation will discuss the development and efficacy of gamified VRET for spider phobia compared to traditional exposure therapy along with 12-month follow-up data. The third presentation will describe combining in vivo behavioral observations to enhance in virtuo exposure. The fourth presentation will describe VR systems as a potential adjunct to treatment of stress-related disorders. The final presentation will show the relative efficacy of in vivo and in virtual exposure for social anxiety disorder. Finally, the discussant who has decades of experience in the field of VRET will cover implications and future directions in the field of VR in the treatment of mental disorders.

  • 304. Powers, Mark B.
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Technology: Bridging the Gap from Research to Practice2016Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 1, s. 1-4Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Anxiety disorders are the most common mental disorders and they account for approximately one-third of all mental health care costs. Fortunately, meta-analyses show exposure-based therapy is effective for most patients with anxiety disorders. Based on such findings, international treatment guidelines recommend exposure therapy for anxiety disorders as the gold standard. For example, the Institute of Medicine stated “the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD” (p. 97) but they did not find sufficient evidence for any other psychotherapy or pharmacotherapy. Following these guidelines should be uncomplicated, but in general therapists seem to prefer to use their clinical experience rather than research findings to improve their practice.

    Although well supported for over 50 years, most people with anxiety disorders still do not receive exposure therapy. In fact, most people with emotional disorders do not receive any treatment. This gap in what is known and what is available to patients is frustrating. Examination of obstacles to dissemination reveals how recent advances in technology may help bridge the gap. Below we briefly review some of the proposed obstacles to successful dissemination and potential technological solutions for each.

  • 305. Price, Rebecca B.
    et al.
    Kuckertz, Jennie M.
    Amir, Nader
    Bar-Haim, Yair
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wallace, Meredith L.
    Less is more: Patient-level meta-analysis reveals paradoxical dose-response effects of a computer-based social anxiety intervention targeting attentional bias2017Inngår i: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 34, nr 12, s. 1106-1115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The past decade of research has seen considerable interest in computer-based approaches designed to directly target cognitive mechanisms of anxiety, such as attention bias modification (ABM).

    Methods: By pooling patient-level datasets from randomized controlled trials of ABM that utilized a dot-probe training procedure, we assessed the impact of training "dose" on relevant outcomes among a pooled sample of 693 socially anxious adults.

    Results: A paradoxical effect of the number of training trials administered was observed for both posttraining social anxiety symptoms and behavioral attentional bias (AB) toward threat (the target mechanism of ABM). Studies administering a large (>1,280) number of training trials showed no benefit of ABM over control conditions, while those administering fewer training trials showed significant benefit for ABM in reducing social anxiety (P = .02). These moderating effects of dose were not better explained by other examined variables and previously identified moderators, including patient age, training setting (laboratory vs. home), or type of anxiety assessment (clinician vs. self-report).

    Conclusions: Findings inform the optimal dosing for future dot-probe style ABM applications in both research and clinical settings, and suggest several novel avenues for further research.

  • 306. Price, Rebecca B.
    et al.
    Wallace, Meredith
    Kuckertz, Jennie M.
    Amir, Nader
    Graur, Simona
    Cummings, Logan
    Popa, Paul
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bar-Haim, Yair
    Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias2016Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 50, s. 37-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM's mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n = 778]. Significant main effects of ABM on diagnostic remission (ABM—22.6%, control—10.8%; OR = 2.57; p = 0.006) and AB (β* (95%CI) = − 0.63 (− 0.83, − 0.42); p < 0.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤ 37 y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM's theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential.

  • 307.
    Rafi, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ivanova, Ekaterina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Effects of a workplace prevention programme for problem gambling: Study protocol for a cluster randomised controlled trial2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 9, artikkel-id e015963Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Despite being considered a public health problem, no prevention programme for problem gambling in workplace settings has been scientifically evaluated. This study aims to fill a critical gap in the field of problem gambling by implementing and evaluating a large-scale prevention programme in organisations.

    Methods and analysis: Ten organisations, with a total of n=549 managers and n=8572 employees, will be randomised to either receiving a prevention programme or to a waitlist control condition. Measurements will be collected at the baseline and 3, 12 and 24 months after intervention. The primary outcome of interest is the managers’ inclination to act when worried or suspicious about an employee’s problem gambling or other harmful use. Additional outcomes of interest include the Problem Gambling Severity Index and gambling habits in both managers and employees. Furthermore, qualitative analyses of the responses from semistructured interviews with managers will be performed.

    Ethics and dissemination: This study has been approved by the regional ethics board of Stockholm, Sweden, and it will contribute to the body of knowledge concerning prevention of problem gambling. The findings will be published in peer-reviewed, open-access journals.

    Trial registration number: NCT02925286; Pre-results.

  • 308.
    Rafi, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ivanova, Ekaterina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Lindfors, Petra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Participants' Experiences of a Workplace-Oriented Problem Gambling Prevention Program for Managers and HR Officers: A Qualitative Study2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 1494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Workplace health promotion programs (WHPPs) refer to a set of health promotion and protection strategies implemented at a worksite and designed to meet the health and safety needs of employees. One important question for WHPPs is how middle management experience their participation in a WHPP. This study aims to explore this question further by applying a qualitative content analysis to interviews with thirteen managers and ten human resource officers participating in a WHPP focusing on problem gambling. The WHPP consisted of two components: policy implementation and skills-development training. The participants were interviewed about their experiences of these two components and the implementation process. The qualitative content analysis resulted in six themes: (1) Expectations of the skills-development training, (2) Experiences of and prior beliefs about problem gambling, (3) A good foundation, (4) The difficult conversation, (5) Appreciated aspects of the training sessions, and (6) Remaining obstacles. The results suggest that the presentation of cases, facts, and general knowledge was appreciated by most participants. However, participants also expressed that they would benefit from tailored interventions, more support in the policy implementation process, and following up on the results.

  • 309.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Folke, Fredrik
    Kanter, Jonathan W.
    A learning theory account of depression2016Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 57, nr 1, s. 73-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Learning theory provides a foundation for understanding and deriving treatment principles for impacting a spectrum of functional processes relevant to the construct of depression. While behavioral interventions have been commonplace in the cognitive behavioral tradition, most often conceptualized within a cognitive theoretical framework, recent years have seen renewed interest in more purely behavioral models. These modern learning theory accounts of depression focus on the interchange between behavior and the environment, mainly in terms of lack of reinforcement, extinction of instrumental behavior, and excesses of aversive control, and include a conceptualization of relevant cognitive and emotional variables. These positions, drawn from extensive basic and applied research, cohere with biological theories on reduced reward learning and reward responsiveness and views of depression as a heterogeneous, complex set of disorders. Treatment techniques based on learning theory, often labeled Behavioral Activation (BA) focus on activating the individual in directions that increase contact with potential reinforcers, as defined ideographically with the client. BA is considered an empirically well-established treatment that generalizes well across diverse contexts and populations. The learning theory account is discussed in terms of being a parsimonious model and ground for treatments highly suitable for large scale dissemination.

  • 310.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Gustavsson, Thomas
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Må dåligt: Om psykopatologi i vardagslivet2017Bok (Annet vitenskapelig)
    Abstract [sv]

    När vi ställs inför ångest, depression, självskadebeteende och psykos uppfattar vi det ofta som svårbegripligt och främmande. Med Må dåligt vill författarna öka förståelsen för psykisk ohälsa.  De visar både hur olika tillstånd yttrar sig i vardagslivet och hur allmänmänskliga psykologiska processer bidrar till dem. Bokens utgångspunkt är att psykisk ohälsa utvecklas i samspel mellan den omgivande miljön och vad vi lär oss av våra erfarenheter under livet. Ett huvudbudskap är att psykisk hälsa inte är detsamma som ett liv fritt från det som kan vara plågsamt, utan det avgörande är ett liv som är värt att leva.

  • 311.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson, Billy
    The stability of treatment goals, as assessed by a Swedish version of the Bern Inventory of Treatment Goals2016Inngår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 68, nr 1, s. 30-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Formulating treatment goals has been shown to be an area of vital concern for both outcome and treatment processes. However, it is not as yet an area of structured routine assessment, either in clinical practice or in research. One possible explanation for this is the lack of validated and readily available goal assessment procedures. The present study investigated the test–retest stability of a Swedish translation of the checklist version of the Bern Inventory of Treatment Goals (BIT-C) among 30 patients in primary care. We calculated the consistency of the endorsement of the different therapeutic goal categories over a 2-week period prior to treatment. There were no changes in symptoms or quality-of-life-related measures between the two assessment points. Overall, the goal category items in BIT-C were found to demonstrate moderate to substantial reliability. In conclusion, even though our study was small, it provided initial psychometric support for the Swedish version of BIT-C as a clinically useful tool for the assessment of treatment goals.

  • 312.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson, Billy
    Treatment goals and their attainment: A structured approach to assessment and evaluation2016Inngår i: The Cognitive Behaviour Therapist, ISSN 0965-5794, E-ISSN 1754-470X, Vol. 9, artikkel-id e2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Treatment goals are considered a vital part of therapeutic work, and their role is often emphasized in cognitive behavioural therapy (CBT). However, the attainment of goals is rarely accounted for in terms of treatment outcome. In this study, we set out to investigate a structured format for goal assessment and goal attainment in CBT delivered as routine care. We were especially interested in the sensitivity to change in perceived goal attainment. Patients completed a self-administered version of the Bern Inventory of Treatment Goals (BIT-C) and rated their perceived attainment on a maximum of five prioritized goals before and after 12 weeks of treatment, along with measures on anxiety, depression and health-related quality of life. The results indicated that the prioritized goals only partially correspond to disorder-specific concerns, and that perceived proximity to treatment goals is clearly associated with improvements following treatment. The results are discussed in terms of the BIT-C being a promising tool for use in clinical settings in assessing treatment goals as well as in evaluating the attainment of these goals.

  • 313.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Molander, Olof
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Stockholm County Council, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    What can be learned about gambling from a learning perspective?: A narrative review2019Inngår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 71, nr 4, s. 303-322Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Gambling is a field that harbors both harmless recreational activities and pathological varieties that may be considered an addictive disorder. It is also a field that deserves special interest from a learning theoretical perspective, since pathological gambling represents both a pure behavioral addiction involving no ingestion of substances and behavior that exhibits extreme resistance to extinction. As the field of applied psychology of learning, or behavior analysis, espouses a bottom-up approach, the basis of understanding begins in basic research on behavioral principles. This article provides a narrative review of the field of laboratory experiments conducted to disentangle the learning processes of gambling behavior. The purpose of this review is to give an overview of learning principles in gambling that has been demonstrated under lab conditions and that may be of importance in the development of clinical applications when gambling has become a problem. Several processes, like the importance of delay and probability discounting, reinforcement without actual winning, and rule governed behavior have been experimentally verified. The common denominator appears to be that they impede extinction. Other areas, especially Pavlovian conditioning, are scarce in the literature. Our recommendations for the future would be to study Pavlovian and instrumental conditioning in interaction. Treatment programs should profit from strategies that serve to enhance extinction learning. We also conclude that online gambling should provide a promising environment for controlled research on how to limit excessive gambling, provided that the gambling companies are interested in that.

  • 314. Riise, Eili N.
    et al.
    Kvale, Gerd
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; The Karolinska Institute, Sweden.
    Skjold, Solvei Harila
    Hansen, Bjarne
    Concentrated exposure and response prevention for adolescents with obsessive-compulsive disorder: A replication study2018Inngår i: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 19, s. 15-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A previous effectiveness study (Riise et al., 2016) demonstrated promising findings from a 4-day concentrated exposure and response prevention (ERP) treatment, the Bergen 4-day treatment (B4DT), for adolescents with obsessive-compulsive disorder (OCD). The present study investigated whether the results reported in the original study were replicated in a new sample of adolescents. Forty-one referred patients aged 11–18 underwent treatment at an outpatient clinic, as part of public health care. Treatment was delivered to 2–4 patients and their parents simultaneously, during four consecutive days, followed by a three-week period of self-administered ERP. Obsessive-compulsive symptoms were assessed at pre-treatment, post-treatment, 3- and 6-month follow-up. The results demonstrated significant reductions in OCD-symptoms. Remission was achieved by 33 patients (80%) at post-treatment, and 30 (73%) at follow-up. At post-treatment or follow-up there were no significant differences between the present sample and the sample in Riise et al. (2016) on OCD-severity or on rates of response or remission. The results demonstrate that the treatment was successfully replicated in a new sample and adds further support to the efficacy of the B4DT. Findings suggest that a concentrated treatment format with prolonged sessions might be a viable option to improve treatment outcomes of ERP.

  • 315. Riise, Eili N.
    et al.
    Kvale, Gerd
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. The Karolinska Institute, Sweden.
    Skjold, Solvei Harila
    Hansen, Bjarne
    Does Family Accommodation Predict Outcome of Concentrated Exposure and Response Prevention for Adolescents?2019Inngår i: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 50, nr 6, s. 975-986Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Findings suggest that increased levels of family accommodation are associated with a poorer treatment outcome in obsessive-compulsive disorder (OCD). A concentrated treatment format, the Bergen 4-day treatment (B4DT), has previously demonstrated promising results in the treatment of adolescents with OCD. The present paper examined changes in family accommodation and investigated whether family accommodation predicted outcome, in a sample of 63 adolescents (age range 11-18) participating in the B4DT. There were significant reductions on CY-BOCS and FAS from pre- to post-treatment and from pre-treatment to follow-up (p < 0.001), with large within-group effect sizes on both measures. Pre-treatment levels of symptom severity or family accommodation was not found to predict outcome at post-treatment or at follow-up. Less OCD-related functional impairment at pre-treatment predicted a better outcome at both post-treatment and follow-up. The findings suggest that the B4DT significantly reduces OCD-symptoms regardless of pre-treatment levels of family accommodation or OCD severity.

  • 316. Riise, Eili N.
    et al.
    Kvale, Gerd
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Skjold, Solvei Harila
    Hansen, Hans
    Hansen, Bjarne
    Concentrated exposure and response prevention for adolescents with obsessive-compulsive disorder: An effectiveness study2016Inngår i: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 11, s. 13-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study evaluated the effectiveness of a concentrated exposure and response prevention (ERP) treatment for adolescents with obsessive-compulsive disorder (OCD). Twenty-two adolescents with OCD (range 11–17 years) received therapist-assisted ERP during four consecutive days, followed by a three week period of self-administered ERP. Treatment was delivered to 2–3 patients and their parents simultaneously at an outpatient clinic for child and adolescent psychiatry as part of standard health care. OCD-symptoms were assessed at pre-treatment, post-treatment, 3- and 6-month follow-up. The results demonstrated that patients had significant reduction in OCD-symptoms from pre- to post-treatment and the gains were maintained at follow-up. 91% (n=20) were classified as responders at post-treatment, and 77% (n=17) at six-month follow-up. Remission rates were 73% (n=16) at post-treatment and 68% (n=15) at six-month follow-up. OCD-related impairment and symptoms of anxiety and depression were significantly reduced at post-treatment and follow-up. The results suggest that concentrated ERP is a promising treatment for adolescents with OCD.

  • 317. Ritterband, L.
    et al.
    Riper, H.
    Mohr, D.
    Palermo, T.
    Kay-Lambkin, F.
    Christensen, H.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Munoz, R.
    Van de ven, P.
    Challenges, controversies, and the future of developing, evaluating, and implementing Internet interventions2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Internet intervention research has been well established in the literature over the past two decades. The hundreds, if not thousands, of high quality research trials that have been conducted and published have convincingly demonstrated feasibility, efficacy and even effectiveness. The next decade will be a critical one for the field with numerous obstacles, barriers, disputes and debates to overcome. This talk will highlight many of the known challenges and controversies as well as key areas that will need to be part of future research. Furthermore, each of these areas overlap, resulting in additional topics of needed focus. Challenges include funding, recruitment, and conflict of interests to manage; controversies include best practices for iterative development, the relationship between usage and outcome, and public concerns of technology replacing jobs; issues that intersect with both challenges and controversies include how best to address the digital divide, the use of social networking, and how to determine the best control and comparison groups in ehealth research; future issues include a need to focus on deconstruction and dissemination trials, internationalization of interventions, and a greater emphasis on cost effectiveness; issues that traverse challenges and the future include a need for greater scientific underpinnings to interventions, improving the taxonomy and overall definitions used to define applications, and how best to maintain and sustain programs; controversies/future issues include the problem of so many programs continuing to be developed and made available with little to no scientific validity; and finally, issues that cross challenges, controversies and the future include the ongoing discussions of support, meta-analyses, and stepped care. Although not comprehensive, this list will provide a useful start for discussion and help guide research for the coming years.

  • 318. Rogland, Ulrika
    et al.
    Christianson, Sven Å.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    "Jag kände mig speciell": grooming på Internet2012Bok (Annet (populærvitenskap, debatt, mm))
  • 319. Rothhaupt, Joachim
    et al.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Dreams2018Inngår i: Psychoanalytic Psychotherapy: A Handbook / [ed] Mattias Elzer, Alf Gerlach, Routledge, 2018, s. 79-90Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    Psychoanalytical dream research is concerned with three main aspects of dreaming:

    How a dream is generated (generation).

    Whether the dream contents are meaningful (meaning).

    Whether a dream works for psychological or biological needs (function).

  • 320.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Measuring negative effects / methodological challenges2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Although undermined for decades, the field of negative effects in psychotherapy has become a niche of interest in the last years. This has led to a growing body of evidence in a vast array of domains, including a deeper theoretical understanding, more accurate methodological developments and accordingly more empirical studies examining this topic. As a result of this proliferation, a diversity of conceptualizations and approaches have emerged, which are necessary to be articulated in order to gain consistency for future research projects as well as for a better application of the obtained results in the clinical practice. The current structured discussion aims to present an update of the current state and the future challenges in the study of negative effects. Hence, some of the diverse research lines that arose will be outlined, including the methodological challenges, the study of negative effects within PRN infrastructures, the role of routine outcome monitoring in identifying deterioration, the alliance ruptures, the study of negative effects in technology mediated treatments and the therapist’ perspectives. By targeting these topics, the most pending issues that should be addressed will be discussed, aiming to shed light on the unanswered questions and fostering an integrated course of action for the next years with the researchers interested in the topic.

  • 321.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects of Internet-based cognitive behavior therapy: Monitoring and reporting deterioration and adverse and unwanted events2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) has the potential of providing many patients with an effective form of psychological treatment. However, despite helping to improve mental health and well-being, far from everyone seem to benefit. In some cases, negative effects may also emerge. The overall aim of the present thesis was to establish the occurrence and characteristics of such incidents in ICBT using a combination of quantitative and qualitative methods. Study I determined deterioration, non-response, and adverse and unwanted events in a sample of 133 patients undergoing ICBT for social anxiety disorder. The results indicated that up to 6.8% fared worse during the treatment period, depending on the self-report measure and time point, as determined using the Reliable Change Index (RCI), while the non-response rate was between 29.3 to 86.5% at post treatment assessment, and 12.9% experienced other negative effects. Study II investigated the responses to open-ended questions on adverse and unwanted events among 556 patients in four separate clinical trials of ICBT; social anxiety disorder, panic disorder, major depressive disorder, and procrastination. In total, 9.3% reported negative effects, with a qualitative content analysis revealing two categories and four subcategories; patient-related, i.e., gaining insight and experiencing new symptoms, and treatment-related, i.e., difficulties applying the treatment interventions and problems related to the treatment format. Study III explored the number of patients achieving reliable deterioration, as determined using the RCI on the individual raw scores of 2866 patients from 29 clinical trials of ICBT. The results showed that the deterioration rate was higher among patients in a control condition, 17.4%, in comparison to treatment, 5.8%. Predictors were related to decreased odds of deterioration for patients receiving treatment; clinical severity at pre treatment assessment, being in a relationship, having a university degree, and being older. As for the control condition, only clinical severity at pre treatment assessment was associated with decreased odds of deterioration. Study IV examined a newly developed self-report measure for monitoring and reporting adverse and unwanted events, the Negative Effects Questionnaire. The results suggested a six-factor solution with 32 items; symptoms, quality, dependency, stigma, hopelessness, and failure. One-third of the patients reported experiencing unpleasant memories, stress, and anxiety, with novel symptoms and a lack of quality in the treatment and therapeutic relationship having the greatest negative impact. The general finding of the present thesis is that negative effects do occur in ICBT and that they are characterized by deterioration, non-response, and adverse and unwanted events, similar to psychological treatments delivered face-to-face. Researchers and clinicians in ICBT are recommended to monitor and report negative effects to prevent a negative treatment trend and further the understanding of what might contribute to their incidents. Future research should investigate the relationship between negative effects and treatment outcome, especially at follow-up, to examine if they are transient or enduring. Also, interviews could be conducted with those achieving reliable deterioration to explore if and how it is experienced by the patients and to see if it is attributed to the treatment interventions or other circumstances.

  • 322.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest selfreported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used from www.neqscale.com.

  • 323.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects of psychotherapy: Monitoring and reporting deterioration and adverse and unwanted events2017Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    Internetbaserad kognitiv beteendeterapi (IKBT) har goda förutsättningar att hjälpa människor övervinna psykisk ohälsa och förbättra sitt välmående. Trots detta är det långtifrån alla patienter som erfar en förbättring, vissa kan till och med försämras eller uppleva andra typer av negativa effekter. Aktuell presentation summerar resultatet från fyra studier inom ramen för en doktorsavhandling i psykologi som har undersökt förekomst och kännetecken av negativa effekter i IKBT. Kvantitativa och kvalitativa ansatser har använts för att utforska fenomenet bland cirka 3000 patienter. Sammanfattningsvis försämras 5,8 % av alla patienter som får IKBT, jämfört med 17,4 % i väntelista, där bland annat högre ålder, högre utbildningsnivå och att vara i ett förhållande minskar oddsen för försämring i IKBT. På öppna frågor rapporterar även 9,3 % av alla patienter nya symptom och problem att fullfölja behandlingsprogrammen som negativt. Ett nytt självskattningsformulär utvecklades för att lättare mäta dessa typer av negativa effekter, the Negative Effects Questionnaire, bestående av 32 items där faktorerna symptom och bristande kvalitet på behandlingen förklarade den största delen av variansen. Implikationerna av fynden kommer att diskuteras, liksom vikten av fortsatt forskning för att minska risken för negativa effekter inom IKBT samt kognitiv beteendeterapi.

  • 324.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Boettcher, Johanna
    Ebert, David Daniel
    Cuijpers, Pim
    Knaevelsrud, Christine
    Ljótsson, Brjánn
    Kaldo, Viktor
    Titov, Nickolai
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Consensus statement on defining and measuring negative effects of Internet interventions2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 1, s. 12-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet interventions have great potential for alleviating emotional distress, promoting mental health, and enhancing well-being. Numerous clinical trials have demonstrated their efficacy for a number of psychiatric conditions, and interventions delivered via the Internet will likely become a common alternative to face-to-face treatment. Meanwhile, research has paid little attention to the negative effects associated with treatment, warranting further investigation of the possibility that some patients might deteriorate or encounter adverse events despite receiving best available care. Evidence from research of face-to-face treatment suggests that negative effects afflict 5–10% of all patients undergoing treatment in terms of deterioration. However, there is currently a lack of consensus on how to define and measure negative effects in psychotherapy research in general, leaving researchers without practical guidelines for monitoring and reporting negative effects in clinical trials. The current paper therefore seeks to provide recommendations that could promote the study of negative effects in Internet interventions with the aim of increasing the knowledge of its occurrence and characteristics. Ten leading experts in the field of Internet interventions were invited to participate and share their perspective on how to explore negative effects, using the Delphi technique to facilitate a dialog and reach an agreement. The authors discuss the importance of conducting research on negative effects in order to further the understanding of its incidence and different features. Suggestions on how to classify and measure negative effects in Internet interventions are proposed, involving methods from both quantitative and qualitative research. Potential mechanisms underlying negative effects are also discussed, differentiating common factors shared with face-to-face treatments from those unique to treatments delivered via the Internet. The authors conclude that negative effects are to be expected and need to be acknowledged to a greater extent, advising researchers to systematically probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to share their findings in scientific journals.

  • 325. Rozental, Alexander
    et al.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    In the Absence of Effects: An Individual Patient Data Meta-Analysis of Non-response and Its Predictors in Internet-Based Cognitive Behavior Therapy2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 589Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Negative effects of psychological treatments have recently received increased attention in both research and clinical practice. Most investigations have focused on determining the occurrence and characteristics of deterioration and other adverse and unwanted events, such as interpersonal issues, indicating that patients quite frequently experience such incidents in treatment. However, non-response is also negative if it might have prolonged an ongoing condition and caused unnecessary suffering. Yet few attempts have been made to directly explore non-response in psychological treatment or its plausible causes. Internet-based cognitive behavior therapy (ICBT) has been found effective for a number of diagnoses but has not yet been systematically explored with regard to those patients who do not respond.

    Methods: The current study collected and aggregated data from 2,866 patients in 29 clinical randomized trials of ICBT for three categories of diagnoses: anxiety disorders, depression, and other (erectile dysfunction, relationship problems, and gambling disorder). Raw scores from each patient variable were used in an individual patient data meta-analysis to determine the rate of non-response on the primary outcome measure for each clinical trial, while its potential predictors were examined using binomial logistic regression. The reliable change index (RCI) was used to classify patients as non-responders.

    Results: Of the 2,118 patients receiving treatment, and when applying a RCI of z ≥ 1.96, 567 (26.8%) were classified as non-responders. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline, Odds Ratio (OR) = 2.04, having a primary anxiety disorder (OR = 5.75), and being of male gender (OR = 1.80), might have higher odds of not responding to treatment.

    Conclusion: Non-response seems to occur among approximately a quarter of all patients in ICBT, with predictors related to greater symptoms, anxiety disorders, and gender indicating increasing the odds of not responding. However, the results need to be replicated before establishing their clinical relevance, and the use of the RCI as a way of determining non-response needs to be validated by other means, such as by interviewing patients classified as non-responders.

  • 326. 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-Analysis2018Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, artikkel-id 1588Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 327. 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-Analysis2019Inngår 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. 310-310Konferansepaper (Fagfellevurdert)
    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.

  • 328.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Castonguay, L.
    Dimidjian, S.
    Lambert, M.
    Shafran, R.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects in psychotherapy: Current understanding and future research directions2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Psychotherapy can help alleviate mental distress and improve quality of life, but little is known about the potential negative effects of psychotherapy and how to determine their frequency and characteristics. Meanwhile, many researchers and clinicians are unfamiliar to the idea of patients faring worse or experiencing adverse and unwanted events during treatment. The present report thus intends to provide an overview of the current understanding and future research directions of negative effects in psychotherapy. Method: An anonymous survey was distributed to a selection of highly renowned researchers, using an analytical framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Results: The researchers recognize an increased awareness of negative effects in psychotherapy in recent years, but also describe many issues related to their definition, assessment, and reporting, e.g., the lack of a clear and coherent terminology. Both qualitative methods and naturalistic designs are regarded as important to find out what negative effects exist and how to prevent them, although a number of methodological obstacles associated with such methods are identified and need to be resolved. Discussion: Negative effects of psychotherapy are multifaceted, warranting careful considerations in order to be monitored and reported in both routine care and research settings.

  • 329. Rozental, Alexander
    et al.
    Castonguay, Louis
    Dimidjian, Sona
    Lambert, Michael
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice2018Inngår i: BJPsych Open, E-ISSN 2056-4724, Vol. 4, nr 4, s. 307-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Psychotherapy can alleviate mental distress and improve quality of life, but little is known about its potential negative effects and how to determine their frequency.

    Aims: To present a commentary on the current understanding and future research directions of negative effects in psychotherapy.

    Method: An anonymous survey was distributed to a select group of researchers, using an analytical framework known as strengths, weaknesses, opportunities and threats.

    Results: The researchers perceive an increased awareness of negative effects in psychotherapy in recent years, but also discuss some of the unresolved issues in relation to their definition, assessment and reporting. Qualitative methods and naturalistic designs are regarded as important to pursue, although a number of obstacles to using such methods are identified.

    Conclusion: Negative effects of psychotherapy are multifaceted, warranting careful considerations in order for them to be monitored and reported in research settings and routine care.

  • 330.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsell, E.
    Svensson, A.
    Andersson, G.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Overcoming procrastination: One-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: Procrastination refers to the purposeful delay of an intended course of action and can become a persistent behavioral pattern associated with reduced mood, increased stress, and poorer performance. One-fifth of the adult population and half of the student population experience significant difficulties due to procrastination, but has received little attention in clinical research. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has been found promising for several conditions, but has not yet been used in relation to procrastination. The current study thus aimed to examine the efficacy of ICBT for procrastination at post treatment and one-year follow-up, as well as to investigate predictors of change.

    Method: Participants (N = 150) were randomized to a ten-week treatment programme; guided self-help, unguided self-help, and wait-list control (receiving unguided self-help after the first treatment period). Outcome measures were administered at screening, post treatment, one-year follow-up, or weekly, consisting of the Pure Procrastination Scale (PPS), the Irrational Procrastination Scale (IPS), the Susceptibility to Temptation Scale, the Montgomery Åsberg Depression Rating Scale, the Generalized Anxiety Disorder Assessment, and the Quality of Life Inventory. Intention-to-treat was used for all statistical analyses, with mixed-effects models to assess the effect of time and group.

    Results: Moderate to large effect sizes were obtained at post treatment comparing guided and unguided self-help with wait-list control, the PPS, Cohen’s d = 0.70, 95% confidence interval (CI) [0.29, 1.10], and d = 0.50, 95% CI [0.10, 0.90], and the IPS, d = 0.81 95% CI [0.40, 1.22], and d = 0.69 95% CI [0.29, 1.09]. Clinically significant change was achieved among 31.3–40.0% for guided self-help, compared with 24.0–36.0% for unguided self-help. Neither of the treatment conditions was found to be superior on any of the outcome measures, Fs (98, 65.17-72.55) < 1.70, p > .19. One-year follow-up data has just been collected and the results of will be available at the time of the conference, including predictors of change.

    Conclusion: ICBT could be useful for managing self-reported problems of procrastination, with results at one-year follow-up and predictors of change revealing the long-term benefit and possible variables responsible for a successful treatment outcome.

  • 331.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsell, Erik
    Svensson, Andreas
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Overcoming procrastination: one-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 3, s. 177-195Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Procrastination is a common self-regulatory failure that can have a negative impact on well-being and performance. However, few clinical trials have been conducted, and no follow-up has ever been performed. The current study therefore aimed to provide evidence for the long-term benefits and investigate predictors of a positive treatment outcome among patients receiving Internet-based cognitive behavior therapy (ICBT). A total of 150 self-recruited participants were randomized to guided or unguided ICBT. Self-report measures of procrastination, depression, anxiety, and quality of life were distributed at pre-treatment assessment, post-treatment assessment, and one-year follow-up. Mixed effects models were used to investigate the long-term gains, and multiple linear regression for predictors of a positive treatment outcome, using the change score on the Irrational Procrastination Scale as the dependent variable. Intention-to-treat was implemented for all statistical analyses. Large within-group effect sizes for guided and unguided ICBT, Cohen’s d = .97–1.64, were found for self-report measures of procrastination, together with d = .56–.66 for depression and anxiety. Gains were maintained, and, in some cases, improved at follow-up. Guided and unguided ICBT did not differ from each other, mean differences −.31–1.17, 95% CIs [−2.59–3.22], and none of the predictors were associated with a better result, bs −1.45–1.61, 95% CIs [−3.14–4.26]. In sum, ICBT could be useful and beneficial in relation to managing procrastination, yielding great benefits up to one year after the treatment period has ended, with comparable results between guided and unguided ICBT.

  • 332.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsell, Erik
    Svensson, Andreas
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Overcoming procrastination: One-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 542-542Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Procrastination is defined as the voluntary delay of an intended course of action despite resulting in negative consequences. Procrastination can become a persistent behavioral pattern associated with reduced mood, increased stress, and poorer performance. Approximately one-fifth of the adult population and more than half of the student population experience significant difficulties due to procrastination. However, despite its prevalence, it has received little attention in clinical research. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has been found promising for several psychiatric conditions, but has not yet been used in relation to procrastination. The current study thus aimed to examine the efficacy of ICBT for procrastination at post treatment and one-year follow-up. Furthermore, predictors of change were investigated in order to distinguish variables that might predict at positive treatment outcome.

    Method: Self-recruited participants (N = 150) with severe and chronic procrastination were randomized to a ten-week treatment program administered via the Internet; guided self-help, unguided self-help, and wait-list control (receiving unguided self-help after the first treatment period). Outcome measures were administered at screening, post treatment, one-year follow-up, or weekly; the Pure Procrastination Scale (PPS), the Irrational Procrastination Scale (IPS), the Susceptibility to Temptation Scale, the Montgomery Åsberg Depression Rating Scale, the Generalized Anxiety Disorder – 7 Items, and the Quality of Life Inventory. The intention-to-treat principle was used for all statistical analyses.

    Results: Moderate to large effect sizes were obtained at post treatment comparing guided and unguided self-help with wait-list control, the PPS, Cohen’s d = 0.70, 95% confidence interval (CI) [0.29, 1.10], and d = 0.50, 95% CI [0.10, 0.90], and the IPS, d = 0.81 95% CI [0.40, 1.22], and d = 0.69 95% CI [0.29, 1.09]. Clinically significant change was achieved among 31.3–40.0% for guided self-help, compared with 24.0–36.0% for unguided self-help. Neither of the treatment conditions were found to be superior on any of the outcome measures, Fs (98, 65.17-72.55) < 1.70, p > .19. In terms of the outcome at the one-year follow-up, the results will be available at the time of the conference, including the analyses of predictors of change.

    Conclusion: ICBT could be useful for managing self-reported problems of procrastination, with results from post treatment revealing that both guided self-help and unguided self-help can be of great aid. Findings from the one-year follow-up and analyses of predictors of change will help to determine the long-term benefit and the possible variables responsible for a successful treatment outcome.

  • 333.
    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 groups2017Konferansepaper (Fagfellevurdert)
    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.

  • 334.
    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 groups2017Inngår i: BABCP Manchester 2017: Abstract Book, 2017, s. 60-60Konferansepaper (Fagfellevurdert)
    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.

  • 335.
    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 groups2018Inngår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, nr 2, s. 180-197Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 336.
    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 groups2017Konferansepaper (Fagfellevurdert)
    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.

  • 337. Rozental, Alexander
    et al.
    Kothari, Radha
    Wade, Tracey
    Egan, Sarah
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Shafran, Roz
    Reconsidering Perfect: A Qualitative Study of The Experiences of Undergoing Internet-Based Cognitive Behaviour Therapy for Perfectionism2019Inngår 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. 233-233Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) is a promising format for treating different psychiatric disorders. In addition, several clinical trials have found positive results for implementing transdiagnostic treatments via the Internet, as well as for using ICBT to target transdiagnostic processes, such as perfectionism. However, few qualitative studies have been conducted on the experiences of patients undergoing such treatments, making it unclear what aspects might facilitate or hinder their delivery. In the current study, patients completing twelve-week therapist-guided ICBT for perfectionism responded to open-ended questions at post-treatment. In total, 30 out of 62 (48.4%) rated the ease of understanding and completing the treatment program, as well as described their impressions of its content and the support provided by their therapist. The results were analysed qualitatively using thematic analysis. Overall, patients were satisfied, finding treatment easy to comprehend and use. Five themes were found in the responses; Learning how to do things differently, Noticing the positives, Feeling safe to be honest, A comfortable treatment format and Barriers to treatment. The results suggest that many patients were able to achieve a change in perspective in relation to their perfectionism and started facing their fears. They were also able to report the benefits of doing things differently as part of treatment, such as an improvement in their interpersonal relationships. Most patients were also positive about the treatment format, enjoying its flexibility and the encouragement offered by their therapist. However, obstacles such as conflicting commitments, personal difficulties, time-consuming and comprehensive modules, and a desire for more support were brought up by some, suggesting that there are aspects that could be considered in the future.

  • 338.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kottorp, Anders
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 6, artikkel-id e0157503Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest self-reported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used from www.neqscale.com.

  • 339.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kottorp, Anders
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 284-284Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest self-reported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used.

  • 340. 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 treatments2019Inngår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 47, nr 5, s. 559-572Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 341. 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 Treatments2019Inngår 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. 227-227Konferansepaper (Annet vitenskapelig)
    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

  • 342. 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 psychotherapy2018Konferansepaper (Fagfellevurdert)
    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.

  • 343.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, K.
    Boettcher, J.
    Andersson, G.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: During the last couple of decades research on the efficacy and effectiveness of psychological treatments has provided evidence for its use in alleviating mental distress and enhancing well-being. Meanwhile, novel ways of delivering evidence-based methods, such as, via the Internet or smartphone applications, have received increasing support, with the potential of becoming an important and widely used addition to the health care system. Internet-based cognitive behavior therapy (ICBT) has for instance been shown to be beneficial in relation to a number of psychiatric and somatic disorders. However, research has almost solely focused on the positive results, neglecting the fact that psychological treatments also might have negative effects. Investigations from face-to-face settings have found that 5-10% of all patients deteriorate, but whether this is true for ICBT has been unclear. Hence, in order to examine deterioration in cognitive behavior therapy delivered via the Internet, an individual patient data meta-analysis was performed.

    Method: Patient-level data from 29 clinical trials of ICBT for depression, anxiety disorders, and other problems, e.g., pathological gambling and erectile dysfunction, were aggregated, totaling 2866 participants receiving either a treatment or control condition. Deterioration was assessed using the Reliable Change Index on each of the primary outcome measures. Participants identified as having deteriorated were subsequently analyzed using logistic regression to find potential predictors of a negative treatment outcome.

    Results: Using only available data, a total of 89 participants (3.1%) were recognized as having reliably deteriorated from pre to post treatment assessment, with an additional 17 participants (0.6%) from pre treatment to follow-up assessment. In general, more participants (N = 56) diagnosed with an anxiety disorder deteriorated, compared to depression (N = 16), and other problems (N = 30). Results using imputed values for missing data and an exploration of predictors of deterioration will be available at the time of the conference.

    Conclusion: Preliminary evidence indicates that deterioration among participants receiving ICBT afflicts approximately 3.1%, with higher rates for anxiety disorders than depression and other problems. A closer inspection could reveal potential predictors for deterioration, which, in turn, might be used to prevent or reverse a negative treatment outcome.

  • 344.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, K.
    Boettcher, J.
    Andersson, G.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) has shown promising results in relation to treating many psychiatric disorders. However, research on the potential for negative effects of their use has been lacking. An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was thus performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models and binomial logistic regression. Missing data was handled by multiple imputation. Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21, 4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50, 0.77], and 0.51, 95% CI [0.51, 0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35, 0.95], having at least a university degree, 0.54, 95% CI [0.33, 0.88], and being older, 0.78, 95% CI, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients in a treatment condition. In sum, deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers in order to reverse and prevent a negative treatment trend.

  • 345.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Conclusion: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers in order to reverse and prevent a negative treatment trend.

  • 346.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017Inngår i: BABCP Manchester 2017: Abstract Book, 2017, s. 119-120Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. 

    An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation.

    Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition.

    Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers in order to reverse and prevent a negative treatment trend.

    Negative effects of psychological treatments is largely unknown for many researchers and clinicians. However, evidence suggest that 5-10% of all patients deteriorate during treatment and that some also experience other adverse and unwanted events. The results from the current study indicate that deterioration occurs among some patients receiving cognitive behaviour therapy via the Internet. Furthermore, certain sociodemographic variables seem to be associated with lower odds of deterioration; older age, higher educational level, being in a relationship, and having higher symptom severity at pre treatment assessment. In addition, proportionally more patients deteriorated while in wait- list control, suggesting that a better match between patient and treatment format may be required, and that there are ethical and methodological issues surrounding the use of waitings periods in randomised controlled trials.

  • 347.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For Better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 85, nr 2, s. 160-177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive–behavioral therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2,866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, odds ratios (ORs) = 3.10, 95% confidence interval (CI) [2.21, 4.34]. Clinical severity at pretreatment was related to lower odds, OR = 0.62, 95% CI [0.50, 0.77], and OR = 0.51, 95% CI [0.51, 0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, OR = 0.58, 95% CI [0.35, 0.95], having at least a university degree, OR = 0.54, 95% CI [0.33, 0.88], and being older, OR = 0.78, 95% CI, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Conclusion: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend.

  • 348.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Oscarsson, Martin
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Konsten att hålla nyårslöftet2018Inngår i: Modern psykologi, ISSN 2000-4087, nr 10, s. 26-34Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 349. Rozental, Alexander
    et al.
    Oscarsson, Martin
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Tio i tolv: en bok om att lyckas med nyårslöften, mål och beteendeförändringar2018Bok (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    När det börjar dra ihop sig till tolvslag nyårsnatten är vi många lovar att ta tag i saker under det nya året enligt undersökningar avger var åttonde man och var femte kvinna i Sverige ett nyårslöfte. Ofta håller dock våra föresatser inte särskilt länge, framåt februari är det redan glesare på gymmen. Det är vanligt att gå ut för hårt i början samtidigt som det är lätt att falla tillbaka i gamla ovanor. Efter ett bakslag eller två är det lätt att ge upp.

    Trots detta visar psykologisk forskning att nyårslöften är förvånansvärt bra på att skapa varaktiga beteendeförändringar. Det gäller bara att komma lite mer förberedd till tolvslaget, ha realistiska förutsättningar och understryka att förändringsarbetet inte handlar om en kort sprint utan snarare utgör ett maratonlopp kombinerat med hinderbana.

    Tio i tolv förklarar varför nyårslöften är ett smart sätt att komma igång med nya vanor och överge gamla. Med hjälp av studier och undersökningar inom bland annat målsättning, rutiner och prokrastinering får läsaren kunskap om hur hen lättare kan lyckas med en förändring. Intressanta rön om svenskar egna nyårslöften presenteras, varvat med handfasta tips för att lättare uppnå våra mål vare sig det handlar om ett nyårslöfte eller en nystart efter semestern.

    Boken bygger på världens största vetenskapliga studie kring människors nyårslöften, utförd av Per Carlbring, Alexander Rozental och Martin Oscarsson vid Stockholms universitet.

  • 350.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University College London, United Kingdom.
    Shafran, Roz
    Wade, Tracey D.
    Kothari, Radha
    Egan, Sarah J.
    Ekberg, Linda
    Wiss, Maria
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Guided web-based cognitive behavior therapy for perfectionism: Results from two different randomized controlled trials2018Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 4, artikkel-id e154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data.

    Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom.

    Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial.

    Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85).

    Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.

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