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  • 51.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2017Conference paper (Refereed)
    Abstract [en]

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

  • 52.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2018In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, no 2, p. 180-197Article in journal (Refereed)
    Abstract [en]

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

  • 53.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, Sam
    Rizzo, Angela
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial.2014In: Internet Interventions, ISSN 2214-7829, Vol. 1, no 2, p. 84-89Article in journal (Refereed)
    Abstract [en]

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

  • 54.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kottorp, Anders
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 284-284Conference paper (Refereed)
    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.

  • 55.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kottorp, Anders
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, article id e0157503Article in journal (Refereed)
    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.

  • 56.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Magnusson, K.
    Boettcher, J.
    Andersson, G.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Conference paper (Refereed)
    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.

  • 57.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Magnusson, K.
    Boettcher, J.
    Andersson, G.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Conference paper (Refereed)
    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.

  • 58.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017In: BABCP Manchester 2017: Abstract Book, 2017, p. 119-120Conference paper (Refereed)
    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.

  • 59.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017Conference paper (Refereed)
    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.

  • 60.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Magnusson, Kristoffer
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    For Better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2017In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 85, no 2, p. 160-177Article in journal (Refereed)
    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.

  • 61.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Malmquist, Anna
    Linköpings universitet.
    Opportunities and restrictions: A discourse analysis of lesbian womens’ experiences of creating a family through assisted reproduction in Swedish public healthcare2012Conference paper (Refereed)
    Abstract [en]

    Female same-sex couples in Sweden have had access to fertility

    treatment within public health care since 2005. Treatment is generally

    tax funded, with a minimal of personal expenses. After birth,

    both mothers gain legal status as the child’s parents. This article

    draws on findings from interviews with 29 lesbian mothers, all of

    whom have sought treatment at fertility clinics within the Swedish

    public health care system. Parts of the interviews in which the mothers

    describe deficiencies in the provided treatment have been scrutinized

    in detail. Results show how heteronormative assumptions

    about the family and a feeling of exposure in the role of patient

    give rise to vulnerability in lesbian mothers. Furthermore, neither

    routines nor the offered treatment are adapted to lesbian women’s

    specific needs. Regarding dealing with deficiencies, the interviews

    are filled with expressions of acceptance, which rhetorically minimize

    the impact of potential stressors. A main conclusion is that

    legal inclusion of lesbians in fertility treatment is of groundbreaking

    importance to lesbians with a desire to become parents. The

    next step is to address heteronormativity within the health care institutions

    in order to develop treatment adapted to lesbian couples’

    specific needs.

  • 62.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Malmquist, Anna
    Vulnerability and acceptance: Lesbian women's family-making through assisted reproduction in Swedish public health care2015In: Journal of GLBT Family Studies, ISSN 1550-428X, E-ISSN 1550-4298, Vol. 11, no 2, p. 127-150Article in journal (Refereed)
    Abstract [en]

    Female same-sex couples in Sweden have had access to fertility treatment within public health care since 2005. Treatment is generally tax funded, with a minimal of personal expenses. After birth, both mothers gain legal status as the child's parents. This article draws on findings from interviews with 29 lesbian mothers, all of whom have sought treatment at fertility clinics within the Swedish public health care system. Parts of the interviews in which the mothers describe deficiencies in the provided treatment have been scrutinized in detail. Results show how heteronormative assumptions about the family and a feeling of exposure in the role of patient give rise to vulnerability in lesbian mothers. Furthermore, neither routines nor the offered treatment are adapted to lesbian women's specific needs. Regarding dealing with deficiencies, the interviews are filled with expressions of acceptance, which rhetorically minimize the impact of potential stressors. A main conclusion is that legal inclusion of lesbians in fertility treatment is of groundbreaking importance to lesbians with a desire to become parents. The next step is to address heteronormativity within the health care institutions in order to develop treatment adapted to lesbian couples’ specific needs.

  • 63.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Oscarsson, Martin
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Konsten att hålla nyårslöftet2018In: Modern psykologi, ISSN 2000-4087, no 10, p. 26-34Article in journal (Other (popular science, discussion, etc.))
  • 64.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University College London, United Kingdom.
    Shafran, Roz
    Wade, Tracey D.
    Kothari, Radha
    Egan, Sarah J.
    Ekberg, Linda
    Wiss, Maria
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Guided web-based cognitive behavior therapy for perfectionism: Results from two different randomized controlled trials2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 4, article id e154Article in journal (Refereed)
    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.

  • 65.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Wade, Tracey
    Egan, Sarah
    Bergman Nordgren, Lise
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Landström, Andreas
    Roos, Stina
    Skoglund, Malin
    Thelander, Elisabet
    Trosell, Linnéa
    Örtenholm, Alexander
    Andersson, Gerhard
    A randomized controlled trial of Internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, p. 79-86Article in journal (Refereed)
    Abstract [en]

    Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68–1.00, 95% Confidence Interval (CI) [0.36–1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.

  • 66.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Wade, Tracey
    Egan, Sarah
    Kothari, Radha
    Allcott-Watson, Hannah
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Is the devil in the detail? A randomized controlled trial of guided Internet-based CBT for perfectionism2017In: Applying CBT in Diverse Contexts: 51st Annual Convention: Program Book, 2017, p. 127-127Conference paper (Refereed)
    Abstract [en]

    An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective. Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean=28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d =0.98 (95% CI: 0.60-1.36) and d =1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.

  • 67.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Wennersten, Lina
    Dansa på deadline: Uppskjutandets psykologi2014Book (Other academic)
  • 68. Shafran, Roz
    et al.
    Wade, Tracey D.
    Egan, Sarah J.
    Kothari, Radha
    Allcott-Watson, Hannah
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Is the devil in the detail?: A randomised controlled trial of guided internet-based CBT for perfectionism2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, p. 99-106Article in journal (Refereed)
    Abstract [en]

    An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60–1.36) and d = 1.04 (95% CI: 0.66–1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.

  • 69. Svartdal, Frode
    et al.
    Pfuhl, Gerit
    Nordby, Kent
    Foschi, Gioel
    Klingsieck, Katrin B.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindblom-Ylänne, Sari
    Rebkowska, Kaja
    On the measurement of procrastination: Comparing two scales in six European countries2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, article id 1307Article in journal (Refereed)
    Abstract [en]

    Procrastination is a common problem, but defining and measuring it has been subject to some debate. This paper summarizes results from students and employees (N = 2893) in Finland, Germany, Italy, Norway, Poland, and Sweden using the Pure Procrastination Scale (PPS) and the Irrational Procrastination Scale (IPS; Steel, 7010), both assumed to measure unidimensional and closely related constructs. Confirmatory factor analyses indicated inadequate configural fit for the suggested one-factor model for PPS; however, acceptable fit was observed for a three-factor model corresponding to the three different scales the PPS is based on. Testing measurement invariance over countries and students employees revealed configural but not strong or strict invariance, indicating that both instruments are somewhat sensitive to cultural differences. We conclude that the PPS and IPS are valid measures of procrastination, and that the PPS may be particularly useful in assessing cultural differences in unnecessary delay.

  • 70. Zetterberg, Molly
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Internet-based treatment of perfectionism: A randomized controlled trial comparing two types of self-help2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Perfectionism may be a clinically relevant problem on its own or as a part of other conditions. Internet-based cognitive behavioral therapy (ICBT) is a promising method for treating perfectionism. ICBT with guidance is recommended over unguided versions; still there remain questions concerning the importance of guidance in ICBT.

    Methods: In this study, seventy-eight self-referred participants were randomized to either ICBT with support or ICBT with support on request in an eight-week treatment of perfectionism. Primary outcome measures included two subscales from Frost Multidimensional Perfectionism Scale, and the Clinical Perfectionism Questionnaire. In addition to this depression, anxiety and quality of life were assessed.

    Results: A mixed effects model revealed significant pre-post reductions on all measures for both groups. Neither significant differences nor considerable effects were detected between groups (Cohen’s d = 0.01-0.33).

    Conclusion: This trial demonstrates that ICBT with or without regular therapist support may be helpful in treating perfectionism.

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