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  • 1. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rück, Christian
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Guided Internet-delivered CBT: Can it really be as good as seeing a therapist?2015In: The Behavior Therapist, ISSN 0278-8403, Vol. 38, no 5, p. 123-126Article in journal (Refereed)
  • 2. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Long-term effects of internet-supported cognitive behaviour therapy2018Conference paper (Other academic)
    Abstract [en]

    Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 3. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University College London, England.
    Shafran, Roz
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University College London, England.
    Long-term effects of internet-supported cognitive behaviour therapy2018In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 18, no 1, p. 21-28Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.

    Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.

    Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 4. Berg, M.
    et al.
    Johansson, S.
    Liljetörn, L.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Toopoco, N.
    Andersson, G.
    The role of knowledge in Internet-based cognitive behavioural therapy for adolescent depression: Results from a randomized controlled trial2017Conference paper (Refereed)
  • 5. Boettcher, Johanna
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Linden, Michael
    Hollon, Steve
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Primun non nocere: Side effects in psychological treatments2018Conference paper (Other academic)
    Abstract [en]

    Psychological treatments help patients overcome mental health problems. Thousands of studies document the positive effects of psychotherapeutic interventions. The potential of these same interventions to cause harm, on the other hand, has scarcely been subject to scientific investigation. The nature and frequency of side effects of psychological treatments are largely unknown. The present symposium aims at shedding light on some important questions concerning negative effects: How should side effects be defined? What are typical side effects? How frequent are side effects in different treatment formats? And how can side effects be effectively measured? 

    In the first presentation, Michael Linden will speak about side effects in group therapy and will report data from two different group therapy formats. Johanna Boettcher will focus on side effects of individual therapy for depression. She will present data from a large trial of Internet-based therapy and will summarize a qualitative analysis of the patients’ experience of negative effects. Steve Hollon will talk specifically about one particular side effect, the deterioration of targeted symptoms. He will report results of an individual patient data meta-analysis and compare rates of deterioration in cognitive-behaviour therapy and pharmacotherapy. Finally, Alexander Rozental will present a new questionnaire for the assessment of negative effects and will demonstrate its psychometric properties in a Rasch analysis.

  • 6.
    Boettcher, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Freie Universitaet Berlin, Germany.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Side effects in Internet-based interventions for social anxiety disorder2014In: Internet Interventions, ISSN 2214-7829, Vol. 1, no 1, p. 3-11Article in journal (Refereed)
    Abstract [en]

    Internet-based interventions are effective in the treatment of various mental disorders and have already been integrated in routine health care in some countries. Empirical data on potential negative effects of these interventions is lacking. This study investigated side effects in an Internet-based treatment for Social Anxiety Disorder (SAD).

    A total of 133 individuals diagnosed with SAD took part in an 11-week guided treatment. Side effects were assessed as open formatted questions after week 2 and at post-treatment after week 11. Answers were independently rated by two coders. In addition, rates of deterioration and non-response were calculated for primary social anxiety and secondary outcome measures (depression and quality of life).

    In total, 19 participants (14%) described unwanted negative events that they related to treatment. The emergence of new symptoms was the most commonly experienced side effect, followed by the deterioration of social anxiety symptoms and negative well-being. The large majority of the described side effects had a temporary but no enduring negative effect on participants' well-being. At post-treatment, none of the participants reported deterioration on social anxiety measures and 0–7% deteriorated on secondary outcome measures. Non-response was frequent with 32–50% for social anxiety measures and 57–90% for secondary outcomes at post-assessment.

    Results suggest that a small proportion of participants in Internet-based interventions experiences negative effects during treatment. Information about potential side effects should be integrated in patient education in the practice of Internet-based treatments.

  • 7.
    Buhrman, Monica
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Gelberg, Olle
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Jovicic, Filip
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Molin, Katarina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Forsstrom, David
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Andersson, Gerhard
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Linköping Univ, Dept Behav Sci & Learning, Linköping, Sweden..
    Carlbring, Per
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Shafran, Roz
    UCL, UCL Great Ormond St Inst Child Hlth, London, England..
    Rozental, Alexander
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;UCL, UCL Great Ormond St Inst Child Hlth, London, England..
    Treating perfectionism using internet-based cognitive behavior therapy: A study protocol for a randomized controlled trial comparing two types of treatment2020In: Internet Interventions, ISSN 2214-7829, Vol. 21, article id 100338Article in journal (Refereed)
    Abstract [en]

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

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  • 8.
    Bystedt, Samuel
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Boettcher, Johanna
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Clinicians' perspectives on negative effects of psychological treatments2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 4, p. 319-331Article in journal (Refereed)
    Abstract [en]

    Negative effects of psychological treatments is a fairly unexplored area of clinical research. Previous investigations have indicated that a portion of all patients experience negative effects in terms of deterioration and various adverse events. Meanwhile, evidence suggests that many clinicians are untrained in identifying negative effects and unaware of the current research findings. The objective of the current study is thus to investigate clinicians' own perspectives and experiences of possible negative effects of psychological treatments. An invitation to participate in an anonymous online survey consisting of 14 open-ended questions was distributed via three mailing lists used by clinicians that primarily identify themselves as cognitive behavior therapists. The responses were analyzed using a qualitative method based on thematic analysis. In total, 74 participants completed the survey. A majority agreed that negative effects of psychological treatments exist and pose a problem, and many reported having experienced both deterioration and adverse events among patients in their own practice. The thematic analysis resulted in three core themes: characteristics of negative effects, causal factors, as well as methods and criteria for evaluating negative effects. The clinicians recognize that negative effects exist, but many are unaware of the current research findings and are unfamiliar with methods and criteria for identifying and preventing deterioration and adverse events. The results provide evidence for further dissemination of the present knowledge regarding negative effects, particularly during basic clinical training, as well as the need for raising awareness of the available methods for identifying and preventing negative effects.

  • 9.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cuijpers, Pim
    Riper, Heleen
    Hedman, Erik
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Andersson, Gerhard
    Internet-Based vs. Face-to-Face CBT: Systematic Review and Meta-Analysis2018Conference paper (Refereed)
    Abstract [en]

    During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlist, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In addition, the long-term effects of ICBT is largely unknown.

    In this presentation a systematic review and meta-analysis, which included 1418 participants, will be presented. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. These included studies on social anxiety disorder, panic disorder, depression, body dissatisfaction etc. Results showed a pooled effect size at post-treatment of Hedges g = 0.05 (95% CI, -0.09 to 0.20), indicating that ICBT and face-to-face treatment produced equivalent overall effects.

    We also reviewed studies in which the long-term effects of guided ICBT were investigated. Following a new set of literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. The duration of the actual treatments was usually short (8-15 weeks). The pre-to follow-up (>2 yrs) effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%.

    While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats. While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects.

  • 10.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Boettcher, Johanna
    Ebert, David Daniel
    Cuijpers, Pim
    Knaevelsrud, Christine
    Ljótsson, Brjánn
    Kaldo, Viktor
    Titov, Nickolai
    Consensus statement on defining and measuring negative effects of Internet interventions2014Conference paper (Refereed)
    Abstract [en]

    Background: Internet interventions have great potential for alleviating emotional distress, promoting mental health, and enhancing well-being. Numerous clinical trials have demonstrated their effectiveness 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.

    Objective: 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 study therefore sought out 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.

    Methods: Ten 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 dialogue 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.

    Results: 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.

    Conclusions: We 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.

  • 11.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bystedt, Samuel
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Practicing clinicians' understanding and experiences of negative effects in psychotherapy2014Conference paper (Refereed)
    Abstract [en]

    Introduction: Research of psychotherapy has primarily focused on examining its efficacy and effectiveness for different psychiatric disorders. Hence, little is known about its potential for generating negative effects among patients undergoing treatment, even though some evidence suggest that 5-10% of all patients experience negative effects in terms of deterioration alone. Meanwhile, other types of adverse events might exist as well, e.g., social stigma, lower self-esteem, and less self-reliance. However, the knowledge of negative effects is currently scarce, and research has found that many practicing clinicians do not acknowledge that some patients might fare worse during treatment. Investigating practicing clinicians’ understanding and experiences of negative effects is therefore important in order to raise awareness of its occurrence and characteristics.

    Method: Participants were recruited through the Swedish Society for Behavior Therapy, the Section for Cognitive Behavior Therapy within the Swedish Psychological Association, and students attending the psychotherapist program at Stockholm University. Seventy four participants completed an online survey regarding negative effects of psychotherapy. The responses were analyzed using thematic analysis.

    Results: A majority of the participants believed that negative effects of psychotherapy exist, and some had personal experiences of patients encountering adverse events during treatment. Few received information about negative effects during their basic training in psychotherapy. Common negative effects were described as discomfort, lack of treatment effect, deterioration, dependency, and invasiveness. Possible causal factors were incompetence or inadequately applied methods, harmful treatment interventions, insufficient working alliance, among others. Only one participant was able to mention methods for monitoring negative effects during treatment.

    Conclusion: Practicing clinicians recognize that negative effects could pose a problem, but few were informed of its existence during their basic training in psychotherapy or know who to monitor it during treatment, warranting an increased awareness of negative effects among future clinicians.

  • 12.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Andersson, Gerhard
    Long-term effects of internet-supported cognitive behaviour therapy2018Conference paper (Other academic)
    Abstract [en]

    Background: Internet-supported and therapist-guided cognitive behavior therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.

    Methods: We reviewed studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n=11) or the Netherlands (n=3).

    Results: Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). The pre-to follow-up effect size was Hedge's g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.

    Conclusion: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 13.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Wade, Tracey
    Egan, Sarah
    Bergman Nordgren, Lise
    Landström, Andreas
    Roos, Stina
    Skoglund, Malin
    Thelander, Elisabet
    Trossell, Linnéa
    Örtenholm, Alexander
    Andersson, Gerhard
    A randomized controlled trial of Internet-based CBT for perfectionism including an investigation of outcome predictors2017In: Program Book, 2017, p. 128-128Conference paper (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.

  • 14.
    Clason van de Leur, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Buhrman, Monica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Åhs, Fredrik
    Mid Sweden Univ, Dept Psychol & Social Work, Kunskapens Väg 1, SE-83140 Östersund, Sweden.
    Rozental, Alexander
    Karolinska Inst, Dept Clin Neurosci, Tomtebodavägen 18A, SE-17176 Stockholm, Sweden.
    Brodda Jansen, Gunilla
    Danderyds Univ Hosp, Dept Clin Sci, Div Rehabil Med, Karolinska Inst, SE-18257 Stockholm, Sweden.
    Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting2020In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 20, no 1, article id 526Article in journal (Refereed)
    Abstract [en]

    Background

    Long-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting.

    Method

    This open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured.

    Results

    There were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91–1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry.

    Conclusion

    SED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population.

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  • 15. Ebert, D. D.
    et al.
    Donkin, L.
    Andersson, G.
    Andrews, G.
    Berger, T.
    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.
    Choi, I.
    Laferton, J. A. C.
    Johansson, R.
    Kleiboer, A.
    Lange, A.
    Lehr, D.
    Reins, J. A.
    Funk, B.
    Newby, J.
    Perini, S.
    Riper, H.
    Ruwaard, J.
    Sheeber, L.
    Snoek, F. J.
    Titov, N.
    Ünlü Ince, B.
    van Bastelaar, K.
    Vernmark, K.
    van Straten, A.
    Warmerdam, L.
    Salsman, N.
    Cuijpers, P.
    Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 13, p. 2679-2693Article, review/survey (Refereed)
    Abstract [en]

    Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.

    Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.

    A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.

    Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

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

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

  • 17. Erlandsson, Anette
    et al.
    Forsström, David
    Rozental, Alexander
    Werbart, Andrzej
    Accessibility at What Price? Therapists’ Experiences of Remote Psychotherapy with Children and Adolescents During the COVID-19 Pandemic2022In: Journal of Infant, Child, and Adolescent Psychotherapy, ISSN 1528-9168, Vol. 21, no 4, p. 293-308Article in journal (Refereed)
  • 18. Erlandsson, Anette
    et al.
    Forsström, David
    Rozental, Alexander
    Werbart, Andrzej
    Accessibility at What Price? Therapists’ Experiences of Remote Psychotherapy with Children and Adolescents During the COVID-19 Pandemic2022In: Journal of Infant, Child, and Adolescent Psychotherapy, ISSN 1528-9168, Vol. 21, no 4, p. 293-308Article in journal (Refereed)
  • 19.
    Fenski, Friederike
    et al.
    Free Univ Berlin, Dept Educ & Psychol, Div Clin Psychol Intervent, Habelschwerdter Allee 45, D-14195 Berlin, Germany..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Heinrich, Manuel
    Free Univ Berlin, Dept Educ & Psychol, Div Clin Psychol Intervent, Habelschwerdter Allee 45, D-14195 Berlin, Germany..
    Knaevelsrud, Christine
    Free Univ Berlin, Dept Educ & Psychol, Div Clin Psychol Intervent, Habelschwerdter Allee 45, D-14195 Berlin, Germany..
    Zagorscak, Pavle
    Free Univ Berlin, Dept Educ & Psychol, Div Clin Psychol Intervent, Habelschwerdter Allee 45, D-14195 Berlin, Germany..
    Boettcher, Johanna
    Psychol Hsch Berlin, Dept Clin Psychol & Psychotherapy, Kolln Pk 1, D-10179 Berlin, Germany.;Free Univ Berlin, Dept Educ & Psychol, Div Clin Psychol & Psychotherapy, Habelschwerdter Allee 45, D-14195 Berlin, Germany..
    Negative effects in internet-based interventions for depression: A qualitative content analysis2021In: Internet Interventions, ISSN 2214-7829, Vol. 26, article id 100469Article in journal (Refereed)
    Abstract [en]

    An increasing number of studies is proving the efficacy of Internet-based interventions (IBI) for treating depression. While the focus of most studies is thereby lying on the potential of IBI to alleviate emotional distress and enhance well-being, few studies are investigating possible negative effects that might be encountered by participants. The current study was therefore exploring self-reported negative effects of participants undergoing a cognitive-behavioral IBI targeting mild to moderate depression over 6 weeks. Data from the client pool of a German insurance company (n = 814, 68% female) revealed that 8.6% of the participants reported the experience of negative effects. Qualitative content analysis yielded two broad categories and five subcategories for the nature of participants' experiences of negative effects: participant-related negative effects (insight and symptom) and program-related negative effects (online format, contact, and implementation). By using both, qualitative and quantitative methods, results did not only shed light on the characteristics of negative effects but analyses also found that working alliance was a predictor for the experience of negative effects. Monitoring the occurrences of negative effects as well as working alliance throughout treatment was considered essential to help prevent negative effects and attrition among participants undergoing IBI for depression.

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  • 20. Fernández-Alvarez, J.
    et al.
    Rozental, Alexander
    Karolinska Institutet, Sweden; University College London, United Kingdom.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Botella, Cristina
    Deterioration rates in virtual reality therapy: An individual patient data meta-analysis and implications for research and practice2018Conference paper (Other academic)
    Abstract [en]

    Ample evidence supports the use of Virtual Reality for anxiety disorders. Throughout 20 years of research there have continuous advancements, not only in the quality of studies but also in the diversity of populations included as well as the technological progresses developed. All those steps forwards are accurately compiled in several meta-analysis, reviews and chapters. Nonetheless, there is no evidence yet on the potential negative effects and its moderators that Virtual Reality treatment strategies can provoke.

    From the diversity of negative effects’ operationalizations, this study uses the deterioration rates concept defined as the worsening of the clinical symptomatology from the pre-test scores to the post-test scores using the Reliable Change Index (RCI). An individual patient data meta-analyses (IPDMA) approach that systematically reviewed all the randomized control trials in Virtual Reality and gathered 16 datasets from the total 35 studies conducted within the field of research. A total of 846 patients constitutes the sample of the study. RCI’s for each primary outcome measure is performed as well as moderator analyses for demographic variables. In this talk the results will be discussed in terms of their clinical and research implications regarding the current status and future challenges of Virtual Reality therapy in the clinical psychology realm.

  • 21. Forsell, E.
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Svensson, A.
    Andersson, G.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Overcoming procrastination: One-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy2016Conference paper (Refereed)
    Abstract [en]

    Procrastination; the purposeful delay of an intended course of action is, for many, a persistent behavior associated with reduced mood, increased stress, and poorer performance. 20 % of adults and 50 % of students experience significant difficulties with procrastination. Internet- based cognitive behavior therapy (ICBT) shows promise for several conditions, but has never been applied to procrastination. The current study examined the efficacy of ICBT for procrastination at post treatment and one-year follow-up, and investigated predictors of change.

    Method: Participants (N = 150) were randomized to 10 weeks of either guided self-help, unguided self-help, or wait-list control (receiving unguided self-help after the first treatment period). Outcome measures were 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 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 and 24.0–36.0% for unguided self-help. Neither treatment condition was superior on any outcome measure, Fs (98, 65.17-72.55) < 1.70, p > .19. One-year follow-up data has been collected and the results will be available at the time of the conference, including predictors of change.

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

  • 22.
    Forsström, David
    et al.
    Stockholm Univ, Dept Psychol, Stockholm, Sweden.;Karolinska Inst, Stockholm Hlth Care Serv, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Kottorp, Anders
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Stockholm Hlth Care Serv, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;UCL Great Ormond St Inst Child Hlth, London, England..
    Lindner, Philip
    Karolinska Inst, Stockholm Hlth Care Serv, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Ctr Dependency Disorders, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Jansson-Fröjmark, Markus
    Karolinska Inst, Stockholm Hlth Care Serv, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Carlbring, Per
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Psychometric properties of the Jonsson-Abbott Scale: Rasch and confirmatory factor analyses2022In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 936685Article in journal (Refereed)
    Abstract [en]

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

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  • 23.
    Forsström, David
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.;Department of Psychology, Stockholm University, Stockholm, Sweden..
    Lindner, Philip
    Månsson, Kristoffer N. T.
    Ojala, Olivia
    Hedman-Lagerlöf, Maria
    El Alaoui, Samir
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden..
    Lundin, Johan
    Jangard, Simon
    Shahnavaz, Shervin
    Sörman, Karolina
    Lundgren, Tobias
    Jayaram-Lindström, Nitya
    Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic: A mediation study2022In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 13, article id 1045709Article in journal (Refereed)
    Abstract [en]

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

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  • 24.
    Forsström, David
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci, Solna, Sweden.;Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Oscarsson, Martin
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Buhrman, Monica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci, Solna, Sweden..
    A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder2023In: Internet Interventions, ISSN 2214-7829, Vol. 33, article id 100652Article in journal (Refereed)
    Abstract [en]

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

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  • 25.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Rozental, Alexander
    Kottorp, Anders
    Lindner, Philip
    Jansson-Fröjmark, Markus
    Hesser, Hugo
    Further Exploration of the Psychometric Properties of GamTest: A Rasch Analysis2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 9, article id 4824Article in journal (Refereed)
    Abstract [en]

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

  • 26.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, S.
    Rizzo, A.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial2015In: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii), Linköping: Linköping University Press , 2015, p. 20-20Conference paper (Refereed)
    Abstract [en]

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

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    SWEsrii 2015 Program with abstracts
  • 27.
    Forsström, David
    et al.
    Stockholm Univ, Dept Psychol, Albanovagen 12, S-11419 Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Region Stockholm Norra Stationsgatan 69, S-11364 Stockholm, Sweden.;Stockholm Hlth Care Serv, Region Stockholm Norra Stationsgatan 69, S-11364 Stockholm, Sweden..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Region Stockholm Norra Stationsgatan 69, S-11364 Stockholm, Sweden.;Stockholm Hlth Care Serv, Region Stockholm Norra Stationsgatan 69, S-11364 Stockholm, Sweden.;UCL, Great Ormond St Hosp Inst Child Hlth, 30 Guilford St, London WC1N 1EH, England..
    Sundqvist, Kristina
    Stockholm Univ, Dept Psychol, Albanovagen 12, S-11419 Stockholm, Sweden..
    Alcohol Use and Gambling Associated with Impulsivity among a Swedish University Sample2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 4, article id 2436Article in journal (Refereed)
    Abstract [en]

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

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  • 28.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; The Centre for Psychotherapy, Education and Research, Sweden.
    Rozental, Alexander
    Wiklund, Emma
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Gamblers' Perception of the Playscan Risk Assessment: A Mixed-Methods Study2022In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 38, no 2, p. 591-606Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    Heinrich, Sarah
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Cotter, Katherine
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Weise, Cornelia
    Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy2016In: Internet Interventions, ISSN 2214-7829, Vol. 4, no 2, p. 120-130Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.

    Aims: Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.

    Method: 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.

    Results: Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.

    Conclusion: There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.

  • 30.
    Jansson-Fröjmark, Markus
    et al.
    Karolinska Institutet, Sweden.
    Nordenstam, Lisa
    Karolinska Institutet, Sweden.
    Alfonsson, Sven
    Karolinska Institutet, Sweden.
    Bohman, Benjamin
    Karolinska Institutet, Sweden.
    Rozental, Alexander
    Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Kristianstad University, Sweden; Örebro University, Sweden.
    Stimulus control for insomnia: A systematic review and meta-analysis2024In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 33, no 1, article id e14002Article in journal (Refereed)
    Abstract [en]

    Stimulus control (SC) is commonly viewed as an evidence-based treatment for insomnia, but it has not been evaluated comprehensively with modern review and meta-analytic techniques. The aim of the current study was thus to perform a systematic review and meta-analysis of trials that examine the efficacy of stimulus control for insomnia. A systematic search for eligible articles and dissertations was conducted in six online bibliographic databases. The 11 included studies, with the majority published between 1978 and 1998, were randomised controlled and experimental studies in adults, comparing stimulus control for insomnia with passive and active comparators and assessing insomnia symptoms as outcomes. A random effects model was used to determine the standardised mean difference Hedge's g at post-treatment and follow-up for three sleep diary measures: the number of awakenings, sleep onset latency, and total sleep time. A test for heterogeneity was conducted, forest plots were produced, the risk of publication bias was estimated, and the study quality was assessed. In the trials identified, stimulus control resulted in small to large improvements on sleep onset latency and total sleep time, relative to passive comparators (g = 0.38-0.85). Compared with active comparators, the improvements following stimulus control were negligible (g = 0.06-0.30). Although methodological uncertainties were observed in the included trials, stimulus control appears to be an efficacious treatment for insomnia when compared with passive comparators and with similar effects to active comparators. More robust studies are, however, warranted before stronger conclusions are possible to infer.

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  • 31.
    Johansson, Fred
    et al.
    Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Edlund, Klara
    Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden;Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Côté, Pierre
    Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
    Sundberg, Tobias
    Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
    Onell, Clara
    Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
    Rudman, Ann
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;Department of Caring Sciences, Dalarna University, Falun, Sweden.
    Skillgate, Eva
    Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden;Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Associations Between Procrastination and Subsequent Health Outcomes Among University Students in Sweden2023In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 1, article id e2249346Article in journal (Refereed)
    Abstract [en]

    Importance  Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

    Objective  To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

    Design, Setting, and Participants  This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

    Exposure  Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 (“very rarely or does not represent me”) to 5 (“very often or always represents me”) and summed to give a total procrastination score ranging from 5 to 25.

    Main Outcomes and Measures  Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

    Results  The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

    Conclusions and Relevance  This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students’ health.

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  • 32.
    Karyotaki, Eirini
    et al.
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Ebert, David Daniel
    Friedrich Alexander Univ Erlangen Nurnberg, Germany.
    Donkin, Liesje
    Univ Sydney, Australia.
    Riper, Heleen
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Twisk, Jos
    Vrije University Amsterdam, Netherlands.
    Burger, Simone
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Rozental, Alexander
    UCL, UK;Karolinska Institutet, Sweden.
    Lange, Alfred
    Univ Amsterdam, Netherlands.
    Williams, Alishia D.
    Univ Utrecht, Netherlands.
    Zarski, Anna Carlotta
    Friedrich Alexander Univ Erlangen Nurnberg, Germany.
    Geraedts, Anna
    HumanTotalCare, Netherlands.
    van Straten, Annemieke
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Kleiboer, Annet
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Meyer, Bjoern
    Gaia AG, Germany;City Univ London, UK.
    Ince, Burgin B. Unlu
    Middle East Tech Univ, Turkey.
    Buntrock, Claudia
    Friedrich Alexander Univ Erlangen Nurnberg, Germany.
    Lehr, Dirk
    Leuphana Univ Luneburg, Germany.
    Snoek, Frank J.
    Vrije University Amsterdam, Netherlands.
    Andrews, Gavin
    Univ New South Wales, Australia.
    Andersson, Gerhard
    Linköping University, Sweden;Karolinska Institutet, Sweden.
    Choi, Isabella
    Univ Sydney, Australia.
    Ruwaard, Jeroen
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Klein, Jan Philipp
    Luebeck Univ, Germany.
    Newby, Jill M.
    Univ New South Wales, Australia;MRC Cognit & Brain Sci Unit, UK.
    Schroder, Johanna
    Univ Med Ctr Hamburg Eppendorf, Germany;Inst Sex Res & Forens Psychiat, Germany.
    Laferton, Johannes A. C.
    Friedrich Alexander Univ Erlangen Nurnberg, Germany.
    Van Bastelaar, Kim
    Vrije University Amsterdam, Netherlands.
    Imamura, Kotaro
    Univ Tokyo, Japan.
    Vernmark, Kristofer
    Linköping University, Sweden.
    Boss, Leif
    Leuphana Univ Luneburg, Germany.
    Sheeber, Lisa B.
    Oregon Res Inst, USA.
    Kivi, Marie
    University of Gothenburg, Sweden.
    Berking, Matthias
    Friedrich Alexander Univ Erlangen Nurnberg, Germany.
    Tito, Nickolai
    Macquarie Univ, Australia.
    Carlbring, Per
    Stockholm University, Sweden;Univ Southern Denmark, Denmark.
    Johansson, Robert
    Linköping University, Sweden;Karolinska Institutet, Sweden.
    Kenter, Robin
    Univ Bergen, Norway.
    Perini, Sarah
    St Vincents Hosp, Australia.
    Moritz, Steffen
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Nobis, Stephanie
    Leuphana Univ Luneburg, Germany.
    Berger, Thomas
    Univ Bern, Switzerland.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Forsell, Yvonne
    Karolinska Institutet, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Sweden.
    Kraepelien, Martin
    Karolinska Institutet, Sweden.
    Bjorkelund, Cecilia
    University of Gothenburg, Sweden.
    Kawakami, Norito
    Univ Tokyo, Japan.
    Cuijpers, Pim
    Vrije university Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands.
    Do guided internet-based interventions result in clinically relevant changes for patients with depression?: An individual participant data meta-analysis2018In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 63, p. 80-92Article, review/survey (Refereed)
    Abstract [en]

    Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving intemet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

  • 33.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Nordby, Kent
    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.
    Svartdal, Frode
    Domain-specific quality of life across five European countries: Cross-cultural validation of the Brunnsviken Brief Quality of life (BBQ) scale2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 590-590Conference paper (Refereed)
    Abstract [en]

    The Brunnsviken Brief Quality of life (BBQ) scale is a valid, reliable and accessible self-report measure of subjective quality of life for use with both clinical and non-clinical populations. Although the BBQ has been professionally translated from original Swedish into over thirty languages, psychometric evaluations of other language versions are so far lacking. BBQ data was collected as part of an international study on procrastination in students and employees: n = 749 from Finland, n = 599 from Sweden, n = 542 from Norway, n = 411 from Germany, and n = 315 from Italy. Weighted satisfaction ratings (score range 0-16) for each of the BBQ’s six domains (Leisure, View on life, Creativity, Learning, Friends and friendships, and View on self), along with a total sum score and Cronbach’s alphas, were calculated and compared. Samples did not differ in BBQ total scores (F[4,2611] = 1.006, p = .403). Although there were some differences between samples on specific items, these were small (total difference M = 0.00, SD = 0.74) and confidence intervals overlapped, with the exception of the German sample that rated lower Learning than all other samples (p < .05, Bonferroni-adjusted). Cronbach’s alpha ranged from 0.752 (Finland) to 0.674 (Italy). Convergent validity (as assessed by correlations with scores on the Satisfaction With Life Scale) was high, ranging from r = .64 (Finland) to r = .42 (Italy). The BBQ is a valid measure of subjective quality of life in the examined languages. There are only minor cross-country differences in the quality of life domains measured by the BBQ.

  • 34.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 748-748Conference paper (Refereed)
    Abstract [en]

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

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

  • 35.
    Lyle, Maria Smitmanis
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Allenius, Emelie
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Salomonsson, Sigrid
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Björkdahl, Anna
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Strand, Mattias
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Flyckt, Lena
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Hellner, Clara
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Lundgren, Tobias
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Jayaram-Lindström, Nitya
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    What are the effects of implementing patient-controlled admissions in inpatient care?: A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 8, article id e065770Article in journal (Refereed)
    Abstract [en]

    Introduction Patient-controlled admissions (PCAs) represent a change in psychiatric inpatient care where patients are allowed to decide for themselves when hospitalisation might be required. Prior research has demonstrated that PCA increase the number of admissions, but decrease days in inpatient care, while both the admissions to and days in involuntary care decrease. However, investigations have been restricted to specific patient groups arid have not examined other possible benefits, such as effects on symptoms, quality of life and autonomy. Methods and analysis This study explores the implementation process and effects of PCA in Region Stockholm, who is currently introducing PCA for all patients with severe psychiatric conditions and extensive healthcare utilisation. In total, the study comprises approximately 45 inpatient wards, including child and adolescent psychiatry. In a naturalistic evaluation, patients assigned PCA will be followed up to 36 months, both with regard to hospitalisation rates and self-reported outcomes. In addition, qualitative studies will explore the experiences of patients, caregivers of adolescents and healthcare providers. Ethics and dissemination Approval has been granted by the Swedish Ethical Review Authority (Dnr: 2020-06498). The findings from this study will be disseminated via publications in international peer-reviewed journals, at scientific conferences, as part of two doctoral theses, and through the Swedish Partnership for Mental Health.

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  • 36. Lätth, Johanna
    et al.
    Landgren, Valdemar
    McMahan, Allison
    Sparre, Charlotte
    Eriksson, Julia
    Malki, Kinda
    Söderquist, Elin
    Öberg, Katarina Görts
    Rozental, Alexander
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Andersson, Gerhard
    Kaldo, Viktor
    Långström, Niklas
    Rahm, Christoffer
    Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet2022In: Internet Interventions, ISSN 2214-7829, Vol. 30, article id 100590Article in journal (Refereed)
    Abstract [en]

    Introduction The use of child sexual abuse material (CSAM) is an international public health and child protection challenge. Objective To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users. Methods We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019–2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre- to post-treatment, according to the Sexual Child Molestation Risk Assessment+. Results A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18–29 [49]; 30–39 [30]; 40–49 [15]; 50–59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre- to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate −0.25, 95 % CI, −0.46 to −0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events. Conclusion We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.

  • 37. Magnusson, Kristoffer
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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 therapy2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 285-285Conference paper (Refereed)
    Abstract [en]

    Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidencebased methods is believed to aid patients in gaining access to the right type of help. 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 of the primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were subsequently 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, yielding a total of 252 (8.8%). 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 treatment. Conclusion: Deterioration among patients receiving ICBT is not uncommon and should be monitored by researchers in order to reverse a negative treatment trend.

  • 38.
    Moell, Astrid
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Buchmayer, Susanne
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Kaltiala, Riittakerttu
    Tampere Univ, Fac Med & Hlth Technol, Tampere, Finland.;Tampere Univ, Tampere Univ Hosp, Dept Adolescent Psychiat, Tampere, Finland..
    Langstrom, Niklas
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff2024In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 24, no 1, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care.

    Methods: During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context.

    Results: The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy.

    Conclusions: The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.

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  • 39. Oscarsson, Martin
    et al.
    Nelson, Martina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden.
    Ginsberg, Ylva
    Carlbring, Per
    Jönsson, Fredrik
    Stress and work-related mental illness among working adults with ADHD: a qualitative study2022In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 751Article in journal (Refereed)
    Abstract [en]

    Background

    Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness.

    Methods

    Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants’ well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews.

    Results

    The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.

    Conclusion

    Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.

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  • 40.
    Oscarsson, Martin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    New Year's resolutions: A large scale randomized controlled trial2017Conference paper (Refereed)
    Abstract [en]

    Introduction: At the start of every new year, millions of people around the world pledge to change some aspect of their lives. More often than not, New Year’s resolutions relate to positive behavior changes, such as quitting bad habits and forming new and more beneficial ones. Unfortunately, most people who try to lose weight, quit smoking or start exercising fail, most of them during the first three months. The aim of this ongoing study is to investigate the different categories of New Year’s resolutions among Swedes, to what degree they succeed in keeping their resolutions, and whether internet-administered support based on cognitive behavior therapy may increase the participants’ chances of keeping their resolutions.

    Methods: The study is a three-arm randomized control trial comparing two different levels of support and one control condition. During the year, participants rate their perceived success in keeping their resolutions. Data from online questionnaires regarding subjective well-being, quality of life, procrastination and self-efficacy is also collected at baseline as well as at follow-up three weeks into the following year.

    Results: A total of 1 066 participants were included in the study. Ten months in we have preliminary results regarding the categories of New Year’s resolutions. More than 70% of the participants report one or more resolutions falling into the “physical health” category. The second largest category is “self-improvement” (10%), followed by “psychological health” (5%). A majority of resolutions, 64%, are phrased as approach-oriented goals and 34% as avoidance-oriented goals.

    Discussion: We believe that this is the largest study of its kind to date. Smaller longitudinal studies of New Year’s resolvers have been published, but none in Sweden. Furthermore, very few studies on positive behavior change have evaluated active interventions to increase participants’ chances of success. Future analyses will provide insight into New Year’s resolutions among Swedes and whether short, non-personal information and exercises administered via email may increase their chances of success.

  • 41. Parks, Allison
    et al.
    Clason van de Leur, Jakob
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. PBM, Stockholm.
    Strååt, Marcus
    Elfving, Fredrik
    Andersson, Gerhard
    Carlbring, Per
    Shafran, Roz
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska institutet; University College London.
    A self-report measure of perfectionism: A confirmatory factor analysis of the Swedish version of the Clinical Perfectionism Questionnaire2021In: Clinical Psychology in Europe, E-ISSN 2625-3410, Vol. 3, no 4Article in journal (Refereed)
    Abstract [en]

    Background: Perfectionism is often defined as the strive for achievement and high standards, but can also lead to negative consequences. In addition to affecting performance and interpersonal relationships, perfectionism can result in mental distress. A number of different self-report measures have been put forward to assess perfectionism. Specifically intended for clinical practice and research, the Clinical Perfectionism Questionnaire (CPQ) was developed and is presently available in English and Persian. To promote its use in additional contexts, the current study has translated and investigated the psychometric properties of the Swedish version of the CPQ.

    Method: A Confirmatory Factor Analysis was performed to examine the best fit with data, using a priori-models and a sample of treatment-seeking participants screened for eligibility to receive Internet-based cognitive behavior therapy (n = 223).

    Results: The results indicated a lack of fit with data. A two-factor structure without the two reversed items (2 and 8) exhibited the best fit, perfectionistic strivings and perfectionistic concerns, but still had poor structural validity. Correlations with self-report measures of perfectionism, depression, anxiety, dysfunctional beliefs, self-criticism, quality of life, and self-compassion were all in the expected directions. Eight-week test-retest correlation was Pearson r = .62, 95% Confidence Interval [.45, .74], using data from 72 participants in the wait-list control, and the internal consistency for the CPQ, once removing the reversely scored items, was Cronbach’s α = .72.

    Conclusion: The CPQ can be used as a self-report measure in Swedish, but further research on its structural validity is needed.

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  • 42. Parks, Allison
    et al.
    van de Leur, Jakob Clason
    Strååt, Marcus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Elfving, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Rozental, Alexander
    A self-report measure of perfectionism: A confirmatory factor analysis of the Swedish version of the Clinical Perfectionism Questionnaire2021In: Clinical Psychology in Europe, E-ISSN 2625-3410, Vol. 3, no 4, p. 1-20Article in journal (Refereed)
    Abstract [en]

    Background: Perfectionism is often defined as the strive for achievement and high standards, but can also lead to negative consequences. In addition to affecting performance and interpersonal relationships, perfectionism can result in mental distress. A number of different self-report measures have been put forward to assess perfectionism. Specifically intended for clinical practice and research, the Clinical Perfectionism Questionnaire (CPQ) was developed and is presently available in English and Persian. To promote its use in additional contexts, the current study has translated and investigated the psychometric properties of the Swedish version of the CPQ.

    Method: A Confirmatory Factor Analysis was performed to examine the best fit with data, using a priori-models and a sample of treatment-seeking participants screened for eligibility to receive Internet-based cognitive behavior therapy (n = 223).

    Results: The results indicated a lack of fit with data. A two-factor structure without the two reversed items (2 and 8) exhibited the best fit, perfectionistic strivings and perfectionistic concerns, but still had poor structural validity. Correlations with self-report measures of perfectionism, depression, anxiety, dysfunctional beliefs, self-criticism, quality of life, and self-compassion were all in the expected directions. Eight-week test-retest correlation was Pearson r = .62, 95% Confidence Interval [.45, .74], using data from 72 participants in the wait-list control, and the internal consistency for the CPQ, once removing the reversely scored items, was Cronbach’s α = .72.

    Conclusion: The CPQ can be used as a self-report measure in Swedish, but further research on its structural validity is needed.

  • 43.
    Rafi, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ivanova, Ekaterina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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.
    Effects of a workplace prevention programme for problem gambling: Study protocol for a cluster randomised controlled trial2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 9, article id e015963Article in journal (Refereed)
    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.

  • 44.
    Rafi, Jonas
    et al.
    Stockholm Univ, Stockholm, Sweden..
    Ivanova, Ekaterina
    Stockholm Univ, Stockholm, Sweden..
    Rozental, Alexander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Lindfors, Petra
    Stockholm Univ, Stockholm, Sweden..
    Andersson, Gerhard
    Linköping Univ, Linköping, Sweden..
    Carlbring, Per
    Stockholm Univ, Stockholm, Sweden..
    Effects of a workplace prevention program for problem gambling: A cluster-randomized controlled trial2022In: Journal of Gambling Issues, E-ISSN 1910-7595, no 50, p. 73-97Article in journal (Refereed)
    Abstract [en]

    Background and Aims: This study evaluated whether a preventive intervention program for problem gambling would increase managers' inclination to act when concerned about gambling in the workplace.

    Design: Cluster randomized controlled trial. Ten workplaces were randomized to either intervention or control condition.

    Participants: At the 12-month endpoint, there were n = 136 managers and n = 1594 subordinates in the intervention group, and n = 137 managers and n = 1150 subordinates in the waitlist group.

    Intervention: The intervention consisted of (1) six hours of skill-development training for managers regarding gambling, problem gambling, gaming, and harmful use of psychoactive drugs, and (2) six to eight hours of assistance in developing or improving workplace gambling policy.

    Measurements: The primary outcome was the managers' self-rated (on a 1 to 10 scale) inclination to act when concerned about an employee's problem gambling 12 months after baseline.

    Findings: The between -group difference in the managers' inclination for the full intervention group (M = 8) and the control group (M = 7.4) was not significant at the 12-month follow-up, but it was when only including managers who attended the skill development training (M = 8.2), d = 0.31, p = .04.

    Conclusion: A workplace prevention program aimed to increase managers' inclination to act when they are concerned regarding an employee's gambling resulted in statistically significant changes for those who attended training, but not for the whole intervention group when non-attendees were included.

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  • 45.
    Rafi, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ivanova, Ekaterina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Participants' Experiences of a Workplace-Oriented Problem Gambling Prevention Program for Managers and HR Officers: A Qualitative Study2019In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 10, article id 1494Article in journal (Refereed)
    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.

  • 46. Reinebo, Gustaf
    et al.
    Alfonsson, Sven
    Jansson-Fröjmark, Markus
    Rozental, Alexander
    Lundgren, Tobias
    Effects of Psychological Interventions to Enhance Athletic Performance: A Systematic Review and Meta-Analysis2023In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035Article in journal (Refereed)
  • 47.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Measuring negative effects / methodological challenges2018Conference paper (Other academic)
    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.

  • 48.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Negative effects of Internet-based cognitive behavior therapy: Monitoring and reporting deterioration and adverse and unwanted events2016Doctoral thesis, comprehensive summary (Other academic)
    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.

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  • 49.
    Rozental, Alexander
    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 events2017Conference paper (Other academic)
    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.

  • 50.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Negative effects of psychotherapy: Monitoring and reporting deterioration and adverse and unwanted events2017Conference paper (Other academic)
    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.

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