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Sökning: WFRF:(Shafran Roz) > Rozental Alexander

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1.
  • Andersson, Gerhard, et al. (författare)
  • Long-term effects of internet-supported cognitive behaviour therapy
  • 2018
  • Ingår i: Expert Review of Neurotherapeutics. - : Informa UK Limited. - 1473-7175 .- 1744-8360. ; 18:1, s. 21-28
  • Forskningsöversikt (refereegranskat)abstract
    • 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.
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2.
  • Buhrman, Monica, 1974-, et al. (författare)
  • Treating perfectionism using internet-based cognitive behavior therapy : A study protocol for a randomized controlled trial comparing two types of treatment
  • 2020
  • Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 21
  • Tidskriftsartikel (refereegranskat)abstract
    • 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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3.
  • Carlbring, Per, et al. (författare)
  • A randomized controlled trial of Internet-based CBT for perfectionism including an investigation of outcome predictors
  • 2017
  • Ingår i: Program Book. ; , s. 128-128
  • Konferensbidrag (refereegranskat)abstract
    • 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.
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4.
  • Carlbring, Per, et al. (författare)
  • Internet-Based vs. Face-to-Face CBT : Systematic Review and Meta-Analysis
  • 2018
  • Konferensbidrag (refereegranskat)abstract
    • 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.
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5.
  • Kothari, Radha, et al. (författare)
  • A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism : Effects on psychopathology and transdiagnostic processes
  • 2019
  • Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Pergamon Press. - 0005-7916 .- 1873-7943. ; 64, s. 113-122
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and objectivesPerfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).MethodsParticipants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.ResultsThe intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5).ConclusionsGuided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.
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6.
  • Parks, Allison, et al. (författare)
  • A self-report measure of perfectionism : A confirmatory factor analysis of the Swedish version of the Clinical Perfectionism Questionnaire
  • 2021
  • Ingår i: Clinical Psychology in Europe. - : Leibniz Institute for Psychology (ZPID). - 2625-3410. ; 3:4, s. 1-20
  • Tidskriftsartikel (refereegranskat)abstract
    • 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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7.
  • Rozental, Alexander, et al. (författare)
  • A randomized controlled trial of Internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors
  • 2017
  • Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 95, s. 79-86
  • Tidskriftsartikel (refereegranskat)abstract
    • 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.
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8.
  • Rozental, Alexander, et al. (författare)
  • Guided web-based cognitive behavior therapy for perfectionism : Results from two different randomized controlled trials
  • 2018
  • Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 20:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data.Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom.Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial.Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85).Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.
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9.
  • Rozental, Alexander, et al. (författare)
  • Negative effects in psychotherapy : commentary and recommendations for future research and clinical practice
  • 2018
  • Ingår i: BJPsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 4:4, s. 307-312
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Psychotherapy can alleviate mental distress and improve quality of life, but little is known about its potential negative effects and how to determine their frequency.Aims: To present a commentary on the current understanding and future research directions of negative effects in psychotherapy.Method: An anonymous survey was distributed to a select group of researchers, using an analytical framework known as strengths, weaknesses, opportunities and threats.Results: The researchers perceive an increased awareness of negative effects in psychotherapy in recent years, but also discuss some of the unresolved issues in relation to their definition, assessment and reporting. Qualitative methods and naturalistic designs are regarded as important to pursue, although a number of obstacles to using such methods are identified.Conclusion: Negative effects of psychotherapy are multifaceted, warranting careful considerations in order for them to be monitored and reported in research settings and routine care.
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10.
  • Rozental, Alexander, et al. (författare)
  • Reconsidering Perfect : A Qualitative Study of The Experiences of Undergoing Internet-Based Cognitive Behaviour Therapy for Perfectionism
  • 2019
  • Ingår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies. - Tübingen : dgvt-Verlag. - 9783871598517 ; , s. 233-233
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Internet-based cognitive behaviour therapy (ICBT) is a promising format for treating different psychiatric disorders. In addition, several clinical trials have found positive results for implementing transdiagnostic treatments via the Internet, as well as for using ICBT to target transdiagnostic processes, such as perfectionism. However, few qualitative studies have been conducted on the experiences of patients undergoing such treatments, making it unclear what aspects might facilitate or hinder their delivery. In the current study, patients completing twelve-week therapist-guided ICBT for perfectionism responded to open-ended questions at post-treatment. In total, 30 out of 62 (48.4%) rated the ease of understanding and completing the treatment program, as well as described their impressions of its content and the support provided by their therapist. The results were analysed qualitatively using thematic analysis. Overall, patients were satisfied, finding treatment easy to comprehend and use. Five themes were found in the responses; Learning how to do things differently, Noticing the positives, Feeling safe to be honest, A comfortable treatment format and Barriers to treatment. The results suggest that many patients were able to achieve a change in perspective in relation to their perfectionism and started facing their fears. They were also able to report the benefits of doing things differently as part of treatment, such as an improvement in their interpersonal relationships. Most patients were also positive about the treatment format, enjoying its flexibility and the encouragement offered by their therapist. However, obstacles such as conflicting commitments, personal difficulties, time-consuming and comprehensive modules, and a desire for more support were brought up by some, suggesting that there are aspects that could be considered in the future.
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