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Anniko, M., Boersma, K., van Wijk, N. P. L., Byrne, D. & Tillfors, M. (2018). Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 6(1), 4-15
Open this publication in new window or tab >>Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents
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2018 (English)In: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, E-ISSN 2245-8875, Vol. 6, no 1, p. 4-15Article in journal (Refereed) Published
Abstract [en]

Background: Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.

Objective: To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.

Method: The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.

Results: A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.

Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.

Place, publisher, year, edition, pages
New York, NY, USA: Exeley Inc., 2018
Keywords
Adolescents, stress measurement, psychometrics, sex invariance, emotional distress
National Category
Psychology (excluding Applied Psychology) Psychiatry
Identifiers
urn:nbn:se:oru:diva-67064 (URN)10.21307/sjcapp-2018-001 (DOI)000438366500002 ()
Funder
Swedish Research Council FormasSwedish Research CouncilVINNOVA
Note

Funding Agency:

Forskningsradet for Arbetsliv och Socialvetenskap (FAS) 

Available from: 2018-05-22 Created: 2018-05-22 Last updated: 2018-08-16Bibliographically approved
Flink, I., Peters, M., Bergbom, S., Bergman, M., Ekstrand, K., Carstens-Söderstrand, J. & Tillfors, M. (2018). Dwelling on a successful task: Does how or why influence affect?. Journal of Experimental Psychopathology, 9(3), Article ID UNSP 047915.
Open this publication in new window or tab >>Dwelling on a successful task: Does how or why influence affect?
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2018 (English)In: Journal of Experimental Psychopathology, ISSN 2043-8087, E-ISSN 2043-8087, Vol. 9, no 3, article id UNSP 047915Article in journal (Refereed) Published
Abstract [en]

Repetitive negative thinking (RNT) has been identified as a key maintaining process of emotional difficulties. However, the consequences of repetitive thinking may depend on whether negative thoughts or feelings are processed in an abstract, evaluative mode, or in a concrete, process-focused mode. In recent years an increasing number of studies has also explored the effect of processing mode in relation to positive events, yielding inconsistent results. So far, the studies using positive material have not examined the interaction between trait rumination and processing mode. Consequently, the purpose of this study was to further explore the effects of abstract vs. concrete mode of processing on positive affect and negative affect in the context of a success task in a sample scoring high on trait rumination. 62 participants were randomly assigned to abstract vs. concrete processing training prior to a success task. The results showed that positive affect increased whereas negative affect and state RNT decreased after the success task in both groups. However, abstract vs. concrete processing did not have an effect on outcome. The findings indicate that processing mode does not influence outcome in the context of a success task.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Processing mode, Repetitive negative thinking, Positive affect, Negative affect
National Category
Psychology (excluding Applied Psychology) Psychiatry
Identifiers
urn:nbn:se:oru:diva-53988 (URN)10.5127/jep.047915 (DOI)000446859400007 ()2-s2.0-85054848903 (Scopus ID)
Available from: 2016-12-15 Created: 2016-12-15 Last updated: 2018-10-22Bibliographically approved
Anniko, M., Boersma, K. & Tillfors, M. (2018). Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems. Nordic Psychology, 70(1), 3-16
Open this publication in new window or tab >>Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems
2018 (English)In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 70, no 1, p. 3-16Article in journal (Refereed) Published
Abstract [en]

Previous research has indicated that cognitive emotion regulation strategies contribute to the development and maintenance of emotional problems in adults and adolescents. However, there is a lack of longitudinal research with adolescent samples, hence knowledge of exactly how these strategies influence the development of emotional problems in adolescence is sparse. This study investigated maladaptive cognitive emotion regulation (cognitive avoidance and repetitive negative thinking) as a potential mediator in the development of anxiety and depressed mood over time in adolescence. Self-reported depressed mood, anxiety, and cognitive emotion regulation strategies were assessed during school hours in a sample of Swedish 10th graders (N=149; 53% girls), with follow-up assessments one and two years later. Repetitive negative thinking and cognitive avoidance formed a unidimensional factor of cognitive emotion regulation. Cognitive emotion regulation was found to mediate the development of both anxiety and depressed mood over time, lending support to the previous findings that cognitive emotion regulation strategies such as cognitive avoidance and repetitive negative thinking might act as transdiagnostic mechanisms in the development of emotional symptoms in adolescence. This suggests that maladaptive forms of cognitive emotion regulation could be important targets in prevention and treatment of emotional problems in adolescence.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
Emotion regulation, anxiety, depressed mood, adolescence, longitudinal design
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:oru:diva-65648 (URN)10.1080/19012276.2017.1323665 (DOI)000425787700002 ()2-s2.0-85019197348 (Scopus ID)
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-05-22Bibliographically approved
Wurm, M., Anniko, M., Tillfors, M., Flink, I. & Boersma, K. (2018). Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender. Journal of Psychosomatic Research, 111, 76-82
Open this publication in new window or tab >>Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender
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2018 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 111, p. 76-82Article in journal (Refereed) Published
Abstract [en]

Objective: Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time.

Methods: Adolescents in 18 public schools were followed from 7th to 9th grade (N=1181) and answered selfreport questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator.

Results: In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys.

Conclusion: Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Psychology (excluding Applied Psychology) Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-67289 (URN)10.1016/j.jpsychores.2018.05.016 (DOI)000437386600012 ()29935758 (PubMedID)2-s2.0-85048472319 (Scopus ID)
Funder
Swedish Research Council FormasSwedish Research CouncilVINNOVA, 2012-65Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-06-17 Created: 2018-06-17 Last updated: 2018-07-25Bibliographically approved
Van Zalk, N. & Tillfors, M. (2017). Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence. Child and Adolescent Psychiatry and Mental Health, 11(1), Article ID 41.
Open this publication in new window or tab >>Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence
2017 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, no 1, article id 41Article in journal (Refereed) Published
Abstract [en]

Objectives: We examined whether co-rumination with online friends buffered the link between social anxiety and depressive symptoms over time in a community sample.

Methods: In a sample of 526 participants (358 girls; M-age = 14.05) followed at three time points, we conducted a latent cross-lagged model with social anxiety, depressive symptoms, and co-rumination, controlling for friendship stability and friendship quality, and adding a latent interaction between social anxiety and co-rumination predicting depressive symptoms.

Results: Social anxiety predicted depressive symptoms, but no direct links between social anxiety and co-rumination emerged. Instead, co-rumination buffered the link between social anxiety and depressive symptoms for adolescents with higher but not lower levels of social anxiety.

Conclusions: These findings indicate that co-rumination exerted a positive influence on interpersonal relationships by diminishing the influence from social anxiety on depressive symptoms over time.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Social anxiety, Depressive symptoms, Co-rumination, Online friends, Early adolescence
National Category
Pediatrics Psychiatry
Identifiers
urn:nbn:se:oru:diva-60596 (URN)10.1186/s13034-017-0179-y (DOI)000408171900001 ()28852420 (PubMedID)2-s2.0-85027722465 (Scopus ID)
Funder
Swedish Research Council, 2012-1233 2009-1444
Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-09-16Bibliographically approved
Wurm, M., Flink, I., Tillfors, M. & Boersma, K. (2017). External and internal social factors as risk factors for the development of back/neck pain in Swedish adolescents. In: : Pain in Europe. Paper presented at 10th Congress of the European Pain Federation (EFIC 2017), Pain in Europe, Copenhagen, Denmark, September 6-9, 2017.
Open this publication in new window or tab >>External and internal social factors as risk factors for the development of back/neck pain in Swedish adolescents
2017 (English)In: : Pain in Europe, 2017Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background and aim: Back/neck pain is common in adolescents. Studies show correlations with social factors, such as bully victimization and individual social functioning (social anxiety). In adult pain populations, comorbid social anxiety has been correlated with higher symptomatology and worse treatment outcome. The aim of this study was to describe the prevalence of back/neck pain and to analyze the influence of bullying and social anxiety on back/neck pain over time in a general population sample of Swedish adolescents.

Method: Data consisted at baseline of all pupils in 7’th grade attending public schools in three Swedish municipalities (N= 1453, Mage= 13.19, sd= .43, 52.6 % boys), followed up yearly. Pupils were categorized as having a pain-problem based on self-reported pain frequency, pain intensity, and functional limitation. A multivariate logistic regression was conducted with bullying victimization, social anxiety, back/neck pain and gender at time 1 as predictors for back/neck pain at time 3.

Results: The prevalence of problematic back/neck pain was 8.4% (N= 122) at time 1, 10.5% (N=144) at time 2 and 9.9% (N=117) at time 3. The regression model was statistically significant (X² (4, N= 1181) = 84.46, p=.000). Gender, back/neck pain and bully victimization at time 1, but not social anxiety, significantly predicted pain problem at time 3.

Conclusions: External social factors rather than individual social function predicted back/neck pain. Since studies have found correlations between bully victimization and social anxiety and social anxiety may be prevalent and influence treatment outcomes in adult pain populations, this relationship should be studied further.

Keywords
epidemiology, back/neck pain, adolescents, bully victimization, social anxiety
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-62936 (URN)
Conference
10th Congress of the European Pain Federation (EFIC 2017), Pain in Europe, Copenhagen, Denmark, September 6-9, 2017
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareVINNOVASwedish Research CouncilSwedish Research Council Formas
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2017-12-06Bibliographically approved
Mörtberg, E., Reuterskiöld, L., Tillfors, M., Furmark, T. & Öst, L.-G. (2017). Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population. Cognitive Behaviour Therapy, 46(4), 300-314
Open this publication in new window or tab >>Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population
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2017 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 300-314Article in journal (Refereed) Published
Abstract [en]

Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Routledge, 2017
Keywords
Social anxiety disorder, Social Phobia Scale (SPS), Social interaction Anxiety Scale (SIAS), psychometric properties, factor structure
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-53760 (URN)10.1080/16506073.2016.1258723 (DOI)000400369600003 ()27894213 (PubMedID)2-s2.0-84999622289 (Scopus ID)
Note

Funding Agency:

Department of Psychology, Stockholm University

Available from: 2016-12-05 Created: 2016-12-05 Last updated: 2017-09-05Bibliographically approved
Wurm, M., Klein Strandberg, E., Lorenz, C., Tillfors, M., Buhrman, M., Holländare, F. & Boersma, K. (2017). Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interventions, 10, 54-64
Open this publication in new window or tab >>Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study
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2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 54-64Article in journal (Refereed) Published
Abstract [en]

In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Internet delivered treatment; pain; transdiagnostic; emotional comorbidity; single case
National Category
Other Medical Sciences not elsewhere specified
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-62356 (URN)10.1016/j.invent.2017.10.004 (DOI)000457134100008 ()2-s2.0-85032807121 (Scopus ID)
Projects
SÅS
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2019-02-13Bibliographically approved
Edlund, S., Wurm, M., Holländare, F., Linton, S. J., Fruzzetti, A. E. & Tillfors, M. (2017). Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome. Scandinavian Journal of Pain, 17, 77-86
Open this publication in new window or tab >>Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome
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2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 77-86Article in journal (Refereed) Published
Abstract [en]

Background and aims: Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored.

Methods: A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored.

Results: Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment.

Conclusions: Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

Place, publisher, year, edition, pages
Walter de Gruyter, 2017
Keywords
Chronic pain; Communication; Validation; Invalidation; Treatment outcome
National Category
Psychology Neurology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-59104 (URN)10.1016/j.sjpain.2017.07.007 (DOI)000419851500012 ()28850377 (PubMedID)2-s2.0-85026788123 (Scopus ID)
Note

Funding Agency:

Regional Research Council (Regionala Forskningsradet, RFR) 

Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2018-08-01Bibliographically approved
Sellin, T., Holländare, F. & Tillfors, M. (2017). Psychiatric ward consumption before suicide: A case-control study. European psychiatry, 41, S295-S296, Article ID EW0559.
Open this publication in new window or tab >>Psychiatric ward consumption before suicide: A case-control study
2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, p. S295-S296, article id EW0559Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-58971 (URN)10.1016/j.eurpsy.2017.02.173 (DOI)000404952200871 ()
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2018-09-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9688-5805

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