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  • 1.
    Anniko, Malin
    Örebro University, School of Law, Psychology and Social Work.
    Stuck on repeat: Adolescent stress and the role of repetitive negative thinking and cognitive avoidance2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Stress and stress-related mental health problems such as anxiety and depressive symptoms are common in adolescents and seem to be increasing, especially in mid- to late-adolescent girls. Although adolescence, as a period of rapid growth and profound change, is often marked by an increase in normal stressors (e.g. conflicts with parents, fitting in with peers, increased academic demands), most adolescents do not develop more persis-tent problems with stress. To be able to develop effective preventive interventions there is a need to understand both what adolescents are ascribing their stress to, how different stressor domains relate to outcomes, and why some adolescents go on to develop stress-related mental health problems while others do not.          

    This dissertation aimed to answer some of these questions by investigating the role of cognitive avoidance and repetitive negative thinking (RNT) in the development of stress-related mental health problems (Study I & III). It also aimed to develop and validate a shortened version of a questionnaire designed to measure stressor load within different life domains in adolescence (Study II). Findings show that the shortened version of the Adolescents Stress Questionnaire seems to be a valid measure of stressor load within different domains in adolescence. School-related stressors were the most prevalent sources of stress, but social stressors seem to have a stronger link to increases in mental health symptoms. Also, adolescents who report higher levels of distress and stressor load tend to increase their engagement in cognitive avoidance and RNT over time which in turn predicts further increases in mental health symptoms. This suggests that cognitive avoidance and RNT may be important mechanisms in the development of stress-related mental health problems in adoles-cence.

    List of papers
    1. Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems
    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
    2. Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents
    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
    Show others...
    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
    3. Stress-related Mental Health Problems in Adolescence: What are Adolescents Stressed About and Could Worry be a Potential Target in Prevention? A Longitudinal Investigation
    Open this publication in new window or tab >>Stress-related Mental Health Problems in Adolescence: What are Adolescents Stressed About and Could Worry be a Potential Target in Prevention? A Longitudinal Investigation
    (English)Manuscript (preprint) (Other academic)
    National Category
    Psychology (excluding Applied Psychology)
    Identifiers
    urn:nbn:se:oru:diva-67066 (URN)
    Available from: 2018-05-22 Created: 2018-05-22 Last updated: 2018-05-22Bibliographically approved
  • 2.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, M
    Faculty of Arts and Social Sciences, Department of Social and Psychological Studies: Psychology, Karlstad University, Karlstad, Sweden.
    Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence2019In: Anxiety, Stress, and Coping, ISSN 1061-5806, E-ISSN 1477-2205, Vol. 32, no 2, p. 155-167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade.

    DESIGN: Prospective cohort study.

    METHODS: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N = 1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later.

    RESULTS: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender.

    CONCLUSIONS: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.

  • 3.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Adolescent Stress Questionnaire: Evaluation of a Short Version in a Sample of Swedish Adolescents2016Conference paper (Refereed)
  • 4.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems2018In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 70, no 1, p. 3-16Article in journal (Refereed)
    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.

  • 5.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Stress and Emotional Distress in Adolesence: The Role of Worry and Rumination2015Conference paper (Refereed)
    Abstract [en]

    Introduction: Adolescence is a time of profound changes in multiple contexts, giving rise to an increased amount of potential stressors. It is also a developmental period were emotional problems tend to have their onset and are common. We know from previous research that stressors are a risk factor for internalizing problems. However, we know less about how this relationship unfolds. There has been a lack of research into potential mechanisms affecting this relationship such as moderating and mediating variables. Concerning stressors in the form of daily hassles, a potent mechanism is how well adolescents regulate their emotions. Studies have shown that especially cognitive regulatory strategies, such as worry and rumination, tend to increase in early adolescence, an increase that precedes increases in emotional problems. However, with a few exceptions, many studies have been cross-sectional and we do not know exactly how these strategies affects or are affected by stressors and emotional problems. The aim of this study is therefore to investigate how cognitive emotion regulation strategies, more specifically worry and rumination, relate to the development of emotional problems in the face of stressors.

    Method: This is a prospective study following 3200 Swedish adolescents in 7th and 8th grade across one year. Participants completed questionnaires about amounts of stressors, levels och worry, rumination, anxiety and depressive symptoms during school hours in the spring of 2014 and again in 2015. Half-longitudinal mediational- and moderation analyses will be performed to investigate how worry and rumination relate to the development of emotional problems in the face of stressors.

    Results: The open paper will give an overview of the above-mentioned analyses and present a discussion of the results with respect to theory and clinical implications.

  • 6.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Stress-related Mental Health Problems in Adolescence: What are Adolescents Stressed About and Could Worry be a Potential Target in Prevention? A Longitudinal Investigation Manuscript (preprint) (Other academic)
  • 7.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    van Wijk, Nikil Ph. L.
    Aquarius Analyses & Training (AA&T), Curaçao.
    Byrne, Don
    The Medical School, College of Medicine Biology and Environment, The Australian National University, Canberra, Australia.
    Tillfors, Maria
    Department of Social and Psychological Studies, Psychology, Karlstad University, Karlstad, Sweden.
    Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents2018In: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, E-ISSN 2245-8875, Vol. 6, no 1, p. 4-15Article in journal (Refereed)
    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.

  • 8.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    YAPI Stress: Guided Internet Based Prevention of Stress Related Ill-health in Adolescence2016Conference paper (Refereed)
  • 9.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Wurm, Matilda
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Stressing Emotions: Emotion Focused Transdiagnostic Treatment for Work Stress2014Conference paper (Refereed)
    Abstract [en]

    Background: Work related stress usually involves a variety of difficulties within the realm of emotional disorders, while CBT treatments are often disorder specific. To effectively address work stress, more versatile and parsimonious interventions are needed. Transdiagnostic treatments, targeting common psychological processes in emotion related disorders are now available. One such treatment, the Unified Protocol (Barlow et al., 2011), has shown promising results. It focuses on inflexible and maladaptive use of emotion regulation strategies. Research implies that maladaptive strategies such as excessive worrying and avoidance may also be important for stress prolongation. Thus, the implementation of a transdiagnostic treatment protocol for work stress needs to be evaluated.

    Aim: To study whether treatment using the Unified Protocol, targeting generic emotional regulation, is feasible for patients who present with work stress. Furthermore, the aim is to investigate whether this treatment affects levels of stress as well as symptoms of anxiety and depression.

    Method: Using a single case experimental design, we recruited six patients seeking treatment for work stress at an occupational health care center. After baseline assessments, they took part in an eight-session treatment using the Unified Protocol. Levels of perceived stress, emotional symptoms and use of regulatory strategies were daily monitored. A six month follow-up was also completed. Results: All participants completed and reported that they were satisfied with treatment. Four out of six participants also improved on reported stress-levels and emotional symptoms. Improvements were sustained at follow-up.

    Discussion: Results showed that it is feasible to use a unified approach for emotional problems in patients with work stress. Treatment was also associated with symptom changes for most participants. Employing a unified CBT approach for stress would provide flexibility and parsimony for clinicians while retaining a strong theoretical framework and guiding principles. Although initial results were promising randomized controlled trials are needed. 

  • 10.
    Wurm, Matilda
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Anniko, Malin
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender2018In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 111, p. 76-82Article in journal (Refereed)
    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.

  • 11.
    Wurm, Matilda
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Anniko, Malin
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Musculoskeletal pain in adolescents: Prevalence, and the role of peer-related stress, worry, and gender in the development of pain problems over timeManuscript (preprint) (Other academic)
1 - 11 of 11
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