Internet-based cognitive behavior therapy for procrastination: study protocol for a randomized controlled trial

Alexander Rozental, Per Carlbring, Alexander Rozental, Per Carlbring

Abstract

Background: Procrastination, to voluntarily delay an intended course of action despite expecting to be worse-off for the delay, is a persistent behavior pattern that can cause major psychological suffering. Approximately half of the student population and 15%-20% of the adult population are presumed having substantial difficulties due to chronic and recurrent procrastination in their everyday life. However, preconceptions and a lack of knowledge restrict the availability of adequate care. Cognitive behavior therapy (CBT) is often considered treatment of choice, although no clinical trials have previously been carried out.

Objective: The aim of this study will be to test the effects of CBT for procrastination, and to investigate whether it can be delivered via the Internet.

Methods: Participants will be recruited through advertisements in newspapers, other media, and the Internet. Only people residing in Sweden with access to the Internet and suffering from procrastination will be included in the study. A randomized controlled trial with a sample size of 150 participants divided into three groups will be utilized. The treatment group will consist of 50 participants receiving a 10-week CBT intervention with weekly therapist contact. A second treatment group with 50 participants receiving the same treatment, but without therapist contact, will also be employed. The intervention being used for the current study is derived from a self-help book for procrastination written by one of the authors (AR). It includes several CBT techniques commonly used for the treatment of procrastination (eg, behavioral activation, behavioral experiments, stimulus control, and psychoeducation on motivation and different work methods). A control group consisting of 50 participants on a wait-list control will be used to evaluate the effects of the CBT intervention. For ethical reasons, the participants in the control group will gain access to the same intervention following the 10-week treatment period, albeit without therapist contact.

Results: The current study is believed to result in three important findings. First, a CBT intervention is assumed to be beneficial for people suffering from problems caused by procrastination. Second, the degree of therapist contact will have a positive effect on treatment outcome as procrastination can be partially explained as a self-regulatory failure. Third, an Internet based CBT intervention is presumed to be an effective way to administer treatment for procrastination, which is considered highly important, as the availability of adequate care is limited. The current study is therefore believed to render significant knowledge on the treatment of procrastination, as well as providing support for the use of Internet based CBT for difficulties due to delayed tasks and commitments.

Conclusions: To our knowledge, the current study is the first clinical trial to examine the effects of CBT for procrastination, and is assumed to render significant knowledge on the treatment of procrastination, as well as investigating whether it can be delivered via the Internet.

Trial registration: ClinicalTrials.gov: NCT01842945; https://ichgcp.net/clinical-trials-registry/NCT01842945 (Archived by WebCite at http://www.webcitation.org/6KSmaXewC).

Keywords: Internet-administered; cognitive behavior therapy; procrastination; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: The current study was based on modules from a self-help book authored by one of the authors (AR). The author plans to release this book on the Swedish market during the first half of 2014. Consequently, AR will not be involved in any of the informed consent procedures or analyses of outcome data.

References

    1. Steel P. The Procrastination Equation. London: Harper Collins; 2011. How to stop putting things off and start getting stuff done.
    1. Dryden W . Overcoming procrastination. London: Sheldon; 2000.
    1. Steel P. The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychol Bull. 2007 Jan;133(1):65–94. doi: 10.1037/0033-2909.133.1.65.
    1. Burka JB, Yuen LM. Procrastination: Why You Do It, What to Do About It Now. New York: Da Capo Press; 2009.
    1. Steel P, Brothen T, Wambach C. Personality and Individual Differences. Stockholm: Datainspektionen; 2001. Jan, Procrastination and personality, performance, and mood; pp. 95–106.
    1. Sirois FM, Melia-Gordon ML, Pychyl TA. "I'll look after my health, later": an investigation of procrastination and health. Personality and Individual Differences. 2003 Oct;35(5):1167–1184. doi: 10.1016/S0191-8869(02)00326-4.
    1. Bogg T, Roberts BW. Conscientiousness and health-related behaviors: a meta-analysis of the leading behavioral contributors to mortality. Psychol Bull. 2004 Nov;130(6):887–919. doi: 10.1037/0033-2909.130.6.887.
    1. Stead R, Shanahan MJ, Neufeld RW. “I’ll go to therapy, eventually”: Procrastination, stress and mental health. Personality and Individual Differences. 2010 Aug;49(3):175–180. doi: 10.1016/j.paid.2010.03.028.
    1. Rothblum ED, Solomon LJ, Murakami J. J Couns Psychol. 1986. Oct, [2013-10-22]. Affective, cognitive, and behavioral differences between high and low procrastinators .
    1. Tice DM, Baumeister RF. Longitudinal study of procrastination, performance, stress, and health: the costs and benefits of dawdling. Psychological Science. 1997 Nov 01;8(6):454–458. doi: 10.1111/j.1467-9280.1997.tb00460.x.
    1. Pychyl TA, Flett GL. Procrastination and self-regulatory failure: an introduction to the special issue. J Rat-Emo Cognitive-Behav Ther. 2012 Mar 29;30(4):203–212. doi: 10.1007/s10942-012-0149-5.
    1. Ferster CB. A functional analysis of depression. Am Psychol. 1973 Oct;28(10):857–870.
    1. Mazzucchelli TG, Kane RT, Rees CS. Behavioral activation interventions for well-being: A meta-analysis. J Posit Psychol. 2010 Mar;5(2):105–121. doi: 10.1080/17439760903569154.
    1. Bennett-Levy J. Oxford guide to behavioural experiments in cognitive therapy. Oxford: Oxford University Press; 2004.
    1. Flett GL, Stainton M, Hewitt PL, Sherry SB, Lay C. Procrastination automatic thoughts as a personality construct: an analysis of the procrastinatory cognitions inventory. J Rat-Emo Cognitive-Behav Ther. 2012 Mar 20;30(4):223–236. doi: 10.1007/s10942-012-0150-z.
    1. Baumeister RF, Gailliot M, DeWall CN, Oaten M. Self-regulation and personality: how interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. J Pers. 2006 Dec;74(6):1773–1802. doi: 10.1111/j.1467-6494.2006.00428.x.
    1. Brennan A, Chugh JS, Kline T. Traditional versus Open Office design: a longitudinal field study. Environment and Behavior. 2002 May 01;34(3):279–299. doi: 10.1177/0013916502034003001.
    1. Lorist MM, Klein M, Nieuwenhuis S, De Jong R, Mulder G, Meijman TF. Mental fatigue and task control: planning and preparation. Psychophysiology. 2000 Sep;37(5):614–625.
    1. Cooper JO, Heron TE, Heward WL. Applied behavior analysis. Upper Saddle River, N.J: Pearson/Merrill-Prentice Hall; 2007.
    1. Rozental A, Wennersten L. Dansa på deadline. Stockholm: Natur & Kultur; 2014.
    1. Donovan DM, Marlatt GA. Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: The Guilford Press; 2007.
    1. Kazantzis N, Deane FP, Ronan KR. Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clin Psychol-Sci Pr. 2000 Jun;7(2):189–202. doi: 10.1093/clipsy.7.2.189.
    1. Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Söderberg M, Ekselius L, Andersson G. Treatment of panic disorder: live therapy vs. self-help via the Internet. Behav Res Ther. 2005 Oct;43(10):1321–1333. doi: 10.1016/j.brat.2004.10.002.
    1. Nordin S, Carlbring P, Cuijpers P, Andersson G. Expanding the limits of bibliotherapy for panic disorder: randomized trial of self-help without support but with a clear deadline. Behav Ther. 2010 Sep;41(3):267–276. doi: 10.1016/j.beth.2009.06.001.
    1. Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med. 2010 Dec;40(12):1943–1957. doi: 10.1017/S0033291710000772.
    1. Andersson G, Bergström J, Holländare F, Carlbring P, Kaldo V, Ekselius L. Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry. 2005 Nov;187:456–461. doi: 10.1192/bjp.187.5.456.
    1. Carlbring P, Gunnarsdóttir M, Hedensjö L, Andersson G, Ekselius L, Furmark T. Treatment of social phobia: randomised trial of Internet-delivered cognitive-behavioural therapy with telephone support. Br J Psychiatry. 2007 Feb;190:123–128. doi: 10.1192/bjp.bp.105.020107.
    1. Carlbring P, Ekselius L, Andersson G. Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. J Behav Ther Exp Psychiatry. 2003 Jun;34(2):129–140.
    1. Paxling B, Almlöv J, Dahlin M, Carlbring P, Breitholtz E, Eriksson T, Andersson G. Guided Internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial. Cogn Behav Ther. 2011 Jul;40(3):159–173. doi: 10.1080/16506073.2011.576699.
    1. Espie CA, Kyle SD, Williams C, Ong JC, Douglas NJ, Hames P, Brown JS. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich Web application. Sleep. 2012 Jun;35(6):769–781. doi: 10.5665/sleep.1872.
    1. Spence J, Titov N, Dear BF, Johnston L, Solley K, Lorian C, Wootton B, Zou J, Schwenke G. Randomized controlled trial of Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder. Depress Anxiety. 2011 Jul;28(7):541–550. doi: 10.1002/da.20835.
    1. Hesser H, Gustafsson T, Lundén C, Henrikson O, Fattahi K, Johnsson E, Zetterqvist Westin V, Carlbring P, Mäki-Torkko E, Kaldo V, Andersson G. A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J Consult Clin Psychol. 2012 Aug;80(4):649–661. doi: 10.1037/a0027021.
    1. Carlbring P, Smit F. Randomized trial of Internet-delivered self-help with telephone support for pathological gamblers. J Consult Clin Psychol. 2008 Dec;76(6):1090–1094. doi: 10.1037/a0013603.
    1. Carlbring P, Andersson G. Internet and psychological treatment. How well can they be combined? Computers in Human Behavior. 2006 May;22(3):545–553. doi: 10.1016/j.chb.2004.10.009.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 2000.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22–33.
    1. Steel P. Arousal, avoidant and decisional procrastinators: Do they exist? Personality and Individual Differences. 2010 Jun;48(8):926–934. doi: 10.1016/j.paid.2010.02.025.
    1. Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS) J Affect Disord. 2001 May;64(2-3):203–216.
    1. Datainspektionen . Personal Data Act (1998:204) Stockholm: Datainspektionen; 1998.
    1. Parker G, Fletcher K, Berk M, Paterson A. Development of a measure quantifying adverse psychotherapeutic ingredients: the Experiences of Therapy Questionnaire (ETQ) Psychiatry Res. 2013 Apr 30;206(2-3):293–301. doi: 10.1016/j.psychres.2012.11.026.
    1. Svanborg P, Asberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994 Jan;89(1):21–28.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Frisch MB, Cornell J, Villanueva M, Retzlaff PJ. Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment. 1992 Mar;4(1):92–101. doi: 10.1037/1040-3590.4.1.92.
    1. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979 Apr;134:382–389.
    1. Lindner P, Andersson G, Ost LG, Carlbring P. Validation of the Internet-Administered Quality of Life Inventory (QOLI) in different psychiatric conditions. Cogn Behav Ther. 2013 Jul 9; doi: 10.1080/16506073.2013.806584.
    1. Gueorguieva R, Krystal JH. Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry. 2004 Mar;61(3):310–317. doi: 10.1001/archpsyc.61.3.310.
    1. Carlbring P, Brunt S, Bohman S, Austin D, Richards J, Öst L, Andersson G. Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior. 2007 May;23(3):1421–1434. doi: 10.1016/j.chb.2005.05.002.
    1. Thorndike FP, Carlbring P, Smyth FL, Magee JC, Gonder-Frederick L, Ost L, Ritterband LM. Web-based measurement: Effect of completing single or multiple items per webpage. Computers in Human Behavior. 2009 Mar;25(2):393–401. doi: 10.1016/j.chb.2008.05.006.
    1. Linden M. How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions. Clin Psychol Psychother. 2013;20(4):286–296. doi: 10.1002/cpp.1765.
    1. Proudfoot J, Klein B, Barak A, Carlbring P, Cuijpers P, Lange A, Ritterband L, Andersson G. Establishing guidelines for executing and reporting Internet intervention research. Cognitive Behaviour Therapy. 2011 Jun;40(2):82–97. doi: 10.1080/16506073.2011.573807.
    1. Brown RT. Journal of College Student Psychotherapy. 1992. Jul, [2013-10-22]. Helping Students Confront and Deal with Stress and Procrastination .
    1. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997.
    1. Judge TA, Bono JE. Relationship of core self-evaluations traits--self-esteem, generalized self-efficacy, locus of control, and emotional stability--with job satisfaction and job performance: a meta-analysis. J Appl Psychol. 2001 Feb;86(1):80–92.
    1. Baumeister RF, Heatherton TF, Tice DM. Losing control: how and why people fail at self-regulation. San Diego: Academic Press; 1994.
    1. Feingold A. Gender differences in personality: a meta-analysis. Psychol Bull. 1994 Nov;116(3):429–526.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12–19.

Source: PubMed

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