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Can mental imagery boost the effect of the positive cognitive bias modification of interpretation (CBM-I) on interpretation bias and memory bias? J Behav Ther Exp Psychiatry 2023; 79:101838. [PMID: 36805612 DOI: 10.1016/j.jbtep.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive bias modification of interpretation (CBM-I) has been widely used and yielded mixed results. This experiment explored the unique role of mental imagery in positive CBM-I. METHODS 60 participants (M = 23.13, SD = 1.04) were randomly assigned to a imagery-based positive CBM-I group (imagery group) and a conventional verbal-based positive CBM-I group (control group). The imagery group received additional practice in generating mental imagery and were instructed to fully focus on the imagery during the formal training. The dependent variables included interpretation bias (probe latencies and similarity ratings for recognition task), memory bias, and intrusive memory. RESULTS (1) For the positive probe scenario, the reaction time of the two groups was shorter in the posterior five blocks than the anterior five blocks. However, the difference in latency between pre- and post- training for the imagery group was larger than that of the control group; (2) For the recognition task, the positive target statement score was significantly higher, while the negative one was significantly lower for the imagery group than that of the control group (3) The imagery group (vs. control); showed more beneficial effects on memory bias. LIMITATIONS The limitations consisted of the difference in time of the manipulation between the two groups, the richness of the imagery operationalization, generalizability, and the lack of pre-manipulation of interpretation bias assessments. CONCLUSIONS The imagery-based CBM-I led to more positive interpretation biases, less negative interpretations, and more positive memory biases, indicating that mental imagery can boost the effect of the positive CBM-I.
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Lawrence HR, Siegle GJ, Schwartz-Mette RA. Reimagining rumination? The unique role of mental imagery in adolescents' affective and physiological response to rumination and distraction. J Affect Disord 2023; 329:460-469. [PMID: 36813044 DOI: 10.1016/j.jad.2023.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
Rumination is associated with increased risk for depression whereas distraction helps draw attention away from negative experiences, lowering risk. Many individuals who ruminate do so in the form of mental imagery and imagery-based rumination is more highly associated with depressive symptom severity than ruminating in the form of verbal thoughts. We do not yet understand why imagery-based rumination may be especially problematic nor how to intervene to reduce imagery-based rumination, however. Adolescents (N = 145) underwent a negative mood induction followed by experimental induction of rumination or distraction in the form of mental imagery or verbal thought while affective, high-frequency heart rate variability, and skin conductance response data were collected. Rumination was associated with similar affective, high-frequency heart rate variability, and skin conductance response regardless of whether adolescents were induced to ruminate in the form of mental imagery or verbal thought. Distraction led to greater affective improvement and greater increases in high-frequency heart rate variability, but similar skin conductance responses when adolescents were inducted to distract themselves in the form of mental imagery compared with verbal thought. Findings emphasize the importance of considering mental imagery in clinical contexts when assessing rumination and when intervening using distraction.
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Affiliation(s)
- Hannah R Lawrence
- School of Psychological Science, Oregon State University, Corvallis, OR, United States of America.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Marciniak MA, Shanahan L, Binder H, Kalisch R, Kleim B. Positive Prospective Mental Imagery Characteristics in Young Adults and Their Associations with Depressive Symptoms. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-12. [PMID: 37363749 PMCID: PMC10140715 DOI: 10.1007/s10608-023-10378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/28/2023]
Abstract
Background Positive prospective mental imagery plays an important role in mental well-being, and depressive symptoms have been associated with difficulties in generating positive prospective mental images (PPMIs). We used a mobile app to gather PPMIs generated by young adults during the COVID-19 pandemic and analyzed content, characteristics, and associations with depressive symptoms. Methods This is a secondary analysis of a randomized controlled trial with 95 healthy young adults allocated into two groups (intervention and control). Participants used the mobile app decreasing mental health symptoms for seven consecutive days. Fifty participants in the intervention group reported PPMIs at least three times per day using a mobile app inducing PPMI generation. We categorized entries into themes and applied moderation models to investigate associations between PPMI characteristics and depressive symptoms. Results We distinguished 25 PPMI themes. The most frequent were related to consuming food and drinks, watching TV/streaming platforms, and doing sports. Vividness and ease of generation of PPMIs, but not their anticipation, pleasure intensity or number of engagements with the app were associated with fewer depressive symptoms. Conclusions We identified PPMI themes in young adults and found significant negative associations between depressive symptoms and vividness and generation ease of PPMIs. These results may inform prevention and intervention science, including the design of personalized interventions. We discuss implications for future studies and treatment development for individuals experiencing diminished PPMI. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10378-5.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
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Li J, Ma H, Yang H, Yu H, Zhang N. Cognitive bias modification for adult's depression: A systematic review and meta-analysis. Front Psychol 2023; 13:968638. [PMID: 36743641 PMCID: PMC9894684 DOI: 10.3389/fpsyg.2022.968638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
Objects This study aimed to elucidate the effect of cognitive bias modification on depression. Methods This research included 10 randomized studies searching four major databases: PubMed, Embase, PsycINFO, and Cochrane Library, with a total sample size of 467. Moreover, they were examined for quality and possible publication bias. Results Cognitive bias modification (CBM) had statistically significant results, g = -0.64, 95% CI = [-0.97-0.32]. The interpretation of cognitive bias modification shows the highest effect size, g = -1.45, 95% CI = [-2.05-0.88]. When the training place is located in the laboratory, the training effect is significant, g = -1.11, 95% CI = [-1.62-0.61]. The difference is statistically significant when the training environment was changed to home, g = -0.28, 95% CI = [-0.51-0.05]. CBM has a statistical effect on moderate-to-severe depression, g = -0.70, 95% CI = [-1.04-0.36]. Conclusion We found that CBM had a moderate therapeutic effect on depression, whether the setting was at home or in the lab. Especially when the interpretation of cognitive bias modification (CBM-I) was used, we got the highest effect value. Furthermore, CBM has a statistical effect on moderate-to-severe depression.
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The effect of positive mental imagery training on Chinese University students with depression: A pilot study. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Faltinsen E, Todorovac A, Staxen Bruun L, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Control interventions in randomised trials among people with mental health disorders. Cochrane Database Syst Rev 2022; 4:MR000050. [PMID: 35377466 PMCID: PMC8979177 DOI: 10.1002/14651858.mr000050.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated. OBJECTIVES To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers. SEARCH METHODS In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers. SELECTION CRITERIA We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment . DATA COLLECTION AND ANALYSIS Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model). MAIN RESULTS We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains. AUTHORS' CONCLUSIONS We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
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Affiliation(s)
- Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | | | - Asbjørn Hróbjartsson
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Harrison O, Wiedenmann C, Rosner R, Steil R. Mental Imagery in Patients with Prolonged Grief Disorder: a Comparison with Matched Bereaved Healthy Controls. Psychiatr Q 2021; 92:1361-1379. [PMID: 33786716 PMCID: PMC8531067 DOI: 10.1007/s11126-021-09914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
Mental imagery is a transdiagnostic feature that has been increasingly researched in mental disorders in the past years. This study is the first to investigate mental imagery in individuals suffering from Prolonged Grief Disorder (PGD), a new disorder which will be included into the new edition of the International Classification of Diseases and Related Health Problems (ICD-11).Our objective was to find out to what extent patients suffering from PGD differ from healthy, but equally bereaved, controls in terms of mental imagery, and how mental imagery is related to psychopathology. Patients with PGD and matched bereaved healthy controls (n = 54) completed a mental imagery questionnaire specifically designed for the study, and other established measures of psychopathology. Patients suffering from PGD reported mental images more frequently, had less control over them, and described negative images as more vivid than did healthy controls. Also, in reaction to mental images, patients less frequently experienced joy, but more often grief, anger and guilt. Besides these group differences, significant correlations between mental imagery other psychopathological measures could be found. Mental imagery is clearly related to PGD. The underlying mechanisms on whether it is a developing or maintaining factor need to be addressed in future studies. Future research should also investigate in what way mental imagery might be used in therapeutic approaches.
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Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt, Hesse, Germany.
| | - Claudio Wiedenmann
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt, Hesse, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstätt, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt, Hesse, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University, Giessen, Germany
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Baruch N, Behrman S, Wilkinson P, Bajorek T, Murphy SE, Browning M. Negative bias in interpretation and facial expression recognition in late life depression: A case control study. Int J Geriatr Psychiatry 2021; 36:1450-1459. [PMID: 33900662 DOI: 10.1002/gps.5557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES While cognitive bias in younger adults with depression has been extensively researched, there have been relatively few investigations of the presence of cognitive bias in late life depression (LLD). This exploratory study aimed to ascertain whether negative cognitive bias exists across a range of cognitive domains in participants with LLD. METHODS/DESIGN Participants were 19 patients with LLD and 19 matched non-depressed older adults. Participants completed standardised tests to assess bias in facial expression recognition, attention, recall of adjectives and interpretation. RESULTS LLD participants were slower to identify surprised faces, and more likely to create negative statements in the interpretation task. There was no evidence of negative bias in memory or attention, but participants with LLD performed more poorly on the recall task. CONCLUSIONS This study provides new evidence of negative bias in interpretation in LLD, but the findings are not consistent with a global cognitive bias Further work is needed to investigate cognitive bias in LLD. It may be that interventions which target negative interpretation biases, such as cognitive bias modification, could be helpful in treating LLD.
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Affiliation(s)
- Nina Baruch
- Older Adult Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sophie Behrman
- Older Adult Services, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Older Adult Services, University of Oxford, Oxford, UK
| | - Philip Wilkinson
- Older Adult Services, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Older Adult Services, University of Oxford, Oxford, UK
| | - Tomasz Bajorek
- Department of Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susannah E Murphy
- Department of Psychiatry, Older Adult Services, University of Oxford, Oxford, UK
| | - Michael Browning
- Older Adult Services, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Older Adult Services, University of Oxford, Oxford, UK.,General Adult Services, Oxford Health NHS Foundation Trust, Oxford, UK
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Namaky N, Glenn JJ, Eberle JW, Teachman BA. Adapting cognitive bias modification to train healthy prospection. Behav Res Ther 2021; 144:103923. [PMID: 34280584 DOI: 10.1016/j.brat.2021.103923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 04/16/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Prospection, the mental simulation of future events, has been theoretically linked to physical and mental health. Prior studies have found that prospection is malleable; however, no research to our knowledge has tested whether a scalable intervention explicitly targeting the simulation of positive future outcomes can lead to more generalized positive prospection, and enhance positive outlook and reduce distress. The current study tested a novel, web-based cognitive bias modification for interpretation (CBM-I) program designed to shift prospective bias towards more positive (as opposed to negative) representations of future outcomes among 172 participants selected for having a relatively negative baseline expectancy bias. Results showed that following CBM-I, participants in active training conditions exhibited more positive expectations about the future, and increased self-efficacy and growth mindset. Also, optimism increased and depression and anxiety symptoms decreased following active training, but this also occurred for the control condition. Analyses did not suggest that changes in positive expectations mediated changes in positive outlook outcomes. Results suggest that an online prospection intervention can lead to more positive expectations about future events and improve positive outlook, though open questions remain about what accounts for the training effects.
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Affiliation(s)
| | - Jeffrey J Glenn
- University of Virginia, United States; Durham Veterans Affairs Health Care System, United States; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), United States
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Pile V, Smith P, Leamy M, Oliver A, Bennett E, Blackwell SE, Meiser-Stedman R, Stringer D, Dunn BD, Holmes EA, Lau JYF. A feasibility randomised controlled trial of a brief early intervention for adolescent depression that targets emotional mental images and memory specificity (IMAGINE). Behav Res Ther 2021; 143:103876. [PMID: 34098409 DOI: 10.1016/j.brat.2021.103876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/01/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
Brief, evidence-based interventions for adolescent depression are urgently required, particularly for school-settings. Cognitive mechanisms research suggests dysfunctional mental imagery and overgeneral memory could be promising targets to improve mood. This feasibility randomised controlled trial with parallel symptomatic groups (n = 56) compared a novel imagery-based cognitive behavioural intervention (ICBI) to non-directive supportive therapy (NDST) in school settings. Blind assessments (of clinical symptoms and cognitive mechanisms) took place pre-intervention, post-intervention and follow-up three months later. The trial aimed to evaluate the feasibility and acceptability of the methodology and interventions, and estimate the likely range of effects of the intervention on self-reported depression. The pre-defined criteria for proceeding to a definitive RCT were met: full recruitment occurred within eleven months; retention was 89%; ICBI acceptability was above satisfactory; and no harm was indicated. Intention-to-treat analysis found large effects in favour of ICBI (relative to NDST) at post-intervention in reducing depressive symptoms (d = -1.34, 95% CI [-1.87, -0.80]) and improving memory specificity (d = 0.79 [0.35, 1.23]), a key cognitive target. The findings suggest that ICBI may not only improve mood but also strengthen abilities associated with imagining and planning the future, critical skills at this life stage. A fully powered evaluation of ICBI is warranted. Trial Registration: https://www.isrctn.com/; ISRCTN85369879.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Abigail Oliver
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Eleanor Bennett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Sweden and Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Can compassion-focused imagery be used as an attention bias modification treatment? CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Naismith I, Kerr S, Mwale A, Feigenbaum J. A thematic analysis of compassion‐focused imagery for people with personality disorder: Inhibitors, facilitators and clinical recommendations. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Iona Naismith
- Department of Psychology, Universidad de Los Andes, Bogota, Colombia,
| | - Shelley Kerr
- North East London NHS Foundation Trust, London, UK,
| | - Amanda Mwale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,
| | - Janet Feigenbaum
- North East London NHS Foundation Trust, London, UK,
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,
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15
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Basanovic J, Grafton B, Ford A, Hirani V, Glance D, MacLeod C, Almeida OP. Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial. Psychol Med 2020; 50:2514-2525. [PMID: 31544719 DOI: 10.1017/s0033291719002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although efficacious treatments for major depression are available, efficacy is suboptimal and recurrence is common. Effective preventive strategies could reduce disability associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel and safe intervention that attenuates biases associated with depression. This study investigated whether the delivery of a CBM programme designed to attenuate negative cognitive biases over a period of 1 year would decrease the incidence of major depression among adults with subthreshold symptoms of depression. METHODS Randomised double-blind controlled trial delivered an active CBM intervention or a control intervention over 52 weeks. Two hundred and two community-dwelling adults who reported subthreshold levels of depression were randomised (100 intervention, 102 control). The primary outcome of interest was the incidence of major depressive episode assessed at 11, 27 and 52 weeks. Secondary outcomes included onset of clinically significant symptoms of depression, change in severity of depression symptoms and change in cognitive biases. RESULTS Adherence to the interventions was modest though did not differ between conditions. Incidence of major depressive episodes was low. Conditions did not differ in the incidence of major depressive episodes. Likewise, conditions did not differ in the incidence of clinically significant levels of depression, change in the severity of depression symptoms or change in cognitive biases. CONCLUSIONS Active CBM intervention did not decrease the incidence of major depressive episodes as compared to a control intervention. However, adherence to the intervention programme was modest and the programme failed to modify the expected mechanism of action.
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Affiliation(s)
- Julian Basanovic
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Andrew Ford
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
| | - Varsha Hirani
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
| | - David Glance
- UWA Centre for Software Practice, The University of Western Australia, Western Australia, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
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16
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Blackwell SE, Dooley D, Würtz F, Woud ML, Margraf J. Inducing positive involuntary mental imagery in everyday life: an experimental investigation. Memory 2020; 28:1157-1172. [PMID: 32985372 DOI: 10.1080/09658211.2020.1822413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positive involuntary mental imagery occurs frequently in daily life but evidence as to its functions and importance is largely indirect. The current study investigated a method to induce positive involuntary imagery in daily life, which would allow direct testing of its impact. An unselected student sample (N = 80) completed a single session of a positive imagery cognitive bias modification (CBM) paradigm, which involved listening to and imagining brief positive imagery scripts. Participants then recorded any involuntary memories of the imagined training scenarios in a three-day diary before returning to the lab for a follow-up assessment. Participants were randomised to imagine the scenarios in either an emotionally involved or emotionally detached manner, providing a test of the role of emotion in the subsequent experience of involuntary memories. Participants reported experiencing involuntary memories of the training scenarios in their daily life, but the number recorded did not differ between the experimental conditions. Exploratory analyses suggested that more vivid imagery and recall testing were associated with a greater number of involuntary memories. The study highlights the potential of the imagery CBM paradigm to further our understanding of the functions and potential importance of positive involuntary mental imagery in daily life.
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Affiliation(s)
- Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Daniela Dooley
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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17
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Köhnen M, Kriston L, Härter M, Baumeister H, Liebherz S. Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint). J Med Internet Res 2020; 23:e24584. [PMID: 36260395 PMCID: PMC8386371 DOI: 10.2196/24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Harnessing Mental Imagery and Enhancing Memory Specificity: Developing a Brief Early Intervention for Depressive Symptoms in Adolescence. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10130-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Treatment innovation for depressive symptoms in adolescence is urgently needed. Adult research suggests interventions targeting underlying cognitive mechanisms, such as dysfunctional mental imagery and overgeneral memory, are promising. Here, we describe and evaluate in a case series a brief imagery-based intervention for depressive symptoms that targets these cognitive mechanisms.
Methods
Nine participants completed the four-session intervention, whose principle components were imagery rescripting and memory specificity training. Questionnaires and experimental tasks (assessing symptomatology and cognitive mechanisms) were administered at three time points: pre-intervention, post-intervention and 3-month follow-up.
Results
The intervention was feasible to deliver and acceptable to participants. There was a large reduction in depression symptom scores from pre to post intervention (d = 1.32; 67% showed reliable improvement, RI) and this was maintained at follow-up (d = 1.46; RI = 75%). There were also reductions in anxiety (post: d = 1.15, RI = 44%; follow-up: d = 1.67, RI = 63%), increases in self-esteem (post: d = − 0.70, RI = 44%; follow-up: d = − 1.20, RI = 50%) and noteworthy changes in memory specificity (post: d = − 1.80, RI = 67%; follow-up: d = − 0.94, RI = 63%).
Conclusions
This is the first study to use imagery rescripting and memory specificity training in adolescence. Initial evidence is provided that the intervention is acceptable and may have clinical utility. Future randomised controlled trials are needed to further assess the intervention.
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19
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Lawrence HR, Schwartz-Mette RA. Imagery and verbal thought during rumination and distraction: Does imagery amplify affective response? Cogn Emot 2019; 33:1006-1019. [DOI: 10.1080/02699931.2018.1535426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Beard C, Rifkin LS, Silverman AL, Björgvinsson T. Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program. Behav Ther 2019; 50:515-530. [PMID: 31030870 DOI: 10.1016/j.beth.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word-sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.
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21
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Di Simplicio M, Lau-Zhu A, Meluken I, Taylor P, Kessing LV, Vinberg M, Holmes EA, Miskowiak KW. Emotional Mental Imagery Abnormalities in Monozygotic Twins With, at High-Risk of, and Without Affective Disorders: Present in Affected Twins in Remission but Absent in High-Risk Twins. Front Psychiatry 2019; 10:801. [PMID: 31780967 PMCID: PMC6856790 DOI: 10.3389/fpsyt.2019.00801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Mental imagery abnormalities feature across affective disorders including bipolar disorder (BD) and unipolar depression (UD). Maladaptive emotional imagery has been proposed as a maintenance factor for affective symptomatology and a target for mechanism-driven psychological treatment developments. Where imagery abnormalities feature beyond acute affective episodes, further opportunities for innovation arise beyond treatments, such as for tertiary/relapse prevention (e.g., in remitted individuals) or primary prevention (e.g., in non-affected but at-risk individuals). The aim of our study was to investigate for the first time the presence of possible mental imagery abnormalities in affected individuals in remission and at-risk individuals for affective disorders using a familial risk design. Methods: A population-based cohort of monozygotic twins was recruited through linkage between the Danish national registries (N=204). Participants were grouped as: affected (remitted BD/UD; n = 115); high-risk (co-twin with history of BD/UD; n = 49), or low-risk (no co-twin history of BD/UD; n = 40). Twins completed mental imagery measures spanning key subjective domains (spontaneous imagery use and emotional imagery) and cognitive domains (imagery inspection and imagery manipulation). Results: Affected twins in remission reported enhanced emotional mental imagery compared to both low- and high-risk twins. This was characterized by greater impact of i) intrusive prospective imagery (Impact of Future Events Scale) and ii) deliberately-generated prospective imagery of negative scenarios (Prospective Imagery Task). There were no significant differences in these key measures between affected BD and UD twins in remission. Additionally, low- and high-risk twins did not significantly differ on these emotional imagery measures. There were also no significant differences between the three groups on non-emotional measures including spontaneous imagery use and cognitive stages of imagery. Conclusions: Abnormalities in emotional prospective imagery are present in monozygotic twins with affective disorders in remission-despite preserved cognitive stages of imagery-but absent in unaffected high-risk twins, and thus do not appear to index familial risk (i.e., unlikely to qualify as "endophenotypes"). Elevated emotional prospective imagery represents a promising treatment/prevention target in affective disorders.
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Affiliation(s)
- Martina Di Simplicio
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Alex Lau-Zhu
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Medical Sciences Division, Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, United Kingdom
| | - Iselin Meluken
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Taylor
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emily Alexandra Holmes
- Division of Psychology, Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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22
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Amini K, Marks D, Cheraghi MA, Eftekhar M, Negarandeh R. Attempting to Restore Integrity of the Self: A Grounded Theory Study of Recovery From Major Depressive Disorder. J Am Psychiatr Nurses Assoc 2019; 25:385-395. [PMID: 30238839 DOI: 10.1177/1078390318800585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: The cultural and social background of the individual would seem to be important factors that can affect recovery from major depressive disorder (MDD). Currently, there is little information on the process of recovery from MDD in Middle Eastern countries, such as Iran. AIMS: This study was conducted to explore the process of recovery from MDD in Iran. METHOD: A grounded theory approach by Corbin and Strauss was used to explore recovery from MDD. Twenty patients were recruited using purposive and theoretical sampling methods. RESULTS: Several themes emerged from the data, the primary of which was "Attempting to restore integrity of the self," which included the two subthemes of "Attempting to restore health," and "Attempting to reacquire the lost abilities." Various contextual factors also affected recovery, including poverty, inefficient health care systems, perceived support, feelings of failure, and social stigma. During the recovery process, participants adopted both "effective strategies" and "ineffective strategies." Following the attempt to restore integrity, participants experienced different levels of integrity, ranging from "complete recovery" to "no recovery/relapse." CONCLUSIONS: The results from this study contribute to the body of knowledge regarding recovery from MDD in Iran. The data suggest that recovery from depressive disorder is a very personal experience that is affected by different and variable factors and conditions. However, the attempt to restore integrity of the self can result in achieving a higher level of performance and health.
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Affiliation(s)
- Kourosh Amini
- 1 Kourosh Amini, RN, PhD, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Dougie Marks
- 2 Dougie Marks, HPsychol, RN, MSc, University of the West of Scotland, Paisley, Scotland
| | - Mohammad Ali Cheraghi
- 3 Mohammad Ali Cheraghi, RN, PhD, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Eftekhar
- 4 Mehrdad Eftekhar, MD, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- 5 Reza Negarandeh, RN, PhD, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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23
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Pile V, Lau JYF. Looking forward to the future: Impoverished vividness for positive prospective events characterises low mood in adolescence. J Affect Disord 2018; 238:269-276. [PMID: 29894932 DOI: 10.1016/j.jad.2018.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/17/2018] [Accepted: 05/25/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Enhancing positive future imagery offers promise for treatment innovation in adult depression but has been neglected in adolescence. While negative life events are linked with depression-onset in adolescence, mechanisms underlying this association are poorly understood. We investigate whether difficulties in generating vivid positive future imagery characterise depression, compared to anxiety, and examine potential moderation of the relationship between negative life events and depressive symptoms in adolescence. METHOD Three hundred and seventy-five young people (11-16 years) completed the Prospective Imagery Task, and self-reported on symptoms of anxiety and depression. They were also asked to describe a past negative life event they had been thinking about or imagining over the last seven days, which was subsequently coded by a clinician over whether it was no, low, moderate or high impact. RESULTS Symptoms of depression were associated with less vivid positive imagery and more vivid negative imagery whether past or future, whilst symptoms of anxiety were associated with increased vividness for past negative events only. The relationship between life event severity and depression was increased for those with poorer vividness for positive future events. LIMITATIONS These data were collected at a single time-point only, limiting conclusions on temporal relationships. All measures were also self-reported, increasing shared method variance. CONCLUSIONS These findings suggest that the relationship between negative life events and prospective positive imagery are specific to depressive symptoms in adolescence and provide foundations for novel approaches to strengthen psychological interventions.
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Affiliation(s)
- Victoria Pile
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Jennifer Y F Lau
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK.
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24
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Blackwell SE, Westermann K, Woud ML, Cwik JC, Neher T, Graz C, Nyhuis PW, Margraf J. Computerized positive mental imagery training versus cognitive control training versus treatment as usual in inpatient mental health settings: study protocol for a randomized controlled feasibility trial. Pilot Feasibility Stud 2018; 4:133. [PMID: 30123524 PMCID: PMC6091085 DOI: 10.1186/s40814-018-0325-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/26/2018] [Indexed: 02/03/2023] Open
Abstract
Background Enhancing the capacity to experience positive affect could help improve recovery across a range of areas of mental health. Experimental psychopathology research indicates that a computerized cognitive training paradigm involving generation of positive mental imagery can increase state positive affect, and more recent clinical studies have suggested that this training could be used as an adjunct treatment module to target symptoms related to positive affect deficits, specifically anhedonia. The current study investigates the feasibility of adding a positive mental imagery computerized training module to treatment for patients in inpatient mental health settings, with a focus on increasing positive affect and reducing anhedonia. The positive mental imagery training (PMIT) is added to treatment as usual (TAU) in the inpatient setting, and compared to TAU alone, or TAU plus an alternative cognitive training module not hypothesized to increase positive affect, cognitive control training (CCT). Methods The study is a feasibility randomized controlled trial with three parallel arms. Up to 90 patients admitted to inpatient mental health treatment clinics in Germany will be randomized to PMIT + TAU, CCT + TAU, or TAU on a 1:1:1 ratio. PMIT or CCT consist of an introductory session followed by up to 8 full training sessions over 2 weeks. All three arms (including TAU) include regular completion of mood measures over the 2-week period. Outcome measures are completed pre and post this 2-week training/monitoring period, and at 2-week follow-up. Data will be presented in the form of both raw means and standardized effect sizes, with 95% confidence intervals, for both intention-to-treat and per-protocol samples. Discussion The study will inform feasibility of conducting a fully powered randomized controlled trial investigating the addition of the positive mental imagery training as a treatment adjunct to inpatient treatments for mental health, including potential refinement of study procedures, inclusion/exclusion criteria, and preliminary indications of the likely range of effect sizes. Trial registration clinicaltrials.gov, NCT02958228 (date registered: 4 November 2016).
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Affiliation(s)
- Simon E Blackwell
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Katharina Westermann
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Marcella L Woud
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Jan C Cwik
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Torsten Neher
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Christian Graz
- Nexus-Klinik Baden-Baden, Hermann-Sielcken-Straße 80, 76530 Baden-Baden, Germany
| | - Peter W Nyhuis
- 3St. Marien Hospital Eickel, Marienstraße 2, 44651 Herne, Germany
| | - Jürgen Margraf
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
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25
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Murphy SE, O'Donoghue MC, Blackwell SE, Nobre AC, Browning M, Holmes EA. Increased rostral anterior cingulate activity following positive mental imagery training in healthy older adults. Soc Cogn Affect Neurosci 2018; 12:1950-1958. [PMID: 29069519 PMCID: PMC5716192 DOI: 10.1093/scan/nsx120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/16/2017] [Indexed: 11/26/2022] Open
Abstract
The ability to form positive mental images may be an important aspect of mental health and well-being. We have previously demonstrated that the vividness of positive prospective imagery is increased in healthy older adults following positive imagery cognitive training. The rostral anterior cingulate cortex (rACC) is involved in the simulation of future affective episodes. Here, we investigate the effect of positive imagery training on rACC activity during the imagination of novel, ambiguous scenarios vs closely matched control training. Seventy-five participants received 4 weeks of positive imagery or control training. Participants underwent a functional magnetic resonance imaging scan, during which they completed an Ambiguous Sentences Task, which required them to form mental images in response to cues describing ambiguous social events. rACC activity was positively correlated with the pleasantness ratings of images formed. Positive imagery training increased rACC and bilateral hippocampal activity compared with the control training. Here, we demonstrate that rACC activity during positive imagery can be changed by the cognitive training. This is consistent with other evidence that this training enhances the vividness of positive imagery, and suggests the training may be acting to increase the intensity and affective quality of imagery simulating the future.
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Affiliation(s)
| | | | - Simon E Blackwell
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, 44787 Bochum, Germany
| | - Anna Christina Nobre
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Experimental Psychology and Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | - Emily A Holmes
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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26
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Abstract
Interpretation Bias Modification (IBM) is gaining attention in the literature as an intervention that alters cognitive biases and reduces associated symptoms. Forty, primarily college-aged, non-treatment-seeking adults with major depressive disorder (MDD) were randomly assigned to receive either IBM targeting hostile interpretation bias (IBM-H) or a healthy video control (HVC) condition. Compared to those in HVC, participants in IBM-H reported more benign interpretations and fewer hostile interpretations at posttreatment. No difference in depressive interpretation bias was found between groups at posttreatment. IBM-H led to improved anger control at posttreatment and follow-up compared to HVC, though no effects of condition were found on trait anger or depressive symptoms. The IBM-H group perceived their treatment as less credible than the HVC group. For individuals with high expectancy of treatment success, IBM-H led to lower posttreatment depressive symptoms compared to HVC, while findings trended in the opposite direction for those with low expectancy of success. Overall, these preliminary findings point to boundary conditions for the efficacy of IBM protocols for anger and depression and potential improvements to be made to future IBM protocols.
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Boland J, Riggs KJ, Anderson RJ. A brighter future: The effect of positive episodic simulation on future predictions in non-depressed, moderately dysphoric & highly dysphoric individuals. Behav Res Ther 2018; 100:7-16. [DOI: 10.1016/j.brat.2017.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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Naismith I, Mwale A, Feigenbaum J. Inhibitors and facilitators of compassion-focused imagery in personality disorder. Clin Psychol Psychother 2017; 25:283-291. [PMID: 29251381 DOI: 10.1002/cpp.2161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/25/2017] [Accepted: 10/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Compassion-focused therapy (CFT) has potential to benefit clients with a personality disorder (PD), given the inflated levels of shame and self-criticism in this population. However, clinical observation indicates that clients with PD may find techniques from this approach challenging. AIMS The aim of this study is to trial one aspect of CFT, compassion-focused imagery (CFI), with this population, and identify factors that predict clients' ability to generate CFI and experience self-compassion during the task, including type of CFI exercise and, second, to establish whether CFI outcomes increase with practice. METHOD In Study 1, 53 participants with a diagnosis of PD completed measures of self-compassion, self-reassurance, shame, self-criticism, fear of self-compassion, affect, anxious and avoidant attachment, and mental imagery abilities. Participants were assigned to trial CFI from memory (n = 25) or from imagination (n = 28), then rated their image's vividness, its compassionate traits, and ease of experiencing compassion. A negative mood manipulation was carried out, and CFI tasks and outcome measures were repeated. For Study 2, self-compassion and self-criticism were measured before and after 1 week of daily CFI practice. RESULTS Study 1 found that negative mood and low mental imagery ability are significant inhibitors to generating compassionate images and affect. The 2 CFI exercises were equally effective. Study 2 suffered from high attrition, but regular practice was associated with significant improvement in self-compassion (though not self-criticism). CONCLUSIONS CFI appears to be effective in improving self-compassion for some clients. However, it is less effective in the presence of negative affect. Clients with low mental imagery ability may benefit more from alternative CFT techniques.
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Affiliation(s)
| | - Amanda Mwale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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A comprehensive meta-analysis of interpretation biases in depression. Clin Psychol Rev 2017; 58:33-48. [DOI: 10.1016/j.cpr.2017.09.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
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Kress L, Aue T. The link between optimism bias and attention bias: A neurocognitive perspective. Neurosci Biobehav Rev 2017; 80:688-702. [PMID: 28780313 DOI: 10.1016/j.neubiorev.2017.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/31/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
Both optimism bias and reward-related attention bias have crucial implications for well-being and mental health. Yet, the extent to which the two biases interact remains unclear because, to date, they have mostly been discussed in isolation. Examining interactions between the two biases can lead to new directions in neurocognitive research by revealing their underlying cognitive and neurophysiological mechanisms. In the present article, we suggest that optimism bias and reward-related attention bias mutually enforce each other and recruit a common underlying neural network. Key components of this network include specific activations in the anterior and posterior cingulate cortex with connections to the amygdala. We further postulate that biased memory processes influence the interplay of optimism and reward-related attention bias. Studying such causal relations between cognitive biases reveals important information not only about normal functioning and adaptive neural pathways in maintaining mental health, but also about the development and maintenance of psychological diseases, thereby contributing to the effectiveness of treatment.
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Modifying Obsessive-Compulsive Beliefs about Controlling One’s Thoughts. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9603-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis. Clin Psychol Rev 2016; 52:92-107. [PMID: 28086133 DOI: 10.1016/j.cpr.2016.12.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/28/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
We review evidence for training programmes that manipulate autobiographical processing in order to treat mood, anxiety, and stress-related disorders, using the GRADE criteria to judge evidence quality. We also position the current status of this research within the UK Medical Research Council's (2000, 2008) framework for the development of novel interventions. A literature search according to PRISMA guidelines identified 15 studies that compared an autobiographical episodic memory-based training (AET) programme to a control condition, in samples with a clinician-derived diagnosis. Identified AET programmes included Memory Specificity Training (Raes, Williams, & Hermans, 2009), concreteness training (Watkins, Baeyens, & Read, 2009), Competitive Memory Training (Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009), imagery-based training of future autobiographical episodes (Blackwell & Holmes, 2010), and life review/reminiscence therapy (Arean et al., 1993). Cohen's d was calculated for between-group differences in symptom change from pre- to post-intervention and to follow-up. We also completed meta-analyses for programmes evaluated across multiple studies, and for the overall effect of AET as a treatment approach. Results demonstrated promising evidence for AET in the treatment of depression (d=0.32), however effect sizes varied substantially (from -0.18 to 1.91) across the different training protocols. Currently, research on AET for the treatment of anxiety and stress-related disorders is not yet at a stage to draw firm conclusions regarding efficacy as there were only a very small number of studies which met inclusion criteria. AET offers a potential avenue through which low-intensity treatment for affective disturbance might be offered.
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Pictet A, Jermann F, Ceschi G. When less could be more: Investigating the effects of a brief internet-based imagery cognitive bias modification intervention in depression. Behav Res Ther 2016; 84:45-51. [DOI: 10.1016/j.brat.2016.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
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Effects of Engaging in Repeated Mental Imagery of Future Positive Events on Behavioural Activation in Individuals with Major Depressive Disorder. COGNITIVE THERAPY AND RESEARCH 2016; 41:369-380. [PMID: 28515538 PMCID: PMC5410208 DOI: 10.1007/s10608-016-9776-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Depression is associated with decreased engagement in behavioural activities. A wide range of activities can be promoted by simulating them via mental imagery. Mental imagery of positive events could thus provide a route to increasing adaptive behaviour in depression. The current study tested whether repeated engagement in positive mental imagery led to increases in behavioural activation in participants with depression, using data from a randomized controlled trial (Blackwell et al. in Clin Psychol Sci 3(1):91–111, 2015. doi:10.1177/2167702614560746). Participants (N = 150) were randomized to a 4-week positive imagery intervention or an active non-imagery control condition, completed via the internet. Behavioural activation was assessed five times up to 6 months follow-up using the Behavioural Activation for Depression Scale (BADS). While BADS scores increased over time in both groups, there was an initial greater increase in the imagery condition. Investigating mental imagery simulation of positive activities as a means to promote behavioural activation in depression could provide a fruitful line of enquiry for future research.
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Holmes EA, Blackwell SE, Burnett Heyes S, Renner F, Raes F. Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications. Annu Rev Clin Psychol 2016; 12:249-80. [PMID: 26772205 DOI: 10.1146/annurev-clinpsy-021815-092925] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.
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Affiliation(s)
- Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , , .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, West Midlands B15 2TT, United Kingdom; .,Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, United Kingdom
| | - Fritz Renner
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, University of Leuven, 3000 Leuven, Belgium;
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Weßlau C, Cloos M, Höfling V, Steil R. Visual mental imagery and symptoms of depression - results from a large-scale web-based study. BMC Psychiatry 2015; 15:308. [PMID: 26631081 PMCID: PMC4668647 DOI: 10.1186/s12888-015-0689-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental imagery may influence the onset and maintenance of depression, but specific mechanisms have not yet been determined. METHODS Nine hundred twelve participants completed questionnaires on positive and negative mental images, as well as images of injury and death that lead to positive emotions ("ID-images"), and depressive symptomatology. The assessment was carried out online to reduce effects of social desirability. RESULTS Positive images were reported by 87 % of the sample, negative images by 77 %. ID-images were present in one-third of the sample. A connection with depression severity was found for the absence of positive mental images and the presence of negative images as well as ID-images. Higher depression scores were associated with more frequent and vivid negative images, greater imagery distress, and a higher proportion of negative relative to positive images. CONCLUSIONS Mental images are clearly related to depression. Future research should focus on ID-images and their connection to suicide-risk in depressed patients.
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Affiliation(s)
- Charlotte Weßlau
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Marie Cloos
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Volkmar Höfling
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
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Murphy SE, Clare O'Donoghue M, Drazich EHS, Blackwell SE, Christina Nobre A, Holmes EA. Imagining a brighter future: the effect of positive imagery training on mood, prospective mental imagery and emotional bias in older adults. Psychiatry Res 2015; 230:36-43. [PMID: 26235478 PMCID: PMC4593863 DOI: 10.1016/j.psychres.2015.07.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 07/03/2015] [Accepted: 07/19/2015] [Indexed: 11/24/2022]
Abstract
Positive affect and optimism play an important role in healthy ageing and are associated with improved physical and cognitive health outcomes. This study investigated whether it is possible to boost positive affect and associated positive biases in this age group using cognitive training. The effect of computerised imagery-based cognitive bias modification on positive affect, vividness of positive prospective imagery and interpretation biases in older adults was measured. 77 older adults received 4 weeks (12 sessions) of imagery cognitive bias modification or a control condition. They were assessed at baseline, post-training and at a one-month follow-up. Both groups reported decreased negative affect and trait anxiety, and increased optimism across the three assessments. Imagery cognitive bias modification significantly increased the vividness of positive prospective imagery post-training, compared with the control training. Contrary to our hypothesis, there was no difference between the training groups in negative interpretation bias. This is a useful demonstration that it is possible to successfully engage older adults in computer-based cognitive training and to enhance the vividness of positive imagery about the future in this group. Future studies are needed to assess the longer-term consequences of such training and the impact on affect and wellbeing in more vulnerable groups.
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Affiliation(s)
- Susannah E Murphy
- Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, Oxford, UK.
| | - M Clare O'Donoghue
- Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erin H S Drazich
- Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Anna Christina Nobre
- Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Peters ML, Vieler JS, Lautenbacher S. Dispositional and induced optimism lead to attentional preference for faces displaying positive emotions: An eye-tracker study. JOURNAL OF POSITIVE PSYCHOLOGY 2015. [DOI: 10.1080/17439760.2015.1048816] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Williams AD, O'Moore K, Blackwell SE, Smith J, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): a randomized controlled trial. J Affect Disord 2015; 178:131-41. [PMID: 25805405 PMCID: PMC4407900 DOI: 10.1016/j.jad.2015.02.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND Accruing evidence suggests that positive imagery-based cognitive bias modification (CBM) could have potential as a standalone targeted intervention for depressive symptoms or as an adjunct to existing treatments. We sought to establish the benefit of this form of CBM when delivered prior to Internet cognitive behavioral therapy (iCBT) for depression METHODS A randomized controlled trial (RCT) of a 1-week Internet-delivered positive CBM vs. an active control condition for participants (N=75, 69% female, mean age=42) meeting diagnostic criteria for major depression; followed by a 10-week iCBT program for both groups. RESULTS Modified intent-to-treat marginal and mixed effect models demonstrated no significant difference between conditions following the CBM intervention or the iCBT program. In both conditions there were significant reductions (Cohen׳s d .57-1.58, 95% CI=.12-2.07) in primary measures of depression and interpretation bias (PHQ9, BDI-II, AST-D). Large effect size reductions (Cohen׳s d .81-1.32, 95% CI=.31-1.79) were observed for secondary measures of distress, disability, anxiety and repetitive negative thinking (K10, WHODAS, STAI, RTQ). Per protocol analyses conducted in the sample of participants who completed all seven sessions of CBM indicated between-group superiority of the positive over control group on depression symptoms (PHQ9, BDI-II) and psychological distress (K10) following CBM (Hedges g .55-.88, 95% CI=-.03-1.46) and following iCBT (PHQ9, K10). The majority (>70%) no longer met diagnostic criteria for depression at 3-month follow-up. LIMITATIONS The control condition contained many active components and therefore may have represented a smaller 'dose' of the positive condition. CONCLUSIONS Results provide preliminary support for the successful integration of imagery-based CBM into an existing Internet-based treatment for depression.
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Affiliation(s)
- Alishia D Williams
- School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia; Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent׳s Hospital, Sydney, NSW, Australia.
| | - Kathleen O'Moore
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent׳s Hospital, Sydney, NSW, Australia
| | | | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent׳s Hospital, Sydney, NSW, Australia
| | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gavin Andrews
- School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia; Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent׳s Hospital, Sydney, NSW, Australia
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Autobiographical memory and well-being in aging: The central role of semantic self-images. Conscious Cogn 2015; 33:422-31. [DOI: 10.1016/j.concog.2015.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 12/25/2022]
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Blackwell SE, Browning M, Mathews A, Pictet A, Welch J, Davies J, Watson P, Geddes JR, Holmes EA. Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial. Clin Psychol Sci 2015; 3:91-111. [PMID: 25984421 PMCID: PMC4359210 DOI: 10.1177/2167702614560746] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022]
Abstract
Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work.
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Affiliation(s)
| | | | - Andrew Mathews
- Department of Psychology, University of California, Davis ; Institute of Psychiatry, King's College London
| | - Arnaud Pictet
- Department of Psychiatry, University of Oxford ; Department of Psychology, University of Geneva
| | - James Welch
- Department of Computer Science, University of Oxford
| | - Jim Davies
- Department of Computer Science, University of Oxford
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit
| | | | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit ; Department of Psychiatry, University of Oxford
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Affiliation(s)
- Akeem Sule
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Wolfson College, University of Cambridge, Cambridge CB3 9BB, UK; South Essex Partnership University NHS Foundation Trust, Bedfordshire LU1 2PJ, UK.
| | - Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Wolfson College, University of Cambridge, Cambridge CB3 9BB, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridge CB21 5HH.
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Fox E, Mackintosh B, Holmes EA. Travellers’ Tales in Cognitive Bias Modification Research: A Commentary on the Special Issue. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9604-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Woud ML, Becker ES. Editorial for the Special Issue on Cognitive Bias Modification Techniques: An Introduction to a Time Traveller’s Tale. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9605-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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