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Ji JL, Woud ML, Rölver A, Notebaert L, Todd J, Clarke PJF, Meeten F, Margraf J, Blackwell SE. Investigating the role of mental imagery use in the assessment of anhedonia. Cogn Emot 2024:1-19. [PMID: 39330940 DOI: 10.1080/02699931.2024.2405008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/01/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024]
Abstract
Anhedonia, or a deficit in the liking, wanting, and seeking of rewards, is typically assessed via self-reported "in-the-moment" emotional and motivational responses to reward stimuli and activities. Given that mental imagery is known to evoke emotion and motivational responses, we conducted two studies to investigate the relationship between mental imagery use and self-reported anhedonia. Using a novel Reward Response Scale (adapted from the Dimensional Anhedonia Rating Scale, DARS; Rizvi et al., 2015) modified to assess deliberate and spontaneous mental imagery use, Study 1 (N = 394) compared uninstructed and instructed mental imagery use, and Study 2 (N = 586) conducted a test of replication of uninstructed mental imagery use. Results showed that greater mental imagery use was associated with higher reward response scores (Study 1 & 2), and this relationship was not moderated by whether imagery use was uninstructed or instructed (Study 1). Importantly, mental imagery use moderated the convergence between reward response and depression scale measures of anhedonia, with lower convergence for those reporting higher mental imagery use (Study 1 & 2). Results suggest that higher spontaneous mental imagery use may increase self-reported reward response and reduce the convergence between reward response scale and depression questionnaire measures of anhedonia. [199 / 200 words].
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Affiliation(s)
- Julie L Ji
- School of Psychology, University of Plymouth, Plymouth, UK
- School of Psychological Science, Centre for the Advancement of Research on Emotion, University of Western Australia, Perth, Australia
| | - Marcella L Woud
- Department of Clinical Psychology and Experimental Psychopathology, Institute of Psychology, University of Göttingen, Göttingen, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Bochum, Germany
| | - Angela Rölver
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Lies Notebaert
- School of Psychological Science, Centre for the Advancement of Research on Emotion, University of Western Australia, Perth, Australia
| | - Jemma Todd
- School of Psychological Science, Centre for the Advancement of Research on Emotion, University of Western Australia, Perth, Australia
- School of Psychology, University of Sydney, Perth, Australia
| | | | - Frances Meeten
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Bochum, Germany
| | - Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Institute of Psychology, University of Göttingen, Göttingen, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Bochum, Germany
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2
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Potsch L, Rief W. How to improve reward sensitivity - Predictors of long-term effects of a randomized controlled online intervention trial. J Affect Disord 2024; 367:647-657. [PMID: 39243822 DOI: 10.1016/j.jad.2024.09.007] [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: 02/05/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Reward sensitivity is a central maintaining factor of depression. Current treatments fail at sufficiently and reliably modifying reward processing. Therefore, we employed interventions targeting reward sensitivity and evaluated the long-term efficacy of different online interventions, additionally exploring predictors of changes in reward sensitivity. METHODS This four-arm randomized controlled trial (RCT) tested the long-term stability of treatment effects during a four-month follow-up in 127 participants of a two-week online intervention (behavioral activation vs. mindfulness and gratitude vs. combination of both). In addition, we investigated predictors of treatment success defined as improvement in reward sensitivity. Predictors we investigated were depressive expectations, stress and the type of reward implemented in the exercises of the intervention (physical activities and social encounters). RESULTS The improvement concerning reward sensitivity, as well as the reduction of anhedonia and depressive symptoms was stable over a four-month follow-up. We did not find evidence for differences between the active intervention groups. Positive changes in depressive expectations were a significant predictor of long-term improvements in reward sensitivity. LIMITATIONS Only self-report measures were used and the interpretation of the long-term efficacy of the online interventions is limited since the waitlist control condition was not extended to the follow-up. CONCLUSIONS Clinicians should focus on violating depressive expectations to facilitate updating the prediction and anticipation of future rewarding experiences. This could be a vital mechanism of change in reward sensitivity. However, future research still needs to unravel what kind of interventions are most effective in targeting reward insensitivity.
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Affiliation(s)
- L Potsch
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032 Marburg, Germany.
| | - W Rief
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032 Marburg, Germany
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3
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Plant O, Kienast A, Drew DS, Slavkova ED, Muhammed K, Kennerley H, Husain M. A Cognitive-Behavioral Model of Apathy in Parkinson's Disease. PARKINSON'S DISEASE 2024; 2024:2820257. [PMID: 39247682 PMCID: PMC11380718 DOI: 10.1155/2024/2820257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 09/10/2024]
Abstract
Apathy is recognized to be a common, disabling syndrome that occurs across a range of psychiatric and neurological conditions, including Parkinson's disease. It can have a significant impact on quality of life, both for people affected and those around them. Currently, there are no established, evidence-based treatments for this debilitating syndrome. Assessment and treatment have been complicated by overlaps with depression and anhedonia, as well as a lack of understanding of the underlying mechanisms. Emerging lines of evidence conceptualize apathy as a reduction of motivation associated with disordered effort-based decision-making and dysfunction of distinct neural circuitry between the basal ganglia and medial prefrontal cortex. Here, we introduce a novel cognitive-behavioral framework that can inform a clinician's conceptualization and treatment of apathy, using cognitive-behavioral therapy (CBT) techniques. We focus on people with Parkinson's disease in our model, but our approach is transdiagnostic and can be applied to other conditions. It considers both individual targets for therapy as well as maintenance and intervention at a systemic level. The generalizability and parsimony of the framework provides a structured assessment and formulation of apathy, while also allowing clinicians to remain sensitive to other neuropsychiatric symptoms that can occur alongside apathy, such as depression and anxiety.
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Affiliation(s)
- Olivia Plant
- Department of Experimental Psychology University of Oxford, Oxford, UK
- Oxford Cognitive Therapy Centre Oxford Health NHS Foundation Trust, Oxford, UK
| | - Annika Kienast
- Department of Experimental Psychology University of Oxford, Oxford, UK
| | - Daniel S Drew
- Department of Experimental Psychology University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
| | - Elitsa D Slavkova
- Department of Experimental Psychology University of Oxford, Oxford, UK
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
- Department of Neurology John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre Oxford Health NHS Foundation Trust, Oxford, UK
| | - Masud Husain
- Department of Experimental Psychology University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
- Department of Neurology John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging University of Oxford, Oxford, UK
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4
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McCann BS, Collin A. Hypnotically enhancing behavioral activation in the treatment of depression. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024; 66:97-107. [PMID: 37971434 DOI: 10.1080/00029157.2023.2270005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Depressive disorders are common conditions associated with high personal and economic burdens. The best treatment outcomes occur in patients receiving both psychotherapy and antidepressant medications. Behavioral activation is one approach within the most widely available and studied psychotherapy frameworks (cognitive behavioral therapy, CBT) utilized for depression, and is effective in treating depression even in isolation from the rest of the CBT approach. Many hypnosis treatments for depression have been developed to incorporate various CBT techniques, including behavioral activation. However, research regarding the applications of hypnosis to facilitate behavioral activation has been slow to emerge. Addressing this relative gap in the literature may be possible through a broader review of the relevant literature. There is quality evidence speaking to the efficacy of diverse clinician-guided visualization or imagery exercises in the treatment of depression by means of behavioral activation. While not explicitly hypnosis, the similarities of these interventions to more typical hypnosis interventions are highly salient. Clinicians and researchers interested in hypnosis's applications to treating depression would benefit from adopting a more comprehensive consideration of the relevant literature.
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5
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Marciniak MA, Shanahan L, Myin-Germeys I, Veer IM, Yuen KSL, Binder H, Walter H, Hermans EJ, Kalisch R, Kleim B. Imager-A mobile health mental imagery-based ecological momentary intervention targeting reward sensitivity: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:576-596. [PMID: 37942875 DOI: 10.1111/aphw.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Robust reward sensitivity may help preserve mental well-being in the face of adversity and has been proposed as a key stress resilience factor. Here, we present a mobile health application, "Imager," which targets reward sensitivity by training individuals to create mental images of future rewarding experiences. We conducted a two-arm randomized controlled trial with 95 participants screened for reward sensitivity. Participants in the intervention group received an ecological momentary intervention-Imager, which encouraged participants to create mental images of rewarding events for 1 week. The control group participants received only ecological momentary assessment, without the instruction to generate mental images. Adherence to Imager was high; participants in the intervention group engaged in 88% of the planned activities. In the follow-up assessment, the intervention group reported less mental health symptoms, mainly in depression (β = -0.34, df = 93, p = .004) and less perceived stress (β = -0.18, df = 93, p = .035), than control group participants and compared with the baseline assessment. Our results show the positive effects of Imager on mental health symptoms. The encouraging effects of the app on mental health outcomes may lead to greater use of ecological momentary interventions in the clinical preventive practice of affective disorders.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ilya Milos Veer
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - 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
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - 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, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
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6
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Garcia Jimenez C, D'Argembeau A. Goal characteristics predict the occurrence of goal-related events through belief in future occurrence. Conscious Cogn 2024; 119:103649. [PMID: 38324924 DOI: 10.1016/j.concog.2024.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
While previous studies have highlighted the role of episodic future thinking in goal pursuit, the underlying cognitive mechanisms remain unexplored. Episodic future thinking may promote goal pursuit by shaping the feeling that imagined events will (or will not) happen in the future - referred to as belief in future occurrence. We investigated whether goal self-concordance (Experiment 1) and other goal characteristics identified as influential in goal pursuit (Experiment 2) modulate belief in the future occurrence of goal-related events and predict the actual occurrence of these events. Results showed that goal self-concordance, engagement, and expectancy had an indirect effect on the actual occurrence of events, which was (partially) mediated by belief in future occurrence. The mediating role of belief supports the view that belief in future occurrence when imagining events conveys useful information, allowing us to make informed decisions and undertake adaptive actions in the process of goal pursuit.
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Affiliation(s)
| | - Arnaud D'Argembeau
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium
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7
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Potsch L, Rief W. Effectiveness of behavioral activation and mindfulness in increasing reward sensitivity and reducing depressive symptoms - A randomized controlled trial. Behav Res Ther 2024; 173:104455. [PMID: 38128402 DOI: 10.1016/j.brat.2023.104455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/08/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Reward insensitivity is a potential key mechanism regarding the maintenance of depression. However, there is a lack of research examining and comparing the effectiveness of different psychological interventions in modifying reward insensitivity. This four-arm randomized controlled trial (RCT) investigated a two-week online intervention. After screening for eligibility, a total of 336 participants were randomized, and 224 participated per-protocol. Participants were assigned to either a) behavioral activation, b) mindfulness and gratitude, c) a combination of both, or d) a waitlist control condition. They received videos and implemented daily exercises. Reward sensitivity and depressive symptoms served as primary outcomes. Behavioral activation and mindfulness significantly improved depressive symptoms and reward sensitivity. However, the effects of behavioral activation were not superior. The combination treatment versus the waiting group was insignificant regarding reward insensitivity. Explorative analyses revealed that all intervention groups reduced anhedonia substantially. Our findings imply that brief online interventions with behavioral activation and mindfulness-based approaches can impact reward insensitivity, while effects for a combination were less clear. Nonetheless, our results do not allow us to infer the differential effectiveness of the interventions. There is a clear need for treatments better targeting maintaining factors of depression, such as reward insensitivity. Clinical trial registration number: NCT05402150.
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Affiliation(s)
- L Potsch
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032, Marburg, Germany.
| | - W Rief
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032, Marburg, Germany
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8
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Kroener J, Schaitz C, Sosic-Vasic Z. Prospective Mental Images: A Transdiagnostic Approach to Negative Affectivity and Mood Dysregulation among Borderline Personality Disorder and Depression. Behav Sci (Basel) 2024; 14:81. [PMID: 38392434 PMCID: PMC10886009 DOI: 10.3390/bs14020081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
There is initial evidence that patients diagnosed with Borderline Personality Disorder (BPD) experience intrusive prospective mental images about non-suicidal self-injury (NSSI). These images, in turn, are associated with the conduct of NSSI. As the negative emotional valence of intrusive images has been established across clinical disorders, negative affectivity might play a key role linking mental imagery and psychopathology. Therefore, the present study aimed to investigate the possible mediating role of symptoms of depression as a proxy for negative affectivity linking intrusive prospective imagery to psychopathology in patients diagnosed with BPD. A total of 233 participants (84 diagnosed with MDD, 66 diagnosed with BPD, 83 healthy controls) completed questionnaires on negative affectivity (BDI-II) and prospective intrusive imagery (IFES-S). Before controlling for negative affectivity, there was a positive correlation between group and intrusive prospective imagery, indicating that healthy participants displayed lower amounts of intrusive prospective images in comparison to patients diagnosed with MDD or BPD. After entering negative affectivity as a mediator, the variable group was no longer associated with intrusive prospective images; however, negative affectivity showed a strong and positive relationship with the group on one side, and intrusive prospective imagery on the other, indicating that negative affectivity mediates the association between intrusive prospective images and clinical disorders. The presented findings point towards a mediating role of negative affectivity in the manifestation of intrusive prospective imagery, not only within BPD, but also in patients with MDD. The possibility of intrusive images acting as a transdiagnostic feature, where negative affectivity and mood dysregulation are at the core of the clinical disorder, are being discussed.
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Caroline Schaitz
- Psychotherapeutic Outpatient Facility, Medical School Berlin, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
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9
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van den Berg KC, Voncken M, Hendrickson AT, Di Simplicio M, Regeer EJ, Rops L, Keijsers GPJ. Exploring aspects of self-reported emotional mental imagery in patients with bipolar disorder. J Behav Ther Exp Psychiatry 2023; 81:101861. [PMID: 37182427 DOI: 10.1016/j.jbtep.2023.101861] [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: 01/17/2022] [Revised: 02/28/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance CBT for bipolar disorder with imagery techniques, research is needed into emotional imagery quality and, related appraisals of imagery and their relationships with mood instability and subsequent behaviour in bipolar disorder. METHODS Patients with bipolar disorder (n = 106), unipolar depression (n = 51), creative imagery prone participants (n = 53) and participants without a history of a mood disorder (n = 135) completed the Dutch Imagery Survey (DImS), an online imagery survey, adapted from the Imagery Interview, assessing self-reported emotional imagery aspects. Imagery quality, appraisals and their self-perceived effects on emotion and behaviour were compared between groups. As unexpected differences within the bipolar group appeared, these were additionally explored. RESULTS Imagery appraisals but not imagery quality discriminated between the patient groups and non-patient groups Imagery was perceived as an emotional amplifier in all groups, but this was specifically apparent in bipolar manic and bipolar depressed groups. Only in the bipolar group imagery was experienced to amplify behavioural tendencies. LIMITATIONS Results need to be replicated using a larger sample of patients with BD who are currently manic or depressed. CONCLUSIONS Not only quality of imagery, but especially appraisals associated with imagery are differentiating between imagery prone people with and without mood disorder. Imagery amplifies emotion in all groups, but only in those patients with bipolar disorder currently manic or depressed did this influence behaviour.
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Affiliation(s)
- K C van den Berg
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands; Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - M Voncken
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - A T Hendrickson
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - M Di Simplicio
- Imperial College London, Division of Psychiatry, Department of Brain Sciences, UK
| | - E J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands
| | - L Rops
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands
| | - G P J Keijsers
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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10
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Eberle JW, Boukhechba M, Sun J, Zhang D, Funk DH, Barnes LE, Teachman BA. Shifting Episodic Prediction With Online Cognitive Bias Modification: A Randomized Controlled Trial. Clin Psychol Sci 2023; 11:819-840. [PMID: 37736284 PMCID: PMC10513109 DOI: 10.1177/21677026221103128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Negative future thinking pervades emotional disorders. This hybrid efficacy-effectiveness trial tested a four-session, scalable online cognitive bias modification program for training more positive episodic prediction. 958 adults (73.3% female, 86.5% White, 83.4% from United States) were randomized to positive conditions with ambiguous future scenarios that ended positively, 50/50 conditions that ended positively or negatively, or a control condition with neutral scenarios. As hypothesized (preregistration: https://osf.io/jrst6), positive training participants improved more than control participants in negative expectancy bias (d = -0.58), positive expectancy bias (d = 0.80), and self-efficacy (d = 0.29). Positive training was also superior to 50/50 training for expectancy bias and optimism (d = 0.31). Training gains attenuated yet remained by 1-month follow-up. Unexpectedly, participants across conditions improved comparably in anxiety and depression symptoms and growth mindset. Targeting a transdiagnostic process with a scalable program may improve bias and outlook; however, further validation of outcome measures is required.
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Affiliation(s)
| | - Mehdi Boukhechba
- Department of Engineering Systems and Environment,
University of Virginia
| | - Jianhui Sun
- Department of Computer Science, University of
Virginia
| | - Diheng Zhang
- Department of Psychology, University of Virginia
| | | | - Laura E. Barnes
- Department of Engineering Systems and Environment,
University of Virginia
- School of Data Science, University of Virginia
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11
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Tiba A, Drugaș M, Sârbu I, Simona T, Bora C, Miclăuș D, Voss L, Sanislav I, Ciurescu D. T-RAC: Study protocol of a randomised clinical trial for assessing the acceptability and preliminary efficacy of adding an exergame-augmented dynamic imagery intervention to the behavioural activation treatment of depression. PLoS One 2023; 18:e0288910. [PMID: 37523359 PMCID: PMC10389719 DOI: 10.1371/journal.pone.0288910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Improving the existent effective treatments of depression is a promising way to optimise the effects of psychological treatments. Here we examine the effects of adding a rehabilitation type of imagery based on exergames and dynamic simulations to a short behavioural activation treatment of depression. We investigate the acceptability and the efficacy of an exergame-augmented dynamic imagery intervention added to behavioural activation treatment and associated mechanisms of change. METHODS AND ANALYSES In a two-arm pilot randomised controlled trial, the acceptability and preliminary efficacy of an exergame-augmented dynamic imagery intervention added to behavioural activation treatment for depressed individuals will be assessed. Participants (age 18-65) meeting criteria for depression are recruited by media and local announcements. 110 participants will be randomly allocated to behavioural activation plus imagery group or to standard behavioural activation group. The primary outcome is depressive symptom severity (Beck Depression Inventory II) and secondary outcomes are anhedonia, apathy and behavioural activation and avoidance. The outcomes are assessed at baseline, mid treatment, posttreatment and 3-month follow-up. Moderation and mediation analyses will be explored. An intention-to-treat approach with additional per-protocol analysis will be used for data analysis.
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Affiliation(s)
- Alexandru Tiba
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Marius Drugaș
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Ioana Sârbu
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Trip Simona
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Carmen Bora
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Daiana Miclăuș
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Laura Voss
- The Hull York Medical School, University of York, York, United Kingdom
| | - Ioana Sanislav
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Daniel Ciurescu
- Faculty of Medicine, Transilvania University, Brașov, Romania
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12
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van Bentum JS, Kerkhof AJFM, Huibers MJH, Holmes EA, de Geus S, Sijbrandij M. The Suicidal Intrusions Attributes Scale (SINAS): a new tool measuring suicidal intrusions. Front Psychiatry 2023; 14:1158340. [PMID: 37476542 PMCID: PMC10354241 DOI: 10.3389/fpsyt.2023.1158340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Suicidal intrusions are uncontrollable, intrusive mental images (e. g., visualizing a future suicidal act). They may also be called suicidal "flash-forwards." Despite the importance of integrating the assessment of suicidal intrusions into a clinical routine assessment, quick self-report screening instruments are lacking. This study describes the development of a new instrument-Suicidal Intrusions Attributes Scale (SINAS)-to assess the severity and characteristics of suicidal intrusions and examines its psychometric properties. Method The sample included currently suicidal outpatients with elevated levels of depression recruited across mental health institutions in the Netherlands (N = 168). Instruments administered were 10-item SINAS, the Suicidal Ideation Attributes Scale (SIDAS), the Prospective Imagery Task (PIT), four-item Suicidal Cognitions Interview (SCI), and the Beck Depression Inventory (BDI-II). Results An exploratory factor analysis identified a one-factor structure. The resulting SINAS demonstrated good internal consistency (Cronbach's α = 0.91) and convergent validity, as expected. Discussion Overall, this study demonstrated acceptable levels of reliability and validity of the measure in a depressed clinical population with suicidal ideation. The SINAS may be a useful screening tool for suicidal intrusions in both research and clinical settings.
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Affiliation(s)
- Jaël S. van Bentum
- Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Clinical Psychology, Universiteit Utrecht, Utrecht, Netherlands
| | - Ad J. F. M. Kerkhof
- Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, Universiteit Utrecht, Utrecht, Netherlands
- NPI Center for Personality Disorders, Arkin, Amsterdam, Netherlands
| | - Emily A. Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Stephan de Geus
- Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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13
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Lawrence HR, Balkind EG, Ji JL, Burke TA, Liu RT. Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review. Clin Psychol Rev 2023; 103:102302. [PMID: 37329877 PMCID: PMC10330912 DOI: 10.1016/j.cpr.2023.102302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/27/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts. METHODS We conducted a systematic review and meta-analysis documenting the prevalence of suicidal and NSSI mental imagery and describing the content and characteristics of suicidal and NSSI mental imagery, links between suicidal and NSSI mental imagery and suicidal and NSSI behavior, and how to intervene on suicidal and NSSI mental imagery. Studies published through December 17, 2022 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS Twenty-three articles were included. Prevalence rates of suicidal (73.56%) and NSSI (84.33%) mental imagery were high among clinical samples. Self-harm mental imagery commonly depicts engagement in self-harm behavior and is experienced as vivid, realistic, and preoccupying. When experimentally induced, self-harm mental imagery reduces physiological and affective arousal. Preliminary evidence suggests that suicidal mental imagery is associated with suicidal behavior. CONCLUSIONS Suicidal and NSSI mental imagery are highly prevalent and may be associated with heightened risk for self-harm behavior. Assessments and interventions for self-harm should consider incorporating and addressing suicidal and NSSI mental imagery to mitigate risk.
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Affiliation(s)
- Hannah R Lawrence
- School of Psychological Science, Oregon State University, Corvallis, OR, United States of America.
| | - Emma G Balkind
- Suffolk University, Boston, MA, United States of America
| | - Julie L Ji
- School of Psychological Science, University of Western Australia, WA, Australia; School of Psychology, University of Plymouth, UK
| | - Taylor A Burke
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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14
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Fung ACO, Zhang RT, Yip SSL, Poon GKS, Cheng CW, Yang TX, Lui SSY, Chan RCK. Prospection deficits in patients with first-episode schizophrenia: a cross-sectional comparative study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:36. [PMID: 37270630 DOI: 10.1038/s41537-023-00365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Prospection refers to the ability to simulate and pre-experience future events. Schizophrenia patients have difficulty in anticipating pleasure in future events, but previous studies examined prospection deficits in chronic schizophrenia patients. This study aimed to investigate prospection deficits in first-episode schizophrenia patients. Thirty first-episode schizophrenia patients and 31 healthy controls completed the Affective Prospection Task, which utilized pictorial cues to involve positive, neutral and negative prospection. Participants' ratings regarding the phenomenal characteristics of their prospected events were collected, and their prospected narratives were coded using a valid scoring manual. We also assessed intelligence, working memory and logical memory. The results showed, in all participants, valence of the cues significantly influenced participants' sense of pre-experience, temporal distance, emotion experience, vividness and participation of the prospected events, as well as the richness of sensory details. The two groups did not differ in self-report phenomenal characteristics of their prospected events. For coded characteristics, schizophrenia patients' prospected narratives were less rich in thought/emotion than controls, even after controlling for intelligence and memory deficits. We extended empirical evidence for prospection deficits from chronic schizophrenia samples to first-episode schizophrenia patients.
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Affiliation(s)
| | - Rui-Ting Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, Hunan Normal University, Chansha, China
- Cognition and Human Behaviour Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Stanley S L Yip
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Grace K S Poon
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Chi-Wai Cheng
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Tian-Xiao Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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15
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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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16
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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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17
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Werthmann J, Tuschen-Caffier B, Ströbele L, Kübel SL, Renner F. Healthy cravings? Impact of imagined healthy food consumption on craving for healthy foods and motivation to eat healthily - Results of an initial experimental study. Appetite 2023; 183:106458. [PMID: 36638961 DOI: 10.1016/j.appet.2023.106458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Craving for high-calorie foods predicts consumption of high-calorie foods thereby contributing to unhealthy eating habits and, potentially in the long term, to the development of overweight, obesity, and eating disorder pathology. Thus, effective interventions tackling craving for unhealthy foods and motivating healthy eating behavior are needed. This initial study tested if an experimental mental imagery procedure could induce craving for healthy foods and increase the motivation to eat healthily. Participants (N = 82) were randomized to either a healthy craving mental imagery condition or to a neutral mental imagery control condition. Craving for healthy foods and motivation to eat healthily was assessed before and after the experimental manipulation via self-report. A (disguised) food choice for healthy versus unhealthy food was added as a behavioural measure at the end of the experiment. Repeated measures of variance analyses with time (pre vs. post experimental manipulation) and condition (healthy craving mental imagery versus neutral mental imagery) yielded significant interactions for healthy craving and motivation to eat healthily: Post-hoc tests showed that craving for healthy foods and motivation to eat healthily increased significantly after the experimental manipulation in the healthy craving mental imagery condition, but not in the neutral mental imagery condition. Results of this initial study suggest that an experimental mental imagery induction of craving for healthy food leads to an increase in healthy craving and motivation to eat healthily. Further experimental research is needed to rule out priming effects, to test the underlying mechanisms of this effect, and evaluate the potential of this mental imagery procedure in a clinical context.
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Affiliation(s)
- Jessica Werthmann
- Albert-Ludwigs-University Freiburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Freiburg, Germany.
| | - Brunna Tuschen-Caffier
- Albert-Ludwigs-University Freiburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Freiburg, Germany
| | - Leonie Ströbele
- Albert-Ludwigs-University Freiburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Freiburg, Germany
| | - Sebastian L Kübel
- Albert-Ludwigs-University Freiburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Freiburg, Germany; Max Planck Institute for the Study of Crime, Security and Law, Department of Criminology, Freiburg, Germany
| | - Fritz Renner
- Albert-Ludwigs-University Freiburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Freiburg, Germany
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18
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Bruijniks SJE, Frank U, Tuschen-Caffier B, Werthmann J, Renner F. Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e8475. [PMID: 37065002 PMCID: PMC10103157 DOI: 10.32872/cpe.8475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/06/2023] [Indexed: 04/18/2023] Open
Abstract
Background To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity. Method 150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator. Discussion Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression. Trial registration The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).
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Affiliation(s)
- Sanne J. E. Bruijniks
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Ulrike Frank
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jessica Werthmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Fritz Renner
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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19
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Hutchinson T, Riddleston L, Pile V, Meehan A, Shukla M, Lau J. Is Future Mental Imagery Associated with Reduced Impact of the COVID-19 Pandemic on Negative Affect and Anhedonic Symptoms in Young People? COGNITIVE THERAPY AND RESEARCH 2023; 47:168-180. [PMID: 36779180 PMCID: PMC9899113 DOI: 10.1007/s10608-023-10352-1] [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: 01/09/2023] [Indexed: 02/05/2023]
Abstract
Background Difficulties with prospective mental images are associated with adolescent depression. Current treatments mainly focus on verbal techniques to reduce negative affect (e.g. low mood) rather than enhancing positive affect, despite anhedonia being present in adolescents. We investigated the concurrent relationships between the vividness of negative and positive prospective mental imagery and negative affect and positive affect; and examined whether negative and positive prospective mental imagery moderated the impact of recent stress (COVID-19-linked stress) on negative and positive affect. Methods 2602 young people (12-25 years) completed the Prospective Imagery Task and self-reported on symptoms of negative affect, anhedonia and COVID-19 linked stress. Results Elevated vividness of negative future mental imagery and reduced vividness of positive future mental imagery were associated with increased negative affect, whereas only reduced vividness of positive future imagery was associated with increased symptoms of anhedonia. Elevated vividness of negative future images amplified the association between COVID-19 linked stress and negative affect, while elevated vividness of positive future images attenuated the association between COVID-19 linked stress and anhedonia. Conclusions Future mental imagery may be differentially associated with negative and positive affect, but this needs to be replicated in clinical populations to support novel adolescent psychological treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10352-1.
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Affiliation(s)
- Taryn Hutchinson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Laura Riddleston
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alan Meehan
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Meenakshi Shukla
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Jennifer Lau
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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20
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Paetzold I, Schick A, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Butz S, Floesser C, Schueltke L, Boehnke JR, Boecking B, Reininghaus U. A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial. JMIR Form Res 2022; 6:e39511. [PMID: 36331526 PMCID: PMC9675017 DOI: 10.2196/39511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Young people are a target population for mental health–related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants’ baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants’ sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants’ sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study’s manual, a scoping review of existing literature and manuals, exchange with experts, the team’s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI −0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=−2.83, 95% CI −5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID) RR2-10.2196/27462
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Butz
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chiara Floesser
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Leonie Schueltke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, United Kingdom
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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21
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Simulation-based learning influences real-life attitudes. Cognition 2022; 227:105202. [PMID: 35714560 DOI: 10.1016/j.cognition.2022.105202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
Humans can vividly simulate hypothetical experiences. This ability draws on our memories (e.g., of familiar people and locations) to construct imaginings that resemble real-life events (e.g., of meeting a person at a location). Here, we examine the hypothesis that we also learn from such simulated episodes much like from actual experiences. Specifically, we show that the mere simulation of meeting a familiar person (unconditioned stimulus; US) at a known location (conditioned stimulus; CS) changes how people value the location. We provide key evidence that this simulation-based learning strengthens pre-existing CS-US associations and that it leads to a transfer of valence from the US to the CS. The data thus highlight a mechanism by which we learn from simulated experiences.
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22
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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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23
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Schürmann-Vengels J, Victor PP, Odyniec P, Flückiger C, Teismann T, Willutzki U. A Mental Imagery Micro-Intervention to Increase Positive Affect in Outpatient CBT Sessions (PACIfIC): Study Protocol of a Randomized Controlled Implementation Trial. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7043. [PMID: 36397941 PMCID: PMC9667424 DOI: 10.32872/cpe.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recent findings indicated that mental disorders are associated with both an up-regulation of negative affect and a down-regulation of positive affect (PA) as distinct processes. Established treatment approaches focus on the modification of problems and negative affect only. Experimental paradigms in healthy samples and research on strengths-based approaches showed that fostering PA may improve psychotherapy process and outcome. Specific and easily implementable interventions targeting PA in treatment sessions are scarce. Mental imagery was shown to be a promising strategy for boosting positive emotional experiences. Method The PACIfIC-study is planned as a longitudinal randomized-controlled trial in the context of cognitive behavioral therapy, implemented at a German outpatient training and research center. In the process analysis, trajectories of PA over the first twelve treatment sessions will be examined with weekly questionnaires. In the intervention analysis, a six-minute positive mental imagery intervention to enhance PA will be developed and tested. The intervention is implemented with loudspeakers at the beginning of each session for a standardized induction of PA. The experimental group will be compared to an active control group (neutral mental imagery) and treatment as usual. Procedures in all treatment arms are parallelized. Main outcomes after twelve sessions of psychotherapy will be psychosocial resources, resilience and self-esteem (theory-driven), as well as psychopathology and working alliance (secondary outcome). Multilevel modeling will be conducted to address the nested data structure. Conclusion Study results may have implications on the consideration of positive constructs in mental disorders and the implementation of strengths-based interventions in psychotherapy.
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Affiliation(s)
- Jan Schürmann-Vengels
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Philipp Pascal Victor
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Patrizia Odyniec
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Christoph Flückiger
- Department of
Clinical Psychology and Psychotherapy, University
of Zurich, Zurich,
Switzerland
| | - Tobias Teismann
- Mental Health
Research and Treatment Center, Ruhr-Universität
Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
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24
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Future-oriented imagery rescripting facilitates conducting behavioral experiments in social anxiety. Behav Res Ther 2022; 155:104130. [DOI: 10.1016/j.brat.2022.104130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/18/2022]
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25
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TIBA AI, VOSS L. " A Motor Imagery Training for Improving Action Cognition Results in the Reduction of Residual Symptoms after Major Depressive Disorder: A Single-Case Study". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2022. [DOI: 10.24193/jebp.2022.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The high rate of recurrence and residual symptoms of depression continuously motivate the search for new treatments addressing this challenging condition. In this single-case study, we reported the application of a cognitive rehabilitation skills training based on remote kinematics as a treatment for residual depression by targeting deficits of mental simulations of action. We found that the administration of Kinect-based rehabilitation training resulted in important improvements showed by significant mean baseline reductions (MBLR) of difficulty in imagining positive actions (MBLR= 54 %), negative emotions (MBLR = 36.3 %), cognitive flexibility (MBLR= 69.7 %), depressive symptoms (MBLR= 80%), and physical retardation (MBLR= 50 %). Similarly, improvements in positive affect (MBLR = 107 %) and vividness of motor imagery for positive actions were registered (MBLR= 100 %). We also found unique effects of our intervention such as reports of involuntary action simulations to distant stimuli or extended affordances. The training was well-accepted and the patient considered it was an entertaining way to do physical exercises and to get in physical and mental shape. We concluded that further scientific research of remote Kinematic interventions in depression may be warranted.
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Pellas J, Renner F, Ji JL, Damberg M. Telephone-based behavioral activation with mental imagery for depression: A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5646. [PMID: 34729823 PMCID: PMC8646381 DOI: 10.1002/gps.5646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To shield vulnerable persons, particularly the elderly, during the Covid-19 pandemic governments around the world have advised to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid-19 pandemic. METHODS In this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA-MI treatment condition, or an Attention-Assessment control condition delivered over the telephone over a 4-week period. RESULTS Depressive symptoms decreased more in the treatment condition compared to the control condition. At post-treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed. CONCLUSIONS This pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.
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Affiliation(s)
- Johnny Pellas
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Centre for Clinical ResearchUppsala University, Västmanland County HospitalVästeråsSweden
| | - Fritz Renner
- Department of Clinical Psychology and PsychotherapyUniversity of FreiburgBreisgauGermany
| | - Julie L. Ji
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Mattias Damberg
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Centre for Clinical ResearchUppsala University, Västmanland County HospitalVästeråsSweden
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Landkroon E, van Dis EAM, Meyerbröker K, Salemink E, Hagenaars MA, Engelhard IM. Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking. Behav Ther 2022; 53:80-91. [PMID: 35027160 DOI: 10.1016/j.beth.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022]
Abstract
Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.
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Abstract
Anhedonia, a loss of interest or pleasure in activities, is a transdiagnostic symptom that characterizes many individuals suffering from depression and anxiety. Most psychological interventions are designed to decrease negative affect rather than increase positive affect, and are largely ineffective for reducing anhedonia. More recently, affective neuroscience has been leveraged to inform treatments for anhedonia by targeting aspects of the Positive Valence Systems, including impairments in reward anticipation, reward responsiveness, and reward learning. In this chapter, we review the efficacy of treatments and, when possible, highlight links to reward constructs. Augmented behavioral approaches and targeted cognitive interventions designed to target reward anticipation, responsiveness, and learning show preliminary efficacy in reducing anhedonia, while there is a relative lack of treatments that target positive emotion regulation and reward devaluation. In addition to developing treatments that address these targets, the field will benefit from establishing standardized measurement of anhedonia across units of analysis, mapping mechanisms of change onto aspects of reward processing, and examining anhedonia outcomes in the long-term.
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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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Ji JL, Geiles D, Saulsman LM. Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities. Behav Res Ther 2021; 145:103947. [PMID: 34433114 DOI: 10.1016/j.brat.2021.103947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
Preliminary evidence suggests mental imagery-based episodic simulation of planned reward activities may amplify motivation and promote greater behavioural engagement, particularly for activities with high motivational barriers (Renner, Murphy, Ji, Manly, & Holmes, 2019). This study conducted a conceptual replication and extension of Renner et al. (2019). N = 81 first-year university students self-selected and scheduled two reward activities (one hedonic, one mastery) for the following week before being randomly allocated to either an Imagery-Experiential elaboration condition (n = 27), a Verbal-Reasoning elaboration condition (n = 28), or a Scheduling-only Control condition (n = 26). Following the lab session, all participants received standardized daily prompts to complete daily activity diaries online for seven days. The Imagery-Experiential condition reported greater increases in anticipatory pleasure (state mood), anticipated pleasure, and self-reported motivation compared to the Scheduling-only Control condition, and greater increases in anticipatory pleasure (state mood), but not anticipated pleasure or motivation, relative to the Verbal-Reasoning condition. Consistent with Renner et al. (2019), the Imagery-Experiential condition, but not the Verbal-Reasoning condition, reported more frequent engagement in high motivational barrier activities than the Scheduling-only Control condition. Exploratory mediational analyses suggested that mental imagery may exert unique motivational impacts via its impact on anticipatory pleasure (state mood), although indirect effects were only observed for self-reported motivation change in the lab, with real world behavioural effects falling short of statistical significance.
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Affiliation(s)
- Julie L Ji
- School of Psychological Science, University of Western Australia, Australia.
| | - Dylan Geiles
- School of Psychological Science, University of Western Australia, Australia
| | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Australia
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Rauschenberg C, Boecking B, Paetzold I, Schruers K, Schick A, van Amelsvoort T, Reininghaus U. A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study. JMIR Ment Health 2021; 8:e25650. [PMID: 34383687 PMCID: PMC8380580 DOI: 10.2196/25650] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. OBJECTIVE This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). METHODS In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). RESULTS In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). CONCLUSIONS Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy.
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Affiliation(s)
- Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Mondriaan Mental Health Center, Maastricht, Netherlands
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Mondriaan Mental Health Center, Maastricht, Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Prospective mental imagery in depression: Impact on reward processing and reward-motivated behaviour. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3013. [PMID: 36397959 PMCID: PMC9667131 DOI: 10.32872/cpe.3013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background Mental imagery has long been part of cognitive behavioural therapies. More recently, a resurgence of interest has emerged for prospective mental imagery, i.e. future-directed imagery-based thought, and its relation to reward processing, motivation and behaviour in the context of depression. Method We conducted a selective review on the role of prospective mental imagery and its impact on reward processing and reward-motivated behaviour in depression. Results Based on the current literature, we propose a conceptual mechanistic model of prospective mental imagery. Prospective mental imagery of engaging in positive activities can increase reward anticipation and reward motivation, which can transfer to increased engagement in reward-motivated behaviour and more experiences of reward, thereby decreasing depressive symptoms. We suggest directions for future research using multimodal assessments to measure the impact of prospective mental imagery from its basic functioning in the lab to real-world and clinical implementation. Conclusion Prospective mental imagery has the potential to improve treatment for depression where the aim is to increase reward-motivated behaviours. Future research should investigate how exactly and for whom prospective mental imagery works. This review provides a selected update of the literature on prospective mental imagery. Prospective mental imagery might decrease depression via reward processing and reward-motivated behaviours. Suggestions for future research to investigate these hypotheses are provided.
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Hoyer J, Dechmann JCG, Stender T, Čolić J. Selecting and imagining rewarding activities during the
COVID
‐19 lockdown: Effects on mood and what moderates them. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:585-593. [PMID: 33942893 PMCID: PMC8239711 DOI: 10.1002/ijop.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Germany
| | | | - Tanja Stender
- Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Germany
| | - Jasmin Čolić
- Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Germany
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Psychometric Properties and Factor Structure of the French Version of the Behavioral Activation for Depression Scale (BADS) in Non-Clinical Adults. Psychol Belg 2021; 61:20-32. [PMID: 33598302 PMCID: PMC7863847 DOI: 10.5334/pb.542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Behavioral activation (BA) is a well-established empirical treatment for depression that aims to improve depressive mood by increasing activation and reducing avoidance. Therefore, it is essential to evaluate activation and avoidance when a BA treatment is applied. The Behavioral Activation for Depression Scale (BADS) was developed to measure the changes in activation and avoidance over the course of BA treatment of depression. This study aims to validate the French version of this scale. In a first study, 131 bilingual adults were recruited to explored internal consistency, test-retest reliability and construct validity of the final French version. In a second study, 409 non-clinical adults completed an online survey assessing concurrent measures. Results of the first study suggested good internal consistency, test-retest reliability and construct validity. The second study revealed a confirmatory factor analysis supporting the original four-factor structure, with Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment subscales. Results also revealed that a 5-factor model distinguishing Behavioral Avoidance and Rumination had a better fit than the original four-factor structure. All subscales showed adequate internal consistency and good construct validity with evidence of convergent validity with depressive symptoms, brooding, psychological flexibility, negative automatic thought, behavioral inhibition and activation system. Furthermore, the French BADS total scale and subscales showed a good ability to predict depressive symptoms. The French version of the BADS appears to be a reliable tool for clinician and researchers to assess mechanisms of change in BA interventions.
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36
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Chen K, Barnes-Horowitz N, Treanor M, Sun M, Young KS, Craske MG. Virtual Reality Reward Training for Anhedonia: A Pilot Study. Front Psychol 2021; 11:613617. [PMID: 33488482 PMCID: PMC7817899 DOI: 10.3389/fpsyg.2020.613617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 02/01/2023] Open
Abstract
Anhedonia is a risk factor for suicide and poor treatment response in depressed individuals. Most evidence-based psychological therapies target symptoms of heightened negative affect (e.g., negative inferential style) instead of deficits in positive affect (e.g., attenuated reward response) and typically show little benefit for anhedonia. Viewing positive scenes through virtual reality (VR) has been shown to increase positive affect and holds great promise for addressing anhedonic symptoms. In this pilot study, six participants with clinically significant depression completed 13 sessions of exposure to positive scenes in a controlled VR environment. Significant decreases were found in self-reported anhedonia, depression, anxiety, and impairments in functioning from baseline to 1-month follow-up. Negative affect decreased over all 13 sessions, and positive affect increased over sessions 8-13. Results suggest that positive experiences in VR may be a novel avenue for the treatment of anhedonia in depressed individuals.
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Affiliation(s)
- Kelly Chen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Nora Barnes-Horowitz
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Treanor
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Sun
- Department of Psychology, Dartmouth College, Hanover, NH, United States
| | - Katherine S. Young
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
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37
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Brunette AM, Schacter DL. Cognitive mechanisms of episodic simulation in psychiatric populations. Behav Res Ther 2020; 136:103778. [PMID: 33338778 DOI: 10.1016/j.brat.2020.103778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 01/30/2023]
Abstract
Episodic simulation is the construction of a mental representation of a specific autobiographical future event. Episodic simulation has increasingly been studied in psychiatric populations. Here we 1) review evidence indicating that episodic simulation is compromised in patients with depression, anxiety, schizophrenia, bipolar disorder, and PTSD; and 2) consider several potential cognitive mechanisms of episodic simulation in psychiatric populations: episodic retrieval, scene construction, mental imagery, components of the CaRFAX model (i.e., capture and rumination, functional avoidance, and executive functioning), and narrative style. We evaluate evidence regarding these mechanisms across psychiatric populations, and identify areas of future research. Understanding the factors that contribute to episodic simulation impairment in psychiatric populations may lead to targeted and effective treatment approaches.
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Affiliation(s)
- Amanda M Brunette
- VA Boston Healthcare System, Psychology Service, 150 South Huntington Avenue, Boston, MA, 02130, United States.
| | - Daniel L Schacter
- Harvard University, Department of Psychology, William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, United States.
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Saulsman LM, Ji JL, Mcevoy PM. The essential role of mental imagery in cognitive behaviour therapy: What is old is new again. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Lisa M. Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
- Cognitive Behaviour Therapy Services Western Australia, Perth, Western Australia, Australia
| | - Julie L. Ji
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter M. Mcevoy
- School of Psychology, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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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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Thonon B, Van Aubel E, Lafit G, Della Libera C, Larøi F. Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms. BMC Psychiatry 2020; 20:464. [PMID: 32977798 PMCID: PMC7517640 DOI: 10.1186/s12888-020-02824-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. METHODS We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. RESULTS The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). CONCLUSIONS This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered. REPORTING Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.
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Affiliation(s)
- Bénédicte Thonon
- grid.4861.b0000 0001 0805 7253Faculty of Psychology, Speech and Laguage Therapy and Education Sciences, Psychology and Neuroscience of Cognition Research Unit, University of Liège, Place des Orateurs 1, 4000 Liège, Belgium
| | - Evelyne Van Aubel
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), Katholieke Universiteit Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), Katholieke Universiteit Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Psychology, Research Group of Quantitative Psychology and Individual, Differences, Katholieke Universiteit Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - Clara Della Libera
- grid.4861.b0000 0001 0805 7253Faculty of Psychology, Speech and Laguage Therapy and Education Sciences, Psychology and Neuroscience of Cognition Research Unit, University of Liège, Place des Orateurs 1, 4000 Liège, Belgium
| | - Frank Larøi
- Faculty of Psychology, Speech and Laguage Therapy and Education Sciences, Psychology and Neuroscience of Cognition Research Unit, University of Liège, Place des Orateurs 1, 4000, Liège, Belgium. .,Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009, Bergen, Norway. .,NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway.
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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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Increasing Anticipatory Pleasure in Major Depression through Enhancing Episodic Future Thinking: a Randomized Single-Case Series Trial. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09820-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Hallford DJ, Yeow JJE, Fountas G, Herrick CA, Raes F, D'Argembeau A. Changing the future: An initial test of Future Specificity Training (FeST). Behav Res Ther 2020; 131:103638. [PMID: 32416495 DOI: 10.1016/j.brat.2020.103638] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
A range of psychiatric disorders are characterised by impairments in episodic future thinking (EFT), and particularly simulating specific, spatiotemporally-located future events. No study has examined whether training can lead to sustained improvement in specific EFT. In this study, participants (N = 60; M age = 31, SD = 13.2) were randomized to a two-session, group-based future thinking program (Future Specificity Training; FeST) or wait-list. At follow-up the training group, relative to wait-list, showed large, statistically-significant improvements in the ability to mentally simulate specific EFT (d = .82), increases in detail (d = 1.32), use of mental imagery (d = 1.32), anticipated (d = 1.78) and anticipatory pleasure (d = 1.07), perceived control (d = 1.20), and likelihood of occurrence (d = 1.09). Some effects were also observed on positive, generalised future self-states. In the context of inherent limitations of subjective reporting in trials, this study provides evidence that EFT specificity can be enhanced, and the effects of FeST indicate a possible avenue to disrupt psychopathological processes.
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Affiliation(s)
- D J Hallford
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Melbourne, Australia.
| | - J J E Yeow
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Melbourne, Australia
| | - G Fountas
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Melbourne, Australia
| | - C A Herrick
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Melbourne, Australia
| | - F Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3712, 3000, Leuven, Belgium
| | - A D'Argembeau
- Psychology and Neuroscience of Cognition Research Unit, Department of Psychology, University of Liège, Belgium and Fonds de La Recherche Scientifique (F.R.S.-FNRS), Belgium
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Zhang R, Kranz GS, Zou W, Deng Y, Huang X, Lin K, Lee TMC. Rumination network dysfunction in major depression: A brain connectome study. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109819. [PMID: 31734293 DOI: 10.1016/j.pnpbp.2019.109819] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rumination is a central feature of major depressive disorder (MDD). Knowledge of the neural structures that underpin rumination offers significant insight into depressive pathophysiology and may help to develop potential intervention strategies for MDD, a mental illness that has become the leading cause of disability worldwide. METHODS Using resting-state fMRI and graph theory, this study adopted a connectome approach to examine the functional topological organization of the neural network associated with rumination in MDD. Data from 96 participants were analyzed, including 51 patients with MDD and 45 healthy controls. RESULTS We found altered functional integration and segregation of neural networks associated with depressive rumination as indicated by reduced global and local efficiency in MDD patients compared with controls. Interestingly, these metrics correlated positively with depression severity, as measured by the Hamilton Depression Rating Scale. Moreover, mediation analysis indicated that the association between network metrics and depression severity was mediated by the ruminative tendency of patients. Disrupted nodal centralities were located in regions associated with emotional processing, visual mental imagery, and attentional control. CONCLUSION Our results highlight rumination as a two-edged sword that reflects a disease-specific neuropathology but also points to a functionality of depressive symptoms with evolutionary meaning.
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Affiliation(s)
- Ruibin Zhang
- The State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China; Laboratory of Social Cognitive and Affective Neuroscience, The University of Hong Kong, Hong Kong, China; Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Georg S Kranz
- The State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Wenjin Zou
- Department of Radiology, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Yue Deng
- Department of Psychiatry, The Second Affiliated Hospital of Guangzhou Medical University, China
| | - Xuejun Huang
- Department of Psychiatry, The Second Affiliated Hospital of Guangzhou Medical University, China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, China.
| | - Tatia M C Lee
- Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, China; The State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China; Laboratory of Social Cognitive and Affective Neuroscience, The University of Hong Kong, Hong Kong, China; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, China.
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Hallford DJ, Sharma MK. Anticipatory pleasure for future experiences in schizophrenia spectrum disorders and major depression: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:357-383. [PMID: 30854671 DOI: 10.1111/bjc.12218] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure. METHODS Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review. RESULTS A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders. CONCLUSIONS Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder. PRACTITIONER POINTS Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.
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Affiliation(s)
- David J Hallford
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Manoj K Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Mental imagery as a "motivational amplifier" to promote activities. Behav Res Ther 2019; 114:51-59. [PMID: 30797989 PMCID: PMC6416378 DOI: 10.1016/j.brat.2019.02.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/15/2019] [Accepted: 02/04/2019] [Indexed: 11/21/2022]
Abstract
Facilitating engagement in rewarding activities is a key treatment target in depression. Mental imagery can increase engagement in planned behaviours, potentially due to its special role in representing emotionally salient experiences. The present study tested the hypothesis that mental imagery promotes motivation and engagement when planning pleasant and rewarding activities. Participants were recruited from a community volunteer panel (N = 72). They self-nominated six activities to complete over the following week, and were randomized to either: a) a single-session Motivational Imagery condition (N = 24); b) an Activity Reminder control condition (N = 24); or c) a No-Reminder control condition (N = 24). As predicted, relative to control groups, the Motivational Imagery group reported higher levels of motivation, anticipated pleasure, and anticipated reward for the planned activities. The Motivational Imagery group also completed significantly more activities than the Activity Reminder group, but not more than the No-Reminder group. Relevance of results to behavioural activation approaches for depression are discussed. Mental imagery of planned activities increases motivation to engage in them. Higher imagery vividness is associated with higher anticipated reward. Mental imagery of planned activities is associated with higher activity completion.
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Abstract
Mental imagery refers to the experience of perception in the absence of external sensory input. Deficits in the ability to generate mental imagery or to distinguish it from actual sensory perception are linked to neurocognitive conditions such as dementia and schizophrenia, respectively. However, the importance of mental imagery to psychiatry extends beyond neurocognitive impairment. Mental imagery has a stronger link to emotion than verbal-linguistic cognition, serving to maintain and amplify emotional states, with downstream impacts on motivation and behavior. As a result, anomalies in the occurrence of emotion-laden mental imagery has transdiagnostic significance for emotion, motivation, and behavioral dysfunction across mental disorders. This review aims to demonstrate the conceptual and clinical significance of mental imagery in psychiatry through examples of mood and anxiety disorders, self-harm and suicidality, and addiction. We contend that focusing on mental imagery assessment in research and clinical practice can increase our understanding of the cognitive basis of psychopathology in mental disorders, with the potential to drive the development of algorithms to aid treatment decision-making and inform transdiagnostic treatment innovation.
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Murphy FC, Peers PV, Blackwell SE, Holmes EA, Manly T. Anticipated and imagined futures: prospective cognition and depressed mood following brain injury. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:91-109. [PMID: 30129665 PMCID: PMC6492087 DOI: 10.1111/bjc.12202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Depression, which is common following acquired brain injury (ABI), has been shown to predict cognitive impairment, rehabilitation outcome, and quality of life. Whilst many studies have examined links between depression and cognitive-affective processing in the non-ABI population, their applicability to this important clinical group, where cognitive difficulties can be marked, remains unknown. Here, we investigated biases in prospective cognition, which is known to be disrupted in (non-ABI) depression yet important for well-being. DESIGN Cross-sectional design with three groups (depressed ABI, non-depressed ABI, and non-ABI control participants). Continuous data were additionally analysed in correlation analyses. METHODS Individuals with ABI varying in extent of self-reported depression and matched non-ABI control participants completed assessments of mood and prospective cognition (anticipating and imagining future events), alongside background tests of executive function and fluid intelligence. RESULTS Relative to non-depressed ABI and control participants, depressed ABI individuals demonstrated a reduced positive bias in prospective cognition: whereas non-depressed ABI and control participants generated more examples of likely or possible positive versus negative future events, there was no evidence for such a positive bias in depressed ABI participants. Non-depressed ABI and control participants also reported more vivid mental imagery for positive versus negative future scenarios, whereas such a pattern was not evident in depressed ABI participants. This pattern emerged despite background impairments in fluid intelligence and executive function associated with ABI. CONCLUSIONS These findings (1) elucidate depression-linked cognitive-affective processes following ABI, where cognitive difficulties are common, and (2) highlight psychological processes associated with depression that are common to ABI and non-ABI populations. PRACTITIONER POINTS Clinical implications A relative negative bias in future-directed cognition is associated with depressed mood in individuals with chronic ABI. Such processes may contribute to the onset and maintenance of depression following ABI. These findings suggest it may be important to consider a role for prospective cognition in psychological interventions for depression following ABI. Limitations of the study The extent to which depressed mood following ABI is associated with biases in other cognitive domains remains unclear. Whether similar patterns would be observed in acute patients with more profound cognitive difficulties requires further investigation. Despite large effect sizes, our sample size is modest; these effects thus require replication in larger groups.
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Affiliation(s)
- Fionnuala C Murphy
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Polly V Peers
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.,Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.,Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tom Manly
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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Panzeri M, Fontanesi L, Busà C, Carmelita A, Ronconi L, Dadomo H. A Contribution to Validation of the Short Schema Mode Inventory in an Italian Clinical Versus Non-clinical Population. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2018. [DOI: 10.1007/s10942-018-0299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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