Harnessing Mental Imagery and Enhancing Memory Specificity: Developing a Brief Early Intervention for Depressive Symptoms in Adolescence

An imagery rescripting based intervention in children and adolescents who endured a negative life event: A pilot study, satisfaction and feasibility survey

BACKGROUND AND OBJECTIVES

ImRs, a technique targeting distressing mental images, has shown promise in adult psychiatric treatment. Initial research indicates positive outcomes in children, with potential for reducing mental health care burden. This pilot study examined the use of Imagery Rescripting (ImRs) as an intervention for children who have experienced negative life events. We aimed to assess short-term emotional changes, participant satisfaction, and the feasibility of a larger-scale ImRs intervention for children.

METHODS

We employed a pre-posttest within-group design, and included 35 children (ages 5-18) who experienced negative life events, as well as 12 coaches. ImRs targeted distressing images related to negative events. Measurement tools included Visual Analogue Scales for distress and emotions, along with satisfaction surveys for both children and coaches. The feasibility of a larger-scale study was also explored through a coach questionnaire.

RESULTS

We found significant short-term improvements for all emotional states, with large effects for anxiety, sadness, and happiness, and a moderate effect for anger. Children reported fair levels of satisfaction with the intervention's acceptability and complexity. Coaches expressed high levels of satisfaction with the intervention as a whole and with its characteristics. Coaches were also strongly motivation for future, more in-depth research. An important limitation of this pilot study was the lack of a control group. In light of the promising results, more extensive studies with diagnostic information, multiple measures, and follow-up assessments are warranted.

CONCLUSION

Altogether, imagery rescripting based interventions seem a promising venue for children who experienced negative events.

Guided recall of positive autobiographical memories increases anticipated pleasure and psychological resources, and reduces depressive symptoms: a replication and extension of a randomised controlled trial of brief positive cognitive-reminiscence therapy

Reminiscence-based interventions focus on recalling autobiographical memories and reflective reasoning to develop a healthy and adaptive view of oneself and one's life. This study aimed to replicate the effects of a three-session, group-based, positive-memory version of cognitive-reminiscence therapy (CRT) on psychological resources and mental well-being and extend the findings to anticipated pleasure. The participants (N = 75, Mage = 43.7 (SD = 16.7), 60% females) were randomised to CRT or control group. Anticipated pleasure, psychological resources (schemas of positive self-esteem, self-efficacy, meaning in life, optimism), mental well-being (depression, anxiety, and stress symptoms) and theorised change processes (automatic negative thoughts, awareness of narrative identity) were assessed. Relative to the control group, the CRT group reported significantly higher anticipated pleasure (d = 0.76-0.93) and psychological resources of self-esteem, self-efficacy, and optimism (d's = 0.58-0.99) at post-CRT and follow-up, and lower depressive symptoms post-CRT and at follow-up (d = 0.56-0.67). Findings on meaning in life and negative automatic thinking were partially replicated. This study replicates findings of the effectiveness of this intervention for improving psychological resources such as self-worth, confidence and optimism and depressive symptoms, and indicates additional effects on anticipated pleasure. CRT may serve as a standalone intervention, or as an adjunct "memory booster" for interventions focused on future thinking and related anticipated reward.

Victim identifiability, number of victims, and unit asking in charitable giving

This study examines the identifiable victim effect (being more willing to help an identified victim than an unidentified), the singularity effect (i.e., being more willing to help a single identified victim than a group of identified victims), and unit asking (first asking donors for their willingness to donate for one unit and then asking for donations for multiple units) in charitable giving. In five studies (N = 7996), we vary the level of identifiability, singularity, and group size. We find that unit asking is making people more sensitive to the number of people in need. Further, while the level of identifiability influences affective reactions, this effect does not extend to donations and, thus, is not affected by unit asking. We do, however, find an "emotion asking effect" where asking donors to rate their affect before donating increase donation levels (compared to donors asked to rate affect after). Emotion asking was attenuated when combined with unit asking.

A Meta-Analysis of the Influence of Cue Valence on Overgeneral Memory and Autobiographical Memory Specificity Among Youth

Overgeneral memory (OGM), or difficulty recalling specific memories when recounting autobiographical events, is associated with psychopathology. According to functional avoidance theory, OGM-or reduced autobiographical memory specificity (AMS)-may serve as an emotion regulation strategy that aids in the avoidance of painful, negative memories (Sumner, 2012; Williams et al., 2007). Some researchers argue that there may be a valence effect for OGM, such that there is a higher frequency of overgenerality when recalling negative memories compared to positive memories. Although not supported among adults, valence effects may be present among children and adolescents if OGM initially develops in response to negative cues and then generalizes to all memory recall over time. This meta-analysis examined differences in child and adolescent OGM and AMS based on cue valance; standardized mean differences between negative and positive valence cues for OGM and AMS indices were calculated. Following PRISMA guidelines, a systematic literature search resulted in 26 studies assessing OGM and 30 assessing AMS. There was a significant effect of valence on OGM (d = 0.17, p = 0.01) and AMS (d = -0.20, p = 0.01). There was a higher frequency of overgeneral responses to negative cue words than positive cue words. Similarly, there was a higher frequency of specific responses for positive cue words than negative cue words. Subgroup analyses considering differences in valence effects by participant age (childhood vs. adolescence), sample type (clinical vs. community), and task instructions (verbal vs. written) were not significant. Theoretical advancements for our understanding of OGM and AMS and clinical implications are discussed.

Effects of reminiscence therapy combined with memory specificity training (RT-MeST) on depressive symptoms in older adults: a randomized controlled trial protocol

BACKGROUND

Geriatric depression has become a serious public health problem, and reduced autobiographical memory and increased overgeneral memory, as the main cognitive markers of depression, are not only associated with current depressive symptoms but also associated with the onset and course of depression, which can lead to a range of harms. Economic and effective psychological interventions are urgently needed. The aim of this study is to confirm the effectiveness of reminiscence therapy combined with memory specificity training in improving autobiographical memory and depressive symptoms in older adults.

METHODS

In this multicentre, single-blind, three-arm parallel randomized controlled study, we aim to enrol 78 older adults aged 65 years or older with a score of ≥ 11 on the Geriatric Depression Scale, and participants will be randomly assigned to either a reminiscence therapy group, a reminiscence therapy with memory specificity training group or a usual care group. Assessments will be conducted at baseline (T0) as well as immediately post-intervention (T1) and 1 (T2), 3 (T3) and 6 (T4) months post-intervention. The primary outcome measure is self-reported depressive symptoms, measured using the GDS. Secondary outcome measures include measures of autobiographical memory, rumination, and social engagement.

DISCUSSION

We believe that the intervention will play a positive role in improving autobiographical memory and depressive symptoms in older adults. Poor autobiographical memory is a predictor of depression and a major cognitive marker, and improving autobiographical memory is of great significance in alleviating depressive symptoms in older people. If our program is effective, it will provide a convenient and feasible strategy for further promoting healthy ageing.

TRIAL REGISTRATION

ChiCTR2200065446.

A causal link between mental imagery and affect-laden perception of climate change related risks

Previous studies have shed light on the importance of affect in risk perception and the role of mental imagery in generating affect. In the current study, we explore the causal relationship between mental imagery, affect, and risk perception by systematically varying the level of mental imagery in three levels (i.e., enhanced, spontaneous, or prevented). In light of the increasing environmental risk of adverse events caused by climate change, we operationalize risk as participants' perceived risk of climate change. One-thousand-fifty-five participants were recruited online and randomized to one of three levels of mental imagery. As predicted, we found a causal link between the level of mental imagery, affective experience, and perceived risk of climate change, in that enhanced mental imagery caused a larger decrease in positive affective valence and a larger increase in perceived risk of climate change. We argue that mental imagery enhances the negative affect associated with the risk event by creating a perceptual experience that mimics seeing the environmental risk events.

Emotional mental imagery generation during spontaneous future thinking: relationship with optimism and negative mood

Optimism is known to buffer against negative mood. Thus, understanding the factors that contribute to individual variation in optimism may inform interventions for mood disorders. Preliminary evidence suggests that the generation of mental imagery-based representations of positive relative to negative future scenarios is related to optimism. This study investigated the hypothesis that an elevated tendency to generate positive relative to negative mental imagery during spontaneous future thinking would be associated with reduced negative mood via its relationship to higher optimism. Participants (N = 44) with varied levels of naturally occurring negative mood reported current levels of optimism and the real-time occurrence and characteristics of spontaneous thoughts during a sustained attention computer task. Consistent with hypotheses, higher optimism statistically mediated the relationship between a higher proportional frequency of positive relative to negative mental imagery during spontaneous future thinking and lower negative mood. Further, the relationship between emotional mental imagery and optimism was found for future, but not past, thinking, nor for verbal future or past thinking. Thus, a greater tendency to generate positive rather than negative imagery-based mental representations when spontaneously thinking about the future may influence how optimistic one feels, which in turn may influence one's experience of negative mood.

An early intervention for adolescent depression targeting emotional mental images and memory specificity: a process evaluation

We have evaluated a novel early intervention for adolescent depression (age 16-18) in a feasibility randomised controlled trial. This nested process evaluation aimed to understand how this complex intervention worked. We sought to understand participants' views and experiences of receiving and interacting with the intervention to evaluate whether the underpinning theoretical basis of the intervention is justified and whether it contributes to valued outcomes for participants. Twelve participants were invited to take part in semi-structured interviews. Framework analysis was employed to identify important aspects of adolescents' experiences. The active ingredients identified by participants were consistent with and extended our understanding of the theoretical basis of the intervention. Four principle themes were identified: understanding how memory works and being able to remember memories in more detail; processing negative experiences and letting go; imagining positive future events; and understanding and being kinder to myself. The outcomes of the intervention were valued by participants. Six principle themes were identified: improving mood and well-being; reducing impact of negative memories; motivation and goal-directed behaviour; overcoming avoidance and rumination; relationships, communication and being open; and self-understanding and acceptance. A simplified logic model is also proposed to connect the intervention components, active ingredients, and valued outcomes. The findings provide an in-depth understanding of how participants interacted with the intervention and what they derived from it. For example, the findings establish processing negative experiences as a core intervention component, extend it to include letting go of these memories, and highlight that reducing the impact of negative memories is valued by participants. This richer understanding guides further intervention development and future implementation.

Harnessing emotional mental imagery to reduce anxiety and depression in young people: an integrative review of progress and promise

Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.

Using Imagery Rescripting as an Early Intervention for Depression in Young People

Innovation is urgently needed for school-based early interventions for depression. Imagery rescripting for aversive memories has been shown to be a valuable therapeutic approach in adults. Yet it is rarely applied to young people or to depression. This is surprising given that intrusive images of aversive memories are implicated in the development and maintenance of depression. We review the literature and describe the co-development of an imagery rescripting protocol for young people (age 16-18) with high symptoms of depression. To contextualize and illustrate this approach, we identify three themes of negative images emerging from the 37 participants who completed imagery rescripting and provide a detailed case example for each theme. The identified themes are failure, interpersonal adversity, and family conflict or disruption. Given that there is some therapist concern about using imagery rescripting, we highlight any reported negative consequences of engaging in imagery rescripting. We propose that imagery rescripting is an acceptable and potentially effective tool for early intervention in depression, which is significantly underutilized in current practice.