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Stavropoulos L, Briggs N, Grisham JR. Self-guided imagery rescripting for worry images: A preliminary experimental investigation. J Clin Psychol 2024; 80:1213-1230. [PMID: 38356250 DOI: 10.1002/jclp.23660] [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: 11/08/2022] [Revised: 07/30/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed first to examine the relationship between trait worry and properties of future-oriented worry images, and second to examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries. METHODS Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions). RESULTS In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type. CONCLUSIONS This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.
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Affiliation(s)
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
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Kip A, Schoppe L, Arntz A, Morina N. Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis. J Anxiety Disord 2023; 99:102772. [PMID: 37699277 DOI: 10.1016/j.janxdis.2023.102772] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Imagery rescripting (ImRs) is frequently applied to treat different psychological complaints. We conducted an updated meta-analysis based on randomised controlled trials on the efficacy of ImRs for mental disorders associated with aversive memories. Medline, PsycInfo, and Web of Science were searched up to May 2023. Seventeen trials were included with a total of 908 participants (417 in the ImRs condition), suffering from posttraumatic stress disorder, anxiety disorders, depression, or eating disorders. Random effect models yielded an overall effect of g = 0.68 (95 % CI 0.18 to 1.18; k = 7) compared to passive controls (mostly waitlist). The effect compared to (prolonged) exposure, cognitive restructuring, and EMDR was non-significant (g = -0.01; 95 % CI -0.18 to 0.15; k = 11). Follow-up assessments indicated a long-term treatment effect. Results suggest that ImRs can effectively treat a variety of psychological disorders and produce similar treatment effects as evidence-based interventions. Limitations include the bounded number of included trials for each mental disorder. The meta-analysis was registered on PROSPERO (CRD42020220696) and received no funding.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Luisa Schoppe
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS Amsterdam, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
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Fuhr K, Bender A, Wiegand A, Janouch P, Drujan M, Cyrny B, Schweizer C, Kreifelts B, Nieratschker V, Batra A. Hypnotherapy for agoraphobia-Feasibility and efficacy investigated in a pilot study. Front Psychol 2023; 14:1213792. [PMID: 37637902 PMCID: PMC10448829 DOI: 10.3389/fpsyg.2023.1213792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
A number of case studies describing hypnotherapy in the treatment of anxiety disorder patients have already been published. Only a few randomized controlled trials (RCTs) investigated the efficacy of hypnotherapy but focused mainly on symptoms rather than specific mental disorders. The goal of this study was to investigate whether hypnotherapy (HT) was superior to a waitlist control group (WL) in the reduction of agoraphobia-related symptoms. Further goals were to report the feasibility of hypnotherapy as well as attrition and completion rates and detect (epi-)genetic variables, which might play a role in treatment outcome. This pilot study was based on a monocentric two-armed randomized controlled rater-blind clinical trial that was conducted between 2018 and 2020 with a waitlist control group. A total of 36 patients diagnosed with agoraphobia were randomized to either HT or WL. Patients in HT received individual outpatient treatment with hypnotherapy with 8 to 12 sessions for a period of 3 months. Patients in WL received HT after 3 months. Agoraphobia-related symptoms were assessed at baseline, after the treatment, and 3 months later in both groups with a clinician rating. The primary hypothesis concerning the difference between groups in the individual percentage symptom reduction could be confirmed in the intention-to-treat, not the per-protocol sample. Additionally, we applied repeated-measures analyses of variance and found a higher symptom decrease in HT compared with WL patients in three of the five imputed datasets. The dropout rate was low, and satisfaction with the treatment was high. HT patients experienced a strong symptom reduction after receiving hypnotherapy. WL patients improved slightly during the waiting period. The COMT Val108/158Met genotype had an effect on the agoraphobia-related symptoms as well as on COMT DNA methylation levels. This is the first study to indicate that hypnotherapy performed better than a waitlist control group regarding the reduction in anxiety symptoms in an RCT. Future studies should confirm the efficacy of hypnotherapy and compare the treatment with a standard treatment for anxiety disorders in a larger trial. Future studies should also investigate whether hypnotic susceptibility is associated with COMT Val108/158Met genotype and could predict treatment success for HT. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT03684577, identifier: NCT03684577.
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Affiliation(s)
- Kristina Fuhr
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Annika Bender
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- Max Planck Fellow Group Precision Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Paul Janouch
- Outpatient Psychotherapy Practice, Bad Salzuflen, Germany
| | - Marta Drujan
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Barbara Cyrny
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Cornelie Schweizer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
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Endhoven B, De Cort K, Matthijssen SJMA, de Jongh A, van Minnen A, Duits P, Schruers KRJ, van Dis EAM, Krypotos AM, Gerritsen L, Engelhard IM. Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE). BMC Psychiatry 2023; 23:157. [PMID: 36918861 PMCID: PMC10011792 DOI: 10.1186/s12888-022-04320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. METHODS A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. DISCUSSION The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. TRIAL REGISTRATION ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.
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Affiliation(s)
- Bart Endhoven
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands.
| | - Klara De Cort
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
| | - Suzy J M A Matthijssen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Ad de Jongh
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, The Netherlands
| | - Puck Duits
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Koen R J Schruers
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Angelos M Krypotos
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
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Voncken MJ, Janssen I, Keijsers GPJ, Dibbets P. Should cognitive restructuring precede imagery rescripting? An experimental pilot study. J Behav Ther Exp Psychiatry 2023; 78:101800. [PMID: 36435542 DOI: 10.1016/j.jbtep.2022.101800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Imagery rescripting (ImRs) is a promising therapeutic technique used in treatment for a variety of psychiatric disorders. During an ImRs session, an aversive disorder-related memory, is activated in imagination and rescripted to a more positive outcome. It has been shown to successfully weaken the negative cognitive meaning, so-called encapsulated beliefs of the targeted aversive memory. In many studies, ImRs is preceded by a cognitive restructuring (CR) technique focused on the encapsulated belief of the target memory. It is not clear whether adding such a CR technique is necessary or that ImRs as standalone technique can achieve comparable effects. METHODS Students with mild psychological distress (N = 53) were randomized over one session of cognitive restructuring plus imagery rescripting (CR + ImRs), a therapist attention placebo plus imagery rescripting (PLA + ImRs) and a double therapist attention placebo (PLA + PLA). Believability of the idiosyncratic encapsulated belief (primary outcome) and quality (vividness, distress and emotional connotation: secondary outcome) of the target memory were assessed at pre, post and at 1-week follow-up. RESULTS Results indicate that both, CR + ImRs and PLA + ImRs, reduced the believability of the encapsulated beliefs in greater extent than PLA + PLA. No differences appeared between the two ImRs conditions. For the secondary outcomes no differences between the three conditions were found. LIMITATIONS This study should be seen as a pilot study, moreover a non-clinical sample was used. CONCLUSION Findings suggest that a CR technique preceding ImRs is redundant. However, this study needs replication in a larger sample.
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Affiliation(s)
- Marisol J Voncken
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - Iris Janssen
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - Ger 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
| | - Pauline Dibbets
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
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Kadriu F, Claes L, Witteman C, Woelk M, Krans J. The effect of imagery rescripting on core beliefs and eating disorder symptoms in a subclinical population. J Behav Ther Exp Psychiatry 2023; 78:101804. [PMID: 36435546 DOI: 10.1016/j.jbtep.2022.101804] [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: 07/29/2021] [Revised: 06/08/2022] [Accepted: 10/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study compared the effect of imagery rescripting focusing on self-compassion, imagery rescripting focusing on mastery, and a positive memory control condition on (1) emotional responses towards the memory (one day after), (2) changes in the believability of negative core beliefs, and dysfunctional eating behaviors (one week after) in individual at risk for developing an eating disorder. METHODS Female participants (N = 69) were allocated to one of three conditions: ImRs focusing on self-compassion (N = 24), ImRs focusing on self-mastery (N = 23), and positive memory control condition (N = 22). Participants in the ImRs conditions received a 20-min self-guided ImRs intervention, whereas participants in the control condition received a 20-min self-guided task focusing on an unrelated positive memory. RESULTS The experimental manipulation successfully induced the use of self-compassion and mastery strategies in the respective imagery rescripting condition. However, our data show that a single 20-min session of self-guided imagery rescripting focusing on compassion and/or mastery has no effect on the emotional response towards the aversive memory or in the change of core beliefs and eating behaviors at follow up. LIMITATIONS We discuss potential reasons for the null findings, including the use of a single imagery rescripting session, the sample size and the measurement of manipulation checks. CONCLUSION Future studies are needed to rule out methodological explanations for the null results. These findings may be of value for the development of future experimental lab paradigms which aim to evaluate the causal effects and working mechanisms of imagery rescripting.
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Affiliation(s)
- Fortesa Kadriu
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Laurence Claes
- Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Cilia Witteman
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Mandy Woelk
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Julie Krans
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD, Pastoor van Laakstr 48, 6663 CB Nijmegen, the Netherlands
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Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore? Compr Psychiatry 2023; 120:152357. [PMID: 36410261 PMCID: PMC10848818 DOI: 10.1016/j.comppsych.2022.152357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
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Affiliation(s)
- David Castle
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Jamie Feusner
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1RB, Canada
| | - Judith M Laposa
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario M6J 1H4, Canada
| | - Peggy M A Richter
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Frederick W Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada
| | - Rahat Hossain
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ana Lusicic
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Lynne M Drummond
- Service for OCD/ BDD, South-West London and St George's NHS Trust, Glenburnie Road, London SW17 7DJ, United Kingdom
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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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Steil R, Fischer A, Gutermann J, Rosner R. Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls. BMC Psychiatry 2022; 22:64. [PMID: 35086493 PMCID: PMC8793273 DOI: 10.1186/s12888-022-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA). METHODS Thirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images). RESULTS The PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group. DISCUSSION Negative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed. TRIAL REGISTRATION Some of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787 , 18 March 2013.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Anne Fischer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany
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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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Kutsuzawa K, Taguchi K, Shimizu E. Attention and Imagery in Cognitive-Behavioral Therapy for Chronic Pain: An Exploratory Study. J Psychosoc Nurs Ment Health Serv 2021; 60:45-54. [PMID: 34846226 DOI: 10.3928/02793695-20211118-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive-behavioral therapy (CBT) has been shown to have a small to medium effect on chronic pain, necessitating further research to identify which components of CBT work for which type of patient. Previously, we developed a high-intensity individual CBT protocol and conducted a single-arm, uncontrolled feasibility study for chronic pain. In the current study, we explored patients' experiences in CBT sessions, including tactile attention-shift training; memory work using the peak-end rule; mental practice of action using motor imagery rescripting; and video feedback, including mirror therapy. Fourteen patients with chronic pain completed 16 CBT sessions. The tactile attention-shift training was very helpful for two patients and somewhat helpful for five, memory work was helpful for nine, mental practice was very helpful for four and somewhat helpful for three, and visual feedback was very helpful for six patients. Effective methodologies for new chronic pain CBT components should be developed. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Szabó J, Tóth S. Collision Every Night: Treating Nightmares with Trauma-focused Methods: Case Report. SLEEP AND VIGILANCE 2021; 5:151-156. [PMID: 33554009 PMCID: PMC7849612 DOI: 10.1007/s41782-021-00126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 01/16/2021] [Indexed: 12/03/2022]
Abstract
Introduction We would like to present the case of a young patient with acute stress disorder and recurrent nightmares following the psychological trauma caused by a severe road traffic accident. The comprehensive therapy carried out at the Department of Traumatology included medication, trauma processing and a psychological method whose aim is to cease the development of nightmares. Case Presentation Psychiatric assessment and treatment was asked for a polytraumatised female patient at the Intensive Care Unit after she had undergone a neurosurgical intervention. Her medicinal treatment was continued at the Department of Traumatology. Besides the antidepressant venlafaxine she was treated in accordance with the EMDR protocol for acute stress disorder, and we also applied imagery rescripting to prevent her from having recurrent (daily) nightmares. As a result of the therapy, her symptoms were fast relieved, the nightmares stopped almost instantly, her mood improved, rumination and anxiety decreased significantly. Conclusions In view of the fast and significant symptomatic improvement, we can expect that the EMDR therapy and its protocol for acute stress disorder have successfully reactivated information processing, and besides the subjective relief we have managed to prevent a mental crisis that could lead to a suicide risk as well as the development of post-traumatic stress disorder. We also hope that the improvement will be long-lasting.
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Paulik G, Maloney G, Arntz A, Bachrach N, Koppeschaar A, McEvoy P. Delivering Imagery Rescripting via Telehealth: Clinical Concerns, Benefits, and Recommendations. Curr Psychiatry Rep 2021; 23:24. [PMID: 33725200 PMCID: PMC7962431 DOI: 10.1007/s11920-021-01238-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE OF THE REVIEW Delivery of psychological therapies via telehealth has increased with the emergence of the COVID-19 pandemic. Therapists may be hesitant in moving to telehealth when delivering therapies targeting memories of traumatic experiences. This paper collates the clinical experiences of clinicians and clients who have delivered or received imagery rescripting, respectively, via telehealth across a range of clinical presentations, and describes key clinical considerations and recommendations. RECENT FINDINGS It is important to consider perceived and real safety; practical and technological issues; therapeutic alliance; depth of emotional processing; and dissociation. There was support for the delivery of imagery rescripting via telehealth being no less effective than face-to-face delivery; however, telehealth delivery was not a viable option for many clients during COVID-19 lockdowns who were living in high density housing, old houses with thin walls, or with some complex disorders.
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Affiliation(s)
- Georgie Paulik
- Perth Voices Clinic, School of Psychology, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.
- School of Psychological Science, University of Western Australia, Crawley, Australia.
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia.
| | - Gayle Maloney
- Perth OCD Clinic, West Perth, Australia
- Yale OCD Research Clinic, Yale University School of Medicine, New Haven, USA
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, Netherlands
- RINO ZUID, Eindhoven, Netherlands
- Tilburg University, Tilburg, Netherlands
| | | | - Peter McEvoy
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Northbridge, Australia
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Mental Imagery in the Science and Practice of Cognitive Behaviour Therapy: Past, Present, and Future Perspectives. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00102-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractMental imagery has a long history in the science and practice of cognitive behaviour therapy (CBT), stemming from both behavioural and cognitive traditions. The past decade or so has seen a marked increase in both scientific and clinical interest in mental imagery, from basic questions about the processes underpinning mental imagery and its roles in everyday healthy functioning, to clinical questions about how dysfunctions in mental imagery can cause distress and impairment, and how mental imagery can be used within CBT to effect therapeutic change. This article reflects on the current state of mental imagery in the science and practice of CBT, in the context of past developments and with a view to future challenges and opportunities. An ongoing interplay between the various strands of imagery research and the many clinical innovations in this area is recommended in order to realise the full therapeutic potential of mental imagery in CBT.
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Hühne V, Vigne P, de Menezes GB, Fontenelle LF. The Remission of Social Anxiety Disorder After Trauma: A Case Report of Posttraumatic Growth? Front Psychiatry 2021; 12:692637. [PMID: 34589004 PMCID: PMC8473609 DOI: 10.3389/fpsyt.2021.692637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic growth (PTG) describes positive psychological change and improvement beyond one's previous functioning. It manifests as a change of self-perception, improvement in the relationship with others, and a better outlook on life. Despite consistent literature on the occurrence of PTG in healthy subjects, there is still a dearth of studies in people with pre-existing mental disorders, especially anxiety disorders. We report the case of a patient previously diagnosed with social anxiety disorder (SAD), whose symptoms remitted, and life view improved after a traumatic event, illustrating a case of PTG. The trauma shattered the patient's previous belief system, allowing the emergence of a new cognitive schema. Although PTG and symptom remission do not necessarily correspond to the same construct, we believe that these phenomena were related to each other in this case, probably because of a notable change in our patient's underlying belief system.
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Affiliation(s)
- Verônica Hühne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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