Mental Imagery and its Relevance for Psychopathology and Psychological Treatment in Children and Adolescents: a Systematic Review

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.

"The mere imagination scares me"-evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain

ABSTRACT

According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed. Adolescents (11-18 years) with chronic headache (CH, n = 46) or chronic abdominal pain (CAP, n = 29) and a control group (n = 28) were asked to imagine individualized pain-associated, neutral and standardized fear scripts. During pain-associated compared with neutral imagery, both pain groups showed higher mean HR, with CH also showing higher HR reactivity, while HR acceleration was not observed within control group. In contrast, during pain-associated compared with neutral imagery, startle response magnitude and SCL remained unchanged in all groups. Additionally, overall levels in self-reports were higher during pain-associated compared with neutral imagery, but significantly more pronounced in the pain groups compared with the control group. Results suggest that the mere imagination of pain-associated sensations elicits specific autonomic fear responses accompanied by increased self-reported fear in adolescents with chronic pain. The specific modulation of heart rate shed new light on our understanding of multimodal fear responses in adolescents with chronic pain and may help to refine paradigms to decrease fear of interoceptive sensations in chronic pain.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking

INTRODUCTION

This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females.

METHOD

Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests.

RESULTS

Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05).

DISCUSSION

Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

The phenomenology of mental imagery in people with intellectual disabilities

OBJECTIVES

Mental imagery is important in the development and maintenance of psychological disorders and well-being but has been neglected in people with intellectual disabilities. A detailed idiographic analysis of the lived experience of mental imagery in this population is presented.

DESIGN

This qualitative study uses interpretative phenomenological analysis (IPA). It involved inclusive research methods with people with intellectual disabilities and other stakeholders (including family members, advocates, support workers and intellectual disability service managers).

METHODS

Ten individual semi-structured interviews were conducted with people with mild-moderate intellectual disabilities. Participants were opportunistically sampled through organisations providing community services to people with intellectual disabilities in the UK. Two men and eight women (mean age 43 years) participated. Interviews were audio-recorded and analysed using IPA.

RESULTS

People with intellectual disabilities are able to experience a range of rich and detailed mental images across all sensory modalities. Participants reported changes in affect based on mental imagery, and an ability to experience both spontaneous and deliberate mental images. The emotional saliency of the object of mental imagery appeared to influence participants' ability to engage with imagery. A number of adaptations make mental imagery more accessible and easier to report. The ability of people with intellectual disabilities to experience vivid mental imagery has important clinical implications for the use of a range of mental imagery interventions with this population.

CONCLUSIONS

The need to consider mental imagery interventions for this population, and how these can be adapted to ensure accessibility is a priority for people with intellectual disabilities and psychological disorders.

Boosting exposure and response prevention with imagery-based techniques: a case study tackling sexual obsessions in an adolescent

Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD.

Key learning aims

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Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls

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.

Mental Imagery and Social Pain in Adolescents-Analysis of Imagery Characteristics and Perspective-A Pilot Study

BACKGROUND

Mental imagery (MI) may play a key role in the development of various mental disorders in adolescents. Adolescence is known to be a fragile life period, in which acceptance by one's favored peer group is extremely important, and social rejection is particularly painful. This is the first pilot study investigating MI and its relationship to social pain (SP).

METHOD

A sample of 80 adolescents (14-20 years; 75.3% female) completed a web-based quasi-experimental design about the contents and characteristics of their spontaneous positive and negative MI and associated emotions, and were asked to complete the Social Pain Questionnaire, the Becks Depression Inventory and the Social Phobia Inventory.

RESULTS

A higher score of SP was significantly associated with increased fear, sadness, and feelings of guilt, and less control over negative MI. Characteristics of negative MI were more precisely predicted by SP scores than depression- and social anxiety scores. Adolescents with higher SP-scores more often reported negative images including social situations and were more likely to perceive negative images in a combination of field-and observer perspectives than adolescents with lower SP scores.

CONCLUSION

SP-sensitivity seems to be linked to unique characteristics of negative MI, which reveals the strong emotional impact of social exclusion in youths. The results do not allow causal conclusions to be drawn, but raise questions about previous studies comparing each imagery perspective individually.