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Varma MM, Zeng S, Singh L, Holmes EA, Huang J, Chiu MH, Hu X. A systematic review and meta-analysis of experimental methods for modulating intrusive memories following lab-analogue trauma exposure in non-clinical populations. Nat Hum Behav 2024:10.1038/s41562-024-01956-y. [PMID: 39169230 DOI: 10.1038/s41562-024-01956-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 07/15/2024] [Indexed: 08/23/2024]
Abstract
Experiencing trauma leads to intrusive memories (IMs), a hallmark symptom of post-traumatic stress disorder (PTSD), which also occurs transdiagnostically. Understanding why IMs increase or decrease is pivotal in developing interventions to support mental health. In this preregistered meta-analysis (PROSPERO: CRD42021224835), we included 134 articles (131 techniques, 606 effect sizes and 12,074 non-clinical participants) to investigate how experimental techniques alter IM frequency, intrusion-related distress and symptoms arising from lab-analogue trauma exposure. Eligible articles were identified by searching eight databases until 12 December 2023. To test potential publication biases, we employed methods including Egger's test and three-parameter selection models. We employed three-level multilevel modelling and meta-regressions to examine whether and how experimental techniques would modulate IM frequency and associated outcomes. Results showed that techniques (behavioural, pharmacological, neuromodulation) significantly reduced intrusion frequency (g = 0.16, 95% confidence interval [0.09, 0.23]). Notably, techniques aimed to reduce IMs also ameliorated intrusion-related distress and symptoms, while techniques that increased IMs exacerbated these related outcomes, thus highlighting IM's centrality in PTSD-like symptoms. Techniques tapping into mental imagery processing (for example, trauma reminder followed by playing Tetris) reduced intrusions when administered immediately after, or at a delayed time after trauma. Although our meta-analysis is limited to symptoms induced by lab-analogue trauma exposure, some lab-based results have now generalized to real-world trauma and IMs, highlighting the promising utility of lab-analogue trauma paradigms for intervention development.
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Affiliation(s)
- Mohith M Varma
- Department of Management, Marketing, and Information Systems, Hong Kong Baptist University, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- The State Key Lab of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Emily A Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jingyun Huang
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Man Hey Chiu
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China.
- The State Key Lab of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
- HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China.
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Daniels JK, Thielemann J, Borg C. Can Listening to a Verbal Trauma Report Induce Intrusions? - Replication of a Randomized Trial. J Trauma Dissociation 2024:1-15. [PMID: 39044421 DOI: 10.1080/15299732.2024.2374369] [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: 12/07/2023] [Accepted: 06/07/2024] [Indexed: 07/25/2024]
Abstract
Recent evidence suggests that indirect verbal exposure to traumatic events can be sufficient to cause intrusions and other posttraumatic stress symptoms. In this study, we used a verbal trauma report to experimentally induce intrusions and a tactile task to manipulate the putative processes underlying intrusion development. Our findings indicate that the verbal report indeed induced intrusive recall. Moreover, the verbal report induced negative mood, state anxiety, and state dissociation, with mood and state dissociation predicting intrusion development. Additionally, the tactile task interfered with intrusion formation as indicated by the primary diary measure, but not the retrospective self-report. However, these results await further replication as this and previous trials suffered from limited statistical power. The findings support the reports by trauma therapists who experience secondary traumatization. They also challenge the assumption that all intrusions develop bottom-up from low-level sensory input via sensory representations. Future studies should explore differential processes for intrusion development based on their modality.
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Affiliation(s)
- Judith K Daniels
- Clinical Psychology, University of Groningen Netherlands, Groningen, Netherlands
| | - Jonathan Thielemann
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt Germany, Eichstätt, Germany
| | - Charmaine Borg
- Clinical Psychology, University of Groningen Netherlands, Groningen, Netherlands
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O'Donohue MP, Amir Hamzah K, Nichols D, Ney LJ. Trauma film viewing and intrusive memories: Relationship between salivary alpha amylase, endocannabinoids, and cortisol. Psychoneuroendocrinology 2024; 164:107007. [PMID: 38503195 DOI: 10.1016/j.psyneuen.2024.107007] [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: 11/13/2023] [Revised: 01/14/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
The endogenous cannabinoid (ECB) system is a small molecule lipid signalling system that is involved in stress response activation and is associated with PTSD, but it is unclear whether salivary ECBs are part of the sympathetic nervous system response to stress. We conducted an adapted trauma film paradigm, where participants completed a cold pressor test (or control) while watching a 10-minute trauma film. We also collected saliva and hair samples and tested them for ECBs, cortisol, and salivary alpha amylase (sAA). As hypothesised, there were significant positive correlations between sAA activity and salivary ECB levels, particularly 2-arachidonoyl glycerol (2-AG), though ECBs were not correlated with sAA stress reactivity. Participants who had a significant cortisol response to the trauma film/stressor reported less intrusive memories, which were also less distressing and less vivid. This effect was moderated by arachidonoyl ethanolamide (AEA), where decreases in AEA post-stress were associated with more intrusive memories in cortisol non-responders only. This study provides new evidence for the role of ECBs in the sympathetic nervous system.
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Affiliation(s)
- Matthew P O'Donohue
- School of Psychology and Counselling, Queensland University of Technology, Australia
| | - Khalisa Amir Hamzah
- School of Psychology and Counselling, Queensland University of Technology, Australia
| | - David Nichols
- Central Science Laboratory, University of Tasmania, Australia
| | - Luke J Ney
- School of Psychology and Counselling, Queensland University of Technology, Australia.
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Woine A, Szczygiel D, Roskam I, Mikolajczak M. An experimental manipulation of cognitive appraisals in parental burnout. Sci Rep 2023; 13:11585. [PMID: 37463946 DOI: 10.1038/s41598-023-38587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
As it often applies to other mental conditions, one may posit that cognitive appraisals might be causal in the onset and maintenance of parental burnout. Recent studies have indeed highlighted that negative cognitive appraisals are positively associated with parental burnout. Howbeit, none of these studies being experimental in design, it has-thus far-been impossible to establish causality. To shed light on the question, the present study relied on an experimental design where the perception of three known antecedents of parental burnout was manipulated: co-parenting support, emotion regulation and child-rearing practices. 313 French- and English-speaking parents took part in the study which employed a 4 (Condition: control, perceived co-parenting support, perceived emotion regulation, perceived efficacy of child-rearing practices) × 2 (Time: pre- and post-manipulation) mixed-design, with Condition as the between-subject factor and Time as the within-subject factor. Results showed that the experimental manipulation was effective in the "co-parenting support" condition solely and this effective manipulation further yielded a significant effect on the decrease of parental burnout scores, hence suggesting a causative relation between cognitive appraisals and parental burnout. Our results highlight both the complexity of manipulating parents' cognitive appraisals and the scope for relieving partnered parents from their parental burnout symptoms.
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Affiliation(s)
- Aline Woine
- Department of Psychology, Psychological Sciences Research Institute, Université Catholique de Louvain (UCLouvain), Place Cardinal Mercier, 10, 1348, Louvain-la-Neuve, Belgium.
| | - Dorota Szczygiel
- Department of Psychology, Faculty in Sopot, SWPS University, Sopot, Poland
| | - Isabelle Roskam
- Department of Psychology, Psychological Sciences Research Institute, Université Catholique de Louvain (UCLouvain), Place Cardinal Mercier, 10, 1348, Louvain-la-Neuve, Belgium
| | - Moïra Mikolajczak
- Department of Psychology, Psychological Sciences Research Institute, Université Catholique de Louvain (UCLouvain), Place Cardinal Mercier, 10, 1348, Louvain-la-Neuve, Belgium
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Can mental imagery boost the effect of the positive cognitive bias modification of interpretation (CBM-I) on interpretation bias and memory bias? J Behav Ther Exp Psychiatry 2023; 79:101838. [PMID: 36805612 DOI: 10.1016/j.jbtep.2023.101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive bias modification of interpretation (CBM-I) has been widely used and yielded mixed results. This experiment explored the unique role of mental imagery in positive CBM-I. METHODS 60 participants (M = 23.13, SD = 1.04) were randomly assigned to a imagery-based positive CBM-I group (imagery group) and a conventional verbal-based positive CBM-I group (control group). The imagery group received additional practice in generating mental imagery and were instructed to fully focus on the imagery during the formal training. The dependent variables included interpretation bias (probe latencies and similarity ratings for recognition task), memory bias, and intrusive memory. RESULTS (1) For the positive probe scenario, the reaction time of the two groups was shorter in the posterior five blocks than the anterior five blocks. However, the difference in latency between pre- and post- training for the imagery group was larger than that of the control group; (2) For the recognition task, the positive target statement score was significantly higher, while the negative one was significantly lower for the imagery group than that of the control group (3) The imagery group (vs. control); showed more beneficial effects on memory bias. LIMITATIONS The limitations consisted of the difference in time of the manipulation between the two groups, the richness of the imagery operationalization, generalizability, and the lack of pre-manipulation of interpretation bias assessments. CONCLUSIONS The imagery-based CBM-I led to more positive interpretation biases, less negative interpretations, and more positive memory biases, indicating that mental imagery can boost the effect of the positive CBM-I.
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Asselbergs J, van Bentum J, Riper H, Cuijpers P, Holmes E, Sijbrandij M. A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm. J Psychiatr Res 2023; 159:116-129. [PMID: 36708636 DOI: 10.1016/j.jpsychires.2023.01.028] [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: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Jaёl van Bentum
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, Dept. of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Medical Centre, VUmc, Dept. of Psychiatry, Amsterdam, the Netherlands; Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Emily Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
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Singh L, Ahmed Pihlgren S, Holmes EA, Moulds ML. Using a daily diary for monitoring intrusive memories of trauma: A translational data synthesis study exploring convergent validity. Int J Methods Psychiatr Res 2023; 32:e1936. [PMID: 35976618 PMCID: PMC9976599 DOI: 10.1002/mpr.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Intrusive memories are a core feature of posttraumatic stress disorder and have transdiagnostic relevance across mental disorders. Establishing flexible methods to monitor intrusions, including patterns and characteristics, is a key challenge. A daily diary has been developed in experimental settings to provide symptom count data, without the need for retrospective self-report over extended time periods (e.g., 1 week, 1 month). We conducted an exploratory, pre-registered data synthesis investigating convergence between the diary and questionnaire measures of intrusive symptoms long used in clinical practice (Impact of Event Scale, IES, and revised version, IES-R, Intrusion subscale). RESULTS Utilising datasets using the daily diary from 11 studies (4 real-world trauma studies, seven analogue trauma studies; total N = 578), we found significant positive associations between the diary and IES/IES-R Intrusion subscale. Exploratory analyses indicated that the magnitude of this association was stronger for the IES (vs. the IES-R), and in individuals with real-world (vs. analogue) trauma. CONCLUSION This study provides first evidence of convergent validity of a daily diary for monitoring intrusions with a widely used questionnaire. A diary may be a more flexible methodology to obtain information about intrusions (frequency, characteristics, triggers, content), relative to questionnaires which rely on retrospective reporting of symptoms over extended timeframes. We discuss potential benefits of daily monitoring of intrusions in clinical and research contexts.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | | | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
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Li J, Ma H, Yang H, Yu H, Zhang N. Cognitive bias modification for adult's depression: A systematic review and meta-analysis. Front Psychol 2023; 13:968638. [PMID: 36743641 PMCID: PMC9894684 DOI: 10.3389/fpsyg.2022.968638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
Objects This study aimed to elucidate the effect of cognitive bias modification on depression. Methods This research included 10 randomized studies searching four major databases: PubMed, Embase, PsycINFO, and Cochrane Library, with a total sample size of 467. Moreover, they were examined for quality and possible publication bias. Results Cognitive bias modification (CBM) had statistically significant results, g = -0.64, 95% CI = [-0.97-0.32]. The interpretation of cognitive bias modification shows the highest effect size, g = -1.45, 95% CI = [-2.05-0.88]. When the training place is located in the laboratory, the training effect is significant, g = -1.11, 95% CI = [-1.62-0.61]. The difference is statistically significant when the training environment was changed to home, g = -0.28, 95% CI = [-0.51-0.05]. CBM has a statistical effect on moderate-to-severe depression, g = -0.70, 95% CI = [-1.04-0.36]. Conclusion We found that CBM had a moderate therapeutic effect on depression, whether the setting was at home or in the lab. Especially when the interpretation of cognitive bias modification (CBM-I) was used, we got the highest effect value. Furthermore, CBM has a statistical effect on moderate-to-severe depression.
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Changing Metacognitive Appraisal Bias in High-Worriers Through Reappraisal Training. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background and Objectives
Worry-related negative metacognitive beliefs about worrying maintain and predict pathological worry. For the current proof-of-principle study, we developed a computerized cognitive bias modification based—reappraisal training (RT), to modify the appraisal of negative metacognitive beliefs in a high-worrying sample. A functional and dysfunctional RT were pitted against each other to investigate whether appraisals of one’s thinking and coping changed following training. Moreover, training effects on the number of negative thoughts and interpretations of the worry content were examined.
Methods
Participants (N = 81) were trained to adopt a functional (disconfirmation of negative metacognitive beliefs) or dysfunctional (confirmation of negative metacognitive beliefs) appraisal style using a series of vignettes that had to be completed in line with the intended training direction. Changes in negative thoughts from pre- to post-RT were assessed with a behavioral state worry task, and transfer to interpretations with an open-ended stem sentence task.
Results
Findings support the use of the RT to alter a metacognitive appraisal bias, as participants receiving the functional RT reported fewer negative appraisals of one’s thinking and coping than participants in the dysfunctional RT group. Number of negative thoughts and interpretations were not directly affected by training.
Limitations
This study employed an analog sample and future research should replicate findings in a clinical sample for which negative metacognitions are more relevant.
Conclusions
These findings highlight the potential of metacognitive RT for future translational studies with (clinical) samples characterized by repetitive negative thinking and/or negative metacognitive beliefs.
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Herzog P, Barth C, Rief W, Brakemeier EL, Kube T. How Expectations Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma Film Paradigm. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10290-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Although intrusions are the hallmark symptom of posttraumatic stress disorder, there is still limited knowledge about the processes that contribute to the development of intrusions. Here, we used the well-established trauma film paradigm (TFP) to investigate how expectations about the intensity and controllability of intrusions influence their occurrence.
Methods
90 healthy participants underwent the TFP before they were randomized to one of three conditions manipulating their expectations about intrusions: positive expectations group; negative expectations group; control group. The primary outcome was the frequency and severity of intrusive memories as assessed with an intrusion diary over seven days.
Results
The TFP was well implemented, as indicated by significant post-film anxiety and a substantial number of intrusions reported for the subsequent week. The three groups did not differ in their expectations about intrusions and, relatedly, in their experience of intrusions. A mediation analysis revealed that the influence of post-film anxiety on intrusive memories was fully mediated by expectations.
Conclusions
Despite the failure of the expectation manipulation, the results of the mediation analysis support the hypothesis that post-film expectations influence the formation of intrusive memories, suggesting that intrusions may result from maladaptive dynamics between emotional and cognitive processes following trauma(like) experiences.
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Woud ML, Blackwell SE, Shkreli L, Würtz F, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:386-402. [PMID: 33621970 DOI: 10.1159/000514166] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. OBJECTIVE We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. METHODS We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. RESULTS In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. CONCLUSIONS Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany,
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Lorika Shkreli
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Clinical Psychology and Psychotherapy, Department of Human Sciences, University of Cologne, Cologne, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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12
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Basanovic J, Grafton B, Ford A, Hirani V, Glance D, MacLeod C, Almeida OP. Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial. Psychol Med 2020; 50:2514-2525. [PMID: 31544719 DOI: 10.1017/s0033291719002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although efficacious treatments for major depression are available, efficacy is suboptimal and recurrence is common. Effective preventive strategies could reduce disability associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel and safe intervention that attenuates biases associated with depression. This study investigated whether the delivery of a CBM programme designed to attenuate negative cognitive biases over a period of 1 year would decrease the incidence of major depression among adults with subthreshold symptoms of depression. METHODS Randomised double-blind controlled trial delivered an active CBM intervention or a control intervention over 52 weeks. Two hundred and two community-dwelling adults who reported subthreshold levels of depression were randomised (100 intervention, 102 control). The primary outcome of interest was the incidence of major depressive episode assessed at 11, 27 and 52 weeks. Secondary outcomes included onset of clinically significant symptoms of depression, change in severity of depression symptoms and change in cognitive biases. RESULTS Adherence to the interventions was modest though did not differ between conditions. Incidence of major depressive episodes was low. Conditions did not differ in the incidence of major depressive episodes. Likewise, conditions did not differ in the incidence of clinically significant levels of depression, change in the severity of depression symptoms or change in cognitive biases. CONCLUSIONS Active CBM intervention did not decrease the incidence of major depressive episodes as compared to a control intervention. However, adherence to the intervention programme was modest and the programme failed to modify the expected mechanism of action.
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Affiliation(s)
- Julian Basanovic
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Andrew Ford
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
| | - Varsha Hirani
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
| | - David Glance
- UWA Centre for Software Practice, The University of Western Australia, Western Australia, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
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Duyser FA, van Eijndhoven PFP, Bergman MA, Collard RM, Schene AH, Tendolkar I, Vrijsen JN. Negative memory bias as a transdiagnostic cognitive marker for depression symptom severity. J Affect Disord 2020; 274:1165-1172. [PMID: 32663947 DOI: 10.1016/j.jad.2020.05.156] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Negative memory bias is a strong risk factor for the development and maintenance of depression. Recent evidence also found negative memory bias in other mental disorders. Here, we aim to: 1) assess the presence and strength of negative memory bias in a range of (comorbid) mental disorders, 2) investigate which disorder-specific symptoms are associated with negative memory bias, and 3) test whether negative memory bias might be a transdiagnostic mechanism. METHODS Negative memory bias was measured in patients with at least one diagnosis of a stress-related disorder (n = 86), a neurodevelopmental disorder (n = 53), or both (n = 68), and 51 controls. Depression, anxiety, attention-deficit/hyperactivity disorder, and autism spectrum disorder symptom severity was assessed using questionnaires. Groups were compared on negative memory bias and the associations between negative memory bias and symptom severity were made using linear regression models. RESULTS All patient groups showed stronger negative memory bias than the controls. Negative memory bias was individually associated with all symptom severity indices, but when added into a single model, only the association with depressive symptom severity remained. This persisted after controlling for diagnostic group. LIMITATIONS Due to the cross-sectional sectional study design, we could only look at the associations between negative memory bias and disorder-specific symptoms and not at the direction of the effects. CONCLUSIONS Negative memory bias is characteristic of a depressotypic processing style and present in different mental disorders. It might play a mechanistic role in the development of (subclinical) co-occurrence between mental disorders.
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Affiliation(s)
- F A Duyser
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands.
| | - P F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - M A Bergman
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - R M Collard
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A H Schene
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - I Tendolkar
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Department of Psychiatry and Psychotherapy, University Hospital Essen, Germany
| | - J N Vrijsen
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, The Netherlands
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14
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Cognitive Bias Modification for the Induction of Negative Versus Benign Interpretations of the Self in Individuals with Elevated Social Anxiety: Effects on Self-related and Anxiety Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-019-10074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Lau-Zhu A, Henson RN, Holmes EA. Intrusive memories and voluntary memory of a trauma film: Differential effects of a cognitive interference task after encoding. J Exp Psychol Gen 2019; 148:2154-2180. [PMID: 31021150 PMCID: PMC7116494 DOI: 10.1037/xge0000598] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methods to reduce intrusive memories (e.g., of traumatic events) should ideally spare voluntary memory for the same event (e.g., to report on the event in court). Single-trace memory accounts assume that interfering with a trace should impact both its involuntary and voluntary expressions, whereas separate-trace accounts assume these two can dissociate, allowing for selective interference. This possibility was investigated in 3 experiments. Nonclinical participants viewed a trauma film followed by an interference task (Tetris game-play after reminder cues). Next, memory for the film was assessed with various measures. The interference task reduced the number of intrusive memories (diary-based, Experiments 1 and 2), but spared performance on well-matched measures of voluntary retrieval-free recall (Experiment 1) and recognition (Experiments 1 and 2)-challenging single-trace accounts. The interference task did not affect other measures of involuntary retrieval-perceptual priming (Experiment 1) or attentional bias (Experiment 2). However, the interference task did reduce the number of intrusive memories in a laboratory-based vigilance-intrusion task (Experiments 2 and 3), irrespective of concurrent working memory load during intrusion retrieval (Experiment 3). Collectively, results reveal a robust dissociation between intrusive and voluntary memories, having ruled out key methodological differences between how these two memory expressions are assessed, namely cue overlap (Experiment 1), attentional capture (Experiment 2), and retrieval load (Experiment 3). We argue that the inability of these retrieval factors to explain the selective interference is more compatible with separate-trace than single-trace accounts. Further theoretical developments are needed to account for this clinically important distinction between intrusive memories and their voluntary counterpart. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit
| | | | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit
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16
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Van Bockstaele B, Notebaert L, Salemink E, Clarke PJF, MacLeod C, Wiers RW, Bögels SM. Effects of interpretation bias modification on unregulated and regulated emotional reactivity. J Behav Ther Exp Psychiatry 2019; 64:123-132. [PMID: 31002978 DOI: 10.1016/j.jbtep.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/15/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Although induced changes in interpretation bias can lead to reduced levels of stress reactivity, results are often inconsistent. One possible cause of the inconsistencies in the effects of interpretation bias modification (IBM) on stress reactivity is the degree to which participants engaged in emotion regulation while being exposed to stressors. In this study, we distinguished between the effects of IBM on natural, unregulated stress reactivity and the effects of IBM on people's ability to up- or downregulate this stress reactivity. METHOD Both in the context of general anxiety (Experiment 1, N = 59) and social anxiety (Experiment 2, N = 54), we trained participants to interpret ambiguous scenarios in either a positive or a negative manner, and we assessed the effects on unregulated and regulated stress reactivity. RESULTS Although we found relatively consistent training-congruent changes in interpretation bias in both experiments, these changes had no effect on either unregulated or regulated stress reactivity. LIMITATIONS In both experiments, we used healthy student samples and relatively mild emotional stressors. CONCLUSIONS In line with previous research, our findings suggest that the effects of IBM on unregulated stress reactivity may be small and inconsistent. Differences in the extent to which participants engaged in emotion regulation during stressor exposure are unlikely to account for these inconsistencies.
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Affiliation(s)
- Bram Van Bockstaele
- ADAPT lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands; Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands.
| | - Lies Notebaert
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Elske Salemink
- ADAPT lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, P.O. Box 80140, 3508 TC, the Netherlands.
| | - Patrick J F Clarke
- School of Psychology and Speech Pathology, Curtin University, Kent St, WA, 6102, Bentley, Australia.
| | - Colin MacLeod
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Reinout W Wiers
- ADAPT lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands.
| | - Susan M Bögels
- ADAPT lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands; Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands.
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18
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Chang EP, Ecker UKH, Page AC. Not wallowing in misery - retractions of negative misinformation are effective in depressive rumination. Cogn Emot 2018; 33:991-1005. [PMID: 30319039 DOI: 10.1080/02699931.2018.1533808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
People often continue to rely on misinformation in their reasoning after they have acknowledged a retraction; this phenomenon is known as the continued-influence effect. Retractions can be particularly ineffective when the retracted misinformation is consistent with a pre-existing worldview. We investigated this effect in the context of depressive rumination. Given the prevalence of depressotypic worldviews in depressive rumination, we hypothesised that depressive rumination may affect the processing of retractions of valenced misinformation; specifically, we predicted that the retraction of negative misinformation might be less effective in depressive ruminators. In two experiments, we found evidence against this hypothesis: in depressive ruminators, retractions of negative misinformation were at least as effective as they were in control participants, and more effective than retractions of positive misinformation. Findings are interpreted in terms of an attentional bias that may enhance the salience of negative misinformation and may thus facilitate its updating in depressive rumination.
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Affiliation(s)
- Ee Pin Chang
- a School of Psychological Science (M304) , University of Western Australia , Perth , Australia
| | - Ullrich K H Ecker
- a School of Psychological Science (M304) , University of Western Australia , Perth , Australia
| | - Andrew C Page
- a School of Psychological Science (M304) , University of Western Australia , Perth , Australia
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19
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Vermeulen M, Brown AD, Raes F, Krans J. Decreasing Event Centrality in Undergraduates Using Cognitive Bias Modification of Appraisals. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9936-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Marks EH, Franklin AR, Zoellner LA. Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events. Psychol Bull 2018; 144:584-640. [PMID: 29553763 PMCID: PMC5938103 DOI: 10.1037/bul0000132] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record
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21
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Krans J, Brown AD, Moulds ML. Can an experimental self-efficacy induction through autobiographical recall modulate analogue posttraumatic intrusions? J Behav Ther Exp Psychiatry 2018; 58:1-11. [PMID: 28746833 DOI: 10.1016/j.jbtep.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/13/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film. METHODS In Experiment I, healthy student participants received a self-efficacy manipulation consisting of the recall of autobiographical memories of success (high self-efficacy condition), failure (low self-efficacy condition) or 'important' memories (control condition). Afterwards, they viewed a trauma film and recorded their intrusions of the film in the following week. In Experiment II the self-efficacy manipulation was given after the film. RESULTS In contrast to expectations, the high self-efficacy condition reported a higher number of intrusions relative to the low self-efficacy condition in both experiments. LIMITATIONS The trauma film provides experimental control but precludes generalization to real-life trauma. The effect of the experimental manipulation was small. The control condition also affected mood and confidence. CONCLUSIONS The results suggest that the relation between self-efficacy and intrusions development is causal, but not straightforward. Recalling personal memories of success before or after a traumatic event may increase the risk of developing intrusions, at least under some circumstances. Conversely, recalling past failure experiences may be protective, perhaps by preparing the individual for adversity, or prompting them to search for coping strategies that have been successful in the past. Overall, autobiographical recall involves complex processes related to the self that could be useful but need to be more fully understood.
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Affiliation(s)
- Julie Krans
- Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
| | - Adam D Brown
- Department of Psychology, Sarah Lawrence College, 1 Mead Way, Bronxville, NY 10708, United States; Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY 10016, United States.
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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Mihailova S, Jobson L. Association between intrusive negative autobiographical memories and depression: A meta-analytic investigation. Clin Psychol Psychother 2018; 25:509-524. [PMID: 29473250 DOI: 10.1002/cpp.2184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/01/2023]
Abstract
The study investigated several associations between depression and intrusive negative autobiographical memories. A systematic literature search identified 23 eligible studies (N = 2,582), which provided 59 effect sizes. Separate meta-analyses indicated that depression was moderately, positively associated with intrusive memory frequency, memory distress, maladaptive memory appraisals, memory avoidance, and memory rumination. Intrusive memory vividness was not significantly associated with depression. There were insufficient data to examine the relationship between depression and memory vantage perspective. Between-study heterogeneity was high for intrusive memory frequency and memory avoidance, and the percentage of females in studies significantly moderated the relationship between these variables and depression. An additional exploratory meta-analysis (3 studies; N = 257) indicated that intrusive memories were experienced more frequently by those with posttraumatic stress disorder than those with depression. Overall, the findings suggest that intrusive memories warrant clinical attention as they may contribute to the maintenance of depressive symptomatology.
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Affiliation(s)
- Stella Mihailova
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Laura Jobson
- School of Psychological Sciences, Monash University, Melbourne, Australia
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23
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Lau-Zhu A, Holmes EA, Porcheret K. Intrusive Memories of Trauma in the Laboratory: Methodological Developments and Future Directions. Curr Behav Neurosci Rep 2018; 5:61-71. [PMID: 29577009 PMCID: PMC5857557 DOI: 10.1007/s40473-018-0141-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose of the Review Intrusive memories are those that spring to mind unbidden, e.g. sensory recollections of stressful/traumatic events. We review recent methods to monitor intrusions of a stressor (a trauma film) within the laboratory. Recent Findings Recent studies suggest three main methodologies after viewing a trauma film by which to monitor intrusions in the laboratory: during post-film rest periods, after exposure to trigger cues, and while performing an ongoing task. These approaches allow factors to be tested (e.g. psychological or pharmacological) that may influence the frequency of occurrence of intrusions. Summary We raise methodological considerations to guide trauma film studies using intrusion monitoring in the laboratory to complement monitoring approaches in daily life (e.g. diaries). Intrusion monitoring in the laboratory also confers greater experimental control and may open novel research avenues, to advance intervention development to mitigate problematic intrusive memory symptoms.
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Affiliation(s)
- Alex Lau-Zhu
- 1Medical Research Council Cognition and Brain Sciences Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,2Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily A Holmes
- 3Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kate Porcheret
- 4Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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24
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Modifying Obsessive-Compulsive Beliefs about Controlling One’s Thoughts. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9603-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Beer UM, Neerincx MA, Morina N, Brinkman WP. Virtual agent-mediated appraisal training: a single case series among Dutch firefighters. Eur J Psychotraumatol 2017; 8:1378053. [PMID: 29163859 PMCID: PMC5687798 DOI: 10.1080/20008198.2017.1378053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023] Open
Abstract
Background: First responders are a prime example of professionals that are at a high risk of being exposed to traumatic experiences. Reappraisal as a coping strategy might help first responders to better cope with their emotional responses to traumatic events. Objective: This study investigated the effects of repeated sessions of a digital reappraisal training among seven firefighters. The training consisted of four sessions supported by a virtual agent, conducted at home or at work, over a two-week period in a single case series. Method: Sixteen data points were collected from each participant in the eight days pre- and post-training. Results: Significantly more themes were used at post-training than at pre-training, implying more flexibility and confirming the main hypothesis of the study. Negative side effects were not reported during or in the week after the training. Conclusions: More controlled studies into the short- and long-term effects of a training of this nature are needed. Furthermore, it provides a reference for developers in this field.
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Affiliation(s)
- Ursula M Beer
- Department of Intelligent Systems, Delft University of Technology, Delft, the Netherlands
| | - Mark A Neerincx
- TNO Perceptual and Cognitive Systems, Soesterberg, the Netherlands.,Department of Intelligent Systems, Delft University of Technology, Delft, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, the Netherlands
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26
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Reducing the negative valence of stressful memories through emotionally valenced, modality-specific tasks. J Behav Ther Exp Psychiatry 2016; 53:92-8. [PMID: 25497310 DOI: 10.1016/j.jbtep.2014.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES People who perform a cognitively demanding secondary task while recalling a distressing memory often experience the memory as less emotional, vivid, or accurate during subsequent recollections. In this experiment, we tested whether the emotional valence (positive versus neutral) and sensory modality (visual, auditory, or both) of a secondary task diminishes the emotionality, vividness, and accuracy of memory of distressing videos. METHODS Participants (N = 156) viewed a distressing video and were then randomized to one of six groups in a 2 (Emotional Valence: positive, neutral) × 3 (Modality: visual, auditory, combined) design. Participants were then exposed to an amusing or a neutral clip that was visual, auditory, or audiovisual. They were asked to recall the distressing video during exposure to the clip. Participants rated the emotionality and vividness of their memory of the distressing video, and completed recognition tests regarding its visual and auditory details before and after exposure to the secondary clip. RESULTS Participants who recalled the distressing video while exposed to the amusing clip rated their memory of the distressing video as less distressing (but not less vivid or accurate) than did participants exposed to the neutral clip. Modality had no significant effects Limitations. Participants were not trauma survivors, and the memories targeted were stressful, but subtraumatic. CONCLUSIONS Inducing positive emotion during recollection of distressing memories may diminish the emotional distress prompted by subsequent recollection.
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27
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Krans J, Pearson DG, Maier B, Moulds ML. Contextual representations of negative images modulate intrusion frequency in an intrusion provocation paradigm. J Behav Ther Exp Psychiatry 2016; 53:52-8. [PMID: 26424087 DOI: 10.1016/j.jbtep.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES To understand how memories of negative events become highly accessible in the context of trauma, we tested the hypothesis that contextual information modulates how easily intrusions can be provoked by perceptual stimuli.. METHODS Healthy participants viewed pictures depicting trauma scenes either with or without accompanying moderate (i.e. survival, recovery) or severe (i.e. fatality, permanent injury) outcome information. All participants viewed the same depictions of trauma scenes. Involuntary memories for the pictures were assessed using self-report diaries and an adapted version of the Impact of Event Scales (IES). A blurred picture perceptual priming paradigm was adapted to be used as an intrusion provocation task. RESULTS The severe outcome group experienced a significantly higher frequency of intrusions on the intrusion provocation task in comparison to both moderate outcome and control (no-context) conditions. The severe outcome condition did not increase intrusions on the self-report diaries or the adapted IES. There was no effect of condition on ratings for the emotionality, self-relevance, valence, or seriousness of the trauma scenes. LIMITATIONS The analogue method should not be generalized directly to incidences of real-life trauma. It was unclear why differences in intrusion frequency were found in the provocation task only. The relative amount of individual conceptual and data-driven processing adopted by the participants was not assessed. CONCLUSIONS Manipulating contextual information that determines the meaning of sensory-perceptual features for a trauma scene can modulate subsequent intrusion frequency in response to visually similar cues.
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Affiliation(s)
- J Krans
- School of Psychology, University of New South Wales, Sydney, Australia; Clinical Psychology, University of Leuven, Leuven, Belgium
| | - D G Pearson
- Department of Psychology, Anglia Ruskin University, Cambridge, UK.
| | - B Maier
- School of Psychology, University of New South Wales, Sydney, Australia
| | - M L Moulds
- School of Psychology, University of New South Wales, Sydney, Australia
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28
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James EL, Lau-Zhu A, Tickle H, Horsch A, Holmes EA. Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. J Behav Ther Exp Psychiatry 2016; 53:25-33. [PMID: 27664818 PMCID: PMC5008913 DOI: 10.1016/j.jbtep.2015.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 10/21/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Visuospatial working memory (WM) tasks performed concurrently or after an experimental trauma (traumatic film viewing) have been shown to reduce subsequent intrusive memories (concurrent or retroactive interference, respectively). This effect is thought to arise because, during the time window of memory consolidation, the film memory is labile and vulnerable to interference by the WM task. However, it is not known whether tasks before an experimental trauma (i.e. proactive interference) would also be effective. Therefore, we tested if a visuospatial WM task given before a traumatic film reduced intrusions. Findings are relevant to the development of preventative strategies to reduce intrusive memories of trauma for groups who are routinely exposed to trauma (e.g. emergency services personnel) and for whom tasks prior to trauma exposure might be beneficial. METHODS Participants were randomly assigned to 1 of 2 conditions. In the Tetris condition (n = 28), participants engaged in the computer game for 11 min immediately before viewing a 12-min traumatic film, whereas those in the Control condition (n = 28) had no task during this period. Intrusive memory frequency was assessed using an intrusion diary over 1-week and an Intrusion Provocation Task at 1-week follow-up. Recognition memory for the film was also assessed at 1-week. RESULTS Compared to the Control condition, participants in the Tetris condition did not report statistically significant difference in intrusive memories of the trauma film on either measure. There was also no statistically significant difference in recognition memory scores between conditions. LIMITATIONS The study used an experimental trauma paradigm and findings may not be generalizable to a clinical population. CONCLUSIONS Compared to control, playing Tetris before viewing a trauma film did not lead to a statistically significant reduction in the frequency of later intrusive memories of the film. It is unlikely that proactive interference, at least with this task, effectively influences intrusive memory development. WM tasks administered during or after trauma stimuli, rather than proactively, may be a better focus for intrusive memory amelioration.
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Affiliation(s)
- Ella L. James
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Alex Lau-Zhu
- Medical Research Council [MRC] Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB22 7EF, UK
| | - Hannah Tickle
- University of Oxford, Department of Experimental Psychology, South Parks Road, Oxford, OX1 3UD, UK
| | - Antje Horsch
- University of Lausanne, Department of Child and Adolescent Psychiatry, Lausanne, Switzerland,University of Lausanne, Department of Neonatology, Lausanne, Switzerland,University of Lausanne, Department of Obstetrics and Gynecology, Lausanne, Switzerland
| | - Emily A. Holmes
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK,Corresponding author. Present address: MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB22 7EF, UK; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Hirsch CR, Meeten F, Krahé C, Reeder C. Resolving Ambiguity in Emotional Disorders: The Nature and Role of Interpretation Biases. Annu Rev Clin Psychol 2016; 12:281-305. [DOI: 10.1146/annurev-clinpsy-021815-093436] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colette R. Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; , , ,
| | - Frances Meeten
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; , , ,
| | - Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; , , ,
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; , , ,
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Woud ML, Zhang XC, Becker ES, Zlomuzica A, Margraf J. Catastrophizing misinterpretations predict somatoform-related symptoms and new onsets of somatoform disorders. J Psychosom Res 2016; 81:31-7. [PMID: 26800636 DOI: 10.1016/j.jpsychores.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/03/2015] [Accepted: 12/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Somatoform disorders are characterized by multiple recurring symptoms that resemble physical illnesses but defy medical explanation. Psychological models suggest that catastrophizing misinterpretations of harmless physical symptoms play a key role. However, the question of whether such biases predict somatoform-related symptoms and the onset of somatoform disorders has not been adressed. Hence, the aim of the present study was to further advance our understanding of the role of catastrophizing misinterpretations in somatoform disorders. METHODS In the present study, we used data from the Dresden Predictor Study (N=1538), in which an epidemiologic sample of young German women was tested at two time points approximately 17 months apart. Each participant completed a diagnostic interview, an interpretation questionnaire for somatoform and hypochondriacal symptoms, and three measures of such symptomatology: somatization subscale of the Symptom Checklist-90-Revised (SCL-90-R), Whiteley Index (WI), Body Sensations Questionnaire (BSQ). RESULTS At follow-up, 33 women were diagnosed with new onsets of lifetime somatoform disorder. Results showed that catastrophizing misinterpretations assessed at baseline were predictive of somatoform-related symptoms at follow-up, i.e., symptoms assessed with the WI and BSQ. Moreover, catastrophizing misinterpretations were predictive of new onsets of somatoform disorders, even after controlling for general threat-related misinterpretations and indices of somatoform symptoms (i.e., SCL-90-R and BSQ). CONCLUSIONS This is the first prospective, longitudinal study to demonstrate that catastrophizing misinterpretations have incremental validity as predictors of future somatoform-related symptomatology and somatoform disorders.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Holmes EA, Blackwell SE, Burnett Heyes S, Renner F, Raes F. Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications. Annu Rev Clin Psychol 2016; 12:249-80. [PMID: 26772205 DOI: 10.1146/annurev-clinpsy-021815-092925] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.
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Affiliation(s)
- Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , , .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, West Midlands B15 2TT, United Kingdom; .,Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, United Kingdom
| | - Fritz Renner
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, University of Leuven, 3000 Leuven, Belgium;
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Salemink E, Wolters L, de Haan E. Augmentation of Treatment As Usual with online Cognitive Bias Modification of Interpretation training in adolescents with Obsessive Compulsive Disorder: A pilot study. J Behav Ther Exp Psychiatry 2015; 49:112-9. [PMID: 25724385 DOI: 10.1016/j.jbtep.2015.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive Behavioral Therapy for children and adolescents with Obsessive Compulsive Disorder (OCD) is effective. However, since almost half of patients remain symptomatic after treatment, there remains room for improvement. Cognitive Bias Modification training of Interpretations (CBM-I) is a promising new intervention, as it targets misinterpretation of intrusions, which is seen as an important characteristic in OCD. To date, there have been no published studies of CBM-I in adolescents with OCD. The aim of the current pilot study was to examine the added value of online CBM-I training as an adjunctive treatment to the Treatment As Usual (TAU; that included CBT and pharmacotherapy) in adolescents with OCD. METHODS Patients receiving TAU were randomly assigned to either an additional CBM-I training (n = 9), or to an additional placebo variant of this procedure (n = 7). RESULTS Immediate, on-line interpretations changed in response to the CBM-I training, while no such effects were observed on slower retrospective off-line interpretations. Patients in the CBM-I training condition reported fewer obsessive compulsive symptoms after training, and clinicians rated them as having fewer obsessive symptoms (corresponding to medium-large effect sizes). No such changes were observed in the placebo group. LIMITATIONS The small sample size precludes strong conclusions and replication is necessary to test the robustness of the findings. CONCLUSIONS This small randomized controlled trial is suggestive, although not conclusive, regarding the promising additive value of OC-related CBM-I training as an adjunctive intervention to TAU in an adolescent clinical population.
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Affiliation(s)
- Elske Salemink
- Addiction, Development and Psychopathology Lab (Adapt Lab), Department of Developmental Psychology, Research Priority Areas 'Yield', and 'Amsterdam Brain and Cognition', University of Amsterdam, The Netherlands; Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands.
| | - Lidewij Wolters
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Academic Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Else de Haan
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Child Development and Education, University of Amsterdam, The Netherlands
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Lee JS, Mathews A, Shergill S, Chan DKY, Majeed N, Yiend J. How can we enhance cognitive bias modification techniques? The effects of prospective cognition. J Behav Ther Exp Psychiatry 2015; 49:120-7. [PMID: 25841654 DOI: 10.1016/j.jbtep.2015.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive bias modification for interpretation, a computerized program which manipulates biased interpretations, has shown therapeutic promise, including evidence that negatively biased interpretations can be reduced, leading to corresponding improvements in symptoms. Cognitive bias modification for cognitive errors (CBM-errors) is a second generation CBM-I procedure which manipulates seven types of cognitive error and is especially relevant to depressive cognition. The aim of this study was to investigate whether the effects of the CBM-errors manipulation would be enhanced by adding a component facilitating prospective cognition to help embed and extend newly acquired interpretations. METHODS A sample of 80 volunteers completed a single session experiment. With a pretraining-posttraining design, we compared the effects of enhanced CBM-errors (targeting cognitive errors plus prospective cognition) with standard CBM-errors (targeting cognitive errors without prospective cognition), on interpretations of new material and mood. RESULTS Significant differences between enhanced and standard CBM-errors revealed that enhanced positive training was more effective at decreasing negative interpretations compared to the standard procedure. LIMITATIONS Extending the current investigation to a sample dysphoria or depression is needed for an appropriate next step. CONCLUSION The findings serve as 'a proof of principle' for the potential of prospective cognition to enhance the effects of CBM-errors and other similar CBM procedures. Further work to enhance the effectiveness of CBM procedures is needed.
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Affiliation(s)
- Jong-Sun Lee
- Institute of Psychiatry, King's College London, United Kingdom.
| | - Andrew Mathews
- Department of Psychology, University of California, Davis, USA
| | - Sukhi Shergill
- Institute of Psychiatry, King's College London, United Kingdom
| | | | - Nadia Majeed
- Institute of Psychiatry, King's College London, United Kingdom
| | - Jenny Yiend
- Institute of Psychiatry, King's College London, United Kingdom.
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Porcheret K, Holmes EA, Goodwin GM, Foster RG, Wulff K. Psychological Effect of an Analogue Traumatic Event Reduced by Sleep Deprivation. Sleep 2015; 38:1017-25. [PMID: 26118556 DOI: 10.5665/sleep.4802] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 01/09/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To examine the effect of sleep deprivation compared to sleep, immediately after experimental trauma stimuli on the development of intrusive memories to that trauma stimuli. DESIGN Participants were exposed to a film with traumatic content (trauma film). The immediate response to the trauma film was assessed, followed by either total sleep deprivation (sleep deprived group, N = 20) or sleep as usual (sleep group, N = 22). Twelve hours after the film viewing the initial psychological effect of the trauma film was measured and for the subsequent 6 days intrusive emotional memories related to the trauma film were recorded in daily life. SETTING Academic sleep laboratory and participants' home environment. PARTICIPANTS Healthy paid volunteers. MEASUREMENTS AND RESULTS On the first day after the trauma film, the psychological effect as assessed by the Impact of Event Scale - Revised was lower in the sleep deprived group compared to the sleep group. In addition, the sleep deprived group reported fewer intrusive emotional memories (mean 2.28, standard deviation [SD] 2.91) compared to the sleep group (mean 3.76, SD 3.35). Because habitual sleep/circadian patterns, psychological health, and immediate effect of the trauma film were similar at baseline for participants of both groups, the results cannot be accounted for by pre-existing inequalities between groups. CONCLUSIONS Our findings suggest that sleep deprivation on one night, rather than sleeping, reduces emotional effect and intrusive memories following exposure to experimental trauma.
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Affiliation(s)
- Kate Porcheret
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Russell G Foster
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Malik A, Goodwin GM, Hoppitt L, Holmes EA. Hypomanic Experience in Young Adults Confers Vulnerability to Intrusive Imagery After Experimental Trauma: Relevance for Bipolar Disorder. Clin Psychol Sci 2014; 2:675-684. [PMID: 25419498 PMCID: PMC4230964 DOI: 10.1177/2167702614527433] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/20/2014] [Indexed: 11/15/2022]
Abstract
Emotional mental imagery occurs across anxiety disorders, yet is neglected in bipolar disorder despite high anxiety comorbidity. Furthermore, a heightened susceptibility to developing intrusive mental images of stressful events in bipolar disorder and people vulnerable to it (with hypomanic experience) has been suggested. The current study assessed, prospectively, whether significant hypomanic experience (contrasting groups scoring high vs. low on the Mood Disorder Questionnaire, MDQ) places individuals at increased risk of visual reexperiencing after experimental stress. A total of 110 young adults watched a trauma film and recorded film-related intrusive images for 6 days. Compared to the low MDQ group, the high MDQ group experienced approximately twice as many intrusive images, substantiated by convergent measures. Findings suggest hypomanic experience is associated with developing more frequent intrusive imagery of a stressor. Because mental imagery powerfully affects emotion, such imagery may contribute to bipolar mood instability and offer a cognitive treatment target.
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Affiliation(s)
| | | | - Laura Hoppitt
- Medical Research Council Cognition & Brain Sciences Unit
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37
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Clerkin EM, Magee JC, Parsons EM. Evaluating Change in Beliefs About the Importance/Control of Thoughts as a Mediator of CBM-I and Responses to an ICT Stressor. J Obsessive Compuls Relat Disord 2014; 3:311-318. [PMID: 25414811 PMCID: PMC4233429 DOI: 10.1016/j.jocrd.2014.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study evaluated an adaptation of a Cognitive Bias Modification-Interpretation (CBM-I) procedure designed to shift interpretations of intrusive thoughts related to beliefs about the Importance and Control of Thoughts (ICT). Individuals high in the ICT belief domain were randomly assigned to one of two conditions: (a) a positive (n = 38) condition in which scenarios about intrusive thoughts were repeatedly paired with benign interpretations; or (b) a control (n = 39) condition in which scenarios about intrusive thoughts were paired with 50% benign and 50% threatening interpretations. Further, participants engaged in an ICT stressor task. Structural equation modeling with bias-corrected bootstrapping was used to examine the effects of training on ICT-relevant interpretations, beliefs, and ICT stressor responding. As predicted, individuals in a positive (vs. control) training condition reported decreases in ICT-relevant interpretations and beliefs. Further, there was a small, statistically significant indirect (i.e., mediated) effect of training on measures of ICT stressor responding, which occurred via decreases in ICT-relevant beliefs. In sum, results indicate that training was effective in influencing interpretations and beliefs tied to Importance/Control of Thoughts and that there may be clinical utility to shifting this belief domain.
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Affiliation(s)
| | - Joshua C Magee
- Department of Family and Community Medicine, University of Cincinnati College of Medicine
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Menne-Lothmann C, Viechtbauer W, Höhn P, Kasanova Z, Haller SP, Drukker M, van Os J, Wichers M, Lau JYF. How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation. PLoS One 2014; 9:e100925. [PMID: 24968234 PMCID: PMC4072710 DOI: 10.1371/journal.pone.0100925] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/01/2014] [Indexed: 11/19/2022] Open
Abstract
The current meta-analysis explores the strength of effects of cognitive bias modification training for interpretation bias (CBM-I) on positive (i.e., adaptive) interpretations and mood as well as the training and sample characteristics influencing these effects. Data-bases were searched with the key words “interpret* bias AND training” and “interpret* bias AND modif*”. Reference lists of identified articles were checked and authors of identified articles were contacted for further relevant articles and unpublished data. Studies were reviewed for inclusion with eligibility criteria being that the study (a) aimed to target interpretation biases through any kind of training, (b) assessed mood and/or interpretation bias as outcome measures, (c) allocated individuals to training conditions at random, and (d) recruited adult samples. A meta-analytic multilevel mixed-effects model was employed to assess standardized mean changes in interpretation bias, negative mood, and emotional reactivity. In addition, several training and sample characteristics were explored for their potential to enhance benign training effectiveness. On average, benign CBM-I resulted in an increase in positive interpretation bias (p<.01) and a decrease in negative mood state (p<.001), but did not affect emotional reactivity. These effects were not consistently different from control conditions with no or neutral training. However, within benign training conditions imagery instructions and more training sessions were related to larger cognitive and mood effects, whereas feedback about training performance and inclusion of non-benign training items (instead of including benign items only) boosted cognitive effects only. Finally, training was more effective in women (cognitive and mood effects) and presumably samples with symptomatic emotional dysregulation (cognitive effects). Although the effects of emotional dysregulation and number of training sessions could not well be distinguished, there is an indication that when used with imagery instructions and more training sessions, benign CBM-I can be employed as a useful complementary treatment to usual psychotherapies.
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Affiliation(s)
- Claudia Menne-Lothmann
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Petra Höhn
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Zuzana Kasanova
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Simone P. Haller
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom
| | - Marjan Drukker
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
- Visiting Professor of Psychiatric Epidemiology King’s College London, King’s Health Partners Department of Psychosis studies Institute of Psychiatry, London, United Kingdom
| | - Marieke Wichers
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Jennifer Y. F. Lau
- Psychology Department, Institute of Psychiatry, Kings College London, London, United Kingdom
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Rohrbacher H, Reinecke A. Measuring Change in Depression-Related Interpretation Bias: Development and Validation of a Parallel Ambiguous Scenarios Test. Cogn Behav Ther 2014; 43:239-50. [DOI: 10.1080/16506073.2014.919605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Grisham JR, Becker L, Williams AD, Whitton AE, Makkar SR. Using Cognitive Bias Modification to Deflate Responsibility in Compulsive Checkers. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9621-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clarke PJF, Nanthakumar S, Notebaert L, Holmes EA, Blackwell SE, MacLeod C. Simply Imagining Sunshine, Lollipops and Rainbows Will Not Budge the Bias: The Role of Ambiguity in Interpretive Bias Modification. COGNITIVE THERAPY AND RESEARCH 2014; 38:120-131. [PMID: 24634553 PMCID: PMC3951959 DOI: 10.1007/s10608-013-9564-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imagery-based interpretive bias modification (CBM-I) involves repeatedly imagining scenarios that are initially ambiguous before being resolved as either positive or negative in the last word/s. While the presence of such ambiguity is assumed to be important to achieve change in selective interpretation, it is also possible that the act of repeatedly imagining positive or negative events could produce such change in the absence of ambiguity. The present study sought to examine whether the ambiguity in imagery-based CBM-I is necessary to elicit change in interpretive bias, or, if the emotional content of the imagined scenarios is sufficient to produce such change. An imagery-based CBM-I task was delivered to participants in one of four conditions, where the valence of imagined scenarios were either positive or negative, and the ambiguity of the scenario was either present (until the last word/s) or the ambiguity was absent (emotional valence was evident from the start). Results indicate that only those who received scenarios in which the ambiguity was present acquired an interpretive bias consistent with the emotional valence of the scenarios, suggesting that the act of imagining positive or negative events will only influence patterns of interpretation when the emotional ambiguity is a consistent feature.
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Affiliation(s)
- Patrick J. F. Clarke
- School of Psychology, University of Western Australia, Crawley, WA 6009 Australia
| | - Shenooka Nanthakumar
- School of Psychology, University of Western Australia, Crawley, WA 6009 Australia
| | - Lies Notebaert
- School of Psychology, University of Western Australia, Crawley, WA 6009 Australia
| | | | | | - Colin MacLeod
- School of Psychology, University of Western Australia, Crawley, WA 6009 Australia
- School of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
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Newby JM, Lang T, Werner-Seidler A, Holmes E, Moulds ML. Alleviating distressing intrusive memories in depression: a comparison between computerised cognitive bias modification and cognitive behavioural education. Behav Res Ther 2014; 56:60-7. [PMID: 24685536 PMCID: PMC4007010 DOI: 10.1016/j.brat.2014.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/05/2014] [Accepted: 03/02/2014] [Indexed: 11/23/2022]
Abstract
Negative appraisals maintain intrusive memories and intrusion-distress in depression, but treatment is underdeveloped. This study compared the efficacy of computerised bias modification positive appraisal training (CBM) versus a therapist-delivered cognitive behavioural therapy session (CB-Education) that both aimed to target and alter negative appraisals of a negative intrusive autobiographical memory. Dysphoric participants (Mean BDI-II = 27.85; N = 60) completed baseline ratings of a negative intrusive memory, negative appraisals and the Impact of Event Scale, and were randomly allocated either one session of CBM, CB-Education, or a no intervention monitoring control condition (Control). Mood and intrusion symptoms were assessed at one week follow-up. For all groups, there were significant reductions over one week in mood (depression and anxiety), memory intrusiveness and negative appraisals. Groups differed in terms of intrusion-related distress, with the CB-Education group showing greatest reduction, followed by the CBM group. The study provides evidence for the link between maladaptive appraisals of intrusive memories and distress in depressed mood. Further, both a single session of CB-Education and (to a lesser degree) CBM are useful in reducing intrusion-related distress. This study may have been underpowered to detect differences and replication is needed with larger samples. We evaluated techniques that targeted negative appraisals of intrusive memories. Compared one-session CBM and CBT interventions, versus Control. CBT education was more effective than control in reducing distress at one week. CBM of appraisals led to intermediate reductions in distress at one week. Maladaptive appraisals of intrusions can be effectively reduced in depression.
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Affiliation(s)
- Jill M Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, The University of New South Wales (UNSW) at St Vincent's Hospital, Level 4, The O'Brien Centre St. Vincent's Hospital, 394-404 Victoria Street Darlinghurst, Sydney, NSW 2010, Australia.
| | - Tamara Lang
- School of Psychology, Level 10 Mathews Building, The University of New South Wales (UNSW), Kensington, Sydney, NSW 2052, Australia; Sydney Children's Hospital, High Street Randwick, NSW 2031, Australia
| | - Aliza Werner-Seidler
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB27EF, United Kingdom
| | - Emily Holmes
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB27EF, United Kingdom
| | - Michelle L Moulds
- School of Psychology, Level 10 Mathews Building, The University of New South Wales (UNSW), Kensington, Sydney, NSW 2052, Australia
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Positive Imagery Cognitive Bias Modification in Treatment-Seeking Patients with Major Depression in Iran: A Pilot Study. COGNITIVE THERAPY AND RESEARCH 2014; 38:132-145. [PMID: 24634554 PMCID: PMC3951961 DOI: 10.1007/s10608-014-9598-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cognitive bias modification paradigms training positive mental imagery and interpretation (imagery CBM-I) hold promise for treatment innovation in depression. However, depression is a global health problem and interventions need to translate across settings and cultures. The current pilot study investigated the impact of 1 week of daily imagery CBM-I in treatment-seeking individuals with major depression in outpatient psychiatry clinics in Iran. Further, it tested the importance of instructions to imagine the positive training materials. Finally, we examined the effects of this training on imagery vividness. Thirty-nine participants were randomly allocated to imagery CBM-I, a non-imagery control program, or a no treatment control group. Imagery CBM-I led to greater improvements in depressive symptoms, interpretive bias, and imagery vividness than either control condition at post-treatment (n = 13 per group), and improvements were maintained at 2-week follow-up (n = 8 per group). This pilot study provides first preliminary evidence that imagery CBM-I could provide positive clinical outcomes in an Iranian psychiatric setting, and further that the imagery component of the training may play a crucial role.
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Mental imagery during daily life: Psychometric evaluation of the Spontaneous Use of Imagery Scale (SUIS). Psychol Belg 2014; 54:19-32. [PMID: 26290615 PMCID: PMC4538780 DOI: 10.5334/pb.ag] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Spontaneous Use of Imagery Scale (SUIS) is used to measure the tendency to
use visual mental imagery in daily life. Its psychometric properties were
evaluated in three independent samples (total N = 1297). We
evaluated the internal consistency and test-retest reliability of the
questionnaire. We also examined the structure of the items using exploratory and
confirmatory factor analysis. Moreover, correlations with other imagery
questionnaires provided evidence about convergent validity. The SUIS had
acceptable reliability and convergent validity. Exploratory and confirmatory
factor analysis revealed that a unidimensional structure fit the data,
suggesting that the SUIS indeed measures a general use of mental imagery in
daily life. Future research can further investigate and improve the psychometric
properties of the SUIS. Moreover, the SUIS could be useful to determine how
imagery relates to e.g. psychopathology.
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Williams AD, Blackwell SE, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioural therapy (iCBT) versus control CBM and iCBT for depression: study protocol for a parallel-group randomised controlled trial. BMJ Open 2013; 3:e004049. [PMID: 24171941 PMCID: PMC3816245 DOI: 10.1136/bmjopen-2013-004049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/02/2013] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The current randomised controlled trial will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification (CBM) intervention for depression when compared with an active control condition and help establish the additive benefit of positive imagery CBM when delivered in combination with internet cognitive behavioural therapy for depression. METHODS AND ANALYSIS Patients meeting diagnostic criteria for a current major depressive episode will be recruited through the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (α set at 0.05, power at 0.80) was identified as 29, but at least 10% more will be recruited to hedge against expected attrition. We will measure the impact of CBM on primary measures of depressive symptoms (Beck Depression Inventory-second edition (BDI-II), Patient Health Questionnaire (PHQ9)) and interpretive bias (ambiguous scenarios test-depression), and on a secondary measure of psychological distress (Kessler-10 (K10)) following the 1-week CBM intervention. Secondary outcome measures of psychological distress (K10), as well as disability (WHO disability assessment schedule-II), repetitive negative thinking (repetitive thinking questionnaire), and anxiety (state trait anxiety inventory-trait version) will be evaluated following completion of the 11-week combined intervention, in addition to the BDI-II and PHQ9. Intent-to-treat marginal and mixed effect models using restricted maximum likelihood estimation will be used to evaluate the primary hypotheses. Clinically significant change will be defined as high-end state functioning (a BDI-II score <14) combined with a total score reduction greater than the reliable change index score. Maintenance of gains will be assessed at 3-month follow-up. ETHICS AND DISSEMINATION The current trial protocol has been approved by the Human Research Ethics Committee of St Vincent's Hospital and the University of New South Wales, Sydney. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000139774 and Clinicaltrials.gov: NCT01787513. This trial protocol is written in compliance with the Standard Protocol Items: recommendations for Interventional Trials (SPIRIT) guidelines.
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Affiliation(s)
- Alishia D Williams
- UNSW Medicine, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Williams AD, Grisham JR. Cognitive Bias Modification (CBM) of obsessive compulsive beliefs. BMC Psychiatry 2013; 13:256. [PMID: 24106918 PMCID: PMC3851748 DOI: 10.1186/1471-244x-13-256] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/07/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cognitive bias modification (CBM) protocols have been developed to help establish the causal role of biased cognitive processing in maintaining psychopathology and have demonstrated therapeutic benefits in a range of disorders. The current study evaluated a cognitive bias modification training paradigm designed to target interpretation biases (CBM-I) associated with obsessive compulsive disorder (OCD). METHODS We evaluated the impact of CBM-I on measures of interpretation bias, distress, and on responses to three OC stressor tasks designed to tap the core belief domains of Importance of Thoughts/Control, Perfectionism/Intolerance of Uncertainty, and Contamination/Estimation of Threat in a selected sample of community members reporting obsessive compulsive (OC) symptoms (N = 89). RESULTS Participants randomly assigned to the Positive condition evidenced a change in interpretation bias towards more positive and less negative OC-relevant interpretations following CBM-I compared to participants assigned to the Control condition. Importantly, a positivity bias was not observed for foil scenarios unrelated to the core OC belief domains. Further, participants in the Positive condition reported less distress and urge to neutralize following an OC stressor task designed to tap Importance of Thoughts/Control. No significant difference emerged on the indices of behavioural response to the OC stressor tasks. Severity of OC symptoms did not moderate the effects of positive CBM-I training. CONCLUSIONS CBM-I appears effective in selectively targeting OC beliefs. Results need to be replicated in clinical samples in order for potential therapeutic benefit to be demonstrated.
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Affiliation(s)
- Alishia D Williams
- The Clinical Research Unit for Anxiety and Depression, School of Psychiatry, The University of New South Wales, Level 4 O'Brien Building at St, Vincent's Hospital, Sydney, Australia.
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, Australia
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Woud ML, Postma P, Holmes EA, Mackintosh B. Reducing analogue trauma symptoms by computerized reappraisal training - considering a cognitive prophylaxis? J Behav Ther Exp Psychiatry 2013; 44:312-5. [PMID: 23454552 PMCID: PMC3617361 DOI: 10.1016/j.jbtep.2013.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/19/2013] [Accepted: 01/21/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Distressing intrusions are a hallmark of posttraumatic stress disorder (PTSD). Dysfunctional appraisal of these symptoms may exacerbate the disorder, and conversely may lead to further intrusive memories. This raises the intriguing possibility that learning to 'reappraise' potential symptoms more functionally may protect against such symptoms. Woud, Holmes, Postma, Dalgleish, and Mackintosh (2012) found that 'reappraisal training' when delivered after an analogue stressful event reduced later intrusive memories and other posttraumatic symptoms. The present study aimed to investigate whether reappraisal training administered before a stressful event is also beneficial. METHODS Participants first received positive or negative reappraisal training (CBM-App training) using a series of scripted vignettes. Subsequently, participants were exposed to a film with traumatic content. Effects of the CBM-App training procedure were assessed via three distinct outcome measures, namely: (a) post-training appraisals of novel ambiguous vignettes, (b) change scores on the Post Traumatic Cognitions Inventory (PTCI), and (c) intrusive symptom diary. RESULTS CBM-App training successfully induced training-congruent appraisal styles. Moreover, those trained positively reported less distress arising from their intrusive memories of the trauma film during the subsequent week than those trained negatively. However, the induced appraisal bias only partly affected PTCI scores. LIMITATIONS Participants used their own negative event as a reference for the PTCI assessments. The events may have differed regarding their emotional impact. There was no control group. CONCLUSIONS CBM-App training has also some beneficial effects when applied before a stressful event and may serve as a cognitive prophylaxis against trauma-related symptomatology.
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Affiliation(s)
- Marcella L. Woud
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, Room A07.03, 6525 HR Nijmegen, The Netherlands,Corresponding author. Tel.: +31 0 24 361 2671; fax: +31 0 24 361 5594.
| | - Peggy Postma
- Hertfordshire Partnership NHS Foundation Trust, Hertford, UK
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Efficacy of Interpretation Bias Modification in Depressed Adolescents and Young Adults. COGNITIVE THERAPY AND RESEARCH 2013; 38:89-102. [PMID: 24729643 DOI: 10.1007/s10608-013-9578-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the efficacy of a four-session Cognitive Bias Modification-Interpretation program for 45 depressed adolescents and young adults (14-21 years old; 12 males, 33 females; Beck Depressive Inventory, Second Edition ≥ 14) randomized to an active intervention condition (repeated exposure to positive outcomes of depression-relevant ambiguous scenarios; n=23) or a control condition (n=22). Both conditions experienced reductions on a Test of Interpretation Bias at post-treatment, with no significant between-group differences. When limited to those with negative bias at baseline, the intervention group showed greater improvement in interpretation bias at mid- and post-treatment. In addition, the intervention group overall had greater improvements in self-reported negative cognitions than the control group at post-intervention and two-week follow-up. However, there were no differences between groups in depression or anxiety symptom change. Potential factors contributing to mixed findings are discussed.
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The use of cognitive bias modification and imagery in the understanding and treatment of depression. Curr Top Behav Neurosci 2013; 14:243-60. [PMID: 22566082 DOI: 10.1007/7854_2012_212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cognitive models of depression form the natural link between neurobiological and social accounts of the illness. Interest in the role of cognition in depression has recently been stimulated by the advent of simple, computer-based "cognitive bias modification" (CBM) techniques which are able to experimentally alter cognitive habits in clinical and non-clinical populations. In this chapter, we review recent work which has used CBM techniques to address questions of aetiology and treatment in depression with a particular focus on the interface with neurobiological and social processes relevant to the illness. We find that there are early signs that CBM may be a useful tool in exploring the aetiology of depression, particularly in regard to the neural and genetic factors which influence susceptibility to the illness and response to treatment. There is also early evidence suggesting that CBM has promise in the treatment and prevention of depression. This work suggests that the beneficial effects of CBM are mediated by the interaction between cognitive functioning and environmental and social information. In summary, by providing a method for altering habitual cognitive function in experimental and clinical settings CBM techniques have begun to further the understanding of and the treatment for depression.
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Yiend J, Lee JS, Tekes S, Atkins L, Mathews A, Vrinten M, Ferragamo C, Shergill S. Modifying Interpretation in a Clinically Depressed Sample Using ‘Cognitive Bias Modification-Errors’: A Double Blind Randomised Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9571-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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