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Elkington S, Brown M, Wright K, Regan J, Pattarnaraskouwski K, Steel C, Hales S, Holmes E, Morant N. Experiences of imagery-based treatment for anxiety in bipolar disorder: A qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial. Psychol Psychother 2024. [PMID: 38940581 DOI: 10.1111/papt.12538] [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: 10/22/2023] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Intrusive mental imagery is associated with anxiety in bipolar disorder (BD) and presents a novel treatment target. Imagery-based treatments show promise in targeting anxiety and improving mood instability. This qualitative study explored experiences of receiving up to 12 sessions of a brief structured psychological intervention: Image-Based Emotion Regulation (IBER), which targets maladaptive mental imagery in the context of BD with an aim to modify the emotional impact of these images. DESIGN A qualitative study embedded within the Image Based Emotion Regulation (IBER) feasibility randomised controlled trial. METHODS Semi-structured interviews were conducted with 12 participants in the treatment arm of the trial who received IBER + treatment as usual. Data were analysed using thematic analysis. RESULTS Despite some initial scepticism about imagery-focused treatment, all participants expressed broadly positive accounts of treatment experiences. High levels of engagement with imagery modification techniques, beneficial use of techniques post treatment and improvements in anxiety management and agency were described by some. Three sub-groups were identified: those who reported a powerful transformative impact of treatment; those who embedded some new techniques into their daily lives, and those who felt they had techniques to use when needed. No participants reported overall negative experiences of the IBER treatment. CONCLUSIONS Findings from this study highlight the value for treatment recipients of modifying the underlying meanings associated with maladaptive imagery, and the personalised skills development to manage anxiety within bipolar disorders. Findings can inform treatment refinements and further trial-based evaluations.
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Affiliation(s)
| | - Michael Brown
- Pembroke College, University of Cambridge, Cambridge, UK
| | | | | | | | - Craig Steel
- Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
| | - Susie Hales
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Emily Holmes
- Uppsala University and Karolinska Institutet, Stockholm, Sweden
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M'Bailara K, Echegaray F, Di Simplicio M. What's in the mind's eye of individuals with bipolar disorders: an exploration of the content and characteristics of mental images in different thymic phases. Behav Cogn Psychother 2023:1-16. [PMID: 37737052 DOI: 10.1017/s1352465823000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Mental imagery, or 'seeing with the mind's eye' (Kosslyn et al. ), provokes strong emotional responses (Ji et al., ). To date, there is a lack of data on the content and clinical characteristics (e.g. vividness, likelihood, emotional effects) of spontaneous mental images (MI) in people with bipolar disorder (BD) according to their thymic states. AIM The current study sought to assess the characteristics associated with the contents of MI in people with BD. METHOD Forty-two euthymic individuals diagnosed with BD (American Psychiatric Association, ) were asked to self-report their MI during depression, (hypo)mania and euthymia. Participants also rated levels of vividness, likelihood and emotional activation related to MI (i.e. valence, arousal, type of emotion). RESULTS The contents of the MI revealed phenomenological aspects of BD. Different themes were associated with each thymic phase. In (hypo)mania and in euthymia, the mental images were assessed as being as vivid as probable (p>.05). (Hypo)manic and euthymic-related MI activated more pleasure than displeasure (p<.001) and were mainly associated with joy. In depression, MI were assessed as more vivid than likely (p<.05). In depression, MI activated more displeasure than pleasure (p<.0001) and induced mainly sadness. DISCUSSION Overall, a congruence between the contents of images and the three thymic phases was found. The content of the MI was related to self-reported emotional effects that were congruent with the thymic phases concerned. The results add new clinical information for the use of imagery-based cognitive therapy in individuals with BD.
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Affiliation(s)
- K M'Bailara
- Laboratoire de psychologie, Labpsy UR4139, Université de Bordeaux, France
- Centre Hospitalier Charles Perrens, Pôle PGU, Bordeaux, France
- Centre Expert Trouble bipolaire, Fondation FondaMental, France
| | - F Echegaray
- Laboratoire de psychologie, Labpsy UR4139, Université de Bordeaux, France
| | - M Di Simplicio
- Centre for Psychiatry, Brain Sciences Division, Imperial College, London, UK
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Schaaf JV, Weidinger L, Molleman L, van den Bos W. Test-retest reliability of reinforcement learning parameters. Behav Res Methods 2023:10.3758/s13428-023-02203-4. [PMID: 37684495 DOI: 10.3758/s13428-023-02203-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 09/10/2023]
Abstract
It has recently been suggested that parameter estimates of computational models can be used to understand individual differences at the process level. One area of research in which this approach, called computational phenotyping, has taken hold is computational psychiatry. One requirement for successful computational phenotyping is that behavior and parameters are stable over time. Surprisingly, the test-retest reliability of behavior and model parameters remains unknown for most experimental tasks and models. The present study seeks to close this gap by investigating the test-retest reliability of canonical reinforcement learning models in the context of two often-used learning paradigms: a two-armed bandit and a reversal learning task. We tested independent cohorts for the two tasks (N = 69 and N = 47) via an online testing platform with a between-test interval of five weeks. Whereas reliability was high for personality and cognitive measures (with ICCs ranging from .67 to .93), it was generally poor for the parameter estimates of the reinforcement learning models (with ICCs ranging from .02 to .52 for the bandit task and from .01 to .71 for the reversal learning task). Given that simulations indicated that our procedures could detect high test-retest reliability, this suggests that a significant proportion of the variability must be ascribed to the participants themselves. In support of that hypothesis, we show that mood (stress and happiness) can partly explain within-participant variability. Taken together, these results are critical for current practices in computational phenotyping and suggest that individual variability should be taken into account in the future development of the field.
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Affiliation(s)
- Jessica V Schaaf
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
- Cognitive Neuroscience Department, Radboud University Medical Centre, Nijmegen, the Netherlands.
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands.
| | - Laura Weidinger
- DeepMind, London, United Kingdom
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Lucas Molleman
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Wouter van den Bos
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
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Marciniak MA, Shanahan L, Binder H, Kalisch R, Kleim B. Positive Prospective Mental Imagery Characteristics in Young Adults and Their Associations with Depressive Symptoms. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-12. [PMID: 37363749 PMCID: PMC10140715 DOI: 10.1007/s10608-023-10378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/28/2023]
Abstract
Background Positive prospective mental imagery plays an important role in mental well-being, and depressive symptoms have been associated with difficulties in generating positive prospective mental images (PPMIs). We used a mobile app to gather PPMIs generated by young adults during the COVID-19 pandemic and analyzed content, characteristics, and associations with depressive symptoms. Methods This is a secondary analysis of a randomized controlled trial with 95 healthy young adults allocated into two groups (intervention and control). Participants used the mobile app decreasing mental health symptoms for seven consecutive days. Fifty participants in the intervention group reported PPMIs at least three times per day using a mobile app inducing PPMI generation. We categorized entries into themes and applied moderation models to investigate associations between PPMI characteristics and depressive symptoms. Results We distinguished 25 PPMI themes. The most frequent were related to consuming food and drinks, watching TV/streaming platforms, and doing sports. Vividness and ease of generation of PPMIs, but not their anticipation, pleasure intensity or number of engagements with the app were associated with fewer depressive symptoms. Conclusions We identified PPMI themes in young adults and found significant negative associations between depressive symptoms and vividness and generation ease of PPMIs. These results may inform prevention and intervention science, including the design of personalized interventions. We discuss implications for future studies and treatment development for individuals experiencing diminished PPMI. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10378-5.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032 Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
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van den Berg KC, Hendrickson AT, Hales SA, Voncken M, Keijsers GPJ. Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial. J Affect Disord 2023; 320:691-700. [PMID: 36206888 DOI: 10.1016/j.jad.2022.09.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS These findings need to be replicated in a larger trial. CONCLUSIONS Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.
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Affiliation(s)
- K C van den Berg
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands; Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - A T Hendrickson
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - S A Hales
- Oxford Institute of Clinical Psychology Training, University of Oxford, UK; Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - M Voncken
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - G P J Keijsers
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Positive moods are all alike? Differential affect amplification effects of 'elated' versus 'calm' mental imagery in young adults reporting hypomanic-like experiences. Transl Psychiatry 2022; 12:453. [PMID: 36261422 PMCID: PMC9581908 DOI: 10.1038/s41398-022-02213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022] Open
Abstract
Positive mood amplification is a hallmark of the bipolar disorder spectrum (BPDS). We need better understanding of cognitive mechanisms contributing to such elevated mood. Generation of vivid, emotionally compelling mental imagery is proposed to act as an 'emotional amplifier' in BPDS. We used a positive mental imagery generation paradigm to manipulate affect in a subclinical BPDS-relevant sample reporting high (n = 31) vs. low (n = 30) hypomanic-like experiences on the Mood Disorder Questionnaire (MDQ). Participants were randomized to an 'elated' or 'calm' mental imagery condition, rating their momentary affect four times across the experimental session. We hypothesized greater affect increase in the high (vs. low) MDQ group assigned to the elated (vs. calm) imagery generation condition. We further hypothesized that affect increase in the high MDQ group would be particularly apparent in the types of affect typically associated with (hypo)mania, i.e., suggestive of high activity levels. Mixed model and time-series analysis showed that for the high MDQ group, affect increased steeply and in a sustained manner over time in the 'elated' imagery condition, and more shallowly in 'calm'. The low-MDQ group did not show this amplification effect. Analysis of affect clusters showed high-MDQ mood amplification in the 'elated' imagery condition was most pronounced for active affective states. This experimental model of BPDS-relevant mood amplification shows evidence that positive mental imagery drives changes in affect in the high MDQ group in a targeted manner. Findings inform cognitive mechanisms of mood amplification, and spotlight prevention strategies targeting elated imagery, while potentially retaining calm imagery to preserve adaptive positive emotionality.
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Liu M, Chen Y, Yin X, Peng D, Wang X, Ye B. Measuring Prospective Imagery: Psychometric Properties of the Chinese Version of the Prospective Imagery Task. Front Psychol 2021; 12:645127. [PMID: 34113287 PMCID: PMC8185034 DOI: 10.3389/fpsyg.2021.645127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/23/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Prospective negative imagery is suggested to play an important role in the development and maintenance of anxiety and depression. The Prospective Imagery Task (PIT) was developed to assess prospective imagery. Given the importance of prospective imagery for mental health in the Chinese cultural context, our objective was to examine the psychometric properties of the PIT in a Chinese sample. Methods The instrument was validated among a sample of 1,372 Chinese individuals (mean age = 19.98, SD = 4.57; 35.2% male) who completed the PIT immediately following the Beck Depression Inventory-II (BDI-II) and State-Trait Anxiety Inventory-Trait version (STAI-T). Results The two-factor structure of the PIT was in line with the original study, with satisfactory reliability and positive correlations with the BDI-II and STAI-T scores. Latent profile analysis revealed a three-class pattern. The measurement invariance indicated that the instrument can be used among different age groups as well as among males and females. Conclusion The Chinese version of the PIT is a reliable and valid tool to measure prospective imagery, and the positive subscale is meaningful for clinical psychology. Limitations and future research directions are discussed.
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Affiliation(s)
- Mingfan Liu
- Center of Mental Health Education and Research, Jiangxi Normal University, Nanchang, China.,Institute of Psychological Technology Application, Jiangxi Normal University, Nanchang, China
| | - Yiting Chen
- Center of Mental Health Education and Research, Jiangxi Normal University, Nanchang, China
| | - Xiaoying Yin
- Jiangxi Provincial People's Hospital, Nanchang, China
| | - Dandan Peng
- Center of Mental Health Education and Research, Jiangxi Normal University, Nanchang, China
| | - Xinqiang Wang
- Center of Mental Health Education and Research, Jiangxi Normal University, Nanchang, China.,Institute of Psychological Technology Application, Jiangxi Normal University, Nanchang, China
| | - Baojuan Ye
- Center of Mental Health Education and Research, Jiangxi Normal University, Nanchang, China.,Institute of Psychological Technology Application, Jiangxi Normal University, Nanchang, China
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How to project oneself without positive and integrated memories? Exploration of self-defining memories and future projections in bipolar disorder. Behav Res Ther 2021; 138:103817. [PMID: 33524807 DOI: 10.1016/j.brat.2021.103817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/03/2021] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
Bipolar disorder (BD) is a disabling disorder with functional impact on everyday life. Recent studies suggest that autobiographical memory impairment may contribute to the maintenance of psychopathology, leading to enduring altered self-construct. Moreover, past personal experiences also support the ability to project oneself into the future to pre-experience an event, this capacity can be modified by psychiatric disorders. Self-defining memories and future projections by accessing highly significant events that are vivid and focused on central goals or enduring concerns can both provide a better understanding of the impact of disorders on self-perception and on the ability to project oneself into the future. Therefore we proposed to explore self-defining memories and future projections in BD patients (n = 25) compared to control participants (n = 25). BD patients' self-defining events were associated with more tension, life-threatening events, and negative emotion. BD patients also reported less integrated past but not less integrated future self-defining events. And their future projections were more closely related to leisure, and associated with positive emotions, compared to controls. For both groups, the future projections were less specific, integrated, and tense than the memories. These results question the self-coherence of patients' identity and should be confirmed to propose appropriate interventions to project oneself adaptively into the future and contribute to a better outcome.
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Maier A, Schaitz C, Kröner J, Berger A, Keller F, Beschoner P, Connemann B, Sosic-Vasic Z. The Association Between Test Anxiety, Self-Efficacy, and Mental Images Among University Students: Results From an Online Survey. Front Psychiatry 2021; 12:618108. [PMID: 34916965 PMCID: PMC8668864 DOI: 10.3389/fpsyt.2021.618108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: A substantial portion of students report test anxiety, and those reporting low levels of self-efficacy seem to be especially affected. Previous research has indicated the relevance of mental images in the maintenance of anxiety disorders, however, no data are available with respect to test anxiety. In order to close this gap, the present study investigates the association between test anxiety, self-efficacy and mental images. Method: One hundred sixty-three university students completed an online survey. Test anxiety (PAF), general self-efficacy (WIRKALL-r), study-related self-efficacy (WIRK_STUD), intrusiveness of mental images (IFES), spontaneous use of imagery (SUIS) and vividness of imagery (VVIQ) were examined. Results: Test-related mental images were frequently reported among the surveyed students. Test anxiety showed a positive correlation with IFES and a negative correlation with self-efficacy. Mediation analyses showed that about one fifth of the influence of self-efficacy on test anxiety is mediated by IFES. Discussion: The present study gives first indication about an association between test anxiety, self-efficacy and mental images, even though the results are limited with respect to generalizability. Further investigations with respect to the impact of test-related mental images on the self-efficacy/test-anxiety linkage are needed.
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Affiliation(s)
- Anna Maier
- Department for Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Caroline Schaitz
- Department for Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Julia Kröner
- Devision for Applied Psychotherapy, Hospital Christophsbad Göppingen, Göppingen, Germany
| | - Alexander Berger
- Department for Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Ferdinand Keller
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Petra Beschoner
- Department for Psychosomatic Medicine and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Bernhard Connemann
- Department for Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Devision for Applied Psychotherapy, Hospital Christophsbad Göppingen, Göppingen, Germany
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Koenders M, Dodd A, Karl A, Green M, Elzinga B, Wright K. Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Brunette AM, Schacter DL. Cognitive mechanisms of episodic simulation in psychiatric populations. Behav Res Ther 2020; 136:103778. [PMID: 33338778 DOI: 10.1016/j.brat.2020.103778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 01/30/2023]
Abstract
Episodic simulation is the construction of a mental representation of a specific autobiographical future event. Episodic simulation has increasingly been studied in psychiatric populations. Here we 1) review evidence indicating that episodic simulation is compromised in patients with depression, anxiety, schizophrenia, bipolar disorder, and PTSD; and 2) consider several potential cognitive mechanisms of episodic simulation in psychiatric populations: episodic retrieval, scene construction, mental imagery, components of the CaRFAX model (i.e., capture and rumination, functional avoidance, and executive functioning), and narrative style. We evaluate evidence regarding these mechanisms across psychiatric populations, and identify areas of future research. Understanding the factors that contribute to episodic simulation impairment in psychiatric populations may lead to targeted and effective treatment approaches.
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Affiliation(s)
- Amanda M Brunette
- VA Boston Healthcare System, Psychology Service, 150 South Huntington Avenue, Boston, MA, 02130, United States.
| | - Daniel L Schacter
- Harvard University, Department of Psychology, William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, United States.
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12
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Imagine food, weight and shape: mental imagery in women with eating disorders compared with healthy controls. Behav Cogn Psychother 2020; 49:328-339. [PMID: 32924907 DOI: 10.1017/s135246582000065x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research into mental disorders has found mental imagery to be a maintaining factor for psychological distress. However, studies investigating mental imagery in eating disorders are scarce. AIM The aim of the present study was to compare spontaneous mental imagery related to eating, weight and/or appearance and intrusive prospective imagery in women with an eating disorder with female healthy controls. METHODS Spontaneous mental imagery and intrusive prospective imagery were assessed in adult women with an eating disorder (n = 29) and in female healthy controls (n = 32) using a semi-structured interview and the Impact of Future Events Scale, respectively. RESULTS In comparison with healthy controls, the spontaneous mental images in individuals with an eating disorder involved more sensory modalities (U = 156.50, p < .001, r = -.51), were more vivid (t (52) = 2.04, p = .047, d = .55), negative (U = 103.00, p < .001, r = -.62), and anxiety provoking (U = 158.50, p < .001, r = -.49), and were experienced with a lower sense of control (U = 215.00, p = .009, r = -.36). The emotional impact of intrusive prospective imagery (U = 105.00, p < .001, r = -.66) was also higher in individuals with an eating disorder, as was the number of negative prospective images (U = 283.00, p = .016, r = -.31). CONCLUSIONS Our findings are consistent with previous research on mental imagery in other psychiatric disorders, and provide possibilities for incorporating imagery-based techniques in treatment interventions.
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Image qualities and mood variability: Evaluating the utility of an imagery survey for bipolar disorder. J Affect Disord 2020; 272:77-83. [PMID: 32379623 DOI: 10.1016/j.jad.2020.03.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/27/2020] [Accepted: 03/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Imagery appears to play an important role in mood variability, a core symptom of patients suffering from bipolar disorder. The present study aimed to explore the validity and reliability of an online self-report measure of imagery, the Dutch Imagery Survey (DImS). The DImS is an adaptation of the Imagery interview used in research on imagery in mental disorders. The present study additionally explored the ability of the DImS to detect relationships between self-reported imagery and subsequent mood and subsequent behaviour. METHOD 135 students completed the DImS and additional mental imagery and mood questionnaires. For re-test reliability, 42 students completed the survey again within two days. RESULTS Internal consistencies and test-retest scores of the five scales of the DImS were reasonable. Imagery Quality correlated with Emotions, and to a lesser degree with Behaviour. Positive Appraisals correlated with Positive Emotions, Negative Appraisals with Negative Emotions, and Positive appraisals with Behaviour. Frequency of Imagery, Imagery Quality and Positive Appraisals correlated with elevated mood. Imagery Quality and Negative Appraisals correlated with low mood. The DImS took approximately 15 min to complete. LIMITATIONS Re-test reliability was limited due to participants changing their dominant image. Results need to be replicated in a clinical sample. CONCLUSIONS Psychometric findings with the DImS appeared reasonable and consistent and showed that, in line with other recent studies, imagery is related to current mood and to both self-perceived emotion and subsequent behaviour. These findings suggested that the DImS is suitable to study the role of imagery in bipolar mood variability.
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Steel C, Wright K, Goodwin G, Simon J, Morant N, Taylor R, Brown M, Jennings S, Hales S, Holmes E. The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder. Pilot Feasibility Stud 2020; 6:83. [PMID: 32549994 PMCID: PMC7294606 DOI: 10.1186/s40814-020-00628-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety is highly prevalent in people diagnosed with bipolar disorder (BD), and can persist between acute episodes of mania and depression. Recent studies indicate that people with BD are prone to experiencing frequent, intrusive and emotional mental images which further fuel their levels of anxiety and mood instability. These intrusive emotional mental images represent a specific target for treatment for this disorder with the potential to reduce anxiety and improve mood stability. A new brief structured psychological intervention for BD called Imagery Based Emotion Regulation (IBER) has been developed, which translates experimental work in the area of imagery and emotion into a skills training programme to improve the regulation of intrusive and distressing emotional mental images in BD. A feasibility trial is required in order to assess whether a full randomised controlled trial is indicated in order to evaluate this approach. Methods The design is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site and minimised on medication status and anxiety severity. Participants are 60 individuals diagnosed with bipolar disorder and experiencing at least a mild level of anxiety. Sites are defined by the geographical boundaries of two National Health Service (NHS) Trusts, with recruitment from NHS teams, GP surgeries and self-referral. The intervention is up to 12 sessions of Imagery Based Emotion Regulation within 16 weeks. The comparator is NHS standard care. The primary aim is to assess the feasibility of conducting a powered multi-site RCT to evaluate effectiveness. Measures of anxiety, depression, mania, mood stability and health care use will be conducted at baseline, end of treatment and at 16-week follow-up. Discussion This is the first feasibility trial of an imagery-based intervention for the treatment of anxiety in bipolar disorder. If the trial proves feasible, a large multi-site trial will be required. Trial registration ISRCTN16321795. Registered on October 16, 2018. 10.1186/ISRCTN16321795
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Affiliation(s)
- Craig Steel
- Oxford Health NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK.,Warneford Hospital, Oxford, OX3 7JX UK
| | | | | | - Judit Simon
- Oxford Health NHS Foundation Trust, Oxford, UK.,Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Susie Hales
- Oxford Health NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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Lee S, Kim JY, Ryu V, Cho HS. Manipulation ability of internal representation in patients with euthymic bipolar I disorder and schizophrenia using a mental rotation task. Asian J Psychiatr 2020; 50:101982. [PMID: 32126521 DOI: 10.1016/j.ajp.2020.101982] [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: 08/22/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A growing body of literature has suggested that effective emotion regulation is influenced by cognitive function. Maintenance and manipulation of internal representations occur in working memory (WM), and impairments of WM have been reported in patients with bipolar disorder. METHODS We examined the manipulation ability of internal representations in WM using mental rotation (MR) tasks, and compared the task performances of euthymic bipolar I disorder patients to those of schizophrenia patients and healthy controls. In this study, 20 euthymic bipolar I disorder patients, 20 schizophrenia patients, and 38 healthy controls were recruited. People and letter MR tasks were employed to evaluate the ability of WM manipulation. RESULTS Compared to healthy controls, euthymic bipolar I disorder patients showed substantially higher error rates of people MR task and slower responses in both people and letter MR tasks. Schizophrenia patients showed no difference in error rate and response time in MR tasks compared to healthy controls; however, they showed significantly slower responses in people MR task compared to controls. MR task performance was not different between euthymic bipolar and schizophrenia patients. CONCLUSION Our study results indicate that manipulation of internal representation, especially in the egocentric MR, is impaired in bipolar disorder even in the emotionally-stable state. We speculate that impaired imagery manipulation might be related to alterations in empathic ability, susceptibility of mental imagery, and emotion regulation strategies observed in bipolar disorder.
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Affiliation(s)
- San Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Ji Yong Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
| | - Vin Ryu
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Goodday SM, Atkinson L, Goodwin G, Saunders K, South M, Mackay C, Denis M, Hinds C, Attenburrow MJ, Davies J, Welch J, Stevens W, Mansfield K, Suvilehto J, Geddes J. The True Colours Remote Symptom Monitoring System: A Decade of Evolution. J Med Internet Res 2020; 22:e15188. [PMID: 31939746 PMCID: PMC6996723 DOI: 10.2196/15188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.
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Affiliation(s)
- Sarah M Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 4YouandMe, Seattle, WA, United States
| | - Lauren Atkinson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Center for Human Brain Activity, University of Oxford, Oxford, United Kingdom
| | - Guy Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Mike Denis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jim Davies
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - James Welch
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - William Stevens
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Juulia Suvilehto
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Martens K, Takano K, Barry TJ, Holmes EA, Wyckaert S, Raes F. Remediating reduced memory specificity in bipolar disorder: A case study using a Computerized Memory Specificity Training. Brain Behav 2019; 9:e01468. [PMID: 31747124 PMCID: PMC6908894 DOI: 10.1002/brb3.1468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Reduced autobiographical memory specificity (rAMS) is a vulnerability factor found across unipolar depression (UD), posttraumatic stress disorder (PTSD), eating disorder, schizophrenia, and bipolar disorder (BD). A group delivered psychological therapy training called Memory Specificity Training (MeST) remediates rAMS in UD and PTSD, with additional downstream effects on related psychological processes and symptoms. Its impact in BD is unknown. In this case study, we examined the impact of a computerized version of MeST (c-MeST) on improving AMS and related symptoms and processes in participant with rapid cycling type I BD. METHOD An experimental case study with an ABA design was used. During baseline (14 days, Phase A), the training phase (nine sessions across 17 days, Phase B), and a 1-month follow-up (Phase A), memory specificity, depressive symptoms, and related processes and symptoms were repeatedly measured. RESULTS Memory specificity increased significantly after the participant completed c-MeST. Session-to-session scores indicated that AMS improved most from the in-person baseline assessment to the first online session. All other measures of processes and symptoms deteriorated during the training phase but regressed to baseline during follow-up. CONCLUSION Memory specificity was improved as indicated by increased AMS from pre-intervention measurement to 1-month follow-up. Other improvements in symptoms were not observed. Rather, some related maladaptive psychological processes and symptoms worsened during the training phase and regressed to baseline during follow-up.
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Affiliation(s)
- Kris Martens
- Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
| | | | - Tom J. Barry
- Department of PsychologyThe University of Hong KongHong KongHong Kong
- Department of PsychologyThe Institute of PsychiatryKing's College LondonLondonUK
| | | | - Sabine Wyckaert
- University Psychiatric Center KU Leuven, Campus KortenbergKortenbergBelgium
| | - Filip Raes
- Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
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18
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Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder. Behav Cogn Psychother 2019; 48:203-215. [PMID: 31597584 DOI: 10.1017/s1352465819000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias. AIMS In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder. METHOD Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery. RESULTS Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62. CONCLUSIONS Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.
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19
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Pearson J. The human imagination: the cognitive neuroscience of visual mental imagery. Nat Rev Neurosci 2019; 20:624-634. [DOI: 10.1038/s41583-019-0202-9] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Benoit RG, Paulus PC, Schacter DL. Forming attitudes via neural activity supporting affective episodic simulations. Nat Commun 2019; 10:2215. [PMID: 31101806 PMCID: PMC6525197 DOI: 10.1038/s41467-019-09961-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 03/29/2019] [Indexed: 01/21/2023] Open
Abstract
Humans have the adaptive capacity for imagining hypothetical episodes. Such episodic simulation is based on a neural network that includes the ventromedial prefrontal cortex (vmPFC). This network draws on existing knowledge (e.g., of familiar people and places) to construct imaginary events (e.g., meeting with the person at that place). Here, we test the hypothesis that a simulation changes attitudes towards its constituent elements. In two experiments, we demonstrate how imagining meeting liked versus disliked people (unconditioned stimuli, UCS) at initially neutral places (conditioned stimuli, CS) changes the value of these places. We further provide evidence that the vmPFC codes for representations of those elements (i.e., of individual people and places). Critically, attitude changes induced by the liked UCS are based on a transfer of positive affective value between the representations (i.e., from the UCS to the CS). Thereby, we reveal how mere imaginings shape attitudes towards elements (i.e., places) from our real-life environment.
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Affiliation(s)
- Roland G Benoit
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, 04103, Germany.
| | - Philipp C Paulus
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, 04103, Germany.,International Max Planck Research School NeuroCom, Leipzig, 04103, Germany
| | - Daniel L Schacter
- Department of Psychology, Harvard University, Cambridge, MA, 02138, USA
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21
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Di Simplicio M, Lau-Zhu A, Meluken I, Taylor P, Kessing LV, Vinberg M, Holmes EA, Miskowiak KW. Emotional Mental Imagery Abnormalities in Monozygotic Twins With, at High-Risk of, and Without Affective Disorders: Present in Affected Twins in Remission but Absent in High-Risk Twins. Front Psychiatry 2019; 10:801. [PMID: 31780967 PMCID: PMC6856790 DOI: 10.3389/fpsyt.2019.00801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Mental imagery abnormalities feature across affective disorders including bipolar disorder (BD) and unipolar depression (UD). Maladaptive emotional imagery has been proposed as a maintenance factor for affective symptomatology and a target for mechanism-driven psychological treatment developments. Where imagery abnormalities feature beyond acute affective episodes, further opportunities for innovation arise beyond treatments, such as for tertiary/relapse prevention (e.g., in remitted individuals) or primary prevention (e.g., in non-affected but at-risk individuals). The aim of our study was to investigate for the first time the presence of possible mental imagery abnormalities in affected individuals in remission and at-risk individuals for affective disorders using a familial risk design. Methods: A population-based cohort of monozygotic twins was recruited through linkage between the Danish national registries (N=204). Participants were grouped as: affected (remitted BD/UD; n = 115); high-risk (co-twin with history of BD/UD; n = 49), or low-risk (no co-twin history of BD/UD; n = 40). Twins completed mental imagery measures spanning key subjective domains (spontaneous imagery use and emotional imagery) and cognitive domains (imagery inspection and imagery manipulation). Results: Affected twins in remission reported enhanced emotional mental imagery compared to both low- and high-risk twins. This was characterized by greater impact of i) intrusive prospective imagery (Impact of Future Events Scale) and ii) deliberately-generated prospective imagery of negative scenarios (Prospective Imagery Task). There were no significant differences in these key measures between affected BD and UD twins in remission. Additionally, low- and high-risk twins did not significantly differ on these emotional imagery measures. There were also no significant differences between the three groups on non-emotional measures including spontaneous imagery use and cognitive stages of imagery. Conclusions: Abnormalities in emotional prospective imagery are present in monozygotic twins with affective disorders in remission-despite preserved cognitive stages of imagery-but absent in unaffected high-risk twins, and thus do not appear to index familial risk (i.e., unlikely to qualify as "endophenotypes"). Elevated emotional prospective imagery represents a promising treatment/prevention target in affective disorders.
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Affiliation(s)
- Martina Di Simplicio
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Alex Lau-Zhu
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Medical Sciences Division, Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, United Kingdom
| | - Iselin Meluken
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Taylor
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emily Alexandra Holmes
- Division of Psychology, Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Kroener J, Schaitz C, Maier A, Connemann B, Sosic-Vasic Z. The German Impact of Future Events Scale (IFES-S): Adaption and Validation for Clinical Samples. Front Psychiatry 2019; 10:813. [PMID: 31803078 PMCID: PMC6875826 DOI: 10.3389/fpsyt.2019.00813] [Citation(s) in RCA: 3] [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: 08/27/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022] Open
Abstract
Prospective intrusive mental images occur frequently among several psychological disorders. Their assessment is an important tool since the imagination of events can drive future behavior, such as suicidal acts. One valid measure evaluating those prospective images is the impact of future events scale (IFES). However, to date, there is no German equivalent to the English IFES. Therefore, the aim of the present study was to adapt and validate the IFES at hand of a clinical sample and a healthy control sample.After translation, item analyzes were conducted, and as a result, four items were excluded from further analysis resulting in the German short version of the IFES, the IFES-S. Construct validity of the German IFES-S was tested through correlational analysis with convergent and divergent measures. Specificity and sensitivity were assessed through ROC analysis. The German IFES-S showed good internal consistency for the overall measurement with a Cronbach's α of .93. Additionally, it displayed good convergent and divergent validity. An optimal cutoff score of 23 was established to discriminate between clinical populations and healthy controls. In summary, the German IFES-S promises to be a valid self-report instrument for the assessment of prospective intrusive imagery within the context of clinical samples.
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Affiliation(s)
- Julia Kroener
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Ulm, Germany
| | - Caroline Schaitz
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Ulm, Germany
| | - Anna Maier
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Ulm, Germany
| | - Bernhard Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Ulm, Germany
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Hales SA, Di Simplicio M, Iyadurai L, Blackwell SE, Young K, Fairburn CG, Geddes JR, Goodwin GM, Holmes EA. Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder: a Pilot Clinical Audit. Behav Cogn Psychother 2018; 46:706-725. [PMID: 29983124 PMCID: PMC6140996 DOI: 10.1017/s1352465818000334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). AIMS This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. METHOD Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. RESULTS Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. CONCLUSIONS This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.
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Affiliation(s)
- Susie A Hales
- Oxford Institute of Clinical Psychology Training,Oxford,UK
| | | | - Lalitha Iyadurai
- Department of Psychiatry,University of OxfordandOxford Health NHS Foundation Trust,UK
| | | | - Kerry Young
- Central and North West London NHS Foundation Trust,UK
| | | | - John R Geddes
- Department of Psychiatry,University of Oxford;NIHR Oxford Health Biomedical Research Centre and Oxford Health NHS Foundation Trust,UK
| | - Guy M Goodwin
- Department of Psychiatry,University of Oxford and Oxford Health NHS Foundation Trust,UK
| | - Emily A Holmes
- Division of Psychology,Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden
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O'Donnell C, Di Simplicio M, Brown R, Holmes EA, Burnett Heyes S. The role of mental imagery in mood amplification: An investigation across subclinical features of bipolar disorders. Cortex 2018; 105:104-117. [DOI: 10.1016/j.cortex.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/16/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
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25
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Tanaka Y, Yoshinaga N, Tsuchiyagaito A, Sutoh C, Matsuzawa D, Hirano Y, Nakazato M, Shimizu E. Mental imagery in social anxiety disorder: the development and clinical utility of a Japanese version of the Spontaneous Use of Imagery Scale (SUIS-J). ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2018. [DOI: 10.1080/21507686.2018.1487455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yasuko Tanaka
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
- Minami Fujisawa Clinic , Kanagawa, Japan
| | - Naoki Yoshinaga
- Organization for Promotion of Tenure Track, University of Miyazaki , Miyazaki, Japan
| | - Aki Tsuchiyagaito
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
| | - Diasuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, International University of Health and Welfare, Atami Hospital , Shizuoka, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
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López-Pérez B, Deeprose C, Hanoch Y. Prospective mental imagery and its link with anxiety and depression in prisoners. PLoS One 2018; 13:e0191551. [PMID: 29543833 PMCID: PMC5854238 DOI: 10.1371/journal.pone.0191551] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/05/2018] [Indexed: 11/18/2022] Open
Abstract
Mental imagery is known to play a key role in the development and maintenance of depression and anxiety. Prisoners commonly experience psychological distress, but interventions to address this are currently lacking. We aimed to examine the link between prospective mental imagery and anxiety and depression among prisoners. One hundred twenty-three male prisoners from a Category C prison in southwest England participated in the study. They completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the General Anxiety Disorder Scale (GAD-7) to measure whether they experience depression and/or anxiety symptoms. Furthermore, they completed additional questionnaires to evaluate their prospective mental imagery. Results showed that 67.5% of prisoners presented with more depression symptoms and 27.7% with more anxiety symptoms. Supporting earlier findings, our data revealed that some dimensions of prospective mental imagery were significantly related with increased anxiety and depression symptoms in prisoners. Namely, intrusive negative personally relevant imagery was a positive predictor and likelihood of positive events a negative predictor of both anxiety and depression symptoms. The perceived likelihood of negative events was a positive predictor of depression. Intrusive verbal thought was a positive predictor of anxiety. The obtained results suggest the need to develop interventions not only targeting the reduction of prospective negative imagery but also the enhancement of positive mental imagery.
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Affiliation(s)
- Belén López-Pérez
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom
- * E-mail:
| | | | - Yaniv Hanoch
- School of Psychology, Plymouth University, Plymouth, United Kingdom
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Hallford D, Austin D, Takano K, Raes F. Psychopathology and episodic future thinking: A systematic review and meta-analysis of specificity and episodic detail. Behav Res Ther 2018; 102:42-51. [DOI: 10.1016/j.brat.2018.01.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 02/05/2023]
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Van der Watt AS, Suryapranata AP, Seedat S. Prospective interepisodal mood monitoring in patients with affective disorders: a feasibility study. Neuropsychiatr Dis Treat 2018; 14:517-524. [PMID: 29491711 PMCID: PMC5817414 DOI: 10.2147/ndt.s152620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Our primary objective was to assess the feasibility of interepisodal telephonic mood monitoring in patients with affective disorders in a low-resource setting. Secondary objectives included gathering data on longitudinal mood trajectories and assessing patient acceptance of mood monitoring. METHODS Inpatients with a primary mood or anxiety disorder were recruited predischarge. Assessment at intake included demographic information, the Life Events Checklist, and the Childhood Trauma Questionnaire. Participants telephonically completed the Altman Self-Rating Mania Scale (ASRM) and Quick Inventory of Depressive Symptomatology (QIDS), weekly, for 26 weeks. Units of alcohol consumed and life events were recorded. Semi-structured interviews were conducted midway through the mood monitoring protocol. RESULTS Of the 61 eligible participants (77% female; mean age =35.3 years), 28 completed 26 weeks of telephonic mood monitoring. Thirty-three participants (54.1%) withdrew prematurely or were lost to follow-up. Males were more likely to terminate study participation prematurely. Despite the significant decline in depression scores over 26 weeks, participants endorsed persistent mild-to-moderate depressive symptoms. Statistically, participants who were married/in a relationship had higher mean depression scores throughout the study compared to participants who were single. Throughout the study, ASRM scores were not indicative of significant mania. Suicidality (as measured by QIDS item 12) was highest at Week 3 and Week 12 postdischarge for those who completed 26 weeks of monitoring. CONCLUSION Despite the high attrition rate, interepisodal telephonic mood monitoring was deemed to be feasible and it can provide useful information to track progress, encourage medication adherence, and manage early warning signs of relapse. Further research is required to determine the benefit of weekly mood monitoring on mood fluctuations and to examine strategies that enhance retention.
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Affiliation(s)
| | | | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Zhang B, Wang J, Zhu Q, Ma G, Shen C, Fan H, Wang W. Hypnotic susceptibility and affective states in bipolar I and II disorders. BMC Psychiatry 2017; 17:362. [PMID: 29121879 PMCID: PMC5679347 DOI: 10.1186/s12888-017-1529-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Highly hypnotizable individuals have impaired executive function, elevated motor impulsivity and increased emotional sensitivity, which are sometimes found in bipolar disorder patients. It is then reasonable to assume that certain aspects of hypnotic susceptibility differ with the types of bipolar disorder. METHODS The Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) test, the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32) and the Plutchick-van Praag Depression Inventory (PVP) were applied to 62 patients with bipolar I disorder, 33 bipolar II disorder, and 120 healthy volunteers. RESULTS The passing rate of the SHSS:C 'Moving hands apart' item was higher in bipolar I patients than in controls, whereas for 'Mosquito hallucination' the rate was lower. Bipolar I and II patients scored significantly higher on MDQ, HCL-32 and PVP scales than controls. The passing rates of 'Mosquito hallucination' in controls, 'Arm rigidity' in bipolar I, and 'Age regression' in bipolar II predicted the respective MDQ scores. CONCLUSION In contrast to cognitive suggestions, bipolar I patients followed motor suggestions more often under hypnosis. Furthermore, both bipolar disorder patients and healthy volunteers demonstrated associations between mania levels and certain hypnotic susceptibility features. Our study aids in better understanding the altered conscious states in bipolar disorders, and encourages the use of related psychotherapy for these patients.
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Affiliation(s)
- Bingren Zhang
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Jiawei Wang
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Qisha Zhu
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Guorong Ma
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Chanchan Shen
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Hongying Fan
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang, 310058, China.
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Pedersen AM, Nielsen Straarup K, Thomsen DK. Narrative identity in female patients with remitted bipolar disorder: a negative past and a foreshortened future. Memory 2017; 26:219-228. [DOI: 10.1080/09658211.2017.1344250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Anne Mai Pedersen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
- Center on Autobiographical Memory Research, (CON AMORE), Aarhus University, Aarhus C, Denmark
| | | | - Dorthe Kirkegaard Thomsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
- Center on Autobiographical Memory Research, (CON AMORE), Aarhus University, Aarhus C, Denmark
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Morina N, Lancee J, Arntz A. Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. J Behav Ther Exp Psychiatry 2017; 55:6-15. [PMID: 27855298 DOI: 10.1016/j.jbtep.2016.11.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/06/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Literature suggests that imagery rescripting (ImRs) is an effective psychological intervention. METHODS We conducted a meta-analysis of ImRs for psychological complaints that are associated with aversive memories. Relevant publications were collected from the databases Medline, PsychInfo, and Web of Science. RESULTS The search identified 19 trials (including seven randomized controlled trials) with 363 adult patients with posttraumatic stress disorder (eight trials), social anxiety disorder (six trials), body dysmorphic disorder (two trials), major depression (one trial), bulimia nervosa (one trial), or obsessive compulsive disorder (one trial). ImRs was administered over a mean of 4.5 sessions (range, 1-16). Effect size estimates suggest that ImRs is largely effective in reducing symptoms from pretreatment to posttreatment and follow-up in the overall sample (Hedges' g = 1.22 and 1.79, respectively). The comparison of ImRs to passive treatment conditions resulted in a large effect size (g = 0.90) at posttreatment. Finally, the effects of ImRs on comorbid depression, aversive imagery, and encapsulated beliefs were also large. LIMITATIONS Most of the analyses involved pre-post comparisons and the findings are limited by the small number of randomized controlled trials. CONCLUSIONS Our findings indicate that ImRs is a promising intervention for psychological complaints related to aversive memories, with large effects obtained in a small number of session.
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Affiliation(s)
- Nexhmedin Morina
- Department of Psychology, University of Münster, Münster, Germany.
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Reducing future fears by suppressing the brain mechanisms underlying episodic simulation. Proc Natl Acad Sci U S A 2016; 113:E8492-E8501. [PMID: 27965391 DOI: 10.1073/pnas.1606604114] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Imagining future events conveys adaptive benefits, yet recurrent simulations of feared situations may help to maintain anxiety. In two studies, we tested the hypothesis that people can attenuate future fears by suppressing anticipatory simulations of dreaded events. Participants repeatedly imagined upsetting episodes that they feared might happen to them and suppressed imaginings of other such events. Suppressing imagination engaged the right dorsolateral prefrontal cortex, which modulated activation in the hippocampus and in the ventromedial prefrontal cortex (vmPFC). Consistent with the role of the vmPFC in providing access to details that are typical for an event, stronger inhibition of this region was associated with greater forgetting of such details. Suppression further hindered participants' ability to later freely envision suppressed episodes. Critically, it also reduced feelings of apprehensiveness about the feared scenario, and individuals who were particularly successful at down-regulating fears were also less trait-anxious. Attenuating apprehensiveness by suppressing simulations of feared events may thus be an effective coping strategy, suggesting that a deficiency in this mechanism could contribute to the development of anxiety.
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Di Simplicio M, Renner F, Blackwell SE, Mitchell H, Stratford HJ, Watson P, Myers N, Nobre AC, Lau‐Zhu A, Holmes EA. An investigation of mental imagery in bipolar disorder: Exploring "the mind's eye". Bipolar Disord 2016; 18:669-683. [PMID: 27995690 PMCID: PMC5299482 DOI: 10.1111/bdi.12453] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/20/2016] [Accepted: 10/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mental imagery abnormalities occur across psychopathologies and are hypothesized to drive emotional difficulties in bipolar disorder (BD). A comprehensive assessment of mental imagery in BD is lacking. We aimed to test whether (i) mental imagery abnormalities (abnormalities in cognitive stages and subjective domains) occur in BD relative to non-clinical controls; and (ii) to determine the specificity of any abnormalities in BD relative to depression and anxiety disorders. METHODS Participants included 54 subjects in the BD group (depressed/euthymic; n=27 in each subgroup), subjects with unipolar depression (n=26), subjects with anxiety disorders (n=25), and non-clinical controls (n=27) matched for age, gender, ethnicity, education, and premorbid IQ. Experimental tasks assessed cognitive (non-emotional) measures of mental imagery (cognitive stages). Questionnaires, experimental tasks, and a phenomenological interview assessed subjective domains including spontaneous imagery use, interpretation bias, and emotional mental imagery. RESULTS (i) Compared to non-clinical controls, the BD combined group reported a greater impact of intrusive prospective imagery in daily life, more vivid and "real" negative images (prospective imagery task), and higher self-involvement (picture-word task). The BD combined group showed no clear abnormalities in cognitive stages of mental imagery. (ii) When depressed individuals with BD were compared to the depressed or anxious clinical control groups, no significant differences remained-across all groups, imagery differences were associated with affective lability and anxiety. CONCLUSIONS Compared to non-clinical controls, BD is characterized by abnormalities in aspects of emotional mental imagery within the context of otherwise normal cognitive aspects. When matched for depression and anxiety, these abnormalities are not specific to BD-rather, imagery may reflect a transdiagnostic marker of emotional psychopathology.
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Affiliation(s)
| | - Fritz Renner
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK,Mental Health Research and Treatment CenterRuhr‐Universität BochumBochumGermany
| | - Heather Mitchell
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | | | - Peter Watson
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Nick Myers
- Oxford Centre for Human Brain Activity (OHBA)University of OxfordOxfordUK,Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Anna C Nobre
- Oxford Centre for Human Brain Activity (OHBA)University of OxfordOxfordUK,Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Alex Lau‐Zhu
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK,Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
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Electronic monitoring of self-reported mood: the return of the subjective? Int J Bipolar Disord 2016; 4:28. [PMID: 27900735 PMCID: PMC5127918 DOI: 10.1186/s40345-016-0069-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/19/2016] [Indexed: 11/10/2022] Open
Abstract
This narrative review describes recent developments in the use of technology for utilizing the self-monitoring of mood, provides some relevant background, and suggests some promising directions. Subjective experience of mood is one of the valuable sources of information about the state of an integrated mind/brain system. During the past century, psychiatry and psychology moved away from subjectivity, emphasizing external observation, precise measurement, and laboratory techniques. This shift, however, provided only a limited improvement in the understanding of mood disorders, and it appears that self-monitoring of mood has the potential to enrich our knowledge, particularly when combined with the advances in technology. Modern technology, with its ability to transfer information from the individual directly to the researcher via electronic applications, enables us now to study mood regulation more thoroughly. Frequent subjective ratings can be helpful in identifying individualized treatment with effective mood stabilizers and recognizing subtypes of mood disorders. The variability of subjective ratings may also help us estimate the increased risk of recurrence and guide a tailored treatment.
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Llewellyn S. Crossing the invisible line: De-differentiation of wake, sleep and dreaming may engender both creative insight and psychopathology. Conscious Cogn 2016; 46:127-147. [DOI: 10.1016/j.concog.2016.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/13/2016] [Indexed: 12/21/2022]
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36
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Pankowski S, Adler M, Andersson G, Lindefors N, Svanborg C. Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety - an open pilot study. Cogn Behav Ther 2016; 46:114-128. [PMID: 27647353 DOI: 10.1080/16506073.2016.1231218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen's d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.
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Affiliation(s)
- Sara Pankowski
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Mats Adler
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Gerhard Andersson
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
.,b Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Nils Lindefors
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Cecilia Svanborg
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
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Bonsall MB, Geddes JR, Goodwin GM, Holmes EA. Bipolar disorder dynamics: affective instabilities, relaxation oscillations and noise. J R Soc Interface 2016; 12:rsif.2015.0670. [PMID: 26577592 PMCID: PMC4685840 DOI: 10.1098/rsif.2015.0670] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Bipolar disorder is a chronic, recurrent mental illness characterized by extreme episodes of depressed and manic mood, interspersed with less severe but highly variable mood fluctuations. Here, we develop a novel mathematical approach for exploring the dynamics of bipolar disorder. We investigate how the dynamics of subjective experience of mood in bipolar disorder can be understood using a relaxation oscillator (RO) framework and test the model against mood time-series fluctuations from a set of individuals with bipolar disorder. We show that variable mood fluctuations in individuals diagnosed with bipolar disorder can be driven by the coupled effects of deterministic dynamics (captured by ROs) and noise. Using a statistical likelihood-based approach, we show that, in general, mood dynamics are described by two independent ROs with differing levels of endogenous variability among individuals. We suggest that this sort of nonlinear approach to bipolar disorder has neurobiological, cognitive and clinical implications for understanding this mental illness through a mechacognitive framework.
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Affiliation(s)
- Michael B Bonsall
- Department of Zoology, University of Oxford, Oxford OX1 3PS, UK St Peter's College, Oxford OX1 2DL, UK
| | - John R Geddes
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX1 7JX, UK
| | - Guy M Goodwin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX1 7JX, UK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, UK Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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James EL, Lau-Zhu A, Clark IA, Visser RM, Hagenaars MA, Holmes EA. The trauma film paradigm as an experimental psychopathology model of psychological trauma: intrusive memories and beyond. Clin Psychol Rev 2016; 47:106-42. [PMID: 27289421 DOI: 10.1016/j.cpr.2016.04.010] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 03/09/2016] [Accepted: 04/15/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Ella L James
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom; University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7NG, United Kingdom
| | - Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Ian A Clark
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7NG, United Kingdom
| | - Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Muriel A Hagenaars
- Utrecht University, Department of Clinical Psychology, 3584 CS Utrecht, The Netherlands
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom; Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 457] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Pearson J, Naselaris T, Holmes EA, Kosslyn SM. Mental Imagery: Functional Mechanisms and Clinical Applications. Trends Cogn Sci 2016; 19:590-602. [PMID: 26412097 PMCID: PMC4595480 DOI: 10.1016/j.tics.2015.08.003] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/31/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022]
Abstract
Mental imagery research has weathered both disbelief of the phenomenon and inherent methodological limitations. Here we review recent behavioral, brain imaging, and clinical research that has reshaped our understanding of mental imagery. Research supports the claim that visual mental imagery is a depictive internal representation that functions like a weak form of perception. Brain imaging work has demonstrated that neural representations of mental and perceptual images resemble one another as early as the primary visual cortex (V1). Activity patterns in V1 encode mental images and perceptual images via a common set of low-level depictive visual features. Recent translational and clinical research reveals the pivotal role that imagery plays in many mental disorders and suggests how clinicians can utilize imagery in treatment.
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Affiliation(s)
- Joel Pearson
- School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Thomas Naselaris
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK; Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Stephen M Kosslyn
- Minerva Schools at the Keck Graduate Institute, San Francisco, CA, USA
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Crespi B, Leach E, Dinsdale N, Mokkonen M, Hurd P. Imagination in human social cognition, autism, and psychotic-affective conditions. Cognition 2016; 150:181-99. [DOI: 10.1016/j.cognition.2016.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 01/08/2023]
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Ng RMK, Di Simplicio M, Holmes EA. Mental imagery and bipolar disorders: Introducing scope for psychological treatment development? Int J Soc Psychiatry 2016; 62:110-3. [PMID: 26582783 DOI: 10.1177/0020764015615905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roger M K Ng
- Department of Psychiatry, Kowloon Hospital, Kowloon, Hong Kong
| | | | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ng RMK, Heyes SB, McManus F, Kennerley H, Holmes EA. Bipolar risk and mental imagery susceptibility in a representative sample of Chinese adults residing in the community. Int J Soc Psychiatry 2016; 62:94-102. [PMID: 26271252 PMCID: PMC4712386 DOI: 10.1177/0020764015597951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We need to better understand the cognitive factors associated with risk for bipolar disorders. Recent research suggests that increased susceptibility to mental imagery may be one such factor. However, since this research was primarily conducted with Western students and at a single time-point, it is not known whether the relationship between imagery susceptibility and bipolar symptoms exists across cultures or within the general community, or whether this relationship remains stable over time. AIM This study evaluated whether Chinese adults identified as being at high (HR) versus low (LR) risk of developing bipolar disorders showed greater mental imagery susceptibility. We aimed to test whether such a relationship was stable over time by measuring imagery characteristics at baseline and at the 7-week follow-up. METHOD This prospective study recruited a community sample of N = 80 Chinese adults screened for the absence of neurotic and psychotic disorders. The sample was split into HR (n = 18) and LR (n = 62) groups at baseline based on a criterion cut-off score on a measure of hypomania, the Mood Disorder Questionnaire (MDQ). Participants completed measures of imagery susceptibility and its impact: the Spontaneous Use of Imagery Scale (SUIS) and the Impact of Future Events Scale (IFES), at baseline and 7 weeks later. RESULTS HR group reported greater tendency to use imagery in daily life (SUIS) and greater emotional impact of prospective imagery (IFES) than LR group at baseline. These results remained stable at follow-up. CONCLUSION This study provides preliminary evidence for increased susceptibility to mental imagery in individuals at high risk of bipolar disorders recruited from a community sample of Chinese adults. This extends previous research in Western student samples suggesting that imagery (both levels of use and its emotional impact) may be a cognitive factor with cross-cultural relevance that is stable over time.
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Affiliation(s)
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, UK Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Freda McManus
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
| | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Görgen SM, Hiller W, Witthöft M. Die Spontaneous Use of Imagery Scale (SUIS)–Entwicklung und teststatistische Prüfung einer deutschen Adaption. DIAGNOSTICA 2016. [DOI: 10.1026/0012-1924/a000135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Mentale Vorstellungsbilder spielen bei zahlreichen kognitiven, motorischen und emotionalen Prozessen eine bedeutende Rolle. Die Spontaneous Use of Imagery Scale (SUIS; Kosslyn, Chabris, Shephard & Thompson, 1998 ) ist ein Selbstbeurteilungsinstrument zur Erfassung von interindividuellen Unterschieden hinsichtlich des alltäglichen Gebrauchs mentaler Vorstellungsbilder. In zwei Studien wurde eine deutsche Adaption der SUIS entwickelt und psychometrisch erprobt. Mittels konfirmatorischer Faktorenanalyse wurde in beiden Studien die Eindimensionalität der Skala nachgewiesen. Erste Validitätshinweise ergeben sich aus Beziehungen der SUIS zu Maßen von bildhaften (visuell-imaginativen) sowie verbal-gedanklichen kognitiven Stilen (Studie 1, N = 216). Mit der deutschen Version konnten auch positive Zusammenhänge mit Hypomanie repliziert werden. In der zweiten Studie (N = 447) konnte die interne Konsistenz der deutschen Version durch eine Erweiterung der Skala deutlich verbessert werden. Mit der erweiterten Version der SUIS liegt nun erstmalig für den deutschsprachigen Raum ein Instrument vor, das die Imaginationsneigung reliabel erfassen kann.
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Malcolm CP, Picchioni MM, Ellett L. Intrusive prospective imagery, posttraumatic intrusions and anxiety in schizophrenia. Psychiatry Res 2015; 230:899-904. [PMID: 26619917 DOI: 10.1016/j.psychres.2015.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Abstract
Trauma exposure and intrusive thoughts are commonly reported in both schizophrenia and posttraumatic stress disorder (PTSD). Information processing accounts suggest that intrusions occur in the two conditions as a result of insufficient state and/or trait contextual processing in long-term memory. Most research has focused on intrusions about past events, while growing evidence suggests that intrusions about prospective imagined events warrants further investigation. Prospective intrusive imagery has yet to be examined in psychotic disorders but could provide crucial information regarding the aetiology and maintenance of psychotic symptoms. The current study examines the role of prospective intrusive imagery, posttraumatic intrusions and anxiety in schizophrenia. Fifty-seven participants (30 patients and 27 healthy controls) completed measures of trauma, PTSD, anxiety, general non-affective use of imagery, and intrusive prospective imagery. Patients reported significantly more intrusive prospective imagery relative to control participants but, importantly, not greater use of general non-affective imagery. Intrusive prospective imagery was associated with posttraumatic intrusions and anxiety in schizophrenia. The findings are consistent with information processing models of intrusions and psychosis, and provide novel insights for theoretical accounts, clinical formulation and therapeutic targets for psychotic symptoms in schizophrenia.
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Affiliation(s)
- Charlotte P Malcolm
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
| | - Marco M Picchioni
- Institute of Psychiatry, King's College, University of London, London SE5 8AF, UK; Academic Centre, St. Andrew's, Cliftonville, Northampton NN1 5DG, UK
| | - Lyn Ellett
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK
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Weßlau C, Cloos M, Höfling V, Steil R. Visual mental imagery and symptoms of depression - results from a large-scale web-based study. BMC Psychiatry 2015; 15:308. [PMID: 26631081 PMCID: PMC4668647 DOI: 10.1186/s12888-015-0689-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental imagery may influence the onset and maintenance of depression, but specific mechanisms have not yet been determined. METHODS Nine hundred twelve participants completed questionnaires on positive and negative mental images, as well as images of injury and death that lead to positive emotions ("ID-images"), and depressive symptomatology. The assessment was carried out online to reduce effects of social desirability. RESULTS Positive images were reported by 87 % of the sample, negative images by 77 %. ID-images were present in one-third of the sample. A connection with depression severity was found for the absence of positive mental images and the presence of negative images as well as ID-images. Higher depression scores were associated with more frequent and vivid negative images, greater imagery distress, and a higher proportion of negative relative to positive images. CONCLUSIONS Mental images are clearly related to depression. Future research should focus on ID-images and their connection to suicide-risk in depressed patients.
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Affiliation(s)
- Charlotte Weßlau
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Marie Cloos
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Volkmar Höfling
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
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Tharp JA, Johnson SL, Sinclair S, Kumar S. Goals in bipolar I disorder: Big dreams predict more mania. MOTIVATION AND EMOTION 2015. [DOI: 10.1007/s11031-015-9519-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Self-images in the present and future: Role of affect and the bipolar phenotype. J Affect Disord 2015; 187:97-100. [PMID: 26322714 PMCID: PMC4595481 DOI: 10.1016/j.jad.2015.08.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/26/2015] [Accepted: 08/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bipolar Spectrum Disorder (BPSD) is associated with changes in self-related processing and affect, yet the relationship between self-image and affect in the BPSD phenotype is unclear. METHODS 47 young adults were assessed for hypomanic experiences (BPSD phenotype) using the Mood Disorders Questionnaire. Current and future self-images (e.g. I am… I will be…) were generated and rated for emotional valence, stability, and (for future self-images only) certainty. The relationship between self-image ratings and measures of affect (depression, anxiety and mania) were analysed in relation to the BPSD phenotype. RESULTS The presence of the BPSD phenotype significantly moderated the relationship between (1) affect and stability ratings for negative self-images, and (2) affect and certainty ratings for positive future self-images. Higher positivity ratings for current self-images were associated with lower depression and anxiety scores. LIMITATIONS This was a non-clinical group of young adults sampled for hypomanic experiences, which limits the extension of the work to clinical levels of psychopathology. This study cannot address the causal relationships between affect, self-images, and BPSD. Future work should use clinical samples and experimental mood manipulation designs. CONCLUSIONS BPSD phenotype can shape the relationship between affect and current and future self-images. This finding will guide future clinical research to elucidate BPSD vulnerability mechanisms and, consequently, the development of early interventions.
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Johnson SL, Tharp JA, Peckham AD, McMaster KJ. Emotion in bipolar I disorder: Implications for functional and symptom outcomes. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 125:40-52. [PMID: 26480234 DOI: 10.1037/abn0000116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California at Berkeley
| | - Jordan A Tharp
- Department of Psychology, University of California at Berkeley
| | | | - Kaja J McMaster
- Department of Psychology, University of California at Berkeley
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Cognitive Emotion Regulation as a Mediator between Posttraumatic Stress Symptoms and Hypomanic Personality within a Non-Clinical Population. Behav Cogn Psychother 2015; 44:104-11. [PMID: 26365097 DOI: 10.1017/s1352465815000508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is a high prevalence of traumatic life events within individuals diagnosed with bipolar disorder. However, currently there is limited theoretical understanding of this relationship. AIMS To explore whether non-clinical symptoms of posttraumatic stress have a direct effect on the non-clinical symptoms of bipolar disorder, or whether this relationship is mediated by cognitive emotion regulation strategies. METHOD A cross-sectional design within non-clinical participants completing an online survey including the Impact of Events Scale, Cognitive Emotion Regulation Questionnaire and the Hypomanic Personality Scale. RESULTS Posttraumatic stress symptoms were associated with hypomanic personality. Intrusive memories contributed a small but significant proportion of the variance between these two measures. Rumination of negative emotions mediated the relationship between posttraumatic stress and hypomanic personality. CONCLUSIONS The relationship between traumatic events and an increased prevalence of bipolar disorder remains poorly understood. Further research should explore rumination as a potential target for treatment within those suffering from both posttraumatic stress and bipolar disorder.
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