Mental imagery in generalized anxiety disorder: A comparison with healthy control participants

Exploring Temporal Relationships Between Anxiety, Mood and Mental Imagery in Patients With Bipolar Disorder: A Network Analysis

INTRODUCTION

Bipolar disorder is a severe mental health problem with limited treatment success. There is a call for improving interventions, requiring an increased understanding of factors driving mood instability. One promising avenue is to study temporal associations between factors that appear relevant according to the emotional amplifier model of Holmes are changes in mood, anxiety and mental imagery.

METHODS

The current study used data from a recent RCT for a secondary analysis which applied a network analysis approach to explore temporal associations between weekly measurements of mania, depression, anxiety and mental imagery measured during 32 weeks in two randomised groups (N = 55) receiving either imagery-focused cognitive therapy (ImCT) or group psychoeducation (PE).

RESULTS

Both negative intrusive mental imagery and anxiety appeared central in the network analyses, driving changes in both mania and depression, but only in the PE group. In the ImCT group, only anxiety was driving changes in mania and depression.

CONCLUSION

Although exploratory, findings suggest that prior increases in anxiety and negative intrusive mental imagery might be associated with subsequent increases in depression and mania symptoms in patients with bipolar disorder. Anxiety might in turn increase negative intrusive imagery and associated negative emotions. Although more research is needed, results are in line with the emotional amplifier model and stress that future interventions with a focus on anxiety and imagery might help to improve psychosocial therapies for patients with bipolar disorder. In addition, this study suggests that a network approach is a helpful and feasible way to study mood instability, anxiety and mental imagery to increase our understanding of mechanisms underpinning mood instability.

Self-guided imagery rescripting for worry images: A preliminary experimental investigation

BACKGROUND

Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed first to examine the relationship between trait worry and properties of future-oriented worry images, and second to examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries.

METHODS

Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions).

RESULTS

In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type.

CONCLUSIONS

This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.

Physiological and subjective arousal to prospective mental imagery: A mechanism for behavioral change?

Emotional prospective mental imagery, in which we simulate possible future events within our minds, have a pronounced impact on behavior. For example, repeated engagement in positive prospective imagery can lead to behavioral activation, while negative prospective imagery can lead to catastrophizing and avoidance. Physiological arousal boosts memory consolidation, creating emotional memories. Thus, if emotional prospective imagery produces an arousal response, the memory consolidation of these simulations of the future may be boosted, offering a possible underlying mechanism for the impact of emotional prospective imagery on behavior. In order to examine the feasibility of arousal as a possible mechanism behind the impact of emotional prospective imagery on behavior, sixty participants produced autobiographical prospective imagery of 30 scenes (10 positive, 10 neutral, and 10 negative), during which arousal responses (skin conductance) were measured, and ratings for subjective arousal, valence, and imagery vividness were collected. Moreover, because vividness of prospective imagery has been related to anxiety and depression, the study examined this relation also for event-related autobiographical prospective imagery. The results showed that emotional prospective imagery were associated with higher subjective arousal ratings as compared to neutral imagery. Physiological arousal responses showed a similar pattern, but further data is needed for a firm conclusion. Nevertheless, arousal-boosted consolidation remains a possible contributing mechanism for the impact of emotional prospective imagery on behavior. Moreover, results suggest both anxiety and depression may entail a reduced ability to invent prospective life situations. However, only anxiety was associated with less vivid imaginations, unless the imaginations were of negative content. Hence, anxious individuals may experience negative prospective imagery more vividly than imagery with neutral and positive content.

The serial mediation effect of prospective imagery vividness and anxiety symptoms on the relationship between perceived stress and depressive symptoms among Chinese vocational college students during the COVID-19 pandemic

The mental health of vocational college students has been neglected during the COVID-19 pandemic. Prospective imagery may play a role in the relationships among stress, anxiety and depression. This study aimed to survey the mental health of Chinese vocational college students and explore the mediation effect of prospective imagery vividness and anxiety symptoms on the relationship between perceived stress and depressive symptoms. A total of 2, 381 vocational college students (Mage = 18.38 years, range: 16-21, SD = 0.92) provided self-report data on perceived stress, anxiety and depressive symptoms and prospective imagery vividness. Two potential serial mediation models were postulated regarding the roles of prospective imagery vividness and anxiety symptoms in the relationship between perceived stress and depressive symptoms. The prevalence rates of stress, anxiety and depressive symptoms were 55.7%, 33.2% and 53.5%, respectively, among vocational college students. Perceived stress was associated with decreased vividness of positive prospective imagery and increased vividness of negative prospective imagery and anxiety symptoms, leading to increased depressive symptoms. Additionally, prospective imagery vividness and anxiety symptoms had a serial mediation effect on the relationship between perceived stress and depressive symptoms. The results demonstrated that impoverished vividness of positive prospective imagery is not only a central feature of depression but also associated with anxiety. Interventions targeting prospective imagery vividness may alleviate anxiety and depressive symptoms among Chinese vocational college students and should be implemented as soon as possible during the COVID-19 pandemic.

Correlates of Dampening and Savoring in Generalized Anxiety Disorder

Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants (N = 233) completed questionnaires online.

In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed.

Visual worry in patients with schizophrenia

OBJECTIVE

Worrying is a pervasive transdiagnostic symptom in schizophrenia. It is most often associated in the literature with verbal modality due to many studies of its presence in generalised anxiety disorder. The current study aimed to elucidate worry in different sensory modalities, visual and verbal, in individuals with schizophrenia.

METHOD

We tested persons with schizophrenia (n = 92) and healthy controls (n = 138) in a cross-sectional design. We used questionnaires of visual and verbal worry (original Worry Modality Questionnaire), trait worry (Penn State Worry Questionnaire) and general psychopathology symptoms (General Functioning Questionnaire-58 and Brief Psychiatric Rating Scale).

RESULTS

Both visual and verbal worry were associated with psychotic, anxiety and general symptoms of psychopathology in both groups with medium to large effect sizes. Regression analyses indicated that visual worry was a single significant predictor of positive psychotic symptoms in a model with verbal and trait worry, both in clinical and control groups (β's of 0.49 and 0.38, respectively). Visual worry was also a superior predictor of anxiety and general psychopathology severity (β's of 0.34 and 0.37, respectively) than verbal worry (β's of 0.03 and -0.02, respectively), under control of trait worry, in the schizophrenia group. We also proposed two indices of worry modality dominance and analysed profiles of dominating worry modality in both groups.

CONCLUSIONS

Our study is the first to demonstrate that visual worry might be of specific importance for understanding psychotic and general psychopathology symptoms in persons with schizophrenia.

Mental Imagery in the Science and Practice of Cognitive Behaviour Therapy: Past, Present, and Future Perspectives

Mental imagery has a long history in the science and practice of cognitive behaviour therapy (CBT), stemming from both behavioural and cognitive traditions. The past decade or so has seen a marked increase in both scientific and clinical interest in mental imagery, from basic questions about the processes underpinning mental imagery and its roles in everyday healthy functioning, to clinical questions about how dysfunctions in mental imagery can cause distress and impairment, and how mental imagery can be used within CBT to effect therapeutic change. This article reflects on the current state of mental imagery in the science and practice of CBT, in the context of past developments and with a view to future challenges and opportunities. An ongoing interplay between the various strands of imagery research and the many clinical innovations in this area is recommended in order to realise the full therapeutic potential of mental imagery in CBT.