Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities

Specificity of Episodic Future Thinking in Adolescents: Comparing Childhood Maltreatment, Autism Spectrum, and Typical Development

Maltreatment and autism can be associated with overlapping difficulties across functional domains (e.g., social, emotional, and sensory) and high rates of mental health problems. A cognitive approach focussing on affect-laden cognition, here on episodic future thinking (FT), could help inform cognitive assessments and adapt psychological interventions. Three groups of adolescents (N = 85), (i) maltreatment (n = 28), (ii) autism (n = 29), and (iii) typical development without maltreatment/autism (TD; n = 28), matched in age (10-16 years old), sex (assigned at birth), and socioeconomic status, completed a newly adapted online Autobiographical Future Thinking Test. As predicted, the maltreatment group generated significantly fewer specific future events relative to the TD group, however, the number of specific future events did not significantly differ between the autism and the other groups. Exploratory analyses showed that lower FT specificity was significantly associated with more depressive (but not anxiety) symptoms across the three groups. These findings shed light on the cognitive profiles of both maltreatment and autism during adolescence and signal FT as a potential therapeutic target for adolescents with these developmental differences. Our study lays the foundation for additional comparisons of maltreatment-related presentations versus autism with improved designs and a broader set of cognitive and clinical domains.

Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury

OBJECTIVES

Non-suicidal self-injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk.

METHOD

An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days.

RESULTS

Mental preoccupation in the form of NSSI mental imagery-based flash-forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross-panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge.

CONCLUSIONS

Mental imagery of NSSI is not simply an epiphenomenal by-product of NSSI urge and may constitute a dynamic and proximal novel intervention target.

The potential of Future Event Specificity Training (FEST) to decrease anhedonia and dampening of positive emotions: A randomised controlled trial

Impaired episodic future thinking (EFT), as reflected in reduced specificity, low levels of detail and less use of mental imagery, has been associated with depressive symptomatology. The beneficial impact of Future Event Specificity Training (FEST) on impaired EFT has recently been demonstrated, as well as on anhedonia, the core symptom of depression reflecting low positive affect. The current study aimed to replicate these previous findings. In addition, this study is the first to examine the potential of FEST to reduce engagement in dampening, a maladaptive response style characterised by reducing the intensity and/or frequency of positive emotional states, which is linked to depressive symptoms and anhedonia. An RCT (FEST vs. waitlist control) was conducted in a large sample of Dutch-speaking undergraduate students (N = 155). In line with prior research, FEST resulted in significant improvements in EFT features. However, likely related to limited room for change detection, no significant changes were found in anhedonia and dampening. In the light of the positive impact of FEST on several EFT features, future studies should address methodological issues to create optimal conditions for potential change detection. Finally, further examination of the proposed theoretical change mechanisms aimed to reduce anhedonia and dampening is warranted.

From anticipation to action: A RCT on mental imagery exercises in daily life as a motivational amplifier for individuals with depressive symptoms

Encouraging engagement in rewarding or pleasant activities is one of the most important treatment goals for depression. Mental imagery exercises have been shown to increase the motivation for planned behaviour in the lab but it is unclear whether this is also the case in daily life. Therefore, we aimed to investigate the effect of mental imagery exercises on motivation and behaviour in daily life. Participants with depressive symptoms (N = 59) were randomly assigned to a group receiving mental imagery (MI) exercises or a control group receiving relaxation (RE) exercises via study phones. We employed an experience sampling design with 10 assessments per day for 10 days (three days baseline, four days with two exercises per day and three days post-intervention). Data was analysed using t-tests and multilevel linear regression analyses. As predicted, MI exercises enhanced motivation and reward anticipation during the intervention phase compared to RE. However, MI did not enhance active behaviour or strengthen the temporal association from reward anticipation (t-1) to active behaviour (t). Mental imagery exercises can act as a motivational amplifier but its effects on behaviour and real-life reward processes remain to be elucidated.

The Nature of Mental Imagery and Its Relationship With Amotivational Psychopathology in People With Schizophrenia Spectrum Disorders

Many people with schizophrenia spectrum disorders (SSDs) experience profound amotivation, which is strongly related to anticipatory anhedonia. Yet, the neuropsychological fundamentals of anticipatory anhedonia and amotivation are barely understood, resulting in a lack of effective treatments for these patients. Aberrancies in positive mental imagery may interfere with the anticipation of pleasure and could thus explain anticipatory anhedonia and amotivation. However, the nature of mental imagery and its relationship with amotivational psychopathology in SSD is largely unknown. In this preregistered study, we therefore examined mental imagery characteristics and their relation to anticipatory anhedonia, amotivation, and daily life activity in SSD. TheN = 86 participants included individuals with SSD (n = 43) and demographically matched healthy controls (n = 43). Mental imagery, anticipatory pleasure, amotivation, and activity engagement were assessed with structured interviews and self-report questionnaires. Ecological momentary assessment was used to measure state anticipatory pleasure and activity engagement in daily life (n = 81). Compared to the control group, the SSD group showed comparable quantity, but less vividness of mental imagery. Reduced vividness of mental imagery in SSD was significantly associated with higher anticipatory anhedonia, amotivation, and low activity engagement in cross-sectional and prospective analyses. Reduced mental imagery vividness may cause a lack of internal incentive to seek pleasurable experiences and could explain amotivation. Interventions aiming to improve mental imagery vividness and related anticipatory pleasure responses in SSD may be effective in targeting amotivation.

Collaborative imagination synchronizes representations of the future and fosters social connection in the present

From close friends to people on a first date, imagining a shared future appears fundamental to relationships. Yet, no previous research has conceptualized the act of imagination as a socially constructed process that affects how connected we feel to others. The present studies provide a framework for investigating imagination as a collaborative process in which individuals cocreate shared representations of hypothetical events-what we call collaborative imagination. Across two preregistered studies (N = 244), we provide evidence that collaborative imagination of a shared future fosters social connection in novel dyads-beyond imagining a shared future individually or shared experience in general. Subjective ratings and natural language processing of participants' imagined narratives illuminate the representational features of imagined events shaped by collaborative imagination. Together, the present findings have the potential to shift how we view the structure and function of imagination with implications for better understanding interpersonal relationships and collective cognition.

Basic processes and clinical applications of mental imagery in worry: A systematic review

BACKGROUND

In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry.

METHODS

PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results.

RESULTS

The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD.

CONCLUSIONS

Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.

Counteract Anhedonia! Introducing an Online-Training to Enhance Reward Experiencing - A Pilot Study

Background

Anhedonia is a risk factor for a severe course of depression but is often not adequately addressed in psychotherapy. This study presents the Training to Enhance Reward Experience (T-REx), a novel self-help approach that uses savoring and mental imagery to target impairments in reward experience associated with anhedonia. We aimed to examine feasibility and acceptability of T-REx and exploratively investigated its effects on anhedonia and other clinical variables.

Method

In an online, randomized controlled trial, 79 subjects participated for five days in T-REx or the active control condition Gratitude Writing (GW). We assessed changes in anhedonia, depression, and active behavior at inclusion, after the waiting period, post-intervention and at follow-up. The intervention effects were examined for the full sample and an anhedonic sub-sample.

Results

T-REx and GW were equally feasible and clearly accepted by the sample. Both interventions significantly reduced depressive symptoms and increased behavioral activation. Although there was no significant main effect of the interventions, between-group differences were observed for depressive symptoms and active behavior at post-intervention and follow-up, favoring T-REx. Further, within-group changes for T-REx were larger than for GW. The observed effects had a greater magnitude in the anhedonic sub-sample, suggesting that individuals with more pronounced anhedonic symptoms derived greater benefit from the interventions.

Discussion

This first study of T-REx provides promising results that should prompt further investigations of T-REx in clinical samples. The results suggest that T-REx has a positive effect on depression symptoms and active behavior. Further, its potential as a valuable adjunct to behavioral activation interventions is discussed.

Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review

BACKGROUND

The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts.

METHODS

We conducted a systematic review and meta-analysis documenting the prevalence of suicidal and NSSI mental imagery and describing the content and characteristics of suicidal and NSSI mental imagery, links between suicidal and NSSI mental imagery and suicidal and NSSI behavior, and how to intervene on suicidal and NSSI mental imagery. Studies published through December 17, 2022 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

Twenty-three articles were included. Prevalence rates of suicidal (73.56%) and NSSI (84.33%) mental imagery were high among clinical samples. Self-harm mental imagery commonly depicts engagement in self-harm behavior and is experienced as vivid, realistic, and preoccupying. When experimentally induced, self-harm mental imagery reduces physiological and affective arousal. Preliminary evidence suggests that suicidal mental imagery is associated with suicidal behavior.

CONCLUSIONS

Suicidal and NSSI mental imagery are highly prevalent and may be associated with heightened risk for self-harm behavior. Assessments and interventions for self-harm should consider incorporating and addressing suicidal and NSSI mental imagery to mitigate risk.

Prospection deficits in patients with first-episode schizophrenia: a cross-sectional comparative study

Prospection refers to the ability to simulate and pre-experience future events. Schizophrenia patients have difficulty in anticipating pleasure in future events, but previous studies examined prospection deficits in chronic schizophrenia patients. This study aimed to investigate prospection deficits in first-episode schizophrenia patients. Thirty first-episode schizophrenia patients and 31 healthy controls completed the Affective Prospection Task, which utilized pictorial cues to involve positive, neutral and negative prospection. Participants' ratings regarding the phenomenal characteristics of their prospected events were collected, and their prospected narratives were coded using a valid scoring manual. We also assessed intelligence, working memory and logical memory. The results showed, in all participants, valence of the cues significantly influenced participants' sense of pre-experience, temporal distance, emotion experience, vividness and participation of the prospected events, as well as the richness of sensory details. The two groups did not differ in self-report phenomenal characteristics of their prospected events. For coded characteristics, schizophrenia patients' prospected narratives were less rich in thought/emotion than controls, even after controlling for intelligence and memory deficits. We extended empirical evidence for prospection deficits from chronic schizophrenia samples to first-episode schizophrenia patients.

Positive Prospective Mental Imagery Characteristics in Young Adults and Their Associations with Depressive Symptoms

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.

Telephone-Based Behavioral Activation with Mental Imagery for Depression in Older Adults in Isolation During the covid-19 Pandemic: Long-term Results from a Pilot Trial

OBJECTIVES

The covid-19 pandemic has highlighted the need for psychological interventions for depression that can be delivered remotely to older adults. Pellas et al. (2022) conducted a pilot trial on the preliminary effectiveness of a four-week telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) intervention to N= 38 adults 65 years and older with clinically significant depressive symptoms living in isolation due to covid-19 in Sweden. This study assessed the feasibility of follow-up assessments and within-group symptom change over a six-month post-intervention period.

METHODS

Retention rates at post-intervention and follow-up assessments of depressive symptoms (MADRS-S) at five time points were assessed (baseline, post-intervention, 1-, 3-, and 6-month follow-up). Effect sizes (Hedges' g) for within-group change scores were calculated between each time point.

RESULTS

Retention rates over time were 95, 82, 89, and 84%. Mean MADRS-S score was 18.26 at baseline, 13.69 at post-intervention (g= .68), 13.42 at 1 month (g= .74), 13.82 at 3 months (g= .74), and 15.59 at 6 months (g= .41).

CONCLUSIONS

Long-term follow-ups were feasible. Within-group decreases in depressive symptoms were maintained with medium effect sizes at 6 months post-intervention.

CLINICAL IMPLICATIONS

Telephone-based BA-MI may be a feasible intervention for depressive symptoms in older adults in isolation with maintained effects over time.

Future self-imagery of young people in Sweden during the COVID-19 pandemic: an exploratory mixed methods analysis

Global restrictions imposed during the COVID-19 pandemic significantly limited the capacity to plan for the future. Little is known about young people's future self-images and the impact the COVID-19 pandemic may have had upon them. Given evidence that the ability to imagine a positive future can be protective for mental health, research into the impact of the pandemic on future self-imagery is needed. In two studies, we therefore explored the consequences of the COVID-19 pandemic for future self-imagery in an unselected sample of young people in Sweden, specifically: (a) how content and characteristics of future self-images changed from before to during the pandemic, and (b) how such change was related to trauma history, intrusive memories of COVID-19 media footage, past time perspective and optimism (assessed with questionnaires/intrusive memory diary). Future self-images before and during the pandemic were assessed using the 'I Will Be' task (N Study1=74; N Study2=99). A mixed methods design, combining quantitative analysis, qualitative content coding and thematic analysis was used. Exploratory results of Study 1 indicated that future images were rated as less positive during than before the pandemic and that this reduction was less pronounced in people with higher optimism. Results were replicated in an independent sample (Study 2, collected later during the pandemic). In conclusion, whilst the findings are preliminary and emerged from an unselected sample, they prompt the suggestion that brief, novel interventions which aim to bolster positive future imagery may hold promise as a scalable means by which to enhance mental health for young people in the context of the COVID-19 pandemic.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04100-z.

Reducing Anhedonia in Major Depressive Disorder with Future Event Specificity Training (FEST): A Randomized Controlled Trial

Background

Improving future thinking, such as characteristics of specificity, detail, and use of mental imagery, may be one means to reduce anhedonia, particularly in a Major Depressive Episode (MDE) in which future thinking is impaired. The current study aimed to test this using a validated program, Future Event Specificity Training (FEST).

Methods

Participants (N = 177; 80.8% women; M age = 43.7, SD = 11.8) with a current depressive episode with anhedonia and high symptom severity were randomized to FEST or no FEST. Future thinking, anhedonia-related variables, and other clinical outcomes were assessed at baseline, one- and three-month follow-up.

Results

Relative to the control group, FEST was associated with significantly improved future thinking characteristics, a reduced likelihood of anhedonia (35.1% vs. 61.1%, p = .015), improvements on other anhedonia-related variables such as anticipatory (d = 0.63, p = .004) and anticipated pleasure for future events (d = 0.77, p < .001), and desirable clinical outcomes such as less people meeting criteria for an MDE (37.8% vs. 64.8%, p = .011), higher behavioural activation (d = 0.71, p = .001) and improved global functioning (d = 0.52, p = .017). Changes in future thinking were found to mediate the effect of FEST on anhedonia.

Conclusion

The quality of future thinking can be enhanced in Major Depression, and this leads to a substantially reduced likelihood of anhedonia, other significant clinical effects, and functional gains.

The traces of imagination: early attention bias toward positively imagined stimuli

Positively imagined activities may capture visual attention due to an increase in positive value. Increasing attention toward activities, in turn, may prove useful for clinical interventions aiming to motivate behavioral engagement. Employing a within-subject experimental design, we examined the effect of positive imagery on attention using a visual probe task with concurrent eye tracking. Adults from the general population (N = 54) imagined performing activities involving visually presented objects in a positive (focusing on the positive emotional impact) or neutral (focusing on a neutral circumstance) manner. They then completed a visual probe task using picture stimuli depicting one object per type of imagery. Positive compared to neutral imagery increased self-reported behavioral motivation and biased the direction, but not the duration, of gaze toward objects associated with the imagined activities. An exploratory analysis showed a positive association between the direction bias and depressive symptoms. Our findings build on existing literature on positive imagery as a motivational amplifier by highlighting early attention as an underlying cognitive mechanism.

Simulating the best and worst of times: the powers and perils of emotional simulation

We are remarkably capable of simulating events that we have never experienced. These simulated events often paint an emotional picture to behold, such as the best and worst possible outcomes that we might face. This review synthesises dispersed literature exploring the role of emotion in simulation. Drawing from work that suggests that simulations can influence our preferences, decision-making, and prosociality, we argue for a critical role of emotion in informing the consequences of simulation. We further unpack burgeoning evidence suggesting that the effects of emotional simulation transcend the laboratory. We propose avenues by which emotional simulation may be harnessed for both personal and collective good in applied contexts. We conclude by offering important future directions.

Imagine How Good That Feels: The Impact of Anticipated Positive Emotions on Motivation for Reward Activities

Background

Disease burden and unsatisfactory treatment outcomes call for innovation in treatments of depression. Prospective mental imagery, i.e. future-directed voluntary imagery-based thought, about potentially-rewarding activities may offer a mechanistically-informed intervention that targets deficits in reward processing, a core clinical feature of depression. We propose that the previously described impact of prospective mental imagery on motivation for everyday activities is facilitated by affective forecasting, i.e. predictions about an individual’s emotional response to the imagined activities.

Methods

Participants (N = 120) self-nominated six activities to engage in over the following week and were randomized to either: (1) an affective forecasting imagery condition (n = 40); (2) a neutral process imagery condition (n = 40); or (3) a no-imagery control condition (n = 40).

Results

As predicted, increases in motivation ratings from pre to post experimental manipulation were significantly higher following affective forecasting imagery compared to both neutral process imagery (d = 0.62) and no-imagery (d = 0.91). Contrary to predictions, the number of activities participants engaged in did not differ between conditions.

Conclusions

Results provide initial evidence for a potentially important role of affective forecasting in prospective mental imagery. We discuss how these findings can inform future research aiming to harness prospective mental imagery’s potential for clinical applications.

Telephone-based behavioral activation with mental imagery for depression: A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic

OBJECTIVES

To shield vulnerable persons, particularly the elderly, during the Covid-19 pandemic governments around the world have advised to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid-19 pandemic.

METHODS

In this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA-MI treatment condition, or an Attention-Assessment control condition delivered over the telephone over a 4-week period.

RESULTS

Depressive symptoms decreased more in the treatment condition compared to the control condition. At post-treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed.

CONCLUSIONS

This pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.