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McIntyre SA, Richardson J, Carroll S, O'Kirwan S, Williams C, Pile V. Measures of mental imagery in emotional disorders: A COSMIN systematic review of psychometric properties. Clin Psychol Rev 2024; 113:102470. [PMID: 39180928 DOI: 10.1016/j.cpr.2024.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Dysfunctional imagery processes characterise a range of emotional disorders. Valid, reliable, and responsive mental imagery measures may support the clinical assessment of imagery and advance research to develop theory and imagery-based interventions. We sought to review the psychometric properties of mental imagery measures relevant to emotional disorders. METHODS A systematic review registered on the Open Science Framework was conducted using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Five databases were searched. COSMIN tools were used to assess the quality of study methodologies and psychometric properties of measures. RESULTS Twenty-three articles describing twenty-one self-report measures were included. Measures assessed various imagery processes and were organised into four groups based on related emotional disorders. Study methodological quality varied: measure development and reliability studies were generally poor, while internal consistency and hypothesis testing studies were higher quality. Most measurement properties assessed were of indeterminate quality. CONCLUSION Imagery measures were heterogenous and primarily disorder specific. Due to a lack of high-quality psychometric assessment, it is unclear whether most included imagery measures are valid, reliable, or responsive. Measures had limited evidence of content validity suggesting further research could engage clinical populations to ensure their relevance and comprehensiveness.
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Affiliation(s)
- Stephen A McIntyre
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Jessica Richardson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK; Trauma, Anxiety and Depression Clinic, South London & Maudsley NHS Trust, London, UK
| | - Susan Carroll
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK; Children's Health Ireland, Dublin, Ireland
| | - Saava O'Kirwan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Chloe Williams
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
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Keeler JL, Kan C, Treasure J, Himmerich H. Novel treatments for anorexia nervosa: Insights from neuroplasticity research. EUROPEAN EATING DISORDERS REVIEW 2024; 32:1069-1084. [PMID: 37823233 DOI: 10.1002/erv.3039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Treatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence-based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN. METHOD This paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies. RESULTS Novel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti-inflammatory medications and brain-derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness-based interventions. CONCLUSIONS Treatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts.
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Affiliation(s)
- Johanna Louise Keeler
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Carol Kan
- Vincent Square Eating Disorder Service, London, UK
| | - Janet Treasure
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Hubertus Himmerich
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
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Simon E, Beeftink J, van 't Hullenaar B, van Hooren S. An imagery rescripting based intervention in children and adolescents who endured a negative life event: A pilot study, satisfaction and feasibility survey. J Behav Ther Exp Psychiatry 2024; 84:101957. [PMID: 38574561 DOI: 10.1016/j.jbtep.2024.101957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/14/2024] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVES ImRs, a technique targeting distressing mental images, has shown promise in adult psychiatric treatment. Initial research indicates positive outcomes in children, with potential for reducing mental health care burden. This pilot study examined the use of Imagery Rescripting (ImRs) as an intervention for children who have experienced negative life events. We aimed to assess short-term emotional changes, participant satisfaction, and the feasibility of a larger-scale ImRs intervention for children. METHODS We employed a pre-posttest within-group design, and included 35 children (ages 5-18) who experienced negative life events, as well as 12 coaches. ImRs targeted distressing images related to negative events. Measurement tools included Visual Analogue Scales for distress and emotions, along with satisfaction surveys for both children and coaches. The feasibility of a larger-scale study was also explored through a coach questionnaire. RESULTS We found significant short-term improvements for all emotional states, with large effects for anxiety, sadness, and happiness, and a moderate effect for anger. Children reported fair levels of satisfaction with the intervention's acceptability and complexity. Coaches expressed high levels of satisfaction with the intervention as a whole and with its characteristics. Coaches were also strongly motivation for future, more in-depth research. An important limitation of this pilot study was the lack of a control group. In light of the promising results, more extensive studies with diagnostic information, multiple measures, and follow-up assessments are warranted. CONCLUSION Altogether, imagery rescripting based interventions seem a promising venue for children who experienced negative events.
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Affiliation(s)
- Ellin Simon
- Clinical Child and Adolescent Psychology, PO Box 2960, NL 6401, DL Heerlen, Chiba 2.11, the Netherlands; Open University, the Netherlands.
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Geschwind N, Keasberry E, Voncken M, Lobbestael J, Peters M, Rijkeboer M, van Heugten-van der Kloet D. Imagery rescripting: The value of an added positive emotion component. J Behav Ther Exp Psychiatry 2024; 84:101958. [PMID: 38493567 DOI: 10.1016/j.jbtep.2024.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Imagery Rescripting (ImRs) aims to reduce trauma-related negative emotions and intrusions. Positive emotions during ImRs may aid coping with the consequences of trauma, but protocols vary in the extent to which they explicitly target such positive emotions. We used a multiple-day design with a trauma film paradigm to investigate whether adding an explicit positive emotion component to ImRs improved intervention effects in a non-clinical sample. In addition, we explored potentially differential effects on high, medium, and low arousal positive affect. METHODS Participants (n = 105) were randomly assigned to either a standard ImRs condition, to an ImRs condition with an added explicit positive emotion component targeting joy (ImRs+), or to a non-intervention control (NIC) condition. Participants watched a trauma film on day 1, received the condition-specific intervention on day 2, and completed additional post-assessments of positive and negative affect on day 3. In addition, participants recorded intrusions from the trauma film from day 1 until day 3. RESULTS Compared to standard ImRs and NIC, ImRs + significantly increased positive affect. Exploratory analyses showed that this increase concerned medium and high, but not low arousal positive affect. No significant between-group differences were found for negative affect and intrusion-related outcomes. LIMITATIONS Floor effects for intrusions and negative affect limited our ability to fully investigate the potential benefits of targeting positive affect. CONCLUSIONS Adding a positive emotion component to ImRs reliably improved positive affect. More research is needed to determine whether explicitly targeting positive affect improves efficacy of ImRs for intrusion-related outcomes.
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Affiliation(s)
- Nicole Geschwind
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
| | - Evelyn Keasberry
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Marisol Voncken
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Maarten Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Marleen Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
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Williams SE, Fergus TA, Ginty AT. Development and Validation of the Ease of Imagery Questionnaire. Assessment 2024:10731911241260233. [PMID: 39054848 DOI: 10.1177/10731911241260233] [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: 07/27/2024]
Abstract
The present series of studies aimed to develop and provide initial validation of the Ease of Imagery Questionnaire (EIQ)-a measure assessing ease of imaging different positive and negative imagery content reflective of valence and engaging or disengaging in adverse situations. Five studies were conducted to collectively examine the questionnaire's factor structure and concurrent validity. Study 1 (N = 336) and Study 2 (N = 207) informed the development of 16 items of the EIQ, with a four-factor structure supported in Studies 3 (N = 219), 4 (N = 135), and 5 (N = 184) using confirmatory factor analysis. Study 3 also supported concurrent validity with significant bivariate correlations (p < .05) with the similar Sport Imagery Ability Questionnaire subscales, while studies 4 and 5 demonstrated criterion validity in the EIQ's prediction of challenge and threat appraisal tendencies, perceived stress, stress mindset, and anxiety and depressive symptoms. Overall, the EIQ demonstrates a replicable four-factor structure and appears to assess ability to image content associated with positive and negative emotions as well as demanding stress-evoking situations.
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Woelk M, Hagenaars MA, Raes F, Vervliet B, Krans J. Imagery rescripting and extinction: Effects on US expectancy, US revaluation, and the generalization of fear reduction. Behav Res Ther 2024; 178:104544. [PMID: 38704975 DOI: 10.1016/j.brat.2024.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/25/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
Exposure therapy consists of exposing patients to their fears and thereby diminishing their harm expectancies (i.e., extinction or expectancy learning). Although effective for many anxiety patients, its long-term success depends on the generalization of these harm expectancies to other stimuli. However, research shows that this generalization of extinction is limited. Besides decreasing harm expectancies, fear reduction may also be achieved by changing the meaning of an aversive memory representation (US revaluation). Imagery rescripting (ImRs) may be more successful in generalizing fear reduction because it allegedly works through US revaluation. The current experiment aimed to test working mechanisms for ImRs and extinction (revaluation and expectancy learning, respectively), and to examine generalization of fear reduction. In a fear conditioning paradigm, 113 healthy participants watched an aversive film clip that was used as the US. The manipulation consisted of imagining a script with a positive ending to the film clip (ImRs-only), extinction (extinction-only), or both (ImRs + extinction). Results showed enhanced US revaluation in ImRs + extinction. US expectancy decreased more strongly in the extinction conditions. Generalization of fear reduction was found in all conditions. Our results suggest different working mechanisms for ImRs and exposure. Future research should replicate this in (sub)clinical samples.
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Affiliation(s)
- M Woelk
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS Utrecht, the Netherlands.
| | - M A Hagenaars
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS Utrecht, the Netherlands
| | - F Raes
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium
| | - B Vervliet
- Research Unit Brain and Cognition, KU Leuven, Tiensestraat 102 box 3717, 3000, Leuven, Belgium
| | - J Krans
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium; Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD, Pastoor van Laakstraat 48, 6663, CB Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525, GD Nijmegen, the Netherlands
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Kroener J, Maier A, Berger A, Sosic-Vasic Z. Coping with test anxiety using imagery rescripting: A two-session randomized controlled trial. J Affect Disord 2024; 356:554-563. [PMID: 38649104 DOI: 10.1016/j.jad.2024.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Up to 55 % of students experience test anxiety (TA), which is characterized by intense physiological and psychological symptoms before or during exams, such as anxiety, fear of failure, sweating, or increased heart rate. Furthermore, TA increases graduation times and can result in discontinuance of the graduate program all together. Previous research demonstrated the beneficial effects of combining cognitive behavioral therapy with imagery rescripting, however, treatment programs are comparably long. Hence, they do not account for the students´ time-sensitive schedules. Therefore, the present study investigates a two-session short-intervention using imagery rescripting to treat TA. METHODS 44 students and pupils were randomly assigned to either the two-session imagery rescripting intervention (22 participants) or the waitlist-control condition (22 participants). One week before the intervention clinical interviews were conducted and self-report questionnaires on TA, self-efficacy, symptoms of depression, and intrusive prospective images were completed (T1). The same questionnaires were completed one week (T2) and six months after the intervention (T3). RESULTS Test anxiety significantly decreased from T1 to T2, as well as from T1 to T3 within the intervention group. Furthermore, there were medium to large within and between group effects for situational test anxiety, self-efficacy, symptoms of depression, as well as prospective intrusive images, showing significant improvements for the intervention group at six months follow-up. LIMITATIONS The study is limited to the comparably small sample size, as well as the sole usage of self-report measurements. CONCLUSIONS The presented short-intervention provides a feasible treatment technique, which can be easily applied within school and university counseling centers.
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Affiliation(s)
- Julia Kroener
- Research Division for Applied Psychotherapy and Psychiatry, Christophsbad Hospital, Jahnstrasse 30, 73037 Goeppingen, Germany; Medical Faculty, University of Ulm, Helmholzstrasse 16, 89081 Ulm, Germany.
| | - Anna Maier
- Department for Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Alexander Berger
- Department for Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Zrinka Sosic-Vasic
- Research Division for Applied Psychotherapy and Psychiatry, Christophsbad Hospital, Jahnstrasse 30, 73037 Goeppingen, Germany; Medical Faculty, University of Ulm, Helmholzstrasse 16, 89081 Ulm, Germany
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Stavropoulos L, Briggs N, Grisham JR. Self-guided imagery rescripting for worry images: A preliminary experimental investigation. J Clin Psychol 2024; 80:1213-1230. [PMID: 38356250 DOI: 10.1002/jclp.23660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/30/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
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Duken SB, Neumayer F, Dzinalija N, Kindt M, van Ast VA, Visser RM. Can neutral episodic memories become emotional? Evidence from facial expressions and subjective feelings. Behav Res Ther 2024; 177:104528. [PMID: 38593572 DOI: 10.1016/j.brat.2024.104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/11/2024]
Abstract
Maladaptive emotional memories are a transdiagnostic feature of mental health problems. Therefore, understanding whether and how emotional memories can change might help to prevent and treat mental disorders. We tested whether neutral memories of naturalistic events can retroactively acquire positive or negative affect, in a preregistered three-day Modification of Valence in Episodes (MOVIE) paradigm. On Day 1, participants (N = 41) encoded memories of neutral movie scenes, representing lifelike naturalistic experiences. On Day 2, they retrieved each episode before viewing a happy, sad, or neutral scene from the same movie (yielding a within-subjects design with a neutral-negative, neutral-positive, and neutral-neutral condition). On Day 3, participants again retrieved each memory from Day 1. We assessed the affective tone of episodes through facial expressions of positive and negative affect (using facial electromyography, fEMG) and through self-reported feelings. Positive updating of neutral episodes led to increased expressions of positive affect, whereas negative updating led to increased self-reported negative feelings. These results suggest that complex neutral episodic memories can retroactively acquire an affective tone, but the effects were modest and inconsistent across affect readouts. Future research should investigate alternative approaches to updating emotional memories that produce more profound changes in the valence of memories.
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Affiliation(s)
- Sascha B Duken
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Franziska Neumayer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadza Dzinalija
- Department of Medical Humanities, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Merel Kindt
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa A van Ast
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Renée M Visser
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
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Rattel JA, Danböck S, Miedl SF, Liedlgruber M, Wilhelm FH. Hitting the Rewind Button: Imagining Analogue Trauma Memories in Reverse Reduces Distressing Intrusions. COGNITIVE THERAPY AND RESEARCH 2024; 48:932-943. [PMID: 39329077 PMCID: PMC11422422 DOI: 10.1007/s10608-024-10488-8] [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: 04/03/2024] [Indexed: 09/28/2024]
Abstract
Background Intrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by 'rewinding', a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward. Methods The present analogue study was the first to investigate 'rewinding' in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly. Results Results indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged. Conclusion Present findings strengthen the view that 'rewinding' could be a promising intervention to reduce intrusions.
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Affiliation(s)
- Julina A. Rattel
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Sarah Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Stephan F. Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Frank H. Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
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Thunnissen MR, de Jong PJ, Rijkeboer MM, Voncken MJ, Nauta MH. Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes. Clin Psychol Psychother 2024; 31:e2996. [PMID: 38769942 DOI: 10.1002/cpp.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.
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Affiliation(s)
- Marjolein R Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marisol J Voncken
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
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Koetsier T, Apeldoorn J, Nugter A. Working mechanisms of imagery rescripting (ImRs) in adult patients with childhood-related PTSD: a pilot study. Eur J Psychotraumatol 2024; 15:2339702. [PMID: 38629412 PMCID: PMC11025401 DOI: 10.1080/20008066.2024.2339702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Imagery rescripting (ImRs) has shown to be an effective treatment for posttraumatic stress disorders (PTSD) resulting from childhood-related trauma. The current theory is that the change of meaning of the trauma memory is central to the treatment. Several authors have suggested that the expression of needs, feelings and actions may act as potential healing factors, but little specific research aimed at (in)validating this hypothesis has been done so far.Objective: In this study we investigated to what extent the expression of inhibited action tendencies and the fulfilling of needs lead to the reduction of PTSD symptoms in clients with early childhood trauma.Method: Recordings of 249 therapy sessions of 24 ImRs treatments were rated with an observation instrument developed for this purpose, after which the scores were related to pre and posttreatment symptoms, assessed with the Impact of Events Scale-Revised (IES-R).Results: Scores on the IES-R decreased from pretreatment to posttreatment. The two subscales of the NATS (At-scale and N-scale)significantly predicted the posttreatment scores on the IES-R after controlling for the influence of pretreatment IES-R scores: the better the expression of inhibited action tendencies and the better the fulfilling of needs, the lower the symptoms after treatment.Conclusions: This pilot study on the underlying mechanisms of ImRs in PTSD treatment has shown that the expression of action tendencies and fulfilling basic needs during ImRs are associated with a decrease in PTSD symptoms after treatment, and that actions and basic needs cannot be viewed separately. Follow-up research could focus on which of the six domains of the Needs and Action tendencies Scale (NATS) has the greatest effect on the reduction of PTSD symptoms. With this information we can further improve the ImRs protocol.
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Affiliation(s)
| | | | - Annet Nugter
- GGZ Noord-Holland-Noord, NP Hoorn, the Netherlands
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Wong AHK, Franzen M, Wieser MJ. Unconditioned stimulus devaluation decreases the generalization of costly safety behaviors. J Anxiety Disord 2024; 103:102847. [PMID: 38422593 DOI: 10.1016/j.janxdis.2024.102847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Safety behaviors are often maladaptive in clinical anxiety as they typically persist without realistic threat and cause various impairments. In the laboratory, safety behaviors are modelled by responses to a conditioned stimulus (CS) that reduce the occurrence of an expected aversive unconditioned stimulus (US). Preliminary evidence suggests that US devaluation, a procedure that decreases US aversiveness, devalues the threat value of the CS and thus diminishes safety behaviors to the CS. This study (n = 78) aimed to extend this finding and examined whether US-devaluation can reduce the generalization of safety behaviors to various stimuli. After acquiring safety behaviors to CSs of different categories, the US predicted by one CS category was devalued. In test, participants showed a selective reduction in safety behaviors to novel stimuli of the devalued CS category, reflecting a decrease in generalization of safety behaviors. Trait anxiety was associated with persistent generalized safety behaviors to novel stimuli of the devalued category. We discuss how US devaluation may improve treatment outcome but also the challenges of clinical translation.
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Affiliation(s)
- Alex H K Wong
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands.
| | - Minita Franzen
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands
| | - Matthias J Wieser
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands
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14
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Rameckers SA, van Emmerik AAP, Boterhoven de Haan K, Kousemaker M, Fassbinder E, Lee CW, Meewisse M, Menninga S, Rijkeboer M, Schaich A, Arntz A. The working mechanisms of imagery rescripting and eye movement desensitization and reprocessing: Findings from a randomised controlled trial. Behav Res Ther 2024; 175:104492. [PMID: 38359658 DOI: 10.1016/j.brat.2024.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 10/10/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
We studied the mechanisms of eye movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We hypothesized that EMDR works via changes in memory vividness, that ImRs works via changes in encapsulated beliefs (EB), and that both treatments work via changes in memory distress. Patients (N = 155) with childhood-related posttraumatic stress disorder (Ch-PTSD) received 12 sessions of EMDR or ImRs. The vividness, distress, and EB related to the index trauma were measured with the Imagery Interview. PTSD severity was assessed with the Impact of Events Scale-Revised and the Clinician-Administered PTSD Scale for DSM-5. We conducted mixed regressions and Granger causality analyses. EMDR led to initially stronger changes in all predictors, but only for distress this was retained until the last assessment. No evidence for vividness as a predictive variable was found. However, changes in distress and EB predicted changes in PTSD severity during ImRs. These findings partially support the hypothesized mechanisms of ImRs, while no support was found for the hypothesized mechanisms of EMDR. Differences in the timing of addressing the index trauma during treatment and the timing of assessments could have influenced the findings. This study provides insight into the relative effectiveness and working mechanisms of these treatments.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, the Netherlands.
| | | | | | | | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Kiel University, Germany
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | | | | | - Marleen Rijkeboer
- Department of Clinical Psychology, University of Amsterdam, the Netherlands; Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anja Schaich
- Department of Psychiatry and Psychotherapy, Kiel University, Germany; Department of Psychiatry and Psychotherapy, Lübeck University, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
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15
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Kanczok J, Jauch-Chara K, Müller FJ. Imagery rescripting and cognitive restructuring for inpatients with moderate and severe depression - a controlled pilot study. BMC Psychiatry 2024; 24:194. [PMID: 38459520 PMCID: PMC10921678 DOI: 10.1186/s12888-024-05637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND This controlled pilot study investigates the effect of the combined use of cognitive restructuring (CR) and imagery rescripting (IR) compared to treatment as usual among inpatients with moderate and severe depression. Alongside expert ratings and self-report tools, fitness wristbands were used as an assessment tool. METHODS In addition to the standard inpatient care (SIC) program, 33 inpatients with moderate and severe depression were randomly assigned to an intervention group (two sessions of IR and CR) or an active treatment-as-usual (TAU) control group (two sessions of problem-solving and build-up of positive activity). Depression severity was assessed by the Hamilton Depression Rating Scale-21 (HDRS-21), the Beck Depression Inventory-II (BDI-II), and as a diagnostic adjunct daily step count via the Fitbit Charge 3™. We applied for analyses of HDRS-21 and BDI-II, 2 × 2 repeated-measures analysis of variance (ANOVA), and an asymptotic Wilcoxon test for step count. RESULTS The main effect of time on both treatments was η2 = .402. Based on the data from the HDRS-21, patients in the intervention group achieved significantly greater improvements over time than the TAU group (η2 = .34). The BDI-II data did not demonstrate a significant interaction effect by group (η2 = .067). The daily hourly step count for participants of the intervention group was significantly higher (r = .67) than the step count for the control group. CONCLUSIONS The findings support the utilization of imagery-based interventions for treating depression. They also provide insights into using fitness trackers as psychopathological assessment tools for depressed patients. TRIAL REGISTRATION The trial is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien) under the registration number: DRKS00030809.
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Affiliation(s)
- Jabin Kanczok
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany.
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Franz-Josef Müller
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
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16
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Hardy A, Keen N, van den Berg D, Varese F, Longden E, Ward T, Brand RM. Trauma therapies for psychosis: A state-of-the-art review. Psychol Psychother 2024; 97:74-90. [PMID: 37795877 DOI: 10.1111/papt.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/11/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Traumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post-traumatic stress disorder (PTSD) and other trauma-related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis. METHOD This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis. RESULTS We will first introduce how seminal cognitive-behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma-related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post-traumatic stress symptoms and trauma-related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma-focused Cognitive-Behavioural Therapy for psychosis (tf-CBTp). Finally, emerging dialogic approaches for targeting trauma-related voice-hearing will be considered, demonstrating the potential value of adopting co-produced (Talking with Voices) and digitally augmented (AVATAR) therapies. CONCLUSION We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.
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Affiliation(s)
- Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nadine Keen
- South London and Maudsley NHS Foundation Trust, London, UK
| | - David van den Berg
- Mark van der Gaag Research Centre, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Vrije University, Amsterdam, The Netherlands
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Eleanor Longden
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Thomas Ward
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel M Brand
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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17
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Aleksic M, Reineck A, Ehring T, Wolkenstein L. When does imagery rescripting become a double-edged sword? - Investigating the risk of memory distortion through imagery rescripting in an online Trauma film study. Behav Res Ther 2024; 174:104495. [PMID: 38401468 DOI: 10.1016/j.brat.2024.104495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Abstract
Imagery Rescripting (ImRs) has proven effective in reducing involuntary emotional memories. However, it is unclear whether and when it may lead to reduced accuracy of voluntary memory. Although previous analogue studies suggest that ImRs does not pose a general risk regarding memory distortion, it can not be ruled out that ImRs could cause memory impairment under certain risk conditions. In our three-day online trauma film study we investigated in a healthy sample (N = 267) whether specific instructions during ImRs as typically provided in clinical practice (i.e., detailed imagery with a sensory focus) increase the risk of memory distortions. Additionally, we examined whether the completeness of the original memory moderates these instruction effects. Contrary to our expectations, a sensory focus during ImRs was associated with higher memory accuracy in a recognition task, independently of the quality of the original memory. These results extend previous findings by suggesting that ImRs does not even impair memory performance when the quality of the original memory is poor and when the production of sensory-rich images is specifically encouraged. Our results question current practices employed to assess witness statement credibility, which are partly based on concerns that trauma-focused interventions like ImRs undermine memory accuracy.
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18
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Asselbergs J, Riper H, Engelhard IM, Mannes F, Sijbrandij M. The effectiveness of two novel approaches to prevent intrusions: A pilot study comparing Tetris_dualtask and imagery rescripting to control. J Behav Ther Exp Psychiatry 2024; 82:101920. [PMID: 37988886 DOI: 10.1016/j.jbtep.2023.101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Post-traumatic stress disorder (PTSD) is a global health problem. Although effective treatments for it exist, early interventions that prevent PTSD from developing are lacking. The aim of this pilot analogue trauma study was to compare the effects of two potential early intervention strategies, namely Tetris_dualtask and imagery rescripting (IR) to a no-intervention control group on intrusion frequency and the vividness and emotionality of aversive film memory. METHODS Sixty healthy students were subjected to the trauma film paradigm and randomly allocated to either: Tetris_dualtask, IR or no-intervention. Main outcomes were the number of film-related intrusions at one week and vividness and emotionality ratings of the most aversive film memory. Secondary outcomes were PTSD-like symptoms, intrusion intensity, and explicit film memory. RESULTS The Tetris_dualtask group reported significant fewer intrusions compared to the no-intervention group; whereas the IR group did not. No effect was found on vividness and emotionality ratings, PTSD-like symptoms, intrusion intensity, and explicit memory. LIMITATIONS The sample size was small, and analogue trauma in healthy individuals was examined, thus generalizability may be limited. Also, to increase comparability between interventions, the duration of Tetris_dualtask and IR was standardized. As a result, the IR intervention was shorter compared to other studies, which might have decreased its efficacy. CONCLUSIONS The results of this pilot study suggest that playing Tetris during retrieval of traumatic images, might hold potential as an early intervention strategy to reduce intrusions in the early aftermath of trauma and adversity. However, future large-scale replication research is needed.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands; GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, the Netherlands
| | | | - Fancy Mannes
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
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19
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van Dis EAM, Hagenaars MA, Engelhard IM. Mental threat rehearsal increases fear generalization. J Behav Ther Exp Psychiatry 2024; 82:101917. [PMID: 37984086 DOI: 10.1016/j.jbtep.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Fear generalization to harmless stimuli characterizes anxiety-related disorders, but much remains unknown about its determinants. Based on studies showing that mental imagery of threat can increase conditioned fear responding, we tested whether it also facilitates fear generalization, and whether threat inflation moderates this effect. METHODS In a fear conditioning study, 120 participants first completed an acquisition phase, in which one of two pictures was followed by an aversive sound (human scream). Then, the sound was presented 11 times at an increasing (threat inflation) or constant volume (no threat inflation). Finally, a generalization stimulus was presented, and some participants were asked to imagine the last sound (threat rehearsal) and others were not (no threat rehearsal). RESULTS Bayesian informative hypotheses tests indicated that imagery-based threat rehearsal increased generalization of threat expectancy, and, combined with threat inflation, it also resulted in stronger generalized distress. LIMITATIONS due to the absence of a test phase, it is unclear whether our effects would transfer to other GSs and whether they would persist beyond the manipulation phase. CONCLUSIONS Mental imagery of threat may put individuals at risk for fear generalization. Future studies should examine whether modulating imagery may prevent clinical anxiety.
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Affiliation(s)
- Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | | | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands
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20
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Sosic-Vasic Z, Schaitz C, Mayer B, Maier A, Connemann B, Kroener J. Treating emotion dysregulation in patients with borderline personality disorder using imagery rescripting: A two-session randomized controlled trial. Behav Res Ther 2024; 173:104454. [PMID: 38194759 DOI: 10.1016/j.brat.2023.104454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
Studies on Emotionally Dysregulated Behavior (EDB) demonstrated that the conduct thereof is associated with emotion dysregulation and preceded by mental imagery of EDB, which can direct future behavior. These findings are specifically important within the context of Borderline Personality Disorder (BPD), where emotion dysregulation and EDB are at the core of the disorder. The present study aims to evaluate the efficacy of imagery rescripting (IR) in treating emotion dysregulation associated with EDB in patients diagnosed with BPD. Forty-eight females diagnosed with BPD were randomly allocated to the IR intervention or treatment-as-usual group. Assessment took place one week before the first treatment session, as well as one week, and twelve weeks after the last treatment session evaluating emotion regulation strategies, borderline-symptomatology, EDB, depressiveness, impulsivity, mental imagery, and illness severity. Within-, and between subject, intention-to-treat-, and per-protocol analysis were conducted. Results showed decreased maladaptive emotion regulation strategies and increased adaptive emotion regulation strategies within the intervention group. Borderline-symptomatology improved immediately after treatment for the intervention group. Additionally, BPD patients within the intervention group improved regarding their impulsivity, depressiveness, and EDB symptomatology in comparison to patients in the TAU group. The presented intervention has proven to be effective in improving BPD-related symptomatology, such as emotion regulation, EDB, depressiveness, and impulsivity. Imagery rescripting could be routinely applied when EDB related images are present. TRIAL REGISTRATION: German Clinical Trials Registry (DRKS) ID: DRKS00010620.
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Affiliation(s)
- Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035, Göppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Caroline Schaitz
- MSB Medical School Berlin, Psychotherapeutic Outpatient Facility, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstrasse 13, 89075, Ulm, Germany
| | - Anna Maier
- Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Bernhard Connemann
- Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Julia Kroener
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035, Göppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
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21
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Gagliardi M. The role of developmental caregiving programming in modulating our affiliation tendency and the vulnerability to social anxiety and eating disorders. Front Psychol 2024; 14:1259415. [PMID: 38239461 PMCID: PMC10794631 DOI: 10.3389/fpsyg.2023.1259415] [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] [Received: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Attachment is the evolutionarily-established process through which humans create bonds with others to receive care from them. The phenomenon is as essential to our physical survival as it is to our psychological development. An increasing number of studies demonstrates that in sensitive periods during the early years of life, our brain circuitry is programmed in the interactions with our caregivers, with the imprinting of information over multiple attachment dimensions. Adopting a basic brain-computer analogy, we can think of this knowledge as the psycho-social firmware of our mind. According to a recently proposed extension of the classical three-dimensional view, one attachment dimension - somaticity - concerns the caregiver's task of reflecting and confirming the child's (internal) states - such as sensations, emotions, and representations - to support the child's ability to identify and define those entities autonomously. Relying on multidisciplinary evidence - from neuroscientific, developmental, evolutionary, and clinical sources - we suggest that somaticity (H1) has the adaptive function to modulate our tendency to comply and affiliate with a reference group but also (H2) increases the vulnerability to developing Social Anxiety (SA) and Eating Disorders (EDs). We evaluate H1-H2, (1) indicating the evolutionary role of somaticity in modulating our affiliation tendency to optimize the ancestral threat-opportunity balance coming from infectious diseases and (2) showing the deep connection between SA-EDs and the features most closely related to somaticity - interoception and parenting style. Finally, we discuss three relevant implications of H1-H2: (A) Bringing into research focus the adaptive role of our firmware knowledge system versus the hardware (neural substrate) and software (higher cognition) ones. (B) Complementing the well-grounded Objectification and Allocentric Lock Theories, allowing us to integrate multiple levels of explanation on the etiology of psychopathology. (C) Suggesting the design of new psychological treatments. While not aiming to prove H1-H2, our analysis supports them and encourages their direct testing.
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Wagner B, Böhm M, Grafiadeli R. Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse - A randomized controlled trial. CHILD ABUSE & NEGLECT 2024; 147:106557. [PMID: 38029559 DOI: 10.1016/j.chiabu.2023.106557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/15/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Institutional childhood abuse can have a long-term impact on the survivors' mental health, however, treatment for this group is limited and not always accessible. An internet-based intervention was developed, with the aim to reduce psychological sequelae relating to institutional abuse. OBJECTIVE This study aimed to examine the efficacy of an online imagery rescripting intervention for survivors of institutional abuse, through assessing symptoms of depression, anxiety, PTSD, and CPTSD. PARTICIPANTS AND SETTING Seventy-two adult survivors of institutional childhood abuse in the former German Democratic Republic were randomized either to the intervention (n = 38) or to the waitlist condition (n = 34). The intervention consisted of 10 modules, based on written imagery rescripting, and involved asynchronous therapist contact. METHODS Primary outcomes included symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (ITQ), and CPTSD (ITQ DSO). The intervention condition was assessed at baseline, post-intervention, 3-, and 6-month follow-up. RESULTS Intention-to-treat analyses revealed a significant symptom reduction from baseline to post-assessment with medium to large effects for all main outcomes (d = 0.45 to d = 0.76), in favor of the intervention condition. Significant interactions between condition (intervention vs. wailist) and time (baseline vs. post-assesment) were revealed for all main outcomes (p < .001 to p = .024). The effects were maintained at follow-up. CONCLUSIONS The results suggest online writing-based imagery rescripting as a promising treatment option for adults formerly institutionalized in residential care. Future research is needed to explore its effectiveness for other groups of patients suffering from abuse and neglect.
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Affiliation(s)
| | - Maya Böhm
- Medical School Berlin, Berlin, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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23
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Koppeschaar A, Bachrach N, Arntz A. Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial. Front Psychiatry 2023; 14:1204439. [PMID: 38152355 PMCID: PMC10751307 DOI: 10.3389/fpsyt.2023.1204439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023] Open
Abstract
Background Early childhood adversity plays an important role in the etiology of borderline personality disorder (BPD). Current evidence suggests that trauma treatment for patients with BPD can be performed safely and that early trauma treatment has a positive effect on the course of PD. However, there is a scarcity of RCTs comparing the effects of the timing of trauma treatment during schema therapy (ST) for BPD on BPD severity. Therefore, the LUCY trial investigates the effects of the timing of trauma treatment by comparing early trauma treatment using imagery rescripting (ImRs) on the course of BPD during ST to trauma treatment in the middle of the treatment course. Methods In this multicenter RCT, two conditions are compared among 73 individuals with BPD. The participants receive combined individual and group ST in both conditions. However, in condition (A), participants directly start ImRs in the individual sessions in months 2-4, and in condition (B), participants receive ST-as-Usual (STAU), in which ImRs is not allowed during months 2-4. The treatment follows ST treatment protocols, consists of a fixed combination of individual sessions and group sessions with a maximum of nine patients, and has a maximum duration of 25 months. The primary outcome is change in BPD severity, which is assessed using the Borderline Personality Disorder Severity Index-5 by independent raters blinded to the treatment. Secondary outcome measures include treatment retention, disconnection/rejection schemas, general functioning, posttraumatic stress disorder symptoms, general psychopathological complaints, quality of life, happiness, schemas, and schema modes. Multilevel analysis will be performed to analyze and compare changes in BPD severity between conditions and generalized linear mixed model analyses to test predictors and moderators. Discussion This study will increase the knowledge on whether trauma treatment early in therapy positively affects the course of BPD manifestations during ST. When the early application of ImRs leads to a faster decrease in BPD manifestations, the treatment of BPD patients might be shortened, leading to improved treatment outcomes and decreased healthcare expenses. Moreover, the planned sub-studies will expand our knowledge of how ST works and the factors that influence the outcome of treatment.
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Affiliation(s)
- Annemieke Koppeschaar
- Parnassia Groep Academy, The Hague, Netherlands
- Academic Centre for Trauma and Personality, Amsterdam, Netherlands
| | - Nathan Bachrach
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Personality Disorders, GGZ-Oost Brabant, Helmond, Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
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Ganslmeier M, Ehring T, Wolkenstein L. Effects of imagery rescripting and imaginal exposure on voluntary memory. Behav Res Ther 2023; 170:104409. [PMID: 37925798 DOI: 10.1016/j.brat.2023.104409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
Trauma-focused imagery-based interventions, such as Imagery Rescripting (ImRs) and Imaginal Exposure (ImE), are effective in reducing involuntary re-experiencing in PTSD. However, it has been suggested that they may impair voluntary memory. This study investigates whether ImRs and ImE distort voluntary memory of an analogue trauma. We presented a trauma film to N = 120 healthy participants (Session 1) and randomly allocated them to one of two intervention conditions (receiving one session of ImRs or ImE) or to a no-intervention control condition (NIC) afterwards (Session 2). Voluntary memory was assessed using a free recall (Sessions 2 and 3), and a cued recall as well as a recognition task (both Sessions 3 and 4). The ImRs and ImE groups did not differ from NIC in the cued recall task and the recognition task. However, ImE (compared to ImRs and NIC) led to an increase in correct reported details in the free recall. In sum, the current findings do not suggest that ImRs or ImE impair voluntary memory.
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Affiliation(s)
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-Universität, München, Germany
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Kroener J, Hack L, Mayer B, Sosic-Vasic Z. Imagery rescripting as a short intervention for symptoms associated with mental images in clinical disorders: A systematic review and meta-analysis. J Psychiatr Res 2023; 166:49-60. [PMID: 37738780 DOI: 10.1016/j.jpsychires.2023.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/11/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
There is an unmet need for effective short-term therapeutic techniques to reduce clinical symptoms associated with prospective-, as well as retrospective aversive mental images across mental disorders. We investigated the efficacy of imagery rescripting (IR) as a short-term intervention across clinical disorders, as the literature suggests that this technique could be a promising intervention to reduce psychopathology by altering intrusive mental images. A systematic literature review identified 23 trials including 805 adult patients, out of which 15 trials were designed as randomized controlled trials (RCT) including patients with the following diagnoses: Social anxiety disorder (SAD), Posttraumatic-Stress-Disorder (PTSD), Bulimia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Disorder, nightmare disorder, test anxiety, health anxiety, and Generalized Anxiety Disorder. Most studies (14) comprised of one treatment session. Effect size estimates indicate that IR is highly effective in reducing clinical symptoms associated with mental images from pre-, to post-treatment (g = 1.09, 95% CI = [0.64; 1.53]), as well as from pre-treatment to follow-up (g = 1.90, 95% CI = [1.02; 2.77]). Comparing the IR intervention to a passive control group showed large effect sizes at post-treatment (g = -0.99; 95% CI = [-1.79; -0.20]), however, comparing IR to an active control group resulted in a small effect (g = -0.05; 95% CI = [-0.43; 0.33]). Lastly, large effects of IR were found for the SAD and PTSD subgroups, for comorbid symptoms of depression. In summary, our results indicate that IR is a promising short-term therapeutic technique for clinical symptoms associated with aversive prospective-, and retrospective mental images.
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73037, Goeppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - Lisa Hack
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73037, Goeppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, University of Ulm, Schwabstraße 13, 89075, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73037, Goeppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
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Kip A, Schoppe L, Arntz A, Morina N. Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis. J Anxiety Disord 2023; 99:102772. [PMID: 37699277 DOI: 10.1016/j.janxdis.2023.102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Imagery rescripting (ImRs) is frequently applied to treat different psychological complaints. We conducted an updated meta-analysis based on randomised controlled trials on the efficacy of ImRs for mental disorders associated with aversive memories. Medline, PsycInfo, and Web of Science were searched up to May 2023. Seventeen trials were included with a total of 908 participants (417 in the ImRs condition), suffering from posttraumatic stress disorder, anxiety disorders, depression, or eating disorders. Random effect models yielded an overall effect of g = 0.68 (95 % CI 0.18 to 1.18; k = 7) compared to passive controls (mostly waitlist). The effect compared to (prolonged) exposure, cognitive restructuring, and EMDR was non-significant (g = -0.01; 95 % CI -0.18 to 0.15; k = 11). Follow-up assessments indicated a long-term treatment effect. Results suggest that ImRs can effectively treat a variety of psychological disorders and produce similar treatment effects as evidence-based interventions. Limitations include the bounded number of included trials for each mental disorder. The meta-analysis was registered on PROSPERO (CRD42020220696) and received no funding.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Luisa Schoppe
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS Amsterdam, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
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Winter HR, Norton A, Wootton BM. Internet videoconferencing delivered cognitive behavioral therapy for social anxiety disoder: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 132:107298. [PMID: 37482329 DOI: 10.1016/j.cct.2023.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a fear of scrutiny in social or performance situations. Due to a number of barriers, many individuals do not seek treatment for SAD, resulting in a chronic and debilitating course. Cognitive behaviour therapy (CBT), and more recently Imagery Rescripting (ImR), have been found to be efficacious in the treatment of SAD when delivered face-to-face. However, the efficacy of these treatment approaches when delivered remotely, have not yet been examined in controlled trials. METHODS The authors propose a two-group randomized controlled trial comparing the efficacy of videoconferencing delivered CBT (vCBT) for SAD against a waitlist control group. The study will recruit 78 adults in total with a primary diagnosis of SAD of at least moderate severity. The manualised high-intensity vCBT intervention will be delivered weekly over an 8-week period. After treatment completion, the waitlist participants will receive a high-intensity videoconferencing delivered ImR (vImR) intervention also delivered weekly over an 8-week period. Treatment for both groups will be delivered in real time via an online videoconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. CONCLUSION This trial will report findings on the efficacy of a remote synchronous high-intensity vCBT and vImR intervention for SAD and benchmark the two different treatment methodologies against standard face-to-face CBT. The results have the potential to inform best-practice remote psychological treatment for SAD. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry; ACTRN12623000313639 (5 April 2023).
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Affiliation(s)
- Halaina R Winter
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alice Norton
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia..
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Kuck S, Arntz A, Rameckers SA, Lee CW, Boterhoven de Haan KL, Fassbinder E, Morina N. Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse. Clin Psychol Psychother 2023; 30:1029-1046. [PMID: 37078854 DOI: 10.1002/cpp.2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.
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Affiliation(s)
- Sascha Kuck
- Institute of Psychology, University of Münster, Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher W Lee
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Ganslmeier M, Kunze AE, Ehring T, Wolkenstein L. The dilemma of trauma-focused therapy: effects of imagery rescripting on voluntary memory. PSYCHOLOGICAL RESEARCH 2023; 87:1616-1631. [PMID: 36334113 PMCID: PMC10227147 DOI: 10.1007/s00426-022-01746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
Trauma-focused imagery-based interventions are suspected to alter or even distort declarative voluntary memory of a traumatic event, especially if they involve the active modification of imagery, e.g., as used in imagery rescripting (ImRs). However, systematic research is lacking so far. To investigate whether ImRs modifies voluntary memory of a standardized autobiographical aversive event (Trier Social Stress Test) (Session 1), healthy participants (N = 100) were randomly assigned to either an intervention condition receiving one session of ImRs or to a no-intervention control condition (NIC) (Session 2). Voluntary memory was examined using a free recall (Sessions 2 and 3) and a cued recall (Sessions 3 and 4). Although voluntary memory tended to deteriorate over time, contrary to expectations, this effect was not associated with ImRs. Remarkably, the number of correct details in free recall even improved in ImRs but not in NIC. This challenges the view that ImRs alters voluntary memory.
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Affiliation(s)
- Maximilian Ganslmeier
- Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, 80802, Munich, Germany.
| | - Anna E Kunze
- Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, 80802, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, 80802, Munich, Germany
| | - Larissa Wolkenstein
- Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, 80802, Munich, Germany
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Endhoven B, De Cort K, Matthijssen SJMA, de Jongh A, van Minnen A, Duits P, Schruers KRJ, van Dis EAM, Krypotos AM, Gerritsen L, Engelhard IM. Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE). BMC Psychiatry 2023; 23:157. [PMID: 36918861 PMCID: PMC10011792 DOI: 10.1186/s12888-022-04320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. METHODS A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. DISCUSSION The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. TRIAL REGISTRATION ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.
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Affiliation(s)
- Bart Endhoven
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands.
| | - Klara De Cort
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
| | - Suzy J M A Matthijssen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Ad de Jongh
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, The Netherlands
| | - Puck Duits
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Koen R J Schruers
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Angelos M Krypotos
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
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Voncken MJ, Janssen I, Keijsers GPJ, Dibbets P. Should cognitive restructuring precede imagery rescripting? An experimental pilot study. J Behav Ther Exp Psychiatry 2023; 78:101800. [PMID: 36435542 DOI: 10.1016/j.jbtep.2022.101800] [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: 09/09/2021] [Revised: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Imagery rescripting (ImRs) is a promising therapeutic technique used in treatment for a variety of psychiatric disorders. During an ImRs session, an aversive disorder-related memory, is activated in imagination and rescripted to a more positive outcome. It has been shown to successfully weaken the negative cognitive meaning, so-called encapsulated beliefs of the targeted aversive memory. In many studies, ImRs is preceded by a cognitive restructuring (CR) technique focused on the encapsulated belief of the target memory. It is not clear whether adding such a CR technique is necessary or that ImRs as standalone technique can achieve comparable effects. METHODS Students with mild psychological distress (N = 53) were randomized over one session of cognitive restructuring plus imagery rescripting (CR + ImRs), a therapist attention placebo plus imagery rescripting (PLA + ImRs) and a double therapist attention placebo (PLA + PLA). Believability of the idiosyncratic encapsulated belief (primary outcome) and quality (vividness, distress and emotional connotation: secondary outcome) of the target memory were assessed at pre, post and at 1-week follow-up. RESULTS Results indicate that both, CR + ImRs and PLA + ImRs, reduced the believability of the encapsulated beliefs in greater extent than PLA + PLA. No differences appeared between the two ImRs conditions. For the secondary outcomes no differences between the three conditions were found. LIMITATIONS This study should be seen as a pilot study, moreover a non-clinical sample was used. CONCLUSION Findings suggest that a CR technique preceding ImRs is redundant. However, this study needs replication in a larger sample.
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Affiliation(s)
- Marisol J Voncken
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - Iris Janssen
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - Ger P J Keijsers
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Pauline Dibbets
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
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The treatment of PTSD in refugees and asylum seekers using imagery rescripting within an NHS setting. Behav Cogn Psychother 2023; 51:119-132. [PMID: 36537014 DOI: 10.1017/s1352465822000650] [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: 12/24/2022]
Abstract
BACKGROUND Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service. AIMS To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers. METHOD Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression. RESULTS Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors. CONCLUSIONS Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.
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Kadriu F, Claes L, Witteman C, Woelk M, Krans J. The effect of imagery rescripting on core beliefs and eating disorder symptoms in a subclinical population. J Behav Ther Exp Psychiatry 2023; 78:101804. [PMID: 36435546 DOI: 10.1016/j.jbtep.2022.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 06/08/2022] [Accepted: 10/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study compared the effect of imagery rescripting focusing on self-compassion, imagery rescripting focusing on mastery, and a positive memory control condition on (1) emotional responses towards the memory (one day after), (2) changes in the believability of negative core beliefs, and dysfunctional eating behaviors (one week after) in individual at risk for developing an eating disorder. METHODS Female participants (N = 69) were allocated to one of three conditions: ImRs focusing on self-compassion (N = 24), ImRs focusing on self-mastery (N = 23), and positive memory control condition (N = 22). Participants in the ImRs conditions received a 20-min self-guided ImRs intervention, whereas participants in the control condition received a 20-min self-guided task focusing on an unrelated positive memory. RESULTS The experimental manipulation successfully induced the use of self-compassion and mastery strategies in the respective imagery rescripting condition. However, our data show that a single 20-min session of self-guided imagery rescripting focusing on compassion and/or mastery has no effect on the emotional response towards the aversive memory or in the change of core beliefs and eating behaviors at follow up. LIMITATIONS We discuss potential reasons for the null findings, including the use of a single imagery rescripting session, the sample size and the measurement of manipulation checks. CONCLUSION Future studies are needed to rule out methodological explanations for the null results. These findings may be of value for the development of future experimental lab paradigms which aim to evaluate the causal effects and working mechanisms of imagery rescripting.
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Affiliation(s)
- Fortesa Kadriu
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Laurence Claes
- Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Cilia Witteman
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Mandy Woelk
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Julie Krans
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD, Pastoor van Laakstr 48, 6663 CB Nijmegen, the Netherlands
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Imagery re-scripting for PTSD: session content and its relation to symptom improvement. Behav Cogn Psychother 2023; 51:1-10. [PMID: 36258276 DOI: 10.1017/s1352465822000479] [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: 12/13/2022]
Abstract
Imagery rescripting (ImRs) is a therapy technique that, unlike traditional re-living techniques, focuses less on exposure and verbal challenging of cognitions and instead encourages patients to directly transform the intrusive imagery to change the depicted course of events in a more desired direction. However, a comprehensive account of how and in what circumstances ImRs brings about therapeutic change is required if treatment is to be optimised, and this is yet to be developed. The present study reports on the development of a coding scheme of ImRs psychotherapy elements identified in the literature as potential ImRs mechanisms. The codes were assessed in relation to short-term outcomes of 27 individuals undergoing ImRs for post-traumatic stress disorder. The timing of the change in the image, degree of activation of the new image and associated cognitive, emotional and physiological processes, self-guided rescripting, rescript believability, narrative coherence and cognitive and emotional shift were identified as being related to symptom change and so are potentially important factors for the re-scripting process.
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35
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Niemeyer H. Interventions focusing on the body in recovery from post-traumatic stress disorder. Lancet Psychiatry 2023; 10:2-3. [PMID: 36436533 DOI: 10.1016/s2215-0366(22)00382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Helen Niemeyer
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, 12163 Berlin, Germany.
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Landkroon E, Salemink E, Meyerbröker K, Barzilay S, Kalanthroff E, Huppert JD, Engelhard IM. The effect of imagery rescripting on prospective mental imagery of a feared social situation. J Behav Ther Exp Psychiatry 2022; 77:101764. [PMID: 36113902 DOI: 10.1016/j.jbtep.2022.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether imagery rescripting of aversive memories also reduces negative imagery of future threats. METHODS On Day 1, socially anxious individuals (N = 52) were randomly assigned to imagery rescripting of an aversive memory or progressive relaxation (control condition). Before each intervention, they were asked to imagine a feared social situation that may happen in their future and evaluate this situation. They also rated the aversive memory before and after the intervention phase. The feared future situation was again evaluated at follow-up on Day 2. RESULTS Unexpectedly, no group differences were found on the main outcome measures. That is, negative memory appraisals reduced after both interventions. Likewise, in both groups, negative details decreased, and positive details increased in prospective mental imagery, and anxiety and avoidance towards the imagined event decreased. On the exploratory measures, the imagery rescripting group showed increased positive appraisals of memory and future threat, and decreased negative future-threat appraisals, compared to the progressive relaxation group. LIMITATIONS No passive control group was included, so potential time or placebo effects cannot be precluded. CONCLUSIONS The interventions had similar effects on the main outcomes and influenced mental imagery of future threats. Some differences were found on the exploratory measures that warrant further investigation with a passive control condition.
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Affiliation(s)
- Elze Landkroon
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands.
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands
| | - Katharina Meyerbröker
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands
| | - Snir Barzilay
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel
| | - Eyal Kalanthroff
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands
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Ten Napel-Schutz MC, Karbouniaris S, Mares SHW, Arntz A, Abma TA. Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences. J Eat Disord 2022; 10:188. [PMID: 36451217 PMCID: PMC9710063 DOI: 10.1186/s40337-022-00712-9] [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: 07/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. OBJECTIVE To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. METHOD To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. RESULTS The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. CONCLUSIONS The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094.
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Sciences, Radboud University, Nijmegen, The Netherlands.
| | - Simona Karbouniaris
- Utrecht University of Applied Sciences, Utrecht, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tineke A Abma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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The power of negative and positive episodic memories. COGNITIVE, AFFECTIVE, & BEHAVIORAL NEUROSCIENCE 2022; 22:869-903. [PMID: 35701665 PMCID: PMC9196161 DOI: 10.3758/s13415-022-01013-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
The power of episodic memories is that they bring a past moment into the present, providing opportunities for us to recall details of the experiences, reframe or update the memory, and use the retrieved information to guide our decisions. In these regards, negative and positive memories can be especially powerful: Life’s highs and lows are disproportionately represented in memory, and when they are retrieved, they often impact our current mood and thoughts and influence various forms of behavior. Research rooted in neuroscience and cognitive psychology has historically focused on memory for negative emotional content. Yet the study of autobiographical memories has highlighted the importance of positive emotional memories, and more recently, cognitive neuroscience methods have begun to clarify why positive memories may show powerful relations to mental wellbeing. Here, we review the models that have been proposed to explain why emotional memories are long-lasting (durable) and likely to be retrieved (accessible), describing how in overlapping—but distinctly separable—ways, positive and negative memories can be easier to retrieve, and more likely to influence behavior. We end by identifying potential implications of this literature for broader topics related to mental wellbeing, education, and workplace environments.
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Blended delivery of imagery rescripting for childhood PTSD: A case study during the COVID-19 pandemic. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7815. [DOI: 10.32872/cpe.7815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background
Despite the growing evidence that trauma-focused treatments can be applied as first-line approaches for individuals with childhood trauma-related PTSD (Ch-PTSD), many therapists are still reluctant to provide trauma-focused treatments as a first-choice intervention for individuals with Ch-PTSD, especially by telehealth. The current manuscript will therefore give an overview of the evidence for the effectiveness of trauma-focused therapies for individuals with Ch-PTSD, the delivery of trauma-focused treatments via telehealth, and a case example on how a specific form of trauma focused therapy: Imagery Rescripting (ImRs) can be applied by telehealth.
Method
This article presents a clinical illustration of a blended telehealth trajectory of imagery rescripting (ImRs) Ch-PTSD delivered during the COVID-19 pandemic.
Results
The presented case shows that ImRs can be safely and effectively performed by telehealth for ch-PTSD, no stabilization phase was needed and only seven sessions were needed to drastically reduce Ch-PTSD and depressive symptoms, and to increase quality of life.
Conclusion
This case report shows the effectiveness of ImRs by telehealth for Ch-PTSD, which gives hope and additional possibilities to reach out to patients with ch-PTDS. Telehealth treatment might have some of advantages for specific patients, especially, but certainly not only, during the pandemic.
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An Investigation of Cognitive and Affective Changes During Group Imagery Rescripting for Social Anxiety Disorder. Behav Ther 2022; 53:1050-1061. [PMID: 35987535 DOI: 10.1016/j.beth.2022.04.012] [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: 07/30/2021] [Revised: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022]
Abstract
Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioral therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.
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Rudstam G, Elofsson UO, Söndergaard HP, Bonde LO, Beck BD. Trauma-focused group music and imagery with women suffering from PTSD/Complex PTSD: A randomized controlled study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maloney G, Kelmendi B, Pittenger C. Imagery Rescripting (ImRs) as an Adjunctive Treatment to Exposure and Response Prevention (ERP)-Resistant Obsessive-Compulsive Disorder: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221123797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Exposure and response prevention (ERP), a specific type of Cognitive and Behaviour Therapy, is well recognised as the first-line psychological treatment in obsessive-compulsive disorder (OCD), either alone or in combination with selective serotonin reuptake inhibitor pharmacotherapy. However, given that up to half of patients suffering from OCD do not experience a clinically significant reduction in symptoms following ERP, further treatment options for treatment-resistant OCD are needed. Initial research into using ImRs as a psychological adjunct for treatment-resistant OCD has been encouraging. We provide a detailed case study of a 61-year-old male who continued, following ERP treatment, to suffer debilitating OCD symptoms of compulsive checking to prevent making mistakes. Following ERP, the individual received two sessions of ImRs as a therapy adjunct, which resulted in a further reduction of 56% in OCD symptoms. The individual reported associated improvements in mood, life satisfaction, and occupational and interpersonal relationships. This case study describes how ImRs can be incorporated into ERP treatment for OCD. Details of the ERP and ImRs treatment are provided, along with transcript excerpts to highlight the ImRs process. Further research is needed to enhance understanding of mechanisms and optimal deployment of ImRs in treatment sequencing for OCD sufferers.
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Affiliation(s)
- Gayle Maloney
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Perth OCD Clinic, Perth, Australia
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center and Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
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Maine I, Horvath AJ, Lau P. 'Touch for Health' based kinesiology interventions: An innovative qualitative research exploring clients' perspectives. Complement Ther Clin Pract 2022; 49:101643. [PMID: 36029556 DOI: 10.1016/j.ctcp.2022.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Touch for health (TFH) based kinesiology is a complementary therapy with foundations in a natural health training developed utilising techniques from chiropractic, osteopathy and acupressure therapies. Although popular, the impact of the therapy is poorly understood. The aim of this study was to understand outcomes of TFH-based kinesiology interventions that clients perceive as important in their lives. MATERIALS AND METHODS A qualitative phenomenological approach was chosen to capture rich descriptive data. Thirteen individuals were recruited from TFH-based kinesiology practices. Focus groups included semi-structured questions, photo-elicitation and a wellness word activity to prompt discussion on impacts of interventions. Audio-recordings were transcribed, coded and grouped to develop themes. Comparisons were made and linked with the wellness model, theory of planned behaviour and mindfulness-based interventions. RESULTS Three interrelated themes emerged: impact on awareness, experience of effects and impact on action. TFH-based kinesiology was perceived to enhance self-awareness and feelings of wellbeing, promote self-care and support new actions to manage stress and complement conventional healthcare. The use of a mind-body approach with feedback from muscle testing and less need for dialogue were valued. Photo-elicitation generated rich narratives recounting experiences after interventions. Impacts aligned with the wellness model and resembled outcomes of mindfulness-based interventions. CONCLUSION This study provides an insight into experiences and impacts of TFH-based kinesiology. Interventions were seen to facilitate self-awareness, experiences of wellbeing and promote self-care. Findings contribute towards a knowledge-base to foster dialogue and inform TFH-based kinesiologists, health professionals, consumers and research of TFH-based kinesiology and comparative therapies.
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Affiliation(s)
- Ingrid Maine
- Department of Medical Education, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Anita Julieanne Horvath
- Department of Medical Education, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Phyllis Lau
- Department of General Practice, The University of Melbourne, Parkville, VIC, 3010, Australia
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Kredlow MA, de Voogd LD, Phelps EA. A Case for Translation From the Clinic to the Laboratory. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1120-1149. [PMID: 35245166 PMCID: PMC9271534 DOI: 10.1177/17456916211039852] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychology, Tufts University
- Department of Psychology, Harvard University
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition, and Behavior, Radboud University and Radboud University Medical Center
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Hewitt OM, Steel C, Hales SA, Hayden N, Gundeslioglu H, Tapp K, Langdon P. A systematic review and narrative synthesis of mental imagery tasks in people with an intellectual disability: Implications for psychological therapies. Clin Psychol Rev 2022; 96:102178. [PMID: 35738164 DOI: 10.1016/j.cpr.2022.102178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/22/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022]
Abstract
Mental imagery is recognised for its role in both psychological distress and wellbeing, with mental imagery techniques increasingly being incorporated into psychological interventions. In this systematic review and narrative synthesis (PROSPERO 2021: CRD42021240930), we identify and evaluate the evidence base for the phenomenon and phenomenology of mental imagery in people with intellectual disabilities, to ascertain the applicability of such interventions for this population. Electronic searches of nine databases and grey literature identified relevant publications. Two reviewers independently assessed titles and abstracts of retrieved records (n = 8609) and full-text articles (n = 101) against eligibility criteria. Data were extracted and quality appraised. Forty-onepapers met our eligibility criteria. The quality and designs were variable. Mental imagery was facilitated through ensuring participants understood tasks, providing opportunity to rehearse tasks (including using concrete prompts) and using scaffolding to help participants elaborate their responses. People with intellectual disabilities can engage with mental imagery, with appropriate adaptations, although the associated phenomenology has not been thoroughly investigated. Mental imagery interventions may be useful for people with intellectual disabilities with appropriate modifications.
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Affiliation(s)
- Olivia Mary Hewitt
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK; Learning Disability Services, Berkshire Healthcare NHS Foundation Trust, 7-9 Cremyll Road, Reading RG1 8NQ, UK.
| | - Craig Steel
- xford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, Oxford OX3 7JX, UK
| | - Susie A Hales
- Emotion and Mental Imagery Lab (EMIL), Department of Psychology, Uppsala University, Box 1225, 751 42, Sweden; Oxford Health NHS Foundation Trust, Littlemore Mental Health Centre, Sandford Road, Littlemore, Oxford OX4 4XN, UK
| | - Nikita Hayden
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Hatice Gundeslioglu
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Katherine Tapp
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Peter Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK; Coventry and Warwickshire Partnership NHS Trust, Rainbow Unit, Brooklands Hospital, Marston Green, Birmingham B37 5RY, UK
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Using Imagery Rescripting to Treat Posttraumatic Stress Disorder in Refugees: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A randomised multiple baseline case series of a novel imagery rescripting protocol for intrusive trauma memories in people with psychosis. J Behav Ther Exp Psychiatry 2022; 75:101699. [PMID: 34813973 DOI: 10.1016/j.jbtep.2021.101699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/01/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES There has been limited investigation of therapies targeting trauma-related psychological mechanisms hypothesised to play a role in post-traumatic and psychosis symptoms. Imagery rescripting (ImRs) is a therapeutic technique which involves transforming images, such as episodic memories, to modify associated distressing beliefs. This study is the first ImRs study for psychosis to incorporate experimental controls. We used a novel ImRs protocol, targeting present-focused, self-referential distressing meanings associated with intrusive trauma memories. A multiple baseline case series design investigated whether the protocol was feasible, safe, acceptable and effective. METHODS 12 participants with a psychosis diagnosis and intrusive trauma memories were assessed and randomised to a monitoring period (one, two or three weeks), followed by three ImRs sessions (over three weeks), a further two-week monitoring period with a post-therapy assessment a week after completing therapy. Memory phenomenology was assessed daily during monitoring. Post-traumatic stress symptoms and wellbeing were assessed pre and post therapy. RESULTS ImRs was feasible, safe and rated as highly acceptable. No participants dropped-out of the brief, targeted intervention. There were moderate effects on the frequency, distress, controllability and appraisals of trauma memories. Notably, ten participants showed reliable change, and seven clinically significant change, in post-traumatic stress symptoms. LIMITATIONS Assessments were not blinded and impact on psychosis was not examined. CONCLUSIONS The study indicates that a brief, novel ImRs protocol targeting present-focused, self-referential meanings is a promising intervention for intrusive trauma memories. Future research should investigate its integration into trauma-focused therapy for psychosis and impact on psychosis severity.
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Is it magic? An exploratory randomized controlled trial comparing imagery rescripting and cognitive restructuring in the treatment of depression. J Behav Ther Exp Psychiatry 2022; 75:101721. [PMID: 35121250 DOI: 10.1016/j.jbtep.2021.101721] [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: 07/03/2020] [Revised: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate whether working with intrusive images and the use of imagery processes would be beneficial to treating depression, an imagery-based intervention (imagery rescripting, IR) was compared with a more commonly used verbal-based technique (cognitive restructuring, CR). The study aimed not only to test the efficacy of IR as a brief modular treatment for depression, but to explore whether such experiential use of imagery would alleviate the abstract-evaluative, verbal processes of rumination and worry. METHODS Forty-one participants diagnosed with clinical depression and who also reported intrusive images underwent one assessment session of imagery properties before they were randomly assigned to an IR group or to an active control group of CR. They then received three weekly sessions of treatment, and outcomes were measured before and after treatment, as well as at two-month follow-up. RESULTS The results showed that IR was equally if not more effective than CR in alleviating depression. Significant differential reductions in rumination, worry and experiential avoidance between treatments added support to the technique's experiential nature, and possibly, a defusing out of an abstract-evaluative mode of processing. LIMITATIONS Only self-report measures were used, with a small number of treatment sessions by one clinician. CONCLUSIONS The findings support the therapeutic potential of imagery modalities in the treatment of depression, which compared to cognitive restructuring, appear to bring about more significant emotional change with time (clinical trial registered at the Joint CUHK-NTEC CREC Ref. No. 2015.458).
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Future-oriented imagery rescripting facilitates conducting behavioral experiments in social anxiety. Behav Res Ther 2022; 155:104130. [DOI: 10.1016/j.brat.2022.104130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/18/2022]
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Sleep's role in updating aversive autobiographical memories. Transl Psychiatry 2022; 12:117. [PMID: 35332136 PMCID: PMC8948270 DOI: 10.1038/s41398-022-01878-1] [Citation(s) in RCA: 3] [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: 07/22/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 01/15/2023] Open
Abstract
Aversive autobiographical memories play a key role in the development and maintenance of many mental disorders. Imagery rescripting is a well-established psychotherapeutic intervention aiming to create a more adaptive version of an aversive memory by modifying its interpretation. Sleep has been shown to support reconsolidation of updated neutral memories. Here, we investigated in healthy participants whether a 90-min nap compared to wake supports the adaptive reconsolidation of autobiographical memories. Forty-four university students received a single 50-min imagery rescripting session. Thereafter, half of the participants took a 90-min nap, whereas the other half stayed awake. Subjective (arousal ratings, reports of emotions and dysfunctional cognitions) and heart rate (HR) responses to individual memory scripts were measured before the intervention (pre), after the 90-min retention interval (post 1) and 7 days later (post 2). Results demonstrate a significant decrease in distress of aversive memories pre to post imagery rescripting. The nap group showed less distressing dysfunctional cognitions along with a lower HR in response to the negative memory script as compared to the wake group at post 1. These differences were no longer evident 1 week later (post 2). Central sleep spindle density during the nap was correlated with the reduction in HR in response to the negative memory script from pre to post 1. Our results provide first evidence for sleep benefitting adaptive reconsolidation of aversive autobiographical memories. Future research should expand this approach to clinical populations and investigate precise conditions under which sleep may benefit psychotherapeutic interventions utilizing reconsolidation mechanisms.
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