Coping with test anxiety using imagery rescripting: A two-session randomized controlled trial

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.

Health anxiety amplifies fearful responses to illness-related imagery

Severe health anxiety (HA) is characterized by excessive worry and anxiety about one's health, often accompanied by distressing intrusive imagery of signs of a serious illness or potentially receiving bad news about having a life-threatening disease. However, the emotional responses to these illness-related mental images in relation to HA have not been fully elucidated. Emotional responses to mental imagery of 142 participants were assessed in a well-controlled script-driven imagery task, systematically comparing emotional responses to illness-related imagery with neutral and standard fear imagery. The results revealed that participants reported higher anxiety, aversion, emotional arousal, and a stronger avoidance tendency during imagery of fear and illness-related scenes compared to neutral scenes. Importantly, the emotional modulation varied by the level of HA, indicating that individuals with higher HA experienced stronger emotional responses to illness-related imagery. This association between HA and fearful imagery could not be better accounted for by other psychological factors such as trait anxiety, anxiety sensitivity, somatic symptom severity, or symptoms of depression and anxiety. Fearful responding to standard threat material was not associated with HA. The present findings highlight the importance of considering fear responding to mental imagery in understanding and addressing HA.

Communication as the Origin of Consciousness

Since the middle of the 20th century, more and more data have appeared on the limited role of consciousness in determining human behavior. In this opinion paper, we hypothesize that the basis of consciousness is precisely the communicative function, and discuss relations of consciousness to other cognitive processes such sensory detection, decision-making and emotions. Within the framework of the hypothesis, consciousness is considered as a highly specialized function of the brain, which ensures encoding of personal information as communication messages. On a subjective level, mental representation just means the state of information to be shared in a human group. Accordingly, consciousness affects only those components of human behavior that are associated with the transmission of messages. Sensory detection, decision-making, emotions and other processes are only projected into consciousness during the encoding of information of them. The communication hypothesis assumes that consciousness is an adaptation that increases the efficiency of a collective way of life, and the emergence of consciousness is inextricably linked with the development of language in human culture. In the future, our view of consciousness provides an opportunity for an objective analysis of subjective phenomena by means of a directed study of the formation of messages both at the level of brain processes and at the level of interactions between individuals.

Adoption of measures to mitigate the impact of COVID-19: In search of a Hofstedian explanation for patterns among individual countries and country clusters

We consider multiple safety measures in relation to the COVID-19 virus and look at their adoption levels for a variety of 15 individual countries, based on data from Yougov.co.uk. Subsequently, we establish correlation coefficients between measure-specific uptake levels and Hofstede dimension scores for all countries considered. We notably find that Power Distance Index (PDI) and Individualism (IDV) have a considerable explanatory power. In addition, we carried out a Principal Components Analysis (PCA) and a cluster analysis to see whether the behavioural patterns across countries can be grouped, and which Hofstede dimensions correlate strongest with the two main components that follow from the PCA. The PCA provides further confirmation of PDI and IDV being the most important explanatory factors for the uptake of measures across countries. The cluster analysis, in turn, reveals four broad groups, which only partly coincide with the way that the mental image clustering scheme by Wursten (2019) allots countries into its respective clusters. Hence, this provides a basis to suggest that data-driven exercises like the ones from our paper can serve to adjust Wursten's intuitive scheme.

Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study

BACKGROUND

Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19.

METHODS

In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes.

RESULTS

Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes.

LIMITATIONS

Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear.

CONCLUSIONS

The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.

Mental images, entrapment and affect in young adults meeting criteria of nonsuicidal self-injury disorder (NSSID) - a daily diary study

BACKGROUND

Incidents of nonsuicidal self-injury (NSSI) are often accompanied by mental images which could be perceived as distressing and/or soothing; yet existing data is derived from participants with a history of NSSI using retrospective methods. This study investigated mental images related to NSSI ("NSSI-images"), and their relationship to the proposed Nonsuicidal Self-Injury Disorder (NSSID).

METHODS

An e-mail was sent to all female students of the local University providing the link to an online screening and 201 students with a history of repetitive NSSI responded. Nineteen eligible participants meeting criteria of NSSID (mean age = 25; 32% with migrant background) further completed a baseline interview and a ten-day-diary protocol.

RESULTS

Among the sample of N = 201, 83.6% reported NSSI-images. In the subsample of n = 19 diagnosed with NSSID, the frequencies of NSSI and NSSI-images were correlated; about 80% of the most significant NSSI-images were either of NSSI or of an instrument associated with NSSI (i.e., a razorblade). In the diary, 53% of the sample self-injured. NSSI-images were reported on 94% of NSSI-days, and on days with NSSI and NSSI-images, the images almost always occurred first; the images were overall perceived as twice more distressing than comforting. Images on NSSI-days were characterized by more comfort, intrusiveness and compellingness yet less vividness, and increased subsequent positive and negative affect compared to non-NSSI days. NSSI-days were further marked by increased entrapment beliefs and increased negative yet decreased positive affect at night. These results were non-significant.

LIMITATIONS

Due to non-significant results among a small sample size and a low rate of NSSI among the NSSID-group, results remain preliminary.

CONCLUSIONS

The study provides information on feasibility and methodological challenges such as intervention effects of the diary. NSSI-images may be common among individuals who engage in NSSI; they may capture ambivalent (positive and negative) appraisals of NSSI and thus play a role in NSSI and possibly a disorder such as NSSID. The preoccupation with NSSI (Criterion C of NSSID in DSM-5) may as well be imagery-based.

REGISTRATION

The study was retrospectively registered with the DRKS under the number DRKS00011854.

Treating women with perinatal mood and anxiety disorders (PMADs) with a hybrid cognitive behavioural and art therapy treatment (CB-ART)

This paper presents an overview of a combined, evaluated protocol, cognitive behavioural and art therapy treatment (CB-ART), for the treatment of women with perinatal mood and anxiety disorders (PMADs). The protocol integrates cognitive behavioural interventions and art therapy. CB-ART focuses on changing distressing image, symptom or memory (ISM) that interferes with functioning. The method directs clients to identify compositional elements that characterize their stressful ISM and to alter the element in their imagination, in bodily sensations and on the page. Examples are provided to illustrate the therapeutic process.

Distressing visual mental images in depressed patients and healthy controls - Are they one and the same?

Negative mental images are common in a range of mental disorders. So far, only inconclusive evidence has been obtained for depression specificity. We assessed the disparities and similarities of a variety of imagery characteristics in 17 patients suffering from depressive disorders and 17 healthy matched controls who all reported negative mental images. The number of intrusive images, their frequency, and the associated distress were significantly greater for the depressed individuals. Compared with non-depressed controls, negative images during depression were more frequently triggered by internal factors and led to depression-related emotions. Approximately 30% of the images in the depressed group did not consist of actual memories of real-life events. No significant differences in vividness or perceived controllability were observed, but the depressed patients experienced significantly more bodily symptoms during the intrusions than the healthy controls. The results indicate that the central characteristics of the negative mental images of depressed and non-depressed individuals are distinguishable, despite some similarities, and may contribute to depressive symptoms.

Out of the shadows and into the spotlight: Social blunders fuel fear of self-exposure in social anxiety disorder

In a study designed to clarify and extend previous research on social blunders in social anxiety, 32 participants with social anxiety disorder (SAD), 25 anxious control (AC) participants with anxiety disorders other than SAD, and 25 healthy control (HC) participants with no history of anxiety problems estimated the costs of hypothetical blunders committed by either themselves or by others. Participants with SAD rated the costs of their own imagined blunders as highly inflated relative to both AC and HC participants. In contrast, for blunders participants imagined others committing, only SAD and healthy control participants' cost estimates differed from one another. Moreover, concerns about revealing self-flaws--and, in particular, about appearing socially incompetent--accounted for significant, unique variance in SAD participants' exaggerated cost estimates of self blunders, over and above symptoms of social anxiety and depression. These results enhance our understanding of how and why socially anxious individuals negatively appraise social blunders and help to clarify the potential function and role of social mishap exposures in the treatment of SAD.

Age effect in generating mental images of buildings but not common objects

Imagining a familiar environment is different from imagining an environmental map and clinical evidence demonstrated the existence of double dissociations in brain-damaged patients due to the contents of mental images. Here, we assessed a large sample of young and old participants by considering their ability to generate different kinds of mental images, namely, buildings or common objects. As buildings are environmental stimuli that have an important role in human navigation, we expected that elderly participants would have greater difficulty in generating images of buildings than common objects. We found that young and older participants differed in generating both buildings and common objects. For young participants there were no differences between buildings and common objects, but older participants found easier to generate common objects than buildings. Buildings are a special type of visual stimuli because in urban environments they are commonly used as landmarks for navigational purposes. Considering that topographical orientation is one of the abilities mostly affected in normal and pathological aging, the present data throw some light on the impaired processes underlying human navigation.