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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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van den Berg KC, Ten Bloemendal E, Hendrickson AT, Di Simplicio M, Voncken M, Aalbers G, Keijsers GPJ. Exploring Temporal Relationships Between Anxiety, Mood and Mental Imagery in Patients With Bipolar Disorder: A Network Analysis. Clin Psychol Psychother 2024; 31:e3050. [PMID: 39210656 DOI: 10.1002/cpp.3050] [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: 05/03/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Bipolar disorder is a severe mental health problem with limited treatment success. There is a call for improving interventions, requiring an increased understanding of factors driving mood instability. One promising avenue is to study temporal associations between factors that appear relevant according to the emotional amplifier model of Holmes are changes in mood, anxiety and mental imagery. METHODS The current study used data from a recent RCT for a secondary analysis which applied a network analysis approach to explore temporal associations between weekly measurements of mania, depression, anxiety and mental imagery measured during 32 weeks in two randomised groups (N = 55) receiving either imagery-focused cognitive therapy (ImCT) or group psychoeducation (PE). RESULTS Both negative intrusive mental imagery and anxiety appeared central in the network analyses, driving changes in both mania and depression, but only in the PE group. In the ImCT group, only anxiety was driving changes in mania and depression. CONCLUSION Although exploratory, findings suggest that prior increases in anxiety and negative intrusive mental imagery might be associated with subsequent increases in depression and mania symptoms in patients with bipolar disorder. Anxiety might in turn increase negative intrusive imagery and associated negative emotions. Although more research is needed, results are in line with the emotional amplifier model and stress that future interventions with a focus on anxiety and imagery might help to improve psychosocial therapies for patients with bipolar disorder. In addition, this study suggests that a network approach is a helpful and feasible way to study mood instability, anxiety and mental imagery to increase our understanding of mechanisms underpinning mood instability.
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van den Berg KC, Voncken M, Hendrickson AT, Di Simplicio M, Regeer EJ, Rops L, Keijsers GPJ. Exploring aspects of self-reported emotional mental imagery in patients with bipolar disorder. J Behav Ther Exp Psychiatry 2023; 81:101861. [PMID: 37182427 DOI: 10.1016/j.jbtep.2023.101861] [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: 01/17/2022] [Revised: 02/28/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance CBT for bipolar disorder with imagery techniques, research is needed into emotional imagery quality and, related appraisals of imagery and their relationships with mood instability and subsequent behaviour in bipolar disorder. METHODS Patients with bipolar disorder (n = 106), unipolar depression (n = 51), creative imagery prone participants (n = 53) and participants without a history of a mood disorder (n = 135) completed the Dutch Imagery Survey (DImS), an online imagery survey, adapted from the Imagery Interview, assessing self-reported emotional imagery aspects. Imagery quality, appraisals and their self-perceived effects on emotion and behaviour were compared between groups. As unexpected differences within the bipolar group appeared, these were additionally explored. RESULTS Imagery appraisals but not imagery quality discriminated between the patient groups and non-patient groups Imagery was perceived as an emotional amplifier in all groups, but this was specifically apparent in bipolar manic and bipolar depressed groups. Only in the bipolar group imagery was experienced to amplify behavioural tendencies. LIMITATIONS Results need to be replicated using a larger sample of patients with BD who are currently manic or depressed. CONCLUSIONS Not only quality of imagery, but especially appraisals associated with imagery are differentiating between imagery prone people with and without mood disorder. Imagery amplifies emotion in all groups, but only in those patients with bipolar disorder currently manic or depressed did this influence behaviour.
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van den Berg KC, Hendrickson AT, Hales SA, Voncken M, Keijsers GPJ. Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial. J Affect Disord 2023; 320:691-700. [PMID: 36206888 DOI: 10.1016/j.jad.2022.09.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS These findings need to be replicated in a larger trial. CONCLUSIONS Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.
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von Dawans B, Trueg A, Voncken M, Dziobek I, Kirschbaum C, Domes G, Heinrichs M. Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder. Front Psychiatry 2022; 13:875750. [PMID: 35911212 PMCID: PMC9326503 DOI: 10.3389/fpsyt.2022.875750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from social anxiety disorder (SAD) fear social interaction and evaluation, which severely undermines their everyday life. There is evidence of increased prosocial behavior after acute social stress exposure in healthy individuals, which may be interpreted as stress-regulating "tend-and-befriend" behavior. In a randomized controlled trial, we measured empathic abilities in a first diagnostic session. In the following experimental session, we investigated how patients with SAD (n = 60) and healthy control participants (HC) (n = 52) respond to an acute social stressor (Trier Social Stress Test for groups) or a non-stressful control condition, and whether empathic abilities and acute social stress interact to modulate anxious appearance and social behavior in a social conversation test. Salivary cortisol, heart rate, and subjective stress response were repeatedly measured. The anxious appearance and social behavior of participants were rated by the conversation partner. SAD patients demonstrated stronger subjective stress responses while the biological responses did not differ from HC. Moreover, patients performed worse overall in the conversation task, which stress additionally undermined. Finally, we found that both emotional and cognitive empathy buffered the negative effects of acute stress on social behavior in SAD, but not in HC. Our data highlight the importance of empathic abilities for SAD during stressful situations and call for multimodal clinical diagnostics. This may help to differentiate clinical subtypes and offer better-tailored treatment for patients. General Scientific Summary: This study shows that high levels of cognitive and emotional empathy can buffer the negative effects of acute stress on social behavior in social anxiety disorder (SAD). Empathic abilities may be included as an additional diagnostic resource marker for SAD.
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Dibbets P, Lemmens A, Voncken M. Turning negative memories around: Contingency versus devaluation techniques. J Behav Ther Exp Psychiatry 2018; 60:5-12. [PMID: 29477486 DOI: 10.1016/j.jbtep.2018.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 02/05/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES It is assumed that fear responses can be altered by changing the contingency between a conditioned stimulus (CS) and an unconditioned stimulus (US), or by devaluing the present mental representation of the US. The aim of the present study was to compare the efficacy of contingency- and devaluation-based intervention techniques on the diminishment in - and return of fear. We hypothesized that extinction (EXT, contingency-based) would outperform devaluation-based techniques regarding contingency measures, but that devaluation-based techniques would be most effective in reducing the mental representation of the US. Additionally, we expected that incorporations of the US during devaluation would result in less reinstatement of the US averseness. METHODS Healthy participants received a fear conditioning paradigm followed by one of three interventions: extinction (EXT, contingency-based), imagery rescripting (ImRs, devaluation-based) or eye movement desensitization and reprocessing (EMDR, devaluation-based). A reinstatement procedure and test followed the next day. RESULTS EXT was indeed most successful in diminishing contingency-based US expectancies and skin conductance responses (SCRs), but all interventions were equally successful in reducing the averseness of the mental US representation. After reinstatement EXT showed lowest expectancies and SCRs; no differences were observed between the conditions concerning the mental US representation. LIMITATIONS A partial reinforcement schedule was used, resulting in a vast amount of contingency unaware participants. Additionally, a non-clinical sample was used, which may limit the generalizability to clinical populations. CONCLUSION EXT is most effective in reducing conditioned fear responses.
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Lobbestael J, Arntz A, Voncken M, Potegal M. Responses to dominance challenge are a function of psychopathy level: A multimethod study. ACTA ACUST UNITED AC 2018. [DOI: 10.1037/per0000252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lobbestael J, de Bruin A, Kok E, Voncken M. Through rose-coloured glasses: An empirical test of narcissistic overestimation. Personal Ment Health 2016; 10:305-316. [PMID: 27406650 DOI: 10.1002/pmh.1347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Grandiosity is designated as a hallmark trait of narcissism. The current study tested whether narcissistic traits are related to overestimation of a range of agentic performances. METHOD Eighty-five non-patients executed six objective tasks to assess their level of (emotional) intelligence, first impression, attractiveness, social skills and learning performance. They were also asked to estimate their level of functioning in these six areas. This estimation was given on two moments: before and after performing the objective tasks. Our main variable of interest was the degree to which subjective estimation exceeds objective scores. RESULTS Narcissistic traits were related to overestimation of (emotional) intelligence, attractiveness and social skills, particularly at a global level before performing the tasks. LIMITATIONS The use of a homogenous student sample; Mainly agentic performances, were studied. CONCLUSION Overall, the findings provide a theoretical validation of unwarranted feelings of grandiosity as a core narcissistic criterion. Copyright © 2016 John Wiley & Sons, Ltd.
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Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010; 27:168-89. [PMID: 20143427 DOI: 10.1002/da.20670] [Citation(s) in RCA: 239] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. METHOD A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. RESULTS/CONCLUSIONS Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
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Bögels SM, Voncken M. Social Skills Training Versus Cognitive Therapy for Social Anxiety Disorder Characterized by Fear of Blushing, Trembling, or Sweating. Int J Cogn Ther 2008. [DOI: 10.1521/ijct.2008.1.2.138] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arntz A, Voncken M, Goosen ACA. Responsibility and obsessive–compulsive disorder: An experimental test. Behav Res Ther 2007; 45:425-35. [PMID: 16697349 DOI: 10.1016/j.brat.2006.03.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 03/27/2006] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
To test the causal status of responsibility in obsessive-compulsive disorder (OCD), an experiment was executed in which responsibility was experimentally manipulated. OCD patients, non-OCD anxiety controls, and non-patients executed a classification task in either a high or a low responsibility (LoRes) condition. Subjective ratings related to danger and responsibility indicated that the manipulation was successful. Subjective OCD-like experiences and checking behaviors were higher in OCD patients in the high responsibility (HiRes) condition than in all other groups. Although the checking subscale of the Padua Inventory correlated with subjective ratings in the OCD patients in the HiRes condition, it was not associated with checking behaviors. The results confirm the hypothesis that responsibility plays a causal role in OCD.
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Bögels SM, Sijbers GFVM, Voncken M. Mindfulness and Task Concentration Training for Social Phobia: A Pilot Study. J Cogn Psychother 2006. [DOI: 10.1891/jcop.20.1.33] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A new treatment for social phobia is evaluated: mindfulness training and task concentration training. The treatment consisted of nine sessions of 45–60 minutes and was administered individually. Nine severely socially phobic patients participated. No changes in complaints were observed during the waiting-list period. One patient withdrew during the treatment. Results show that treatment was well accepted and highly effective in reducing social phobia, and results were maintained at a 2-month follow-up. Effects of the treatment were most pronounced on Fear of Negative Evaluation and on the self-ideal discrepancy. Attention as well as cognitive changes may be responsible for the effectiveness. Explanations for the effects and clinical implications are discussed.
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Zhang HY, Langeslag M, Voncken M, Roubos EW, Scheenen WJJM. Melanotrope cells of Xenopus laevis express multiple types of high-voltage-activated Ca2+ channels. J Neuroendocrinol 2005; 17:1-9. [PMID: 15720469 DOI: 10.1111/j.1365-2826.2005.01267.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pituitary melanotrope cells are neuroendocrine signal transducing cells that translate physiological stimuli into adaptive hormonal responses. In this translation process, Ca2+ channels play essential roles. We have characterised which types of Ca2+ current are present in melanotropes of the amphibian Xenopus laevis, using whole-cell, voltage-clamp, patch-clamp experiments and specific blockers of the various current types. Running an activation current-voltage relationship protocol from a holding potential (HP) of -80 mV/or -110 mV, shows that Xenopus melanotropes possess only high-voltage activated (HVA) Ca2+ currents. Steady-state inactivation protocols reveal that no inactivation occurs at -80 mV, whereas 30% of the current is inactivated at -30 mV. We determined the contribution of individual channel types to the total HVA Ca2+ current, examining the effect of each channel blocker at an HP of -80 mV and -30 mV. At -80 mV, omega-conotoxin GVIA, omega-agatoxin IVA, nifedipine and SNX-482 inhibit Ca2+ currents by 21.8 +/- 4.1%, 26.1 +/- 3.1%, 24.2 +/- 2.4% and 17.9 +/- 4.7%, respectively. At -30 mV, omega-conotoxin GVIA, nifedipine and omega-agatoxin IVA inhibit Ca2+ currents by 33.8 +/- 3.0, 24.2 +/- 2.6 and 16.0 +/- 2.8%, respectively, demonstrating that these blockers substantially inhibit part of the Ca2+ current, independently from the HP. We have previously demonstrated that omega-conotoxin GVIA can block Ca2+ oscillations and steps. We now show that nifedipine and omega-agatoxin IVA do not affect the intracellular Ca2+ dynamics, whereas SNX-482 reduces the Ca2+ step amplitude. We conclude that Xenopus melanotrope cells express all four major types of HVA Ca2+ channel, as well as the resulting currents, but no low-voltage activated channels. The results provide the basis for future studies on the complex regulation of channel-mediated Ca2+ influxes into this neuroendocrine cell type as a function of its role in the animal's adaptation to external challenges.
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