An investigation of mental imagery in bipolar disorder: Exploring “the mind's eye”

Simplicio, Martina Di; Renner, Fritz; Blackwell, Simon E.; Mitchell, Heather; Stratford, Hannah J.; Watson, Peter; Myers, Nick; Nobre, Anna C.; Lau‐Zhu, Alex; Holmes, Emily A.

doi:10.1111/bdi.12453

Cited by 47 publications

(70 citation statements)

References 60 publications

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“…"Miss A. 37 There has been extensive research on intrusions. Berntsen [31] argues 'intrusions are experienced as involuntary and uncontrollable in that their appearance in consciousness is spontaneous rather than following a deliberate effort or search' [32] (p. 210).…”

Section: Suicidal Intrusionsmentioning

confidence: 99%

“…It becomes impossible to control them and the individual feels pushed towards suicide. Recently empirical studies verified this obsessive imagination and it is now referred to as 'suicidal mental imagery' [6,36,37] or flash-forwards to suicide [5,[7][8][9]. They include repetitive, intrusive, uncontrollable, vivid images that may occupy the suicidal mind with repetitive ideation, plans, and behavioral intentions.…”

Section: Suicidal Intrusionsmentioning

confidence: 99%

“…While intrusions can possess a multitude of sensory qualities (visual, auditory, olfactory, touch, and movement), most literature is concerned with visual images [32]. Growing evidence supports the existence of intrusive suicidal ideas and images [5,[7][8][9]37]. Moreover, intrusive mental images seem to be an important feature in multiple psychological disorders like PTSD [27,46], agoraphobia [47], social phobia [48], see Holmes and Mathews [49] for a review.…”

Section: Research Evidence On Intrusive Ideas and Imagesmentioning

confidence: 99%

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Treatment of Intrusive Suicidal Imagery Using Eye Movements

Bentum¹,

Sijbrandij²,

Huibers³

et al. 2017

Preprint

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Suicide and suicidal behavior are major public health concerns and affect 3-9% of the population worldwide. Despite growing evidence, there are still few effective interventions available to reduce suicide risk. In this article, we describe theoretical models of suicide ideation and behavior and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.

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Section: Suicidal Intrusionsmentioning

confidence: 99%

Section: Suicidal Intrusionsmentioning

confidence: 99%

Section: Research Evidence On Intrusive Ideas and Imagesmentioning

confidence: 99%

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Treatment of Intrusive Suicidal Imagery Using Eye Movements

Bentum¹,

Sijbrandij²,

Huibers³

et al. 2017

Preprint

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“…Mental imagery can contribute to mood swings, e.g. in the bipolar phenotype [32], and to mood lability across disorders [33]. Mental images can also evoke strong motivational responses [30], encapsulating desires and cravings to engage in both adaptive [34] and maladaptive [35] behavior.…”

Section: Introductionmentioning

confidence: 99%

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

Cloos

Simplicio

Hammerle

et al. 2020

bord personal disord emot dysregul

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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 selfinjured. 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 nonsignificant. Limitations: Due to non-significant results among a small sample size and a low rate of NSSI among the NSSIDgroup, 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.

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“…The treatment translates our experimental work in the area of imagery and emotion into a skills training programme to improve the regulation of intrusive and distressing emotional mental images in BD. IBER also contains a positive imagery module suitable for the small minority of BD patients who may not report anxiety-related mental images [6,10].…”

Section: Introductionmentioning

confidence: 99%

The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder.

Steel

Wright

Goodwin

et al. 2019

Preprint

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Background Anxiety is highly prevalent in people diagnosed with bipolar disorder (BD), and can persist between acute episodes of mania and depression. Recent studies indicate that people with BD are prone to experiencing frequent, intrusive and emotional mental images which further fuel their levels of anxiety and mood instability. These intrusive emotional mental images represent a specific target for treatment for this disorder with the potential to reduce anxiety and improve mood stability. A new brief structured psychological intervention for BD called Imagery Based Emotion Regulation (IBER) has been developed, which translates experimental work in the area of imagery and emotion into a skills training programme to improve the regulation of intrusive and distressing emotional mental images in BD. A feasibility trial is required in order to assess whether a full randomized controlled trial is indicated in order to evaluate this approach.Methods The design is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site and minimised on medication status and anxiety severity. Participants are 60 individuals diagnosed with bipolar disorder and experiencing at least a mild level of anxiety. Sites are defined by the geographical boundaries of two NHS Trusts, with recruitment from NHS teams, GP surgeries and self-referral. The intervention is up to 12 sessions within 16 weeks of Imagery Based Emotion Regulation. The comparator is NHS standard care. The primary aim is to assess the feasibility of conducting a powered multi-site RCT to evaluate effectiveness. Measures of anxiety, depression, mania, mood stability and health care use will be conducted at baseline, end of treatment and at 16-weeks follow-up.Discussion This is the first feasibility trial of an imagery based intervention for the treatment of anxiety in bipolar disorder. If the trial proves feasible, a large multi-site trial will be required.

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An investigation of mental imagery in bipolar disorder: Exploring “the mind's eye”

Cited by 47 publications

References 60 publications

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Treatment of Intrusive Suicidal Imagery Using Eye Movements

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

The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder.

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