Feasibility of computerised positive mental imagery training as a treatment adjunct in in-patient mental health settings: randomised controlled trial

Abstract

Background Positive affect and anhedonia are important but challenging targets for mental health treatments. Previous research indicates the potential of a computerised cognitive training paradigm involving generation of positive mental imagery, termed positive mental imagery training (PMIT), to increase positive affect and reduce anhedonia. Aims Our main aim was to investigate the feasibility of PMIT as a positive affect-focused, transdiagnostic adjunct to treatment as usual for patients in in-patient mental health settings. Method We ran an open feasibility, randomised controlled trial with three parallel arms: treatment as usual; treatment as usual plus PMIT; and treatment as usual plus an active comparator, cognitive control training. Fifty-seven patients from two different in-patient mental health treatment clinics in Germany were randomised in a 1:1:1 ratio. PMIT and cognitive control training comprised an introductory session followed by eight 15-min training sessions over 2 weeks. Clinical outcomes such as positive affect (primary outcome measure) and anhedonia were assessed at pre- and post-training, and at a further 2-week follow-up. Results Adherence was good and attrition was low. The patterns of results for the outcome data were not consistent with a specific effect of PMIT on positive affect, but were more consistent with a specific effect on anhedonia. Conclusions The results indicate feasibility and potential promise of a larger efficacy trial investigating PMIT as a treatment adjunct in in-patient mental health settings. Limitations include lack of researcher blinding, small sample size and lack of pre-specified feasibility outcomes. Anhedonia may be a more suitable primary outcome for a future larger trial.

Future-oriented cognition: links to mental health problems and mental wellbeing in preschool-aged and primary-school-aged children

“…Supporting the cognitive reserve hypothesis, instructing participants to imagine a future event vividly led to a significant reduction in delay discounting, impulsive behavior and substance consumption ( Peters and Büchel, 2010 ; Forster et al, 2021 ). Similar effects have been found for internalizing behavior such as depression and anxiety ( Jing et al, 2016 ; Westermann et al, 2021 ).…”

“…Experimental studies confirmed these findings and suggest that the observed link may provide possible implications for clinical practice (e.g., Renner et al, 2021 ). For example, training or instructing EFT about positive future events did not only elicit positive affect in the here-and-now, but also increased anticipated pleasure and the intention to perform related activities in healthy controls ( Hallford et al, 2020a ; Westermann et al, 2021 ; Hallford et al, 2022 ). Beyond EFT, there is some, albeit considerably less evidence, that also other facets of future-oriented cognition such as delay discounting, planning and prospective memory may be altered in subjects showing internalizing symptoms ( Miloyan et al, 2014 ; McFarland and Vasterling, 2018 ; for a review).…”

Demonstration of a ‘leapfrog’ randomized controlled trial as a method to accelerate the development and optimization of psychological interventions

“…Holmes, Lang, and Shah, 2009 ) and clinical (e.g. Blackwell et al, 2015 ; Westermann et al, 2021 ) studies. The interventions comprised a series of training sessions (e.g.…”

“…More recently applications have focused specifically on anhedonia (e.g. Blackwell et al, 2015 ; Westermann et al, 2021 ), a challenging clinical target where there is great need for treatment innovation (e.g. Craske, Meuret, Ritz, Treanor, and Dour, 2016 ; Dunn et al, 2020 ).…”

Making the leap: From experimental psychopathology to clinical trials

“…Whitehead et al, 2016). As you will collect outcome data during a feasibility or pilot trial you will generate estimates of likely efficacy of your intervention (see Hitchcock et al, 2018; Kanstrup et al, 2021; Westermann et al, 2021, for some examples); if these provide absolutely no indication of likely success, you may wish to take a step back before moving to a full-scale RCT. However, effect size estimates generated from feasibility and pilot studies should be treated with a high level of caution, particularly given the a priori knowledge that the trial is underpowered.…”