Feasibility of computerized positive mental imagery training as a treatment adjunct in inpatient mental health settings: a randomized controlled trial

Abstract

Background: Positive affect and anhedonia are important but challenging targets for mental health treatments. Previous research indicates the potential of a computerized cognitive training paradigm involving generation of positive mental imagery, here termed positive mental imagery training (PMIT), to increase positive affect and reduce anhedonia. Aims: Our main aim was to investigate feasibility of PMIT as a positive affect-focussed transdiagnostic adjunct to treatment as usual (TAU) for patients in inpatient mental health settings (clinicaltrials.gov: NCT02958228). Method: We ran an open feasibility randomized controlled trial (RCT) with three parallel arms: TAU, TAU + PMIT, and TAU + an active comparator, cognitive control training (CCT). Fifty-seven patients from two different inpatient mental health treatment clinics in Germany were randomized in a 1:1:1 ratio. PMIT or CCT consisted of an introductory session then eight 15-minute training sessions over two 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 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.Conclusion: The results indicate feasibility and potential promise of a larger efficacy RCT investigating PMIT as a treatment adjunct in inpatient mental health settings. Limitations include lack of researcher blinding, the 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

“…All intervention arms were variants of imagery CBM, adapted from previous experimental (e.g., Holmes et al, 2009) and clinical (e.g., Westermann et al, 2021) CBMv1. CBMv1 started with an initial introductory session comprising an extended introduction to mental imagery followed by 20 training scenarios, as per a recent study (Westermann et al, 2021). The first two training weeks then included four sessions with 40 scenarios each, and the final two weeks included two sessions of 40 scenarios.…”

“…Participants then completed the sets of training scenarios. In between each set of scenarios, participants were shown a tabular display of their minimum, maximum, and average vividness ratings for all sets completed so far that session, and encouraged to reflect on the scores, what had helped or hindered them in generating vivid imagery, and how they could try to improve on this in the subsequent set (adapted from Westermann et al, 2021).…”

“…Imagery CBM was originally developed in the context of depression, with negative interpretation biases and deficits in positive mental imagery as the target mechanisms (Everaert et al, 2017;Holmes et al, 2016). More recently applications have focussed specifically on anhedonia (e.g., Westermann et al, 2021), a challenging clinical target where there is great need for treatment innovation (e.g., Craske et al, 2016;Dunn et al, 2020). Imagery CBM currently stands at a critical stage of clinical translation, needing to make the crucial transition from early-phase trials to tests of realworld implementations.…”