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.
Highlights
Positive affect and anhedonia are important but challenging targets for mental health treatments
One potential candidate proposed for this purpose is a computerised cognitive training procedure derived from experimental psychopathology research, positive imagery cognitive bias modification (CBM).[8]
For depression (QIDS) and anxiety (GAD-7), the results showed a reduction across all the groups, with medium within-group effect sizes, and the pattern was for greater reduction from pre- to post-training within the treatment as usual (TAU) and cognitive control training (CCT) groups compared with the positive mental imagery training (PMIT) group
Summary
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. 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. Study arms were treatment as usual (TAU), Downloaded from https://www.cambridge.org/core. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Study materials (with the exception of standardised questionnaires available from the provider), original protocol, computer software for the training interventions, anonymous research data and analysis scripts are available at https://osf.io/gm4fw/
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