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BackgroundEnhancing the capacity to experience positive affect could help improve recovery across a range of areas of mental health. Experimental psychopathology research indicates that a computerized cognitive training paradigm involving generation of positive mental imagery can increase state positive affect, and more recent clinical studies have suggested that this training could be used as an adjunct treatment module to target symptoms related to positive affect deficits, specifically anhedonia. The current study investigates the feasibility of adding a positive mental imagery computerized training module to treatment for patients in inpatient mental health settings, with a focus on increasing positive affect and reducing anhedonia. The positive mental imagery training (PMIT) is added to treatment as usual (TAU) in the inpatient setting, and compared to TAU alone, or TAU plus an alternative cognitive training module not hypothesized to increase positive affect, cognitive control training (CCT).MethodsThe study is a feasibility randomized controlled trial with three parallel arms. Up to 90 patients admitted to inpatient mental health treatment clinics in Germany will be randomized to PMIT + TAU, CCT + TAU, or TAU on a 1:1:1 ratio. PMIT or CCT consist of an introductory session followed by up to 8 full training sessions over 2 weeks. All three arms (including TAU) include regular completion of mood measures over the 2-week period. Outcome measures are completed pre and post this 2-week training/monitoring period, and at 2-week follow-up. Data will be presented in the form of both raw means and standardized effect sizes, with 95% confidence intervals, for both intention-to-treat and per-protocol samples.DiscussionThe study will inform feasibility of conducting a fully powered randomized controlled trial investigating the addition of the positive mental imagery training as a treatment adjunct to inpatient treatments for mental health, including potential refinement of study procedures, inclusion/exclusion criteria, and preliminary indications of the likely range of effect sizes.Trial registrationclinicaltrials.gov, NCT02958228 (date registered: 4 November 2016)

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.

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.