Computerized positive mental imagery training versus cognitive control training versus treatment as usual in inpatient mental health settings: study protocol for a randomized controlled feasibility trial

Abstract

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)

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

“…The study was prospectively registered (Clinicaltrials.gov identifier NCT02958228) and the protocol was submitted for publication when recruitment was ongoing. 7 There were no substantial changes to methods after trial commencement (…”

“…The CCT was an adaptive Paced Auditory Serial Addition Test, adapted from that implemented in several studies investigating CCT in the context of depression and rumination. 13,14,19 Participants were presented via headphones with a continuous stream of digits (1)(2)(3)(4)(5)(6)(7)(8)(9), and asked to calculate the sum of the last two digits heard by clicking a corresponding button on the screen (1-18). The task difficulty was adaptive to participants' performance, in that each session started with an interstimulus interval (ISI) of 3000 ms, and this was reduced by 100 ms following four consecutive correct responses or increased by 100 ms following four consecutive incorrect responses.…”

State Anhedonia in Young Healthy Adults: Psychometric Properties of the German Dimensional Anhedonia Rating Scale (DARS) and Effects of the COVID-19 Pandemic

“…We applied the original 17-item version of the DARS (Rizvi et al, 2015 ) in a German translation by selecting only those items from an extended 26-item version which has been translated to German at the Ruhr-Universität Bochum, Germany, in conjunction with the scale authors (Blackwell et al, 2018 ). The DARS is rated on a five-point Likert scale from 0 (not at all) to 4 (very much), higher values indicating less anhedonia.…”

Positive imagery cognitive bias modification for symptoms of depression among university students in Pakistan: A pilot study

“…Breaks were self-paced and comprised two screens. The first reminded participants of the task instructions, and the second provided visual feedback on their vividness ratings (as in Blackwell et al, 2018). The visual feedback comprised a graph showing, for each block completed so far that session, their mean, minimum, and maximum vividness ratings.…”