Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults

Abstract

Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work.

Brightening the Day With Flashes of Positive Mental Imagery: A Case Study of an Individual With Depression

“…The positive imagery CBM intervention as implemented in the trial (Blackwell et al., 2015) comprised an initial face‐to‐face introductory session at the research center followed by 12 sessions completed from home over the Internet. Six sessions used audio presentation of training stimuli, in which participants listened to brief descriptions of everyday situations that were structured so that they started ambiguous as to their potential resolution but always ended positively (for example, “As you are getting dressed in the morning, you think about the day ahead.…”

“…(2015), and the reduction to zero of Theresa's anhedonic symptoms. Further, the hypothesised link between the positive imagery and behavioral activation fits with the observation that participants in the positive imagery condition in the trial showed initially greater increases in self‐reported behavioral activation (as measured by the BADS) than those in the control condition (Renner, Ji, Pictet, Holmes, & Blackwell, 2016).…”

“…(2015) and showed marked improvements. It is chosen as an example that illustrates some interesting processes that may contribute to the beneficial effects of a positive imagery CBM intervention, suggesting hypotheses for future research and clinical application.…”

“…Blackwell & Holmes, 2010). In a subsequent randomized controlled trial (RCT), 150 adults with current major depression were randomized to complete either a four‐week positive imagery CBM schedule via the internet or a “sham training” control condition (Blackwell et al., 2015). However, there was no difference between the two conditions in the trial's primary outcome measure, reduction in symptoms of depression.…”

“…(2015) highlighted some of the potential difficulties that may be encountered in the process of clinical translation, they also suggested areas of promise for future research. Exploratory analyses of the trial's “per protocol” sample (i.e., those participants who completed a threshold number of sessions and provided outcome data), found that participants in the positive imagery condition reported a greater reduction in anhedonic symptoms of depression than those in the control condition (Blackwell et al., 2015). …”