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The power of imagination – Breaking through behavioural avoidance in depression with mental imagery

Periodic Reporting for period 1 - MENTAL IMAGERY (The power of imagination – Breaking through behavioural avoidance in depression with mental imagery)

Reporting period: 2016-04-01 to 2018-03-31

Depression is a common psychological disorder and a major public health problem. Although effective treatments for depression exist (e.g. medication, Psychotherapy), about half of the patients with depression do not get better in treatment. Effective interventions for depression such as cognitive-behavioural therapy are associated with long waiting-lists and are costly because they require specialized training of clinicians. This situation calls for the development of cost-effective treatment alternatives that are more accessible.
Depression causes significant suffering for the person who is affected but also for those around them and the society at large. The costs associated with depression are substantial due to direct costs of the disorder (i.e. costs of treatment) as well as indirect costs (e.g. work absence). Developing innovative and accessible interventions for depression has the potential to have a significant impact on the well-being of patients and their significant others (societal impact) which can ultimately contribute to significant reductions in health care costs (economic impact).
The overall objective of this project was to develop and test innovative procedures that might have the potential to help individuals with depression to engage in enjoyable activities. Individuals with depression are often stuck in cycles of low mood, negative thinking and avoidance of activities. One goal of many treatments for depression is to help individuals with depression engage in enjoyable activities. However, a lack of energy, low motivation and a general loss of interest in activities are typical symptoms of depression which make it difficult to achieve this goal. One potential way forward is to develop procedures that more directly promote engagement in potentially enjoyable activities. Previous research has indicated that mentally simulating engagement in a wide range of activities (e.g. exercising) through mental imagery (i.e. seeing with the mind’s eye) can boost engagement in these activities. Testing if mental imagery of engaging in potentially enjoyable activities can increase motivation and engagement in these activities has potential implications for the treatment of depression where the aim is to help patients engage in enjoyable activities.
The research conducted during this fellowship supports the idea that engaging in mental imagery to simulate actions (as if rehearsing them in the mind’s eye) can be used to boost engagement in behavioural actions (in individuals with depression). We have reviewed the literature on mental imagery and depression and argued that imagery based interventions might help to engage individuals with depression in enjoyable activities (Renner & Holmes, 2018). This idea is also supported empirically in the main publication related to this fellowship: Individuals with depression who received a training consisting of engaging in positive future imagery reported higher levels of behavioural activation following the intervention compared to those who were randomized to a control condition (Renner, Ji, Pictet, Holmes, & Blackwell, 2017).
After having presented initial evidence that mental imagery of positive activities leads to increased behavioural activation in individuals with depression the next question was whether and under which conditions a specific behavioural activity can be promoted by positive mental imagery. We have started to explore this question during the fellowship. In an experimental study conducted under the fellowship, individuals with varying levels of depressive symptoms have selected and planned in six activities to engage in over the following week. Participants in a mental imagery condition simulated engagement in the selected activities and the associated positive emotional experiences. The study is currently under consideration for publication and results are promising in demonstrating positive effects of the mental imagery condition compared to control groups.
The research conducted during this fellowship supports the idea that engaging in mental imagery to simulate actions (as if rehearsing them in the mind’s eye) can be used to boost engagement in behavioural actions (in individuals with depression). We have reviewed the literature on mental imagery and depression and argued that imagery based interventions might help to engage individuals with depression in enjoyable activities (Renner & Holmes, 2018). This idea is also supported empirically in the main publication related to this fellowship: Individuals with depression who received a training consisting of engaging in positive future imagery reported higher levels of behavioural activation following the intervention compared to those who were randomized to a control condition (Renner, Ji, Pictet, Holmes, & Blackwell, 2017). (2016)
After having presented initial evidence that mental imagery of positive activities leads to increased behavioural activation in individuals with depression the next question was whether and under which conditions a specific behavioural activity can be promoted by positive mental imagery. We have started to explore this question during the fellowship. In an experimental study conducted under the fellowship, individuals with varying levels of depressive symptoms have selected and planned in six activities to engage in over the following week. Participants in a mental imagery condition simulated engagement in the selected activities and the associated positive emotional experiences. The study is currently under consideration for publication and results are promising in demonstrating positive effects of the mental imagery condition compared to control groups.

Project publications so far

Di Simplicio, M., Renner, F., Blackwell, S. E., Mitchell, H., Stratford, H. J., Watson, P., … Holmes, E. A. (2016). An investigation of mental imagery in bipolar disorder: Exploring “the mind’s eye.” Bipolar Disorders, 18(8). https://doi.org/10.1111/bdi.12453

Renner, F., & Holmes, E. A. (2018). Mental imagery in Cognitive Therapy: Research and examples of imagery-focussed emotion, cognition and behaviour change. In R. L. Leahy (Ed.), Science and Practice in Cognitive Therapy: Foundations, Mechanisms, and Applications. Guilford Press, New York; in press.

Renner, F., Ji, J. L., Pictet, A., Holmes, E. A., & Blackwell, S. E. (2017). Effects of Engaging in Repeated Mental Imagery of Future Positive Events on Behavioural Activation in Individuals with Major Depressive Disorder. Cognitive Therapy and Research, 41(3), 369–380. https://doi.org/10.1007/s10608-016-9776-y