A taxonomy of intrusive mental images in clinical disorders: what can "non-veridical" images tell us about the nature of human memory?

Intrusive mental images associated with autobiographical memories or depicting imagined scenes are common in psychological disorders. Although there is a growing body of literature on their contribution to psychopathology and their role in therapy, to date there have been limited attempts to categorise the different types of images that patients experience. In this article, we present a taxonomy which ranges from veridical to non-veridical intrusive images. We highlight the fact that many types of images consist of a blend of veridical and imagined details. After presenting some of the main explanations for the existence of blended and non-veridical images, we reflect on what the evidence on the content and origin of intrusive images tells us about the nature of human memory. We argue that it supports the idea of memory being constructive and briefly discuss what this means for clinical and non-clinical settings in which intrusive images have to be evaluated and used.

The Relationship Between Adult Attachment and Complicated Grief: A Systematic Review.

Attachment insecurity, including attachment anxiety and attachment avoidance, is proposed as a key factor disrupting adaptive recovery following bereavement, resulting in complicated grief. However, findings are inconsistent across studies. This review aimed to synthesise existing research on attachment patterns in adults experiencing complicated grief to better understand this relationship. 22 cross-sectional and longitudinal studies (5149 participants), published between 2003 and 2020, met inclusion criteria. Higher levels of attachment anxiety were consistently associated with symptoms of complicated grief. Higher levels of attachment avoidance were associated with symptoms of complicated grief, although this relationship was less consistent. The review has implications for clinical practice as bereaved adults with insecure attachment histories may be particularly vulnerable to experiencing complicated grief. The research is limited by the reliance on mainly cross-sectional studies. Future research should focus on longitudinal studies, and studies that explore men's experiences, and of individuals living in non-Western countries.

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes.

BACKGROUND: Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base. AIMS: This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions - memory characteristics and self-representations - and level of paranoia. METHOD: We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data. RESULTS: As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS: While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

Impact of imagery rescripting on adverse self-defining memories and post-recall working selves in a non-clinical sample: a pilot study.

Imagery rescripting (ImRS) effectively targets intrusive images and symptoms in a number of disorders, but the mechanisms of change behind it are not yet clear. This study investigated the impact of ImRS on the characteristics of adverse self-defining memories and post-recall working selves in a non-clinical sample. In the first session, participants recalled an adverse memory and completed state self and affect measures. Then they attended an ImRS session and a follow-up session one week later. Participants rated their memory as less negative, less distressing and less important for their sense of self at follow-up compared to the first session. They also reported higher state self-esteem and positive affect, as well as reduced negative affect and anxiety after recalling the memory. Results suggest that, by modifying the meaning of adverse memories, ImRS may facilitate their integration with individuals' sense of self and reduce the negative impact that they have on individuals' online representation of the self when retrieved. An implication of these findings is that cognitive-behavioural therapy may need to conceptualise the self in broader terms, moving beyond core beliefs. To complement this, research could focus on changes in patients' sense of self in order to understand the mechanisms through which interventions like ImRS work.

The retrieval of self-defining memories is associated with the activation of specific working selves.

This article presents two studies that investigated the impact of the retrieval of self-defining memories on individuals' sense of self. Participants recalled positive and/or negative self-defining memories, rated memory characteristics and completed measures focusing on different self-aspects. Study 1 found that participants reported higher state self-esteem after recalling a positive memory than after recalling a negative one. They also reported lower negative self-consistency and higher state self-concept clarity and positive self-consistency, but this result became non-significant after controlling for state self-esteem. Study 2 found that participants reported higher state self-esteem, a marginally higher proportion of recreation/exploration, goals and a marginally lower proportion of achievement goals after recalling a positive memory than after recalling a negative one. They also reported a higher proportion of self-cognitions referring to emotional states after recalling memories from which they had not abstracted meaning than after recalling memories from which they had done this. These findings suggest that the retrieval of vivid, emotional and highly self-relevant memories may be accompanied by the activation of specific self-representations or working selves. They also suggest that the experience of memory-related intrusive images may temporarily influence individuals' sense of self. The implications of these findings for clinical practice are discussed.

Cognitive control processes in paranoia: the impact of threat induction on strategic cognition and self-focused attention.

BACKGROUND: Current clinical models emphasize certain cognitive processes in the maintenance of distressing paranoia. While a number of these processes have been examined in detail, the role of strategic cognition and self-focused attention remain under-researched. AIMS: This study examined the deployment of cognitive strategies and self-focused attention in people with non-clinical paranoia. METHOD: An experimental design was used to examine the impact of a threat activation task on these processes, in participants with high and low non-clinical paranoia. Twenty-eight people were recruited to each group, and completed measures of anxiety, paranoid cognition, strategic cognition and self-focused attention. RESULTS: The threat activation task was effective in increasing anxiety in people with high and low non-clinical paranoia. The high paranoia group experienced more paranoid cognitions following threat activation. This group also reported greater use of thought suppression, punishment and worry, and less use of social control strategies when under threat. No differences were found between the groups on measures of self-focused attention. CONCLUSIONS: This study shows that the threat activation task increased anxiety in people with high non-clinical paranoia, leading to increased paranoid thinking. The use of strategic cognition following threat activation varied dependent on level of non-clinical paranoia. If these differences are replicated in clinical groups, the strategies may be implicated in the maintenance of distressing psychosis, and may therefore be a valuable target for therapeutic intervention.

The influence of age on emotion regulation strategies and psychological distress.

BACKGROUND: To date there is promising, yet limited, evidence to suggest that differences exist between older and younger adults' emotion regulation styles. AIMS: The study aimed to explore emotion regulation style across the adult lifespan by assessing whether self-reported reappraisal, or suppression, differs across age groups, and how these emotion regulation strategies may impact upon psychological distress. METHOD: Three hundred and seventeen younger, 175 middle-aged and 85 older adults' emotion regulation styles and levels of psychological distress were measured using self-report questionnaires and examined using a cross-sectional design. RESULTS: The findings suggest that, compared to younger adults, older adults make greater use of suppression, the emotion regulation strategy. This greater use of suppression by older adults was not related to increased levels of psychological distress. By contrast, younger adults who reported high levels of suppression reported higher levels of psychological distress. In addition, older adults reported less anxiety and stress than younger adults, with no age differences in depression. CONCLUSIONS: Findings suggest a possible decoupling of the use of emotional suppression and psychological distress with age. Suppression may be a useful form of emotion regulation for the stressors experienced in later life and, arguably, therefore may not be associated with the negative outcomes observed in younger adults.

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives.

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Images of the self and self-esteem: do positive self-images improve self-esteem in social anxiety?

Negative self-images play an important role in maintaining social anxiety disorder. We propose that these images represent the working self in a Self-Memory System that regulates retrieval of self-relevant information in particular situations. Self-esteem, one aspect of the working self, comprises explicit (conscious) and implicit (automatic) components. Implicit self-esteem reflects an automatic evaluative bias towards the self that is normally positive, but is reduced in socially anxious individuals. Forty-four high and 44 low socially anxious participants generated either a positive or a negative self-image and then completed measures of implicit and explicit self-esteem. Participants who held a negative self-image in mind reported lower implicit and explicit positive self-esteem, and higher explicit negative self-esteem than participants holding a positive image in mind, irrespective of social anxiety group. We then tested whether positive self-images protected high and low socially anxious individuals equally well against the threat to explicit self-esteem posed by social exclusion in a virtual ball toss game (Cyberball). We failed to find a predicted interaction between social anxiety and image condition. Instead, all participants holding positive self-images reported higher levels of explicit self-esteem after Cyberball than those holding negative self-images. Deliberate retrieval of positive self-images appears to facilitate access to a healthy positive implicit bias, as well as improving explicit self-esteem, whereas deliberate retrieval of negative self-images does the opposite. This is consistent with the idea that negative self-images may have a causal, as well as a maintaining, role in social anxiety disorder.

Views and experiences of compassion in Sri Lankan students: An exploratory qualitative study.

Practicing compassion has shown to reduce distress and increase emotional well-being in clinical and non-clinical populations. The existing research is primarily focused on Western populations although the concepts of compassion are heavily influenced by Asian Buddhist views. There is a dearth of compassion research conducted particularly in the Asian context. Therefore, this study aimed to explore the views and lived experiences of compassion in Sri Lankan students, to understand whether compassion is a socially embraced construct in Sri Lanka, considering that Sri Lanka is a Buddhist influenced society. Participants' views and lived experiences of compassion towards themselves and to/from others were also investigated, with a specific focus on their perceived inhibitors and facilitators of compassion. Aims were set to identify whether Western compassion-based practices could be successfully applied to Asian societies such as Sri Lanka. An Interpretative Phenomenological Analysis approach was used to obtain and analyse qualitative data from a convenience sample of 10 Sri Lankan students, recruited from a Psychology course. The phenomenological analysis of the semi-structured face-to-face interviews elicited three predominant themes: What compassion means to me, what I make of it, and compassion through facilitators and inhibitors. The findings suggested that participants shared a similar understanding of the concept of compassion as reflected in the Western definitions. Experiences and views of compassion were shaped by several factors including religion, culture, society, and upbringing. In general, this study revealed that participants were well aware of the concept of compassion as well as its impact on their psychological well-being. Despite this, inhibitors existed in experiencing compassion. The religious and collectivistic-cultural influences need to be further explored and taken into account when implementing Western compassion-based practices to non-Western contexts such as Sri Lanka.

The effect of attachment security priming and oxytocin on physiological responses to trauma films and subsequent intrusions.

To further understand protective mechanisms to prevent post-traumatic stress disorder or assist recovery from psychological trauma, this study investigated whether pharmacological and psychological activation of a secure attachment representation elicits higher felt-security and a related response pattern of reduced physiological arousal and increased parasympathetic activation; and whether it protects individuals from developing intrusions and experiencing distress in the week following exposure to a trauma film. Using a double-blind, experimental mixed factorial design, 101 volunteers received either oxytocin or placebo and either secure attachment or neutral priming before watching a trauma film. We measured felt security as an indicator of the strength of activation of a secure attachment representation, skin conductance and heart rate as indicators of physiological arousal, and high frequency heart rate variability as an indicator of parasympathetic activation during the priming and the film. Participants then completed a seven-day intrusion diary. Secure attachment priming, but not oxytocin administration or the combination of both, was associated with reduced physiological arousal and increased parasympathetic activity during priming. Although secure attachment priming was not related to the absolute number of intrusions or to less perceived distress or physiological arousal during the trauma film, it was associated with lower intrusion-related distress in the 7-days post-testing. Our findings extend previous research that suggests the importance of interventions that address intrusion-related distress for recovery from trauma, and suggest a promising role for secure attachment priming in trauma-focused psychological therapies. We contribute to the growing literature that finds that higher subjective distress during a trauma is associated with higher intrusion-related distress. We discuss theoretical implications and possible mechanisms through which secure attachment priming may exert potential beneficial effects.

Why is the self important in understanding and treating social phobia?

Current cognitive models of social phobia all agree that the self plays a key maintaining role in the disorder. However, all of these models use a relatively limited conceptualisation of the self. The author proposes a tripartite approach in which theories of the self are grouped into three broad categories: content, structure, and process. Content refers to knowledge and information about the self, structure to the way that information is organised, and process to the ways in which individuals attend to and regulate the self. Structure has been largely neglected to date, and the author outlines ways in which the structural organisation of self-knowledge could contribute to social anxiety. High social anxiety is associated with low clarity about the self and with more uncertainty about self-judgments. Structure interacts with content, and in the final part of the article potential interactions among imagery, self-concept, and self-structure are discussed.

Expert viewpoints of peer support for people experiencing homelessness: A Q sort study.

Peers have shared experiences of phenomena such as mental illness, addiction, and homelessness. Homelessness services are increasingly utilizing peers in their models to support people experiencing homelessness. While there is extensive literature on peer support in general, few studies focus on the potential change mechanisms that might underpin this intervention, particularly regarding homelessness. This study aims to utilize expert opinions to identify common viewpoints on components involved in effective peer support. Forty-three statements were developed from previous literature that broadly describes elements involved in peer support. Forty experts (20 peers and 20 professionals) ranked the statements into a hierarchy. Q methodology is a rigorous method to objectively research participants' subjective viewpoints, using a by-person rather than by-variable approach to factor analysis. The study was done in three stages: first-order analysis to identify shared viewpoints within (a) the peer participant group, (b) the professional participant group, and (c) a second-order analysis of Stage 1 and 2 results to identify common viewpoints held across participant groups. Stage 3 analysis resulted in three differing viewpoints; the dominant viewpoint asserts that effective peer support is rooted in experiential knowledge, where peers build unique, trusting relationships to provide clients with a different level of support. The results highlighted different types of peer support and defined a new one: a unidirectional, mentorship type of intentional peer support. Strengths and limitations are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Private and public self-awareness in social anxiety.

Clark and Wells' [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.

The looming maladaptive style in social anxiety.

This exploratory study examined the relationship between the looming maladaptive style (i.e., an enduring and traitlike cognitive pattern to appraise threat as rapidly rising in risk, progressively worsening, or actively speeding up and accelerating) and three different aspects of trait social anxiety (i.e., fear of negative evaluation, social interaction anxiety, and public scrutiny fears) as well as general anxiety and depression. A large nonclinical, female-only sample (n=152) completed the Looming Maladaptive Style Questionnaire-II (Riskind, J. H., Williams, N. L., Theodore, L. G., Chrosniak, L. D., & Cortina, J. M. (2000). The looming maladaptive style: Anxiety, danger, and schematic processing. Journal of Personality and Social Psychology, 79, 837-852), which assesses two types of looming vulnerability: social (i.e., looming appraisals in response to potentially threatening social situations) and physical (i.e., looming appraisals in response to potentially threatening physical stimuli). Multiple regression analyses indicated that social looming uniquely predicted fear of negative evaluation, social interaction anxiety, and public scrutiny fears, accounting for 7%, 4%, and 3% of the variance, respectively. However, social looming did not predict depression. These findings support the looming model of anxiety and encourage further attention to the possible role of social looming as an anxiety-specific vulnerability factor in social anxiety.

The impact of self-imagery on aspects of the self-concept in individuals with high levels of eating disorder cognitions.

BACKGROUND AND OBJECTIVES: Low self-esteem has been identified as a maintaining factor in Cognitive Behavioural models of eating disorders and links have been identified between early memories, negative core beliefs and mental imagery. This study explored the impact of positive and negative self-imagery on aspects of the working self (implicit and explicit self-esteem, self-concept clarity and self-discrepancy) and affect. METHODS: Participants with high levels of eating disorder cognitions completed measures of explicit self-esteem, self-concept clarity, self-discrepancy and affect prior to completing a positive or negative self-imagery retrieval task. Baseline measures were then repeated and a measure of implicit self-esteem completed. RESULTS: Positive self-imagery retrieval led to a significant increase in positive explicit self-esteem and a significant reduction in negative explicit self-esteem and actual-ideal self-discrepancies. Negative self-imagery retrieval led to a significant increase in negative explicit self-esteem and actual-ideal self-discrepancies and a significant reduction in positive explicit self-esteem. Levels of implicit self-esteem did not differ between the two groups post imagery manipulation. Retrieving a positive self-image also led to an improvement in state self-concept clarity; however, no effect was found for the negative self-imagery intervention. Holding a positive self-image in mind led to an increase in state positive affect and a reduction in state negative affect. The opposite was found for negative self-image retrieval. LIMITATIONS: The study did not measure implicit self-esteem at baseline. CONCLUSIONS: Imagery techniques that involve the retrieval of a positive self-image may help to improve aspects of the working-self and affect in those with eating difficulties.

Post-event processing in social anxiety.

Clark and Wells' [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.

The spotlight effect and the illusion of transparency in social anxiety.

[Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In: R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 69-93). New York: Guildford Press] cognitive model of social phobia suggests that both public and private sources of information contribute to the construction of the self as a social object, which is thought to maintain the disorder. This study used two concepts developed in social psychology that might help to explain the processes that contribute to the development of this constructed self. These two concepts are the spotlight effect [Gilovich, T., Medvec, V. H., & Savitsky, K. (2000). The spotlight effect in social judgment: an egocentric bias in estimates of the salience of one's own actions and appearance. Journal of Personality and Social Psychology, 78(2), 211-222] and the illusion of transparency [Gilovich, T., Medvec, V. H., & Savitsky, K. (1998). The Illusion of transparency: biased assessments of others' ability to read one's own emotional states. Journal of personality and social psychology, 75(2), 332-346]. Participants performed a memory task under either a low or a high social-evaluative condition. In the high social-evaluative condition, participants reported higher levels of the spotlight effect and more negative evaluation of task performance, compared to participants in the low social-evaluative condition. There were no differences between the two conditions in levels of the illusion of transparency. Surprisingly, however, in the low social-evaluative condition, participants reported higher levels of the illusion of transparency than the spotlight effect, whereas, in the high social-evaluative condition, they reported the opposite. Results suggest that the spotlight effect may be specific to social-evaluative concerns, whereas, the illusion of transparency may represent more general features of social anxiety concerns. Implications of the results for Clark and Wells' cognitive model of social phobia model are discussed.

Images of the self in social anxiety: effects on the retrieval of autobiographical memories.

Cognitive models of social phobia propose that negative self-images play an important role in maintaining anxiety. This study examines the effect of holding a positive or a negative image in mind during a speech on the retrieval of autobiographical memories. Twenty high socially anxious participants performed a standard autobiographical memory task (AMT), which used positive, negative and neutral cue words. Participants performed the AMT twice: once after giving a speech holding a positive image and once while holding a negative image. Participants were more anxious and rated their performance worse in the negative image condition. Negative memories were retrieved faster in the negative image condition and positive memories were retrieved faster in the positive image condition. In the negative image condition, positive memories were retrieved more slowly than either negative or neutral memories. Inhibition and facilitation are proposed as two processes that could explain the effects of differently valenced imagery on autobiographical memory. The clear evidence for an inhibitory effect on positive autobiographical memories in the negative imagery condition is considered in relation to Brewin's [(2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765-784] retrieval competition hypothesis. The paper concludes with a brief discussion of the potential role of inhibition in imagery rescripting.

Implicit views of the self in social anxiety.

We investigated dysfunctional attitudes in high (N=29) and low (N=28) socially anxious participants following a social-threat activation task (being told to give a speech) using the implicit association task (IAT: [Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association task. Journal of Personality and Social Psychology, 74, 1464-1480]) and the Social Attitudes Questionnaire (SAQ: [Clark, D. M. (2001). Social Attitudes Questionnaire, revised. Unpublished manuscript, University of Oxford]). The study also looked at anticipatory thoughts about the speech using questionnaire (Social Cognitions Questionnaire (SCQ): [Wells, Stopa, & Clark (1993). The social cognitions questionnaire. Unpublished]) and think aloud methods. High socially anxious participants endorsed more negative attitudes on the SAQ. In the IAT both groups showed a bias towards associating positive words with self and negative words with other but this was weaker in the high socially anxious group than in the low. The high socially anxious group endorsed more negative thoughts about the speech on the SCQ, believed these thoughts more, and had more thoughts overall on the think-aloud task. There were no differences between the groups on the think-aloud task, but there was an interaction between level of depressive symptoms and thought valence. The results are considered in relation to other studies that have used an IAT to measure associations in social anxiety and in relation to Clark and Wells' [(1995). A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope, & F. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment. New York: Guilford] model of social phobia.