Mediating effect of coping dispositions on the association between trauma and gastrointestinal symptoms.

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two gastrointestinal (GI) conditions known to be exacerbated by traumatic life experiences. One way in which these experiences might influence individuals' susceptibility to GI pathology, is by reducing their ability to deal with adversities effectively and predisposing them to passive coping styles that leave them vulnerable to the somatic effects of trauma. To validate this hypothesis, the present cross-sectional study assessed the mediating effect of coping dispositions on the association between trauma and GI disease activity in an adult sample of 189 bowel patients (94 IBD, 95 IBS) and 92 controls. Results confirmed that GI patients exhibit significantly more cumulative trauma, pervasive feelings of uncontrollability and passive coping strategies than controls. Moreover, the use of passive coping styles was positively associated with the accumulation of trauma and the expression of GI symptoms. Using hierarchical regression and mediation analyses, we found support for the sequential model postulating passive coping styles as (partial) mediators of trauma-induced (GI) disease manifestations. Specifically, out of all coping styles associated with cumulative trauma, behavioural disengagement most powerfully mediated the effect of trauma on GI symptom severity, accounting for 12% (IBD) to 14% (IBS) of its total effect. A somewhat smaller mediating role was observed for social support coping, the reduced reliance on which explained 7% (IBS) to 10% (IBD) of trauma's total effect. Finally, neuroticism acted as a channel through which past traumatization affected subjects' proneness to behavioural disengagement and, consequently, their GI disease activity.

Itsy bitsy spider: Fear and avoidance (generalization) in a free-exploratory virtual reality paradigm.

Most experimental avoidance paradigms lack either control over the experimental situation or simplify real-life avoidance behavior to a great extent, making it difficult to generalize the results to the complex approach-avoidance situations that anxious individuals face in daily life. The current study aimed to examine the usability of our recently developed free-exploratory avoidance paradigm in Virtual Reality (VR) that allows for the assessment of subjective as well as behavioral avoidance in participants with varying levels of spider fear. In a VR escape room, participants searched for cues to decipher a code-locked door. Opening a wooden box marked with a post-it note (conditioned stimulus, CS) resulted in exposure to a virtual crawling spider (unconditioned stimulus, US). Avoidance of the original CS and other objects marked with the CS (generalization stimuli, GSs; EXPgen condition) or non-marked (CONT condition) objects was measured via questionnaires and relative manipulation times in a novel room. We expected a positive linear relationship between US aversiveness (levels of spider fear) and (generalization of) fear and avoidance behaviors. Avoidance learning and generalization was demonstrated on both a subjective and behavioral level. Higher levels of spider fear were, overall, related to more negative emotions in response to the encounter with the spider, higher US expectancies for the GSs, and more self-reported and behavioral avoidance of the original CS and the GSs. Finally, we explored relationships between trait anxiety and intolerance of uncertainty and fear and avoidance (generalization), but no robust associations were observed. In conclusion, we confirmed the expected positive linear relationship between spider fear and (generalization of) fear and avoidance behaviors. Our results suggest that our free-exploratory VR avoidance paradigm is well-suited to investigate avoidance behaviors and the generalization of avoidance.

Food rejection and the relation with category-based induction and memory in young children.

BACKGROUND: Childhood rejection of fruits and vegetables (F/V) has been associated with an immature food categorization system, characterized by difficulties in accurately categorizing and making inductions about foods. This may result in variations in the kind of category-based induction children use, such as relying on the color of a fruit/vegetable. Research indicates that children who reject food frequently tend to prioritize perceptual features like color and shape over abstract features, such as the type of food (e.g., tomato) when making food-related inductions. The way children categorize food can also impact what they remember about foods. Food rejection may therefore be related to better memory for perceptual features and diminished memory for abstract features. To explore this further, a pre-registered study was conducted to examine how category-based induction and memory relate to each other, and to children's food rejection. METHODS: 107 children aged 4-6 years old performed a category-based induction and memory task related to F/V, based on color and shape (perceptual features), and type of food (abstract feature). A vegetable photo task measured vegetable acceptance, and parents completed the Child Food Rejection Scale (CFRS). RESULTS: Children generally used color-based induction and displayed better memory for F/V color. Performance on the two tasks was related: higher type-based induction for F/V was linked to better memory for the type of F/V. However, there were no associations found with food rejection. CONCLUSION: Which category young children use for inductive reasoning about food, is related to what they remember best about food. Nevertheless, our study did not establish a relationship between an immature food categorization system and food rejection. Other factors, such as food familiarity, might play a stronger role in children's food acceptance.

The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.

Choice-induced tasting. Evaluating the effect of choice on children's acceptance of an unfamiliar vegetable.

Children's vegetable intake is in general below recommendations. It is known that self-selection of vegetables out of multiple options can increase intake in children. However, it is not clear if this effect is driven by a pre-existing preference for the selected food, or purely by having a choice. Allowing children to choose could create a positive bias and endorse feelings of autonomy, which could increase acceptance of the food and promote intake. The aim of the present pre-registered study was to investigate the effect of choice in promoting the acceptance of an unfamiliar vegetable during a blind-choice task. Children aged 4-5 years old (n = 161) were randomly assigned to the choice or no-choice condition. Each child was presented with three closed cups, containing a vegetable. The children were unaware that the cups contained the same vegetable, a piece of raw celeriac. In the choice condition, the children were able to choose a cup themselves whereas in the no-choice condition, the experimenter made the decision. We hypothesized that children in the choice condition would show more acceptance of the vegetable compared to children in the no-choice condition and that higher levels of picky eating would lead to less vegetable acceptance. The results demonstrated that choice indeed significantly increased vegetable acceptance (4.7 ± 1.7 versus 4.0 ± 1.9 on a 6-point scale), irrespective of pickiness in eating. In addition, picky children showed less acceptance of the vegetable compared to non-picky children. The results of this study imply that choice is an important factor in promoting unfamiliar vegetable intake in young children. Including children in the decision process may be a practical strategy for educators and caregivers to increase children's vegetable intake.

Should cognitive restructuring precede imagery rescripting? An experimental pilot study.

BACKGROUND AND OBJECTIVES: Imagery rescripting (ImRs) is a promising therapeutic technique used in treatment for a variety of psychiatric disorders. During an ImRs session, an aversive disorder-related memory, is activated in imagination and rescripted to a more positive outcome. It has been shown to successfully weaken the negative cognitive meaning, so-called encapsulated beliefs of the targeted aversive memory. In many studies, ImRs is preceded by a cognitive restructuring (CR) technique focused on the encapsulated belief of the target memory. It is not clear whether adding such a CR technique is necessary or that ImRs as standalone technique can achieve comparable effects. METHODS: Students with mild psychological distress (N = 53) were randomized over one session of cognitive restructuring plus imagery rescripting (CR + ImRs), a therapist attention placebo plus imagery rescripting (PLA + ImRs) and a double therapist attention placebo (PLA + PLA). Believability of the idiosyncratic encapsulated belief (primary outcome) and quality (vividness, distress and emotional connotation: secondary outcome) of the target memory were assessed at pre, post and at 1-week follow-up. RESULTS: Results indicate that both, CR + ImRs and PLA + ImRs, reduced the believability of the encapsulated beliefs in greater extent than PLA + PLA. No differences appeared between the two ImRs conditions. For the secondary outcomes no differences between the three conditions were found. LIMITATIONS: This study should be seen as a pilot study, moreover a non-clinical sample was used. CONCLUSION: Findings suggest that a CR technique preceding ImRs is redundant. However, this study needs replication in a larger sample.

Examining the effect of stress on the flexible updating of avoidance responses.

Acute stress has been found to impair the flexible updating of stimulus - outcome associations. However, there is a lack of studies investigating the effect of acute stress on the flexible updating of stimulus-response associations, like active avoidance responses. The current study used an avoidance reversal learning paradigm to address this question. Sixty-one participants learned that a red dot was associated with an aversive sound, whereas a green dot was not (Pavlovian Acquisition phase). Next, they were trained to avoid the aversive stimulus by selectively pressing a button in response to the red, but not the green, dot (Avoidance Acquisition phase). Subsequently, participants either underwent a stress induction task or a no-stress control task. The flexible updating of expectancies of the US and avoidance responses were assessed after reversal of the original contingencies (Reversal Test). Acute stress did not impair the flexible updating of avoidance responses during the Reversal Test. In contrast, results showed that in the stress group the expectancies of the aversive sound were more in accordance with the reversed contingencies compared to the ratings of control participants. Additionally, cortisol responders avoided less often in comparison to cortisol non-responders. Increased noradrenergic activity in stressed participants was related to impairments in the flexible updating of avoidance responses after contingency reversal, while this association was absent in the control participants. In conclusion, our results suggest that the autonomic response might account for shifting the balance toward inflexible updating of stimulus-outcome awareness while stress does not impair flexible updating of avoidance responses.

Impact of the COVID-19 pandemic on inflammatory bowel disease: The role of emotional stress and social isolation.

Inflammatory bowel disease (IBD) is a chronic health condition exacerbated by negative emotional stress experiences. In the current study, we examined whether the outbreak of the COVID-19 pandemic coincided with an increase in stress experiences and accordingly an aggravation of disease activity in IBD patients. Sixty-three IBD patients (30 Crohn's disease or CD, 33 ulcerative colitis) completed an online survey during the COVID-19-related lockdown, assessing clinical disease activity, disease-related quality of life, presence of functional gastrointestinal symptoms, social isolation and stress experiences. Scores were then compared to pre-lockdown baseline screening. The pandemic yielded a significant baseline-to-lockdown increase in emotional stress and social isolation. Stress increments, particularly those occasioned by interpersonal tension and excessive interpersonal proximity, were associated with a worsening of functional gastrointestinal symptoms. Exacerbations of loneliness coincided with an escalation of CD activity, functional gastrointestinal symptoms and a decline in subjective health. Lastly, COVID-19 anxiety was significantly related to CD symptom severity and social dysfunction. The findings show that shifts in IBD expression are closely linked to changes in emotional stress experiences and interpersonal relatedness. As such, they contribute to a better understanding of inter-individual differences in IBD progression and provide leads for therapeutic interventions.

Overgeneralization of fear, but not avoidance, following acute stress.

Research has demonstrated the spreading of fear from threat-related stimuli to perceptually similar, but innocuous, stimuli. Less is known, however, about the generalization of avoidance behavior. Given that stress is known to affect learning and memory, we were interested in the effect of acute stress on (over)generalization of fear and avoidance responses. On the first day, one geometrical shape was paired with a mild electrical stimulus (CS+), whereas another shape was not (CS-). One day later, after participants had been exposed to the Maastricht Acute Stress Test or a control task, generalization of avoidance responses and fear (shock expectancy and skin conductance responses) was tested to a range of perceptual generalization stimuli. Generalization gradients were observed across different outcome measures. Stress enhanced generalization of shock expectancy to the stimulus most similar to the CS+. Our findings confirm that stress can affect the generalization of fear, but further studies are warranted.

Filthy fruit! Confirmation bias and novel food.

Fruit and vegetable consumption is worldwide too low, resulting in poor diet quality and health-related problems. A cognitive factor that might contribute to this low consumption is confirmation bias. Confirmation bias has been established in anxiety research and comprises the tendency to search for reinforcing negative information, while ignoring counter attitudinal information. If applicable to food, asking for negative food information reinforces the negative attitude and decreases the willingness to try (novel) food. The aim of the current study was twofold. First, to examine if confirmation bias translates to food stimuli. Second, to investigate if this bias is exaggerated in persons with higher levels of food neophobia. To this end, 117 participants (age M = 21.45, SD = 4.48) carried out an online study. They filled in the food neophobia scale (FNS) and performed a search for additional information scale (SAIS) task. Four novel fruits were used, two looking tasteful (pomelo and rose apple) and two looking non-tasteful (black sapote and noni fruit). Participants rated their willingness to eat these fruits and subsequently could indicate how eager they were to receive positive or negative information regarding that fruit. The results indicated that the participants were more willing to try the tasteful looking fruits than the non-tasteful. Additionally, higher levels of food neophobia coincided with less willingness to eat all fruits. Confirmation bias was observed, more negative information was requested for the non-tasteful than for the tasteful fruits. This bias was not related to levels of food neophobia. These results are important as confirmation bias might make people even more negative towards novel foods and could contribute to even less fruit and vegetable consumption, especially when they look less appetizing.

A novel virtual reality paradigm: Predictors for stress-related intrusions and avoidance behavior.

BACKGROUND AND OBJECTIVES: Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops a stress-related disorder. To examine risk factors for the development of stress-related symptoms, such as intrusions and avoidance, analogue trauma studies are necessary. The often-used trauma film paradigm has proven to be valuable to examine intrusions, but inherently to its technique is less suitable for assessing behavioral avoidance, a core symptom of stress-related disorders. The aim of the present study was twofold, first to further develop an analogue that explicitly addresses behavioral avoidance and second, to link previously-established risk factors for the development of stress-related symptoms. METHOD: Eighty-two healthy participants were subjected to a trauma induction using virtual reality (VR). At follow-up, participants were placed in a similar VR environment and could approach or avoid the trauma-scene, a trauma-related scene or a neutral, unrelated scene. Several pre- and peri-trauma risk factors were measured. RESULTS: The VR paradigm increased negative mood and heart rate, decreased positive mood and heart rate variability, and resulted in stress-related symptoms as trauma-related thoughts and beliefs, intrusions and avoidance behavior. The most prominent risk factors that contributed to the stress-related symptoms were negative emotions during the trauma induction, trait anxiety, and avoidant coping strategies. LIMITATIONS: The stress-related symptoms were mild, resulting in a vast amount of participants without intrusions and limited avoidance behavior. CONCLUSION: The current VR paradigm can elicit stress-related symptoms, including avoidance; risk factors contributing to these symptoms were similar to those observed in clinical research, indicating the potential of the general set up.

Renewal of conditioned fear responses using a film clip as the aversive unconditioned stimulus.

BACKGROUND AND OBJECTIVES: Pavlovian fear conditioning paradigms are valuable to investigate fear learning and the return of extinguished fear in the lab. However, their validity is limited, because the aversive stimuli (e.g., electric shocks) typically lack the modalities and complexity of real-world aversive experiences. To overcome this limitation, we examined fear acquisition, extinction and contextual renewal using an audiovisual unconditioned stimulus (US). METHOD: On day 1, 50 healthy participants completed an acquisition phase in a specific context (i.e., desk or bookcase, 'context A'). Pictures of colored lamps served as conditioned stimuli and an aversive film clip was used as US. On day 2, extinction took place in the same context ('context A') or in a different context ('context B'). Afterwards, renewal was tested in the acquisition context (AAA vs. ABA design). RESULTS: As hypothesized, fear acquisition and extinction, as measured by US expectancy ratings, fear potentiated startle (FPS), and skin conductance responses (SCRs), were successful. Most importantly, conditioned responding was renewed on all measures in the ABA condition, but not in the AAA condition. Differential renewal (i.e., larger renewal for CS + than for CS-) was only observed for US expectancy ratings. LIMITATIONS: The return of conditioned responses was non-differential for FPS and SCR. CONCLUSIONS: The current set-up enables investigation of fear renewal using an audiovisual US. Future studies can utilize this paradigm to investigate interventions that aim to reduce fear renewal by modifying the US memory, such as Eye Movement Desensitization and Reprocessing and imagery rescripting.

Interpretation bias in the face of pain: a discriminatory fear conditioning approach.

Background and aims Interpreting pain- and illness-related stimuli as health-threatening is common among chronic pain patients but also occurs in the general population. As interpretation bias (IB) may affect pain perception and might even play part in the development and maintenance of chronic pain, it is important to improve our understanding of this concept. Several studies suggest an association between IB and pain-related anxiety. However, those studies often rely on verbal and pictorial IB tasks that do not entail a threat of actual pain, therefore lacking personal relevance for healthy participants. The current study investigated whether healthy individuals show an IB towards ambiguous health-related stimuli in a context of actual pain threat, and explored whether this bias is associated to pain anxiety constructs. Methods Thirty-six healthy participants were conditioned to expect painful electrocutaneous shocks (unconditioned stimulus - US) after health-threat words (CS+) but not after neutral (non-health-threat) words (CS-) in order to establish fear of pain. Subsequently, they completed a verbal interpretation task that contained new CS+ and CS- stimuli as well as ambiguous non-reinforced health-threat and non-health-threat words. IB was assessed through shock expectancy ratings and startle responses to ambiguous and evident health threatening or neutral word stimuli. Pain-related anxiety was measured with validated questionnaires. Results The results show a general IB towards ambiguous health-related words on pain expectancies but not on startle response. An exploratory analysis suggests that this effect exists irrespective of pain-related anxiety levels which however may be due to a lack of power. Conclusion We present a novel experimental paradigm employing actual health threat that captures IB towards health-related stimuli in healthy individuals. Taken together, results provide evidence for the further consideration of IB as a latent vulnerability factor in the onset and maintenance of pain chronicity. In contrast to previous studies employing a safe, pain-free context, we found that healthy participants show an IB towards ambiguous health-related stimuli, when confronted with pain threat. Implications Like chronic pain patients, healthy individuals display an IB towards health-threat stimuli when these stimuli become personally relevant by carrying information about pending health threat. Therefore, the presented paradigm could be valuable for pain-related cognitive bias research in healthy participants as it may have a higher ecological validity than previous study designs. Future studies will have to elucidate the influence of anxiety constructs on IB in larger samples.

Turning negative memories around: Contingency versus devaluation techniques.

BACKGROUND AND OBJECTIVES: It is assumed that fear responses can be altered by changing the contingency between a conditioned stimulus (CS) and an unconditioned stimulus (US), or by devaluing the present mental representation of the US. The aim of the present study was to compare the efficacy of contingency- and devaluation-based intervention techniques on the diminishment in - and return of fear. We hypothesized that extinction (EXT, contingency-based) would outperform devaluation-based techniques regarding contingency measures, but that devaluation-based techniques would be most effective in reducing the mental representation of the US. Additionally, we expected that incorporations of the US during devaluation would result in less reinstatement of the US averseness. METHODS: Healthy participants received a fear conditioning paradigm followed by one of three interventions: extinction (EXT, contingency-based), imagery rescripting (ImRs, devaluation-based) or eye movement desensitization and reprocessing (EMDR, devaluation-based). A reinstatement procedure and test followed the next day. RESULTS: EXT was indeed most successful in diminishing contingency-based US expectancies and skin conductance responses (SCRs), but all interventions were equally successful in reducing the averseness of the mental US representation. After reinstatement EXT showed lowest expectancies and SCRs; no differences were observed between the conditions concerning the mental US representation. LIMITATIONS: A partial reinforcement schedule was used, resulting in a vast amount of contingency unaware participants. Additionally, a non-clinical sample was used, which may limit the generalizability to clinical populations. CONCLUSION: EXT is most effective in reducing conditioned fear responses.

On the Link between Perceived Parental Rearing Behaviors and Self-conscious Emotions in Adolescents.

This study examined relationships between the self-conscious emotions of guilt and shame in both clinical (N = 104) and non-clinical (N = 477) (young) adolescents aged 11-18 years, who completed a questionnaire to assess perceived parental rearing behaviors (EMBU-C) and a scenario-based instrument to measure proneness to guilt and shame (SCEMAS). Results indicated that parental rearing dimensions were positively related to self-conscious emotions. Regarding the non-clinical sample, both favourable (emotional warmth) and unfavourable (rejection) paternal and maternal rearing dimensions were significant correlates of guilt- and shame-proneness. The results for the clinical sample were less conclusive: only maternal emotional warmth and rejection were found to be significantly associated with guilt and shame. Interestingly, no associations between any of the paternal rearing dimensions and self-conscious emotions emerged. Taken together, these results are in keeping with the notion that parental rearing factors are involved in the development of both adaptive and maladaptive self-conscious emotions in adolescents.

The Influence of State Anxiety on Fear Discrimination and Extinction in Females.

Formal theories have linked pathological anxiety to a failure in fear response inhibition. Previously, we showed that aberrant response inhibition is not restricted to anxiety patients, but can also be observed in anxiety-prone adults. However, less is known about the influence of currently experienced levels of anxiety on inhibitory learning. The topic is highly important as state anxiety has a debilitating effect on cognition, emotion, and physiology and is linked to several anxiety disorders. In the present study, healthy female volunteers performed a fear conditioning task, after being informed that they will have to perform the Trier Social Stress Test task (n = 25; experimental group) or a control task (n = 25; control group) upon completion of the conditioning task. The results showed that higher levels of state anxiety corresponded with a reduced discrimination between a stimulus (CS+) typically followed by an aversive event and a stimulus (CS-) that is never followed by an aversive event both during the acquisition and the extinction phase. No effect of state anxiety on the skin conductance response associated with CS+ and CS- was found. Additionally, higher levels of state anxiety coincided with more negative valence ratings of the CSs. The results suggest that increased stress-induced state anxiety might lead to stimulus generalization during fear acquisition, thereby impairing associative learning.

Cognitive Bias as a Mediator in the Relation Between Fear-Enhancing Parental Behaviors and Anxiety Symptoms in Children: A Cross-Sectional Study.

The present cross-sectional study explored the relations between fear-enhancing parenting behaviors (modeling and threat information transmission) and children's cognitive biases and anxiety symptoms. Participants were 258 children aged 7-12 years (132 boys and 126 girls), and their mothers (n = 199) and/or fathers (n = 117). Children and parents completed the Parental Enhancement of Anxious Cognitions questionnaire, which measures parental modeling and threat information transmission, while children also filled in a scale for assessing anxiety symptoms. In addition, children conducted a number of computerized tasks for measuring confirmation and interpretation bias. The data indicated that both biases mediated the relationship between threat information transmission (of both parents) and children's anxiety symptoms. Only interpretation bias significantly mediated the relationship between modeling (of mothers) and anxiety symptoms. These findings give partial support for the hypothesis that cognitive biases play a mediating role in the relation between fear-enhancing parental behaviors and children's anxiety symptoms.

The influence of stimulus valence on confirmation bias in children.

BACKGROUND AND OBJECTIVES: The aim of the present study was to replicate our previous study and to further examine the relation between fear and positive and negative confirmation bias in children. METHODS: Fifty-three non-clinical children (9-13 years) were shown pictures of a kindly-perceived (quokka) and a dangerous-looking (aye aye) animal. For each animal, levels of fear and information seeking patterns were obtained. RESULTS: The results indicated that the aye aye was rated as more threatening and less kind than the quokka. For the aye aye more negative than neutral or positive information was selected; no differences were observed for the quokka. Regardless of type of animal, higher fear levels coincided with more search for negative information. Positive confirmation bias in the quokka was indirectly observed as low fear levels were associated with an increased search for positive information. Finally, for the quokka searching negative information coincided with an increase in the scariness of the quokka; this pattern was absent for the aye aye. LIMITATIONS: Though the results are informative, no clinically anxious children were tested, a positive beliefs questionnaire was lacking and children were forced to select one of the presented answer alternatives. CONCLUSIONS: The present study indicates that the mere perception of danger can trigger confirmation bias; a positive view can, in case of low fear levels, result in increased search for positive information. Additionally, a relation was observed between increased negative attitude and search for negative information. The results, implications and suggestions for future research are discussed.

Imagery rescripting: Is incorporation of the most aversive scenes necessary?

During imagery rescripting (ImRs) an aversive memory is relived and transformed to have a more positive outcome. ImRs is frequently applied in psychological treatment and is known to reduce intrusions and distress of the memory. However, little is known about the necessity to incorporate the central aversive parts of the memory in ImRs. To examine this necessity one hundred participants watched an aversive film and were subsequently randomly assigned to one of four experimental conditions: ImRs including the aversive scenes (Late ImRs), ImRs without the aversive scenes (Early ImRs), imaginal exposure (IE) or a control condition (Cont). Participants in the IE intervention reported the highest distress levels during the intervention; Cont resulted in the lowest levels of self-reported distress. For the intrusion frequency, only the late ImRs resulted in fewer intrusions compared to the Cont condition; Early ImRs produced significantly more intrusions than the Late ImRs or IE condition. Finally, the intrusions of the Late ImRs condition were reported as less vivid compared to the other conditions. To conclude, it seems beneficial including aversive scenes in ImRs after an analogue trauma induction.

Virtual reality, real emotions: a novel analogue for the assessment of risk factors of post-traumatic stress disorder.

Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops post-traumatic stress disorder (PTSD). Experimental studies are necessary to assess risk factors, such as imagery ability, for the development of PTSD. Up to now the trauma film paradigm (TFP) has functioned as an analogue for PTSD. This paradigm is known to induce involuntary intrusions, a core symptom of PTSD. Though useful, the film paradigm has a drawback, the participant remains an "outsider" and does not immerse in the film scenes. The aim of the present study was to develop a fitting virtual reality (VR) analogue for PTSD and to assess risk factors for the development of PTSD-symptoms, such as intrusions. To this end a novel VR paradigm was compared to the traditional TFP. Both the VR and TFP elicited a negative mood and induction-related intrusions. More immersion was observed in the VR paradigm compared to the TFP. The results of the risk factors were mixed; more imagery ability coincided with a higher intrusion frequency, but also with less distressing intrusions. The results, implications and suggestions for future research are discussed.